The face of the one I couldn't save

[scratrat]

AS a brand new EMT I was forced into attending a CISD after a child related date. I was told at the time that this was mandatory. Had I known it wasn't, I never would have attended. The call didn't necessarily bother me to point where I needed to talk about it. But here I was around 15 people, at least 13 of whom I've never met, and I'm supposed to just pour out my feelings. It doesn't work.

My advice, seek out a professional counseler. And you're only human for continuing to remember this call. I've got a few I think of periodically.

[shira_emt]

Thank you all so very much for your replies. I did indeed seek professional mental health this past summer, for this reason and a few personal reasons. The company I worked for at the time didn't offer me CISD because.......well I'm not sure why really. The owner did ask us what the call was when we came back to station. We told him and his only response was "oh ok, clean your truck so you can take your next run". My partner at the time and I still keep in touch, so that helps.

I want to thank ridryder911 for the link. I didn't know that they had done so much research on CISD and the cause and effects of it. It was a very interesting article.

Thanks to everyone again.

Shira NREMT-I

[windsong]

Here's something I dont want to rememeber but I will say this, my neighbor who lived a few doors down, her son had CF (Cystic Fibrosis) he was only 15 months old and I used to babysit him when she ran to the store. I remember hearing sirens then I saw the ambulance race down my street to her home, thinking the worst I ran out in my PJ's and bare feet, then I saw the medics race in, then the police came around the corner and stopped right where I stood and ran in.

Apparenly Christopher got upset about something that it caused him to stop breathing, it reminds me of how my Uncle when he was 15 months old and wanted so badly to go with his dad (they lived on a farm then) but when his dad, my grandfather said no, Uncle Gervais had a temper tantrum, he choked and couldnt get his breath and he died right there.

Apparently Christopher threw a temper tantrum and choked, he stopped breathing, so when the medics came, they tried to revive him, all their efforts couldnt bring him back.

So when I went to the funeral, I couldnt hold back any longer I cried so hard to the point of throwing up, it was just really that hard to see him like that.

In Memory of Christopher Michael Stanton, age 15 months.

[whit72]

I still remember my first pedi-code like it was yesterday. 4-months, still when ever I smell baby powder I think of her. I remember her name, her birthday, everything about the call is still plain as day. I now think about it when I choose to. It did consume me for a while.

I wanted to quit, never come back again, just pack it in. I was lucky there were people who had been through similar circumstances that helped me learn to deal with it. To be able to keep it in perspective. Who knew the traits and signs of someone that could be in trouble.

For a while every kid I saw around her age made me think of her, those feelings would come rushing back, maybe there was something more we could have done, maybe if we did things differently. Those feelings do eventually subside. You will realize it is part of this field, not a big part, thank god, but a part none the less. That there wasn't anymore you could have done. Like has been stated in this thread numerous times. Kids die, yeah it sucks. However its part of life.

If you choose to stay in EMS, which I hope you do. You will have more bad ones. You have to be able to get by them. You don't have to forget them, just be able to survive them. Some people don't. I have seen EMT and medics with years of experience walk out the door and never come back. It does happen. If you learn to deal with it now, and keep it in perspective. You will not only will recover from this call, you might be able to help others recover from theirs.

Good luck.

[TRTEmt]

I think it is important for all of us to remember that we can not control everything. We save the ones that we can, and give dignity and respect to those we can't. We are a small group of people that are willing to see people on the worst day of there lifes.

When they are pilled up in an accident and praying to be saved, god send us.

When a man is sitting at the end of his bed in the tripod position barely able to breath with chest pains. He is praying to see his family one more time. We answer his prayers.

But not always.... Be proud of what you do either as a full time job or a hobby. But remember we can not control everthing.

[runsoversquirrels]

Thanks for the, did you have do do that, we didn't want to hear it. Just put in advice only. Yes it is long winded but don't make people feel bad for telling their story. No I was not trying to one-up. The counselor I spoke to is a professional and also brought along paperwork explaining some things as well as advice I could follow. Most I didn't, just felt it didn't apply. The part that worked for me was just to tell him about the two calls and get some coping measures.

The screen name just fit![/font:c50747dc03]

[bbledsoe]

I can't let this CISM stuff pass without comment. These are the facts and they are irrefutable:

1. CISM has never been mandated although some states, such as Tennessee, added it to their statutes.

2. There is no evidence, save some poorly done studies by CISM proponents (and those with a financial interest in CISM), that shows it works. In fact, they really can't define what it is.

3. Most studies supporting CISM are published in their own journal (International Journal of Emergency Mental Health) or are non-published.

4. The best empiric studies have shown CISM to be ineffective in mitigating stress or preventing CISM. In fact, it causes stress in some people.

5. You can't treat stress after it has occurred.

6. The new model is resilliency-based care and psychogical first aid. Remove the person from danger, meet physical needs, activate their personal support system, watch them for 4-6 weeks for maladaptation.

NO CISD, NO CISM. If you are ever forced to attend a CISM/CISD session, especially if you did not sign an informed consent form. then you may have a cause of action for negligence--the evidence against CISM is that strong!

References:

Devilley et al. Ready! Fire! Aim! The Status of Psychological Debriefing and Therapeutic Interventions: In the Work Place and After Disasters. Review of General Psychology. 2006;10:318-345

Sibrandid M, et al. Emotional or Education Debriefing after Psychological Trauma: Randomised Controlled Trial. British Journal of Psychiatry. 2006;169:150-155

Kadet A. “Good Grief!” Smart Money. 2002;June, pp. 108-114

Van Emmerik AAP, Kamphuis JH, Hulsbosch AM, Emmelkamp PMG. Single-session debriefing after psychological trauma: a meta-analysis. Lancet. 2002;360:766-771.

Rose R, Bisson J, Wessley S. Psychological debriefing for preventing post traumatic stress disorder (PTSD) (Cochrane Review). The Cochrane Library. 2002;4.

Fullerton CS, Ursano RJ, Vance K, Lemming W. Debriefing following trauma. Psychiatric Quarterly. 2000;71:259-276.

Harris MB, Stacks JS. A three-year five state study on the relationships between critical incident stress debriefings, firefighters’ disposition, and stress reactions. USFA-FEMA CISM Research Project. Commerce, TX, Texas A&M University—Commerce, 1998

Harris MB, Balo›lu M, Stacks JR. Mental health of trauma-exposed firefighters and critical incident stress debriefing. Journal of Loss and Trauma.2002;7:223-238

Carlier IVE, Voerman AE, Gersons BPR. The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers. British Journal of Medical Psychology. 2000;73:87-98.

Carlier IVE, Lamberts RD, van Ulchelen AJ, Gersons BPR. Disaster-related post-traumatic stress in police officers: A field study of the impact of debriefing. Stress Medicine. 1998;14:143-148

Macnab AJ, Russel JA, Lowe JP, Gagnon F. Critical incident stress intervention after loss of an air ambulance: two-year follow-up. Prehospital Disaster Med. 1999;14(1):8-12.

Hobbs M, Mayou R, Harrelson B, Worlock P. A randomized controlled trial of psychological debriefing for victims of road traffic accidents. Br Med J. 1996;313:1438-1439

Mayou RA, Ehlers A, and Hobbs M. Psychological debriefing for road traffic accident victims: Three-year follow-up of a randomized controlled trial. Br J Psychiatry.2000;176:589-593.

Rose S, Brewin CR, Andrews B, Lirk M. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychological Medicine. 1999;29:793-799.

Hytten K, Hasle A. Fire fighters: A study of stress and coping. Acta Psychiatr Scand. 1989;80:50-56.

National Institute of Mental Health. Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus on Best Practices. NIH Publication No. 02-5138, Washington, D.C., U.S. Government Printing Office, 2002. (available at http://www.nimh.nih.gov/research/massviolence.pdf ).

World Health Organization. Mental Health in Emergencies: Mental and Social Aspects of Populations Exposed to Extreme Stressors. Geneva. World Health Organization (available at http://www5.who.int/mental_health/download...?id=0000000640).

Parry G (Chair, Development Group). Evidence-Based Treatment Guidelines in Psychological Therapies and Counselling. Department of Health, National Health Service, United Kingdom, (available at http://www.aaebhs.org/guideline/BritishDeptHealth.pdf ).

North Atlantic Treaty Organization. North Atlantic Treaty Organization (NATO)-Russia Advanced Research Workshop on Social and Psychological Consequences of Chemical, Biological, and Radiological Terrorism. (available at http://www.nato.int/science/e/020325-arw2.htm ).

New South Wales Health Department. Disaster Mental Health Response Handbook: An Educational Resource for Mental Health Professionals Involved in Disaster Management. NSW Health Department, Sydney, NSW, 2000 (available at http://www.nswiop.nsw.edu.au)

Australasian Critical Incident Stress Association. Guidelines for Good Practice for Emergency Responder Groups in Relation to Early Intervention after Trauma and Critical Incidents (Glenelg Declaration) 1999 (available at http://www.ctsn-rcst.ca/glenelg.html)

McNally, R. J., Bryant, R., & Ehlers, A. (2003). Does early psychological intervention promote recovery from post traumatic stress. Psychological Science

in The Public Interest, 4, 45–79.

Litz, B. T., Adler, A. B., Castro, C. A., Wright, K., & Thomas, J., & Suvak, M. K. (2004, November). A controlled trial of Group Debriefing. In M. Friedman

(Chair), Military psychiatry, then and now.Plenary session conducted at the 20th Annual Meeting of the International Society for Traumatic Stress Studies, New Orleans, LA.

Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science

and Practice, 9, 112–134.

Lohr, J. M., Hooke, W., Gist, R., & Tolin, D. F. (2003). Novel and controversial treatments for trauma-related stress disorders. In S. O. Lilienfeld, S. J. Lynn, & J. M. Lohr (Eds.), Science and pseudoscience in clinical psychology (pp. 243 – 272). New York: Guilford Press.

Bledsoe, B. E. (2002). CISM: Possible liability for EMS services? Best Practices in Emergency Medical Services, 5, 66–67.

Bledsoe, B. E. (2003). Critical Incident Stress Management (CISM): Benefit or risk for emergency services? Prehospital Emergency Care, 7, 272–

279.

[shira_emt]

WOW TRTEMT. I think you said it all right there. I've never had someone put it like that before, thanks.

[EMT*Sweet]

I've been watching this post grow for a couple of days and have hesitated on commenting..We have gone from one girl's plea to the controversy of CISD...Don't know why things have to get so technical !!

Simple solution to CISD -- If by some odd chance any of you have a Mentor in this field ( an elder of sorts, someone who has been here for years, someone who has struggled thru the trials and errors of healing) A person of respect who's time in EMS came before our time of LABELS, SYNDROMES and the Multitude of Medicinal crutches which were created to keep us in the "RUT" >>> GO TO THEM..........There is no need to subject yourself to being drawn into an office by inexperienced college professionals or those who have no clue of what it is we need to express only to walk out feeling like you have been poked, prodded, analyzed, judged----Sheesh!!

Addressing the original Post from SHira____ ( My opinion only) The problems you are having now are " Self-Inflicted self pity"

-If you chose to hang on to it, you will

-Go back to your training__Read up on Respiratory arrest in Infants..You did all you could do!! Plain and simple..

-Put the facts together, rationalize it in your head, deal with it in your heart, and move past it.

- Get over it and TOUGHEN UP because I assure you that you will see worse, deal with worse and not every call will be successful.

None of us likes to deal with the "death of innocence" but things happen and just be glad that you were there to try to help!!

NOW THEN--Go out there, believe in yourself, keep your head up and MAKE IT HAPPEN!!! :wink:

[Ridryder 911]

The reason the topic went from the original post is so many put false faith into CISD/CISM. As well things to get so technical is because we as health care providers need to be sure that the suggestions we promote are valid and well sounded. Discussing, with a mentor is nice, but this does not solve true problems. Touchy, feely, statements are nice but being sure one of our own is taken care appropiately is a big deal. An appropiate mentor would advise you to see true profesional help. Medics are not trained or educated enough, for these situations.

Thank you Dr. Bledsoe for addressing this issue with your research and comments. I agree with your position and as well have always thought the same, since the conception of CISD. I refused CISD during the OKC bombing due to the poor research and no known scientific basis to validate it.

Again, another form of medical care without validity and based on assumption.

R/r 911