# QI and CISD Sessions anyone?



## MMiz (Jan 25, 2004)

Whie I've read about them in the book and saw them mentioned on the national registry test, I'm wondering if your service actually has them.

I'm looking forward to the responses!


----------



## SafetyPro2 (Mar 15, 2004)

We had a bad fire in town a couple of months ago that resulted in the death of a resident. She was most likely dead before we ever got dispatched (flames 40 feet through the roof upon the first engine's arrival), but it was still a traumatic event for those involved (I was still a Trainee at the time and not on-scene). The Department Chaplain (who was a Captain at the time and is a Battalion Chief now) organized several sessions for members who were involved.


----------



## MMiz (Mar 15, 2004)

> _Originally posted by SafetyPro_@Mar 15 2004, 06:13 PM
> * We had a bad fire in town a couple of months ago that resulted in the death of a resident. She was most likely dead before we ever got dispatched (flames 40 feet through the roof upon the first engine's arrival), but it was still a traumatic event for those involved (I was still a Trainee at the time and not on-scene). The Department Chaplain (who was a Captain at the time and is a Battalion Chief now) organized several sessions for members who were involved. *


 Yeah,  I'm finding that it is much more common for fire departments to hold these sessions instead of private ambulance companies.

I know with my private company 10% of my low-priority calls go through a QI screener, and I get comments in my mailbox, and that 100% of high priority calls go through the process, but I have yet to see a CISD session.


----------



## SafetyPro2 (Mar 16, 2004)

Not sure how big your company is, Matt, but you might want to check in your benefits package whether you have an Employee Assistance program. Many times, these programs can provide CISD services if needed.


----------



## MMiz (Mar 18, 2004)

> _Originally posted by SafetyPro_@Mar 16 2004, 12:14 AM
> * Not sure how big your company is, Matt, but you might want to check in your benefits package whether you have an Employee Assistance program. Many times, these programs can provide CISD services if needed. *


 Good thinking.  The company I work for does provide an Employee Assistance Program.  There is always a supervisor available at the office/station should one need some help.

I just remember hearing so much about them during my EMT course two years ago, but wasn't sure how widespread implementation was.

Good thinking on that one.


----------



## SafetyPro2 (Mar 18, 2004)

We used that concept at my last two (non-EMS) jobs. We had a workplace shooting at the first one...guy walked in, shot a co-worker (he's a parapalegic now) and killed himself. Was done right at break, so most everyone saw it. The EAP was great in sending as many people as they could down to the incident to talk with the co-workers.

At my last job, we had the same concept on paper, but fortunately never had to use it during my time there. I had it written into the AED program though.


----------



## Margaritaville (Nov 27, 2004)

Just thought I would bring up a new question on this.

How many of you here are very familiar with CISD? and or have actively participated in it. 

Does it help for later? Just wondering. All the years I have been in EMS, never encountered a CISD. 

Maybe volunteers are not counted for this stuff. h34r:


----------



## ffemt8978 (Nov 28, 2004)

As a volunteer FF/EMT, I've been invited to four of them (but haven't attended one yet).  Granted, these programs are great for SOME people, they do not work for everyone.  I personally feel that I have mechanisms already in place (includng this great forum   ) that allow me to deal with this type of stress in a way that is more beneficial to me than sitting around and talking about it with a bunch of people.


----------



## rescuecpt (Nov 28, 2004)

In my county each agency is required to do QA/QI with a county designated field-physician.  We bought into a group of about 8 other fire departments from my Township and we have quarterly quality assurance reviews.  We are told to bring 20 examples of  certain types of PCRs, and the doc has checklists for the basis things that must be on a PCR, as well as information specific to the type of calls we're looking at that quarter.  We analyze each of our PCRs and then talk about common issues as a group.

The ambulance corps does it's own QA/QI since they have so many calls and their own doc on staff.

We have a good County CISD team that is very quick to respond when needed.  We also can call into a CISD hotline.


----------



## ksEMTbabe (Jan 20, 2005)

My dept defintely has in the past made use of the CISD - anyone from the EMS director down to the newbies like me can call/request one after any call they were affected by.  I've only been to one, as I've only been on the dept a few months, and it was because the presence of everyone that was actually on the call was requested to be there.  I agree with the thought that they're not for everyone... some people just aren't talkers about that sort of thing.  I'd much rather engage in some retail therapy or some other form of "alone time" to help me cope.


----------



## rescuemedic7306 (May 2, 2005)

> _Originally posted by ffemt8978_@Nov 28 2004, 12:08 AM
> *As a volunteer FF/EMT, I've been invited to four of them (but haven't attended one yet). Granted, these programs are great for SOME people, they do not work for everyone. I personally feel that I have mechanisms already in place (includng this great forum  ) that allow me to deal with this type of stress in a way that is more beneficial to me than sitting around and talking about it with a bunch of people.*


I've been to 2 or 3 CISD debriefings in the last 3 years, they seem to work for some, but not for others (me). One of the debriefs I went to didn't take place until 3 days after the event which was a BIG mistake. People had already started to deal with it on their own and this just brought it all back. If you're going to use them they need to be no later than 24 hours after the incident. 
Strangely, when I started in EMS back in the 70s, CISD was unheard of. We were running 10-11 calls every 8 hour shift so we basically went from one to the next with no time to dwell on each one. It seemed to work ok at the time although I occasionally have a flashback to one particularly nasty Ped call (I was diagnosed with PTSD about 20 years later) so maybe CISD would have helped, who knows?.
I certainly think it has a place in low volume community based services since some calls involving friends, neighbors, and relatives can be really distressing in small towns.


----------



## Jon (May 2, 2005)

> _Originally posted by rescuemedic7306_@May 2 2005, 04:31 AM
> * I certainly think it has a place in low volume community based services since some calls involving friends, neighbors, and relatives can be really distressing in small towns. *


 Amen.

My squad often takes the "sit on the front of the rescue" and re-hash the call afterwards. We will get to find out what everyone was doing onscene, and talk openly about what issues we had. It isn't CISM, but seems to help everyone deal with it, and if someone is having trouble., the senior guys will pull him/her aside and talk im more detail.


Only actual CISM session I went to was when one of our Explorers killed herself. Our company was the responder on that as well. Very tough for all involved, and the session helped a little.


Jon


----------



## emtffboop (Jun 6, 2005)

on the 9th it will be the 2yrs anniversary when 2 of my county police officer and sheriff officers were hit and killed by a driver when they were putting out spike strips. i was at the opposite end of the county when it happened. a few days later they had a gib cism, had specialist come in all across tn, the guys that went to it that were involved in the incident said that it really helped.


----------



## vtemti (Jun 10, 2005)

We are a small community where you're patients are usually people you know. We have held a few CISD sessions and have found them to be very helpful. In fact, two of our members are also members the Green Mountain CISD team. We even use them on scene at times to help family members deal with the situation.


----------



## Stevo (Jun 10, 2005)

> *Does it help for later? Just wondering.*



yes if you can't shut off that _instant replay_...

~S~


----------



## rescuemedic7306 (Jun 10, 2005)

yes they do....mostly


----------



## usafmedic45 (Jun 10, 2005)

> _Originally posted by Stevo_@Jun 10 2005, 12:52 PM
> *
> 
> 
> ...


 It doesn't always work.  In fact, there have been studies done that says it has little if any effect in managing, controlling or preventing symptoms of PTSD or similar conditions.


----------



## ECC (Jun 10, 2005)

My thoughts on this subject.


----------



## usafmedic45 (Jun 10, 2005)

I agree ECC


----------



## Stevo (Jun 10, 2005)

> *It doesn't always work*



never made claim it did, an aspirin doesn't work for_ every_ headache either...

it is a resource available

~S~


----------



## ffemt8978 (Jun 10, 2005)

Having finally been to one (and it will probably be my last), I can see how they help some people.  For me, it didn't help much.  I prefer to do my stress debriefing here, and with a few close friends involved in EMS.

Then I go to the range and repeatedly ventilate some paper using high velocity lead therapy.


----------



## Phridae (Jun 11, 2005)

Last year sometime there was a 3 yo who rolled his head up in a window. No CISD there.

February we had a murder/suicide. The guy was the brother of a firefighter. My first gunshot wound call. shot gun wounds actually. No CISD there. And we needed it then.

I hear about it, but I 've never seen it.  Its a myth around here.


----------



## Frankie (Jul 3, 2005)

HA CISD what a joke.  Ive been to plenty of them and there never any help. Personaly i need a good friend to open up and talk to. Not some person who only comes out when something "BAD" happened and then tries to help u get through it.
Yes it may be a resource but hell ihave never had it help me or anyone else i know.


----------



## vtemti (Jul 4, 2005)

Just like many types of therapy, helps some, but doesn't others and if you attend them with a bad attitude from the very beginning, then of course they won't help.


----------



## MMiz (Jul 4, 2005)

> _Originally posted by FrankieCastle_@Jul 3 2005, 03:48 PM
> * HA CISD what a joke.  Ive been to plenty of them and there never any help. Personaly i need a good friend to open up and talk to. Not some person who only comes out when something "BAD" happened and then tries to help u get through it.
> Yes it may be a resource but hell ihave never had it help me or anyone else i know. *


 But as you're read on the forum, it does help people.  I know many employees that attended a CISD after certain calls, and while it's not helpful for all, it does help others.  I think that if it helps just one then it's worth it.


----------



## TTLWHKR (Jul 4, 2005)

I'm not the type of person that can sit down w/ a large group of people and talk about my feelings. I'd rather console myself, in my own ways. Usually it gets bottled up and set aside for another day, and I do something that sets my mind somewhere else. I have had a few instances where I'm sitting alone watching TV, or reading and something triggers a memory and it takes me back to that. Some call them flashbacks, or delayed stress reactions. I think of it more as time slowing down and my mind catches up with it, since I do put most things off to deal with in the future. Is it healthy? Probably not, but its not like I'm nuts, at least not anymore than anyone else in the field. I've been to one CISD, and the only purpose was that LEOs wanted to sit in and hear the whole story of what happened before the shooting victims became unresponsive. I felt that if they want to debrief us, the cops should not have been there, it would have been fine to interview us, not listen in on the CISD. That was more of a violation to us, than anything else. I refused to talk about it, the cops got pissed and started asking questions, people left.. cops followed them and were grilling them. After that we had no trust in management, so now if we all want to talk...... we go to a bar and talk.


----------



## akflightmedic (Jul 4, 2005)

Obviously, it sounds as if your CISD was not handled properly. You are right, the PD should not have been there and questioning you. This is why it is SO important that only trained people handle these sessions-and no you do not have to be a shrink or any of that crap. I am a trained CISD facilitator. It has to be handled properly or it will not work.
     The problem with CISD is it has a negative connotation to start with. You say the words mental illness and immediately you want nothing to do with it. Since CISDs are working with mental/stress issues, we as professionals associate it with mental illness and we also do not want others to see us as weak or inept in our ability to handle a call.
     To make CISDs work, we need to erradicate the negative stigma associated with it. How do we do this? In my experience, it is a long and difficult process. The people that have the most trouble sitting thorugh these sessions are firefighters, because as well all can probably agree, the fire mentality is way different than a service that only does EMS. It is ok to sit in front of the rig and "defuse", but you have not yet gone through a debriefing. Big difference. Someone mentioned earlier that their CISD took place three days later. That is ok. Sometimes, it takes that long before you are able to reorganize yourself and be prepared to deal with it, or symptoms may have been delayed. However you should have had a defusing before that time.
     It is true that it does not work for everyone, but EVERYONE that was involved on a call that is going to be a CISD needs to be present. Your presence may not benefit yourself, but it may be helping someone else in attendence. Shouldn't we be helping each other out? I believe so. In a study done on emergency workers that attended a CISD, greater than 90% said they would recommend a CISD even though it did not benefit them. So wake up people, don't be so condescending to a treatment that may help our fellow brothers and sisters. Encourage them and do not pick on or make fun of someone that requests a CISD. They might go home and handle it some other way.
     One way to remove the stigma is to make it mandatory. Now before you get your feathers ruffled, lets look at this from a SAFETY perspective. First remove the word mandatory and let's just call it automatic. Now imagine from here on out, that if you go on a certain type of call, it generates an "automatic CISD'. No longer do you have a stigma, its part of your job and you accept it. You know you are going to go. So, what's the harm. Would you enter a fire without putting on SCBA? Would you treat a patient without putting on gloves? No, its all about safety. Would you go to a sexually assaulted, shaken baby, pediatric code without checking your mental well being after? No.
     LAFD county, who has over 3,000 firefighters did such a thing. After making it automatic, you know what they found. First, turnover dropped, morale improved, sick time decreased, and the use of EAP for certain other vices(abuses) decreased. This was not a fluke. Its time we take care of ourselves because no on else is.
     Sorry about the long story, but I am passionate about this subject and angered when people are narrowminded. Give it a shot. The life you help save, may be you partners...


----------

