CISD procedures and effectiveness

[crash_cart]

CISD is a fascinating topic to me and has kept my interest throughout my basics class. I have looked up the research on it and surprisingly, there is scant evidence that it is effective, let alone how it should be appropriately managed.<_< I would be curious to learn from others what they think of the CISD process and if they've undergone it, what they think the strengths and flaws of what they experienced are.

 

[VentMedic]

I have not been to a CISD session since the 1980s when it first became very popular. I knew then that there were some serious issues amongst everyone in the room that were more complex than what could be handled generically across the board for all. The incident in question is only one aspect to what an individual experiences from previous memories or his/her own life's events and personal emotional situations.


Good article.

http://www.merginet.com/index.cfm?pg=wellness&fn=rescuepers
The “Rescue Personality”: Another EMS Myth
By Bryan E. Bledsoe, DO, FACEP

The potential effectiveness of the CISD with fire, emergency medical, and police service workers is theoretically dependent on these individuals being a homogenous, but independent, group. Specifically, within the emergency services this homogeneity is, in part, assumed to be reflected in the rescue personality, a personality that is purported to characterize the type of individual who chooses to perform rescue-related work. Currently, there is little evidence for a distinct personality type that is reflective of emergency service workers as a whole.”

What this tells us is that EMS people are not unique when compared to the population as a whole. Like the population, we are all quite different and respond to stress in different ways. Therefore, “cookie cutter” intervention programs such as CISM/CISD and other forms of “crisis intervention” may benefit some and harm others.

Any sort of mental health care for EMS providers must be tailored to the individual and not the whole population. The sooner we recognize this, the sooner we can embrace mental heath interventions that are evidence-based and abandon those of a pseudoscientific nature.

 

[JPINFV]

Another good article by the same author.

http://publicsafety.com/print/Emergency--Medical-Services/EMS-Myth-3--Critical-Incident-Stress-Management-CISM-is-effective-in-managing-EMS-related-stress/1$2026

EMS Myth #3: Critical Incident Stress Management (CISM) is effective in managing EMS-related stress
By Bryan E. Bledsoe, DO, FACEP, EMT-P

Conclusion
Why doesn't CISM work? It appears that CISM and other forms of psychological debriefing may actually interfere with the natural recovery process inherent in normal individuals. The alternation of intrusive and avoidant thoughts characterizes normal psychological processing following a traumatic event that may be disrupted by this approach to intervention. CISM may also lead affected personnel to bypass established personal support systems (family, friends, coworkers, clergy) usually used for non-occupational-related crises in the belief that the CISM session should be sufficient to alleviate their distress. Furthermore, a certain amount of time appears necessary for an individual to process the psychological impact of exposure to a traumatic event, and no external stimulus or program may be capable of shortening this interval.13

The last thing we want to do is provide a service that may actually harm our colleagues. Like many archaic and anecdotal EMS practices, CISM is a bad idea and does not work. Let's put it behind us and practice, instead, simple psychological first aid.

 

[VentMedic]

And a recent follow up article to the others Dr. Bledsoe has published.

Killing Vampires
Bryan E. Bledsoe, DO, FACEP
2008 Jan 10
http://www.jems.com/news_and_articles/columns/Bledsoe/Killing_Vampires.html

Occasionally, in my travels, I still run into people who use CISM. The mantra "trained counselors will be on hand" has become a part of our lexicon. Of course, this begs the question: If it's necessary to say that "trained counselors" will be on hand, it implies a problem with "untrained counselors" must exist. Have you ever seen a hospital with a sign that states that trained neurosurgeons are on hand?

If EMS is ever going to evolve into a bona fide profession, we have to give up these anecdotal practices. Why do EMS professionals not go away in the face of overwhelming scientific evidence? Sometimes, convincing them is akin to killing vampires.

So folks, let's move on. There is nothing here to see. CISM is not in the current drafts of the new EMS curricula. It's important to remember that people cope with stress in different ways. People who repress their feelings do just as well as those who don't. Most people are amazingly resilient to stress. In fact, some stress is actually beneficial. Very few will develop psychiatric disorders (e.g., acute stress disorder, post-traumatic stress disorder) following psychological trauma. And, those people will usually have predisposing psychiatric or social issues (e.g., depression, substance abuse, marital problems, and/or financial problems).

 

[Ridryder911]

Simply put Voodoo medicine. Greatest scam since snake oil medicine. Unfortunately, EMS providers jumped on the band wagon and practiced this not just upon others but upon our own!

R/r 911