PTSD/unprocessed trauma

MonkeyArrow

Forum Asst. Chief
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So...that was pretty morose...we save way more than we don't...but we focus on the dead sometimes more than we should or have reason to...it's just that each fatality has that much more significance than the last and each success doesn't seem to have the cumulative effect as the fatalities do and it just adds up sometimes....just an f'in awful 5 days....
It’s funny you put it this way, because I’ve been thinking about this a lot recently. For me, it’s not the deaths but more so the lack of successes that is getting to me. I don’t necessarily think about the bodies, but I feel like I haven’t done anything good/worthwhile in a bit.
 

ffemt8978

Forum Vice-Principal
Community Leader
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I read something that showed mandatory CISM does more harm than good. Anyone else heard that?
I've heard there was a study that showed that, but it doesn't really matter because I'm proof of it. We had a mandatory CISM after a bad accident that involved a family and some kids. I spent the entire time sitting there thinking what a colossal time suck it was. The family was dead on impact, so there is absolutely nothing we could have done to change that. The mediator went around asking us to express what we felt about the accident, and when it came to my turn my reply boiled down to you can make me attend but you cant make me participate. Chief was not happy and later tried to tell me that as a training officer I had to be more supportive of CISM. I replied as soon as you get a real shrink to mediate instead of joe schmoe who took a few hours of training I'd think about it. It was the last mandatory CISM meeting we had...the rest were voluntary.

I've always had the ability to emotionally detach from the situation and review them critically and objectively. I understand that others cant do that, but I have difficulty understanding why that is my problem. I'll support anyone who wants and needs help, but I'm not going to fake that I need help just because they do.

Empathy was never one of my strong suits, and it hindered me in some patient interactions. By the same token, when the feces hit the oscillation device it never fazed me so I was always better in the high pressure chaotic scene calls.

Edit: https://en.m.wikipedia.org/wiki/Critical_incident_stress_management

Check references 7-9 for links to the studies
 
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mgr22

Forum Deputy Chief
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I read something that showed mandatory CISM does more harm than good. Anyone else heard that?

I've found this to be the case, only because mandatory discussion of intensely personal experiences seems misguided to me (but perhaps well-intentioned).
 

mgr22

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It’s funny you put it this way, because I’ve been thinking about this a lot recently. For me, it’s not the deaths but more so the lack of successes that is getting to me. I don’t necessarily think about the bodies, but I feel like I haven’t done anything good/worthwhile in a bit.

If you work or volunteer in EMS, you've probably done lots of good that would be really hard to measure.
 

DragonClaw

Emergency Medical Texan
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No. We don't get too many vague references to marine life in rural Tennessee.

"
Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.

Off in the distance, the old man noticed a small boy approaching. As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea. The boy came closer still and the man called out, “Good morning! May I ask what it is that you are doing?”

The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”

The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”

The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”
 

mgr22

Forum Deputy Chief
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"
Once upon a time, there was an old man who used to go to the ocean to do his writing. He had a habit of walking on the beach every morning before he began his work. Early one morning, he was walking along the shore after a big storm had passed and found the vast beach littered with starfish as far as the eye could see, stretching in both directions.

Off in the distance, the old man noticed a small boy approaching. As the boy walked, he paused every so often and as he grew closer, the man could see that he was occasionally bending down to pick up an object and throw it into the sea. The boy came closer still and the man called out, “Good morning! May I ask what it is that you are doing?”

The young boy paused, looked up, and replied “Throwing starfish into the ocean. The tide has washed them up onto the beach and they can’t return to the sea by themselves,” the youth replied. “When the sun gets high, they will die, unless I throw them back into the water.”

The old man replied, “But there must be tens of thousands of starfish on this beach. I’m afraid you won’t really be able to make much of a difference.”

The boy bent down, picked up yet another starfish and threw it as far as he could into the ocean. Then he turned, smiled and said, “It made a difference to that one!”

Ah, that's what we call lighting a candle instead of cursing the darkness.
 

Seirende

Washed Up Paramedic
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Is anyone familiar with psychological first aid? That seems to be the thing now as opposed to CISM.
 
OP
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Is anyone familiar with psychological first aid? That seems to be the thing now as opposed to CISM.

The term is newish, but the intent and purpose exists under different names. It is very much a part of the CISM discipline.

A distinction needs to be made here and that is CISM should be considered the process and body of knowlege of assisting with critical incident stress but a CISD (that is, debriefing) is what has been shown to be more valuable when it is completely voluntary...the days of mandatory CISD's should be well over.

The evolution of processing trauma has hit a very steep curve in the last several years because of the increased number/awareness of the issue of suicide in law enforcement/fire/ems. To me it almost looks like the early days of ACLS when the algorithms were so complex at all levels of care to the point impracticality....over time and with a lot more experience and knowlege, ACLS became manageable and practical.

Kinda where this is going...
 

mgr22

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Is anyone familiar with psychological first aid? That seems to be the thing now as opposed to CISM.

The term "psychological first aid" has been around at least as long as I've been in EMS (28 years). In my experience, it has had no specific meaning, but was often documented as something we did to allegedly make patients feel better. Adding "PFA" to a PCR is easier than writing "I spoke with the patient as a fellow human being."
 

jgmedic

Fire Truck Driver
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I think everyone is affected in different ways obviously. I always thought I was tough and could just push it all down. Let me tell you, that is the wrong approach, and it could have ended much worse. Friend, SO, therapist, you gotta get this stuff out or it will drown you. I worked on some of the busiest ambulances in the state, and the constant barrage of the worst of humanity will get you at some point.
 
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The term "psychological first aid" has been around at least as long as I've been in EMS (28 years). In my experience, it has had no specific meaning, but was often documented as something we did to allegedly make patients feel better. Adding "PFA" to a PCR is easier than writing "I spoke with the patient as a fellow human being."
"PFA certifications" are offered by organizations from the Red Cross to the VA. Their emphasis spans from COVID-19 related issues to PTSD in combat veterans. There are specific LE/fire ems/ victims programs that go by the TIP moniker (trauma intervention program) in some parts of the country and are geared toward folks whose sole role is to respond to scenes, police stations and firehouses.
 

johnrsemt

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When I worked for 2 busy services in Indianapolis (Private, and 911) things didn't bother me; possibly because I was too busy to think on them very much. When things got bad I just talked to co-workers.
Although looking back it didn't help with marriage issues.

Now that I work for the slowest EMS service in the US; I have lots of time to sit and think and bad runs are coming back to haunt me, sometimes literally. Now not many co-workers to talk to.
 

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