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Permalink Reply by Art "ChiefReason" Goodrich on December 13, 2007 at 4:07pm

Dan:
I'm sorry that you lost your good friend.
We use CISD. It is a team that we know. They aren't internal.
My only complaint is that they only allow the participants of a particular call to participate.
My concern is cumulative effect. Though someone may not have been at THAT call, they might still have issues.
I believe that it should be done as a group. Everyone needs to know how everyone else feels, because one will affect everyone else.
If they don't like it, I'm sure that they will let me know.
But know that, if someone has it in their mind to circumvent the process, we will have little or no control over that.
TCSS.
Art

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Permalink Reply by Brian Dumser on August 10, 2008 at 2:44pm

First let me say I'm sorry for your loss. Here in Chicagoland we've got a CISD team at our disposal if we need it. They will come out for just one person if needed. The hardest thing is to get Firefighters to use CISD and not just keep it inside. We have not had to use it, but it's good to know that it's available. Stay safe!

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Permalink Reply by Kimberly A Bownas on August 10, 2008 at 4:48pm

Dan,
Sorry to hear about your friend and here we us the CISD team. I have used them a couple of times and it did help. It also helped that I had a lot of guys in my department to talk too about that particular call. Our officers will call the members that were at a call that was bad and see how they are doing and if they feel they need to call the CISD team they do. We don't make it mandatory for our members to come when we have the team come out. It is simply up to the individual it they want to be there.

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Permalink Reply by lutan1 on August 10, 2008 at 5:29pm

I'm all for CIS debriefs, etc and early intervention, but I am 100% against peer teams.

I loath the idea of talking to trained peers- I've had first hand negative experiences with it and refuse to go down that path ever again.

On the flipside, I'm a massive fan of the Salvation Army- our service had a couple of Salvo Chaplains and they were awesome! They were trained and could be called on any time day or night and as I discovered with one particular job a number of years ago (Which I still have a few problems with), they know when to handball it upto the next level.

Contrary to what many initially beleived, not once did they push any sort of "religion" on you or preach to you- they simply listened and counselled as required....

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Permalink Reply by Ben Waller on August 10, 2008 at 5:52pm

Mental health professionals claim that CISD is not helpful at best, and harmful to our long-term mental health, at worst. They claim that peer debriefings are worse than useless - because peers aren't trained to recognize the client's in-depth needs. The people who have been doing CISD for a long time disagree, and point to the people that they've helped. I think that there is some validity on both sides of the arguement - CISD isn't scientific, but a lot of what goes through our heads is subjective, and a subjective-based counseling session or two can go a long way to help some people.

I can see both sides of this issue...

I worked in two places that had CISC teams provided. In Tennessee, they're provided by state EMS - one of the better things their state EMS system does. The teams are made up of mental health professionals and peer counselors from fire, EMS, police, rescue, and dispatchers. For peer debriefs, they pair the clients with a peer debriefer with a similar background.

In Greenville County, SC, county EMS has a similar system.

I've been a client of CISD once, and it helped...somewhat. The problem was the lack of follow-up, and it took me much longer than it should to put the proper perspective on cumulative stress from two close friends LODDs and a major incident with numerous burn DOAs. CISD is set up to respond to a specific, point-source incident, so it's not as effective for cumulative trauma.

The other problem with CISD and the lack of follow-up is that each local agency tends to used worker's comp for mental health issues. That means the client ends up discussing some of his/her issues with human resources people who are bureaucrats, not firefighters, EMTs, or mental health professionals.

Then there's the John Wayne syndrome - if I get mental health assistance, I'm going to be perceived as weak, crazy, or otherwise defective or untrustworthy. That's B.S. in almost every case, but it's still out there.

The John Wayne syndrome has affected two different rescue teams of which I'm a former member. Both teams ran VERY bad, very graphic fatal incidents after long periods of literally saving every victim we were called to help. Some of the newer team members had literally never seen a dead person before. Both teams had several members quit over the shock. In both cases, we had mandatory CISD before we let anyone officially quit the organization. A couple of members were helped, stayed in, and have had long, productive, and mentally healthy careers since. A few still quit. On their way out the door, I told them that it was important to the organization and to me personally that they be happy and healthy - mentally, emotionally, and physically. If making a career change was the only way to achieve those goals, then I fully understand and support the decision. Follow-up showed that everyone pretty much made the right choice. The ones that stayed in are now all experienced, dedicated rescuers who can handle death in a professional manner and disconnect the bad stuff at work from the good stuff at the station, home, or when out with their buddies. The ones that got out have a new respect for the ones that stayed in, and are some of the best community support the agency could possibly have...but they don't wear turnouts or respond to calls. It's OK that not everyone is cut out to do what we do.

I'm a fan of letting the client choose who he or she talks to - peer counselors, fire/police chaplains, Salvation Army chaplains, or go straight to the mental health professional, do not pass GO, do not collect $200. This is an intensely personal issue, and different responders will react differently, depending on that person's religious faith, pre-incident stresses, individual personality, and group norms in that person's department.

Agency administrators need to be very proactive in the area of responder mental health. A lot of mental health issues in our professions are cumulative. Our p

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Permalink Reply by Ben Waller on August 10, 2008 at 6:28pm

Siren,

Those are excellent insights. If you don't think you're ready to be a chief yet, how about being the fire department personnel officer?

A former colleague of mine who happens to be female was raped prior to beginning her fire-EMS career. She was involved in one of the CISD/mental health events I described. She told me that the worker's comp process was comparable to the "reliving the rape" process she had to go through to convict her rapist.

I think that's an entirely accurate analagy.

I also have a former fire chief bud who had work-induced CISD. His mayor and council repeatedly stated that he was "just crazy", including in city meetings and in the press. The chief retired, and had about 4 or 5 years of hell. Then the suit came to trial. The city refused to settle. The jury took care of that problem, and the former chief is now enjoying a stress-free retirement, well-funded by said city. The mayor and council involved were a 0ne-term set of politicos, too.

Funny how the courts and elections seem to take care of some problems that won't go away on their own.

Ben

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