Is there anyone in here that is on a Critical Incident Stress Management (CISM) team? I have been on the NW Arkansas team for about 7 years. If so, how to you get people to talk about their 'feelings'? Also, does your department require a debriefing when something real bad happens?

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There is an old saying that you can lead a horse to water, but you can't make him drink it. Getting people to open up after an incident is kind of like that. You have a debriefing to lead them to talk, but you can't force them. A lot of people simply will not open up in a group setting. Some may not vent anyway, while others may finally talk one on one, which may be days after the incident.

Our department will debrief after an incident, but it is more of an informal "the bugles are off, this is just us" type of meeting. We go into why it is important to understand the feeling and emotions they may have are normal and give them an opportunity to talk. I and the other officers will usually follow up with a one on one later. If it is an extremely nasty incident we will call in an outside team for a more formal debriefing. We are a small department and can usually tell when someone is having trouble. But the offer is always there.
There is no requirement to attend a CISD (our last word is debriefing) meeting. If something happens that requires the meeting, they are held. If you attend, you attend. Anyone who requires more help on a one on one basis can do so at anytime. (the card for the CISD team is posted in multiple places in the firehouse)

Forcing someone to talk will only cause them to shut down and the ill effects of the trauma that caused the debriefing to come on will become multiplied in their mind.

We all work differently physically and mentally. Some people just need to be left alone to cope with what happened in their own manner.
I agree with Oldman that there is nothing we can do to force people to open up but having a CISM program lets them know that help is available. My dept does initial defusings according to the Mitchell model of CIS and debriefing if the members are still struggling with the incident after a week. My dept is a small dept as well so it is often easy to know if someone is having troubles with a call. Being a paid dept we also have access to our EAP program if more complex issues arise down the road. One comment that came out of a post defusing discussion I had with a firefighter sort of somes up what I feel the role of CISM ii in the dept. He said " Even though the incident didn't really bother him this time, it is nice to know that people who care are willing to me help the next time I really need it."
Oldman and Engineco913....I know you can't force anyone to talk, but a lot of firefighters and police officers are too "manly" to talk. They think it might make them look like they can't handle things, when in fact it usually makes a person stronger. I have been in the fire service since 1992 and I know how firefighters act, men and women alike. Just remember, sometimes people are very good at hiding their feelings and you might not know until it's too late that someone needs help (too much drinking, depression, suicide). I'm not saying that every incident, even death, needs a debriefing; just make sure you have someone there to help your friends when needed. Maybe sooner or later, that macho ff may decide he/she needs to talk. I will get more info on CISM training later if anyone is interested in learning more.
My team uses the Mitchell model too. What you are doing is what I am talking about. Thanks for posting.
I thought I was a "MACHO" man myself, nothing could bother me. Well......I was WRONG !!!! On Oct of 07 I went to a multiple shooting involving 7 kids from age 14-21. 6 were DOA. All of our EMS and LEO's knew most or all these kids, some were even related. Bad scene all the way around. The county gave us a little 1hr group debreifing, but it really wasnt crap. They stated that if we wanted to talk more or seek professional help, we would have to pay for it, so as most would do, none of us went of course. This past June there was some free and 1 on 1 therapy with a CISM Dr. I finally went, and am very glad I did. I have seen this Dr. every month since, he only comes up here for 2-3 days a month. I finally got another EMT the help they needed because of this guy. Thank you for all you therapist out there that have to listen and put things back in perspective for us, not sure how or why you do it, but I am very glad you do. There is nothing wrong feeling the way you do after a bad scene, you are human, if you dont feel something after one, then you definetly have other issues. I hope others will step up and get help if they need it, thats the "MACHO" thing to do !!!
If anyone is interested in more information about CISM debriefings, defusings, etc., here is the name of a man who trained us in "Assisting Individuals In Crisis". He is a police chaplain who is certified in crisis training. Send him an e-mail. Tell him you got his name from someone who took his one on one class at Springdale, AR. His name is: Doug Ellingsworth --

You never know how this training can help you.
Time to bump this.
It's related to this:
There have been several discussions, but I don't know that any clear consensus prevailed.
Whether it's a formal process or not, people have to understand that their mental health is as critical, if not more so, than physical health.
And we HAVE to make ourselves available and stop treating someone as weak when they need to talk about their last bad run.
Ignore them and you will invite bigger problems.
Kentucky has a statewide network of volunteers trained to respond to Critical Incidents --- everything from LODD's, to whole-community incidents like floods. You can see details at . Response teams are staffed to provide peer to peer support i.e. cop to cop, FF to FF, family to family, at no cost to the requesting agency and individuals. Teams also include social workers, psychologists, chaplains/clergy as appropriate. State law provides confidentiality for participants. We like to respond to first responders before the incident shift ends whenever possible.
I've been a KCCRB responder for 8 years.
KCCRB protocols do not recommend mandatory attendance and do not urge "feeling" talk. My experience has been cops and fire/ems do not react well to feeling questions. They generally do respond to "What happened?" questions, and move to emotional content on their own.
As Chief of a volunteer department, I will call for a response even if the incident doesn't look particularly bad from the outside, but the people who made the run appear troubled. I won't require anyone to attend the CISM response, but I will urge them to attend. When my department is involved I do not function as a KCCRB member in their response.
Billy G. at the Secret List posted this - Scroll down to Psychological 1st Aid (The Secret List), he also provideed this link - I strongly encourage everyone to read this article.

Essentially, while not discounting counseling or CISM it suggests that people can and do get over what they've seen, encountered and experienced, all on their own, without outside help or intervention and move on with their lives. Some people DO need the help but the point is that forcing people to talk about their "feelings" is neither necessary or productive and that peers can be in the best place to observe an individual and recommend further help when necessary.

It has nothing to do with being 'macho', some (many?) people can actually deal with what they've seen quite well on their own with no harmful effects. Humans are much more resilient than many might think.
Yes and No.....LOL...Not in Fire service but I am at work....I now work for the Department of Corrections and we have a "mobile team"....You cannot force anyone to talk about their feelings anymore than you can force the sun to come up....all that you can do is offer the help....what I like to do is simply ask someone what happened and how the incident was resolved...I find that people tend to start telling what "they" saw and then it takes off on its own....Don't try and start the discussion...let it materialize on its own...also you may have problems if it isn't "your" people you are meeting with....People will look at you as an outsider....Gain a degree of trust first....Paul
The long-term clinical efficacy of CISM has been debunked by several scientific, peer-reviewed studies.
Dr. Bryan Bledsoe, a frequent JEMS contributor has this to say on the topic, as well as his famous Killing Vampires article regarding CISM.

Dr. Bledsoe's peer-reviewed views on the subject have, to put it mildly, created lots of controversy.
The backlash has even drawn attention from a group that studies cults - the International Cultic Studies Association.

CISM has been shown to either have no value or to actually cause harm in some of the participants.
Of particular concern to mental health professionals is the tendency for CISM group debriefings to generate false memories in the participants. False memories can actually cause more psychological harm than real memories of the stress event, because the false memories trigger the subject's imagination of the event, rather than being grounded in reality. The realities of stress events are bad enough - we don't need an anecdotal practice that actually can make things worse injected into the aftermath.

I'm not advocating for the old-school, John Wayne, "tough it out" mentality here. After all, John Wayne is dead.
I am advocating for fire-rescue and EMS agencies to have an Employee Assistance Program (EAP) that includes mental health counseling from professionals following stress events. Those events should be handled like any other on-duty injury or personal stress in order to keep us mentally healthy in the same way that we are expected to be physically healthy on the job.

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