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CISM
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?
Thanks,
Tana
Thanks,
Tana
Replies to This Discussion
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Permalink Reply by John Crabbe on
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I've really only been involved in 2 CISD's. One was after a PNB call for one of our fellow FF's wife, it was a good save and she is doing much better today, but one of our senior FF/medics asked for the CISD. For the most part, I would say we were OK, considering the outcome and he just wanted to talk about the call. Went fine.
Second time was after a LODD. We had people around, just there to talk to, no one pressured anyone to talk, but were available. Each individual crew involved sat down with a couple debriefers where it was basically asked how people were doing etc. The chief stated that no one on the first alarms crews were going to be working the rest of the night. Some went home, some stayed at the stations, but no one was to run any more calls that night. When we sat down as a crew, nobody really talked, but people were available. A couple days later there was a larger CISD for both spouses and for those FF's who worked (seperate groups). Again, it was pretty quiet until someone said something that opened the floodgates.
While I can see such debriefings can help some, and I do feel they are beneficial, sometimes it is the long term availabilities that are more important. Access to an EAP or more structured mental health should be available for when the incident does grow old and a CISD may no longer apply.
Having been at the scene, I found it easier to talk to those who were there with me. It is hard to describe things to those who were not physically there. The dept later put together the incident and presented an "incident debrief" for all the crews. It helped to have some of us who were there to relay some of the experiences, because you still don't have the same picture as when you were not there, to answer some of the other questions. From our LODD, it was found that some people who were not there experienced problems as well, but were never at the CISD, nor had people asking how they were doing. Unfortunately for one of our FF's the incident affected him more and he later took his own life. He was never on the scene, but still things had an impact.
Moral of the story, CISD's are good and to ensure those who were on the call are OK, but things affect people differently. The best thing to have would be to have access to such things like EAP or more structured care for those who would like it, just as much as peers looking out for each other. Also, incidents can affect anyone, whether they were physically there or not. Sometimes the guilt feeling of "if I could only have done this" or "had I been there I" can be as bad as those who did experience the event.
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Permalink Reply by Jack/dt on
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In some respects (and in my opinion) CISM will be a self-fulfilling prophecy, tell people that they are going to have nightmares, are going to be depressed, will suffer from insomnia and bingo...some people will. The power of suggestion is great and can both aid as well as hinder.
I'm all for making resources known and available for those that want or need to avail themselves, but I think that for the crews to spontaneously get together, bullshit and talk about the incident has a greater 'healing' effect than any kind of organized 'help'. Black humor exists for a reason, it's a way of making sense of and exorcising images and feelings. It's not suppression or sublimation, rather it's a very human way of dealing with very inhuman circumstances, it's cleansing.
I spent 16 hours at an MCI with 5 fatalities and dozens injured. Once the transports were done and the recoveries completed it was hang around time while the rest of the incident was dealt with. There was a lot of down time and a lot of time to discuss what happened, what we saw and had to deal with. This was all done casually, informally and organically, amongst ourselves. There was a CISM team on scene and they wandered around, chatting and hanging out but that was pretty much it. The conversations took place when they weren't around.
I'm not saying that everyone can always deal with what they've seen, but I can almost guarantee that when you tell certain people that they won't or may not be able to deal with it, they won't be able to. Seems to me you'd better off telling them they're going to be fine. Most will and for those that won't additional resources can always be made available.
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Permalink Reply by Art "ChiefReason" Goodrich on
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Does someone need a little intervention?
A voice of reason, perhaps?
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K:
I understand that.
I'm sure that most of us are sharp enough to know if we need to go beyond talking to a friend.
I talked to my wife alot when I was on the department. I wouldn't go into graphic detail, but I just needed to vent for a few minutes to unwind. Most of the unwinding can be done when we are back in quarters and are tearing down the hose beds to dry the hose, doing the equipment check, doing the reports and getting a bottle of water.
As long as we are mindful that not everyone has the same level of tolerance to seeing serious injury or death and they may need some help in whatever form, I think we can stem the tide of turnover.
Yes?
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K - you're not into the group-hug, Kumbaya thing? Then this vid's for you.
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CISM "counselors" have a vested interest in convincing people they "need help" working through these tough times.The paychecks and / or the self worth of CISM specialists depend on other people "needing debriefing"
I disagree here. You are essentially lumping every CISM team member out there together by stating it is about pay or self worth. Now I can see the issue presented last year when this topic first arose with the OP asking "how to you get people to talk about their 'feelings'?", and as many have pointed out, most don't like to be forced to open up.
However, CISM was put in place to be a peer review of people who should understand the job and some of the issues associated with the service, unlike say a psychologist who sits in an office all day and can't tell you the difference between an engine and a ladder. I would say most of those who are CISM debriefers are doing so solely on their own voluntary basis and not in it for the money, nor even self worth. Despite what studies are done and so forth, I have seen people who stated they were glad they had a debriefing and glad to see others have had some of the same issues they also have.
We have some people who have gone through some training for the CISM team and they don't get paid, they don't do this for self worth, but to be available for others who may want to talk. They have never pressured anyone to talk, nor even encouraged people to talk. For the most part they have made themselves available if someone did want to say something and then basically describe the phases of grief etc and some warning signs to look out for. They discouraged people to turn to "alternate coping mechanisms" like alcohol or even drugs, and encouraged others who were there to just talk amongst themselves and even look out for each other.
Some of these members have been contacted after debriefings because members understood what they said was confidential, vs saying something inside the firehouse that may get spread around or have other unintended consequences. These members received some more training to be able to assist a member who may have an issue to seek further help such as EAP, etc and to perhaps dispel some questions like "will I still have a job if I seek professional help?" Don't think it hasn't been asked.
Now I do agree that sitting down and talking after every serious call is not necessary, but there are some calls where CISM members should be made available and to remind people there are members willing to listen and keep your information confidential. These are people who remind crews of warning signs and to encourage members to talk to each other and keep an eye on each other and so forth, because sometimes what may be going through your mind may be going through someone else's as well. I see that as looking out for the brotherhood, not doing this for money nor even self worth.
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Permalink Reply by Tana Todd on
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Hey Kali...sounds like you have a bad attitude about something!!! Read all my posts before you say the we do this because of a paycheck and/or self worth!!!!!! I really hope that you don't ever need help of any kind. I wish no one needed the help that we provide, but everyone is not like you. Have you ever seen one of your own try to commit suicide or quit the service because they couldn't take that one final scene??? No one on here has said that EVERYONE has the same tolerance, but help is out there if someone ever does. And it has been proven that this method does work FOR CERTAIN PEOPLE, I've seen it. AND i DIDN'T SAY THAT A DEBRIEFING IS ANY BETTER THAN OTHER METHODS...IT'S JUST ONE MORE WAY TO HELP PEOPLE!!!!
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Permalink Reply by Ben Waller on
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Tana,
Despite your good intentions, once again, there is overwhelming evidence that CISM has no benefits to the debriefees, and is actually harmful in some cases.
Your definition of "help" is not really help at all according to mental health professionals and the ovewhelming scientific evidence.
Good intentions do not equal good medicine or good mental health practice.
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I have seen it work, I don't have to show some peer reviewed research. Like I said and almost everyone else has said...No, it's not for everyone!!! I have heard that it could cause bad effects, but also doing nothing can be even worse. The reason I said you had a 'bad attitude' is because you totally cut down the CISM process by what you have seen or heard in your area. Maybe, in other areas you might find it helps. I will agree that sometimes members of any kind of debriefings take the probing too far, but no program is perfect...even CISM teams. Please don't group all CISM teams in one category. Like I said, I may not be a ff anymore, but I am still an EMT on a paid dept. I am one of your peers!!! If I can help someone, you bet I'm going to be there...if only to say I'm there if you need me.
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