Wednesday, January 16, 2008

Bledsoe killing vampires...again

Bryan Bledsoe's column in this month's jems.com is one of Bryan's most controversial topics but a message worthy of repeating: CISM doesn't work and may be dangerous. Bledsoe states:

CISM has been debunked repeatedly through scientific scrutiny by some of the world's foremost authorities on psychological trauma. In fact, it has almost become a punch line or poster child for pseudoscientific practice. In a recent academic debate by the British Psychological Society (BPS) on "the worst idea on the mind," post trauma debriefing (e.g., Critical Incident Stress Debriefing, or CISD) scored third behind prefrontal lobotomy and the chemical imbalance model of mental illness as a pseudoscientific practice. Numerous randomized controlled trials, some conducted in the last two years, have repeatedly shown CISM to be ineffective and potentially harmful.


While this is unpopular to many--and some I know of here in Maine won't be happy--I feel the need to post this article and some excerpts. While CISD may make some people allegedly feel good, some are harmed. I personally would not participate in a debriefing and would advise anyone who asked my opinion to avoid it as well. This does not mean to avoid care altogether. To avoid the CISD model.

The purpose of the article actually runs deeper, and into the realm of how to continue to gain respect in the scientific and medical community when we stick to non-proven, potentially dangerous practices simply because "that is what we have always done" or someone emotionally preaching the praises of CISD during a back-step-of-the-rig sermon.

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.


I remember the 70's and 80's when police officers were involved in shootings. Administrators took the officer's guns and made them get counseling. Do you know what they found? It induced guilt where none initially was. Officers sometimes don't feel that badly. If they took a life defending another or their own, sometimes the shooting isn't as traumatic as some initially thought.

I consider CISD the same. Unproven, many times unnecessary and may cause harm. I also disagree with the tenet that CISD sessions are confidential. In most cases, in the absence of a licensed mental health professional, the conversations are subject to subpoena and testifying in legal proceedings.

And what about the insidious stress that takes more people out of the game than bad calls: no calls or boring calls. We lose more people from a slow, steady diet of no excitement than we do from one career-ending call.

I've sharpened my wooden stake and joined Bryan in this noble quest.

2 comments:

Marc said...

I think that CISD works for some people, and not for others. The difference is forcing people to be a part of it. I've seen people walk away from a debriefing feeling satisfied, and I've seen others waiting in the parking lot with bats and broken beer bottles. Just like patients, not every provider is the same! I personally would not want to be forced into a CISD (although I have been). Any calls I have had trouble with were certainly NOT the type to have a CISD team activated!

Dan Limmer said...

Thanks for the thoughts, Marc. The concept of whether CISD "works" or not unfortunately isn't a light switch which gives us a clear yes/no.

For the group where CISD doesn't work are providers worse? Are they harmed? This is much different than simply not getting a benefit from the debriefing.

Hopefully the days of being forced into a debriefing are nearing an end.

Finally, we are in 100% agreement that stress is an individual issue--not just from the big calls.