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On this horrific morning the East Metro branch dispatched ten crew members out to a train-taxi accident, which within minutes has worst-case initial-situation-reports flooding in.
As a paramedic you arrive on a scene, treat and transport a patient and then hand over the patient to the doctor at a hospital and the problem has gone away. This approach is questionable when you are faced with a major incident that goes beyond your “normal paramedic” coping mechanism.
As a manager of paramedics exposed to situations requiring “beyond normal” coping mechanisms, one feels that all we need is to quickly organize a stress debriefing for the group and there will be no further issues. The staff are then sent off to a Critical Incident Stress Debrief (CISD), which has become the norm over the last 2 decades in the EMS world.
What do we understand about this quick fix term called Critical Incident Stress Debrief (CISD)? How effective is it? What have we learned by using it for the last 20 years?
CISD is defined as a group intervention technique conducted 24 to 72 hours post a traumatic event. A session typically lasts 2 -3 hours. The typical CISD is provided by a specially trained team which includes at least one Mental Health Professional and several peer advisors. “Peers” are paramedic staff who have also received training in CISD. They lend support to the traumatized group as well as credibility to the process.
A CISD is designed to achieve two goals:
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Lessen the impact of a traumatic event i.e. depression, anxiety, anger and long term stress
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Accelerate normal recovery
In this day and age where everything is questioned, critics are arguing a lack of research and scientifically proven process supporting the need for CISD. There is ample literature gathered over the years to argue for and against the effectiveness of CISD with an array of outcomes. The literature is inconclusive as to how we measure the outcome scientifically.
The other concern is that CISD is doing more harm than good for those who don’t want to relive the experience, which could affect on the policy of fire departments, which force their staff to attend CISD.
As we rush to judge the effectiveness of CISD, lets keep in mind that research has shown that CISD makes a lot of people feel better with a few recommendations;
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Effective command presence – having a strong senior person running a traumatic scene when it happens eases the anxiousness of the younger paramedics because “the big brother will know what to do when I don’t”.
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Well developed family support – having an understanding spouse to come home and unload to beats doing it with strangers in a group.
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Solid, consistent developmental supervision – having an employer that consistently tries to grow you as a professional to become stronger and more confident in yourself.
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Physical exercise – get your mind off the event and get exercising to get the cortisol hormones that have built up from the adrenalin release flushed out of your system. Cortisol hormone build-up in the body leads to constant hunger and weight gain, another reason to get out and exercise.
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It helps to talk – talk with other paramedics, those who share our experiences and worlds.
Like many things in life, that which we learned from our Grandma applies more than that which we learned from business school.
When dealing with trauma, remember:
People in general are tough, friends and family are important, conversation helps, and time heals all wounds.
Submitted by East Metro, ER24
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