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WHO Single-session Psychological Debriefing: Not Recommended

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I agree with Romney, as I have been to a few of these, and I do not know of anyone who was damaged by it. It was voluntary, only people who were involved in the call were allowed to attend (no spectators), everyone was given a card with a counselor's name on it that they could see if they felt the need, so that they could remain anonymous about their pain if they wished. Grown men usually do not cry about the calls they run, so when they do it is a sign that they are significantly moved by what has occured. Does not make them mentally ill, but definitely a sign that something is bothering them. I do not know any man that cries all the time dfib, but we grow them a little tougher down here.

Lol.

I just love those arguments.

`No, that`s not true, I`ve seen it myself`.

Those observations have no scientific weight, at all. Kinda like that dude, stating smoking`s not that bad, `cause his grandpa smoked like 65 years and never had a health problem.

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What proof do you have that there is any harm, other than Dr Bledsoe's comments. Are you suggesting that one article is sufficient as scientific proof, I am sure I can find just as many articles that point the other way.

But I forgot, in this room, it is alot like Porky's.................. So Sayeth Bledsoe, Dwayne, AK, whoever, so sayeth the FLOCK--- why is my real life experience worth less than some academic's THEORIES ?

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What proof do you have that there is any harm, other than Dr Bledsoe's comments. Are you suggesting that one article is sufficient as scientific proof, I am sure I can find just as many articles that point the other way.

But I forgot, in this room, it is alot like Porky's.................. So Sayeth Bledsoe, Dwayne, AK, whoever, so sayeth the FLOCK--- why is my real life experience worth less than some academic's THEORIES ?

May i remind you that the Dr. Bledsoe is co-chair of the Curriculum and Evaluation Board (CEB) for the United States Special Operations Command (USSOCOM) at MacDill AFB, FL. Dr. Bledsoe was recently named a 'Hero of Emergency Medicine as part of their 40th year celebration.

Again: I suggest you look to the handouts (it becomes most clear that you have NOT yet reviewed the Power Point Presentation) ... you will find over 20 references by Bledsoe to actual quantitative STUDIES, these are called meta analysis and the philosophy behind present day "Evidence Based Medicine" and if you would care to look to the referenced research you may find that these "PORKIES" are actually reading these documents, in fact did Dwayne or AK even post on this topic ?

The real "fact of the matter" is in my opinion that this franchised CISM programme is a marketing gimmick, can you prove that it does any good at all ? Besides your initial argument was we grow men tougher in this part of the country and they dont cry .. are you begging to get your pee pee whacked ... ?

btw The OP was by W.H.O. that is the World Health Organization its not one man / womens opinion, a consensus but thank you very much for taking this very important thread into the name calling .. I hate lil pee pees ... I always wondered what that handle indicated, and now I know.

cheers

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What proof do you have that there is any harm, other than Dr Bledsoe's comments. Are you suggesting that one article is sufficient as scientific proof, I am sure I can find just as many articles that point the other way.

But I forgot, in this room, it is alot like Porky's.................. So Sayeth Bledsoe, Dwayne, AK, whoever, so sayeth the FLOCK--- why is my real life experience worth less than some academic's THEORIES ?

You didn't read the Power Point did you? You should read it so your commentary will be congruous and make sense. I could even take your side sometimes but you make it impossible with comments like this one. I think you are much smarter than you portray in your careless comments.

I will not go back and count how many studies are referenced in Dr. Bledsoe’s presentation, but it is many more than one. I am sure it would benefit your cause for you to count them before offering unsubstantiated commentaries.

You take a relatively good argument and mess it up by pulling a statement like the one above out of thin air. You make it really hard to take you seriously.

And although I do not personally know Dr. Bledsoe, a guy that started as an EMT 40+ years ago and is now considered "heroic" in EMS as a Emergency Physician is not what I would call an academic. At least not in the derogatory way you mean it.

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Pyschology is a science based largely on the experiences of those who have worked in the field, in some ways. Nonetheless, you must look at statistics. There has been no proven benefit to CISM models. There have been studies indicating that they may cause damage. However, those studies, much like any other study, have been called into contention by those who support CISM. There's a lot of other psychological techniques that carry just as much good/bad dichotomy, and some people choose to support them while others choose not to. Psychology is kind of complex that way.

The honest truth is we just don't know enough about CISM to say whether it's truly harmful or beneficial. Much depends on the psychological history of the individual in question. There are more studies demonstrating harm, but those studies involve debriefings that don't fit the currently accepted model.

I am a certified CISM debrief technician, for small group and individual settings. I honestly can tell you, the course I took to certify me didn't have any test at the end, nor did it require any large understanding of psychology, which is scary as hell. However, since my team chooses to offer debriefings as part of their model for response to crappy calls, I am there as a resource for those who choose a debriefing. It is seldom.

The crux of it is that debriefings must be voluntary, run by at least two individuals with training and must have followup referrals available for individuals who feel that they truly need psychological care. Any "mandatory" debrief run by someone who doesn't know what they're doing is a recipe for disaster. Anyone who thinks they can "prevent PTSD" by offering debriefings doesn't understand psychology.

I personally think it's just a more formalized model of the "let's go down to the bar and work through this shitty thing that happened to us" mentality. Some people do well with that. Some people don't. There's no real good studies on informal peer support to say whether it causes the same potential for detrimental effects.

If you choose to go to a debriefing, by all means, go for it. You're not an idiot if that's what appeals to you. If you start to show warning signs of post traumatic stress that persist past a few weeks, find a professional counselor that you can have a good working relationship with.

Wendy

CO EMT-B

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........... why is my real life experience worth less than some academic's THEORIES ?

Because your real life experience is exclusive to only those preticular experiences and your interpretation of them.

Example: I have only been a part of 1 ROSC. The patient was moved from bed to bed with 3 people. One idiot grabbed his arm and pulled - dislocating it at the shoulder. The patient was then successfully revived and lived to tell the story.

Every other code I have done ended with the patient staying dead.

So it is MY EXPERIENCE that in the setting of cardiac arrest, treatment by dislocating the patients left shoulder has shown improved ROSC with only minor neurological deficits post discharge.

Obvioustly, I am not a credible resource on this topic and my experierience does not count for shit.

I am sure you can see how this applies to almost all your experiences.

Answer #2: I do not need to prove CISD by amature wannabe's will do harm to an individual, I will not deploy or support it until it has shown benefit.

Again.... Proactive vs reactive.

Edited by mobey
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not at all, there are scientist who believe that global warming is still real, there are scientist that believe life begins at intercourse, there are scientist that believe that drilling for oil here is dangerous, my common sense trumps all of them

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not at all, there are scientist who believe that global warming is still real, there are scientist that believe life begins at intercourse, there are scientist that believe that drilling for oil here is dangerous, my common sense trumps all of them

"If we haven't been taught to do no harm, we see no harm in doing harm. We cause harm and shrug it off. We cause harm and laugh about it. We cause harm and brag about it." http://donoharm.us/

You have been taught to do no harm. It is the primary tenet of paramedicine, indeed all medicine. If you do not admit that quantifiable, evidence based science trumps your so called "common sense" and begin to govern your professional actions under it's rigors then I will consign you to the ranks of the hopeless and stop wasting my breath.

Edited to remove errant lines of the first draft.

Edited by CrapMagnet

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Dear hatelilpeepees:

I believe you are confusing the term scientist with that of researcher .. there is a marked difference. especially when dealing with the human mind a completely different set of rules of engagement .. eyedawn stated far better than I can.

Much depends on the psychological history of the individual in question.

That stated I would love to agree with you and your anecdotal comments, but then ... we would both be wrong.

cheers

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not at all, there are scientist who believe that global warming is still real, there are scientist that believe life begins at intercourse, there are scientist that believe that drilling for oil here is dangerous, my common sense trumps all of them

So what you're saying is that sometimes the experts disagree, so we should be skeptical of all opinions, even those considered "expert opinions", and we should all develop an ability to independently and critically appraise the literature? You're suggesting that expert opinion is only slightly more valuable than the personal anecdote of non-experts?

I agree. Welcome to a basic cornerstone of science - rational skepticism. You'll also notice that this is why even published and peer reviewed case reports and case series are generally regarded as better quality data than expert opinion. This is also part of the foundations of evidence-based medicine.

However, if you're suggesting some sort of radical scientific relativism, for example, that because one can find the odd researcher who opposes climate change, versus the overwhelming majority that do, that each opinion is equally valid, or that your uneducated opinion should be considered to be as valid, then you're straying dangerously into UFO-abduction land. Just because there is disagreement about an issue doesn't mean that both sides of the argument are equally valid, or supported by the available data.

As to when scientists believe "life begins", I'm not sure that this is a scientific question, but is probably a religious and /or legal / ethical one. A sperm cell is as alive as a cardiomyocyte, algae, plankton, or a pneumococcus. When people talk about "life beginning", they're usually about to discuss reproductive medicine.

Drilling for oil is dangerous. So is breathing. When we start asking the question "What is the acceptable risk for drilling for oil?" we're asking a moral question. One for the polticians. When we ask "Do our current drilling practices exceed a previously determined level of acceptable risk", then we starting to ask a question that can lead to hypothesis generation and application of the scientific method.

What proof do you have that there is any harm, other than Dr Bledsoe's comments. Are you suggesting that one article is sufficient as scientific proof, I am sure I can find just as many articles that point the other way.

Are you sure? Go to: http://www.pubmed.com/

Then the question becomes, how do we evaluate the available data? Is defining the argument in terms of the number of articles available the best way to form our question? Or should we try and evaluate the quality of the research performed in each individual article and compare them against each other. If only someone had developed a systematic method for reviewing all the available data, and comparing it to each other. If only there was some sort of consortium that regularly published meta-analyses of the available data...

Oh. Wait. It's here:

http://www.thecochra...le/CD000560.pdf

Cochrane reviews. They're new They've been around forever since 1993, but they're good.

Plain language summary (for those of us with common sense, who don't want to read the sciencey bits because they're beneath us.):

P L A I N L A N G U A G E S U M M A R Y

Psychological debriefing for preventing post traumatic stress disorder (PTSD)

This review concerns the efficacy of single session psychological “debriefing” in reducing psychological distress and preventing the development of post traumatic stress disorder (PTSD) after traumatic events. Psychological debriefing is either equivalent to, or worse than, control or educational interventions in preventing or reducing the severity of PTSD, depression, anxiety and general psychological morbidity. There is some suggestion that it may increase the risk of PTSD and depression. The routine use of single session debriefing given to non selected trauma victims is not supported. No evidence has been found that this procedure is effective.

But I forgot, in this room, it is alot like Porky's.................. So Sayeth Bledsoe, Dwayne, AK, whoever, so sayeth the FLOCK--- why is my real life experience worth less than some academic's THEORIES ?

Let's see:

* You're not educated in the subject area, ergo, you probably don't know what you're talking about. Why should we value your personal uneducated opinion over the opinion of a psychologist or psychiatrist? Or Bledsoe, for that matter.

* The academic's theories are formulated based upon the results of peer-reviewed, published data. They are empirical in nature, and they talk not solely to their personal experience, but to the experience of thousands of research participants. They are subject to review in the presence of new data, and are routinely presented and defended at international conferences.

I'm not saying that there's not an element of chance here, that you could be right. I'm just saying that you haven't provided any basis for us to believe that your personal opinion is scientific. Future research might support your position (whatever it actually is). But that still doesn't mean that any of us should necessarily value your opinion as highly as the opinion of an expert. And it certainly doesn't mean that instead of interpreting the available peer-reviewed research, we should all just get on the phone and give you a call to tell us the answer!

Otherwise that science thing would be so much easier. For example, instead of spending all that money at CERN, we could just ask you, hey, what's going on with those neutrinos?

http://www.bbc.co.uk...onment-15830844

Edited by systemet
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