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Another nail in CISD's coffin

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The facade of that fairy tale we call CISD continues to crumble under scientific scrutiny. Now the Canadians (bless their souls) are getting in on the act and denouncing it as bull$hit.

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Despite years of pseudoscientific psychobabble, mainstream psychological

researchers have determined that there is no such thing as a "rescue

personality". The "rescue personality" was described by CISM/CISD founder

Jeff Mitchell, PhD. His model postulated that EMS providers and fire

department personnel were different from the rest of the population and

hence the need for CISM/CISD. Mitchell described the "rescue personality" in

an issue of JEMS and Fire Engineering. However, when mainstream researchers

asked to see his data--it was somehow lost in an office move and could never

be found.

In the current issue of The Australasian Journal of Disaster and

Trauma studies Canadian psychologist Shannon Wagner studied the concept for

a "rescue personality" and found no evidence it exists. She wrote, "Mitchell

and Bray (1990) describe emergency response workers as inner-directed,

action oriented, obsessed with high standards of performance, traditional,

socially conservative, easily bored, and highly dedicated. In addition,

these authors describe emergency workers as people who like control, both of

the situation and themselves, and enjoy being needed. Further, Mitchell

(1988) suggests that in order to effectively implement CISD, a mental health

professional must be aware of "the unique personalities of emergency

personnel and the special jobs they perform" (p. 43).

Currently, the

evidence of benefit, or lack thereof, for the CISD has been the source of

much debate (e.g., McNally, Bryant, & Ehlers, 2003; Jacobs, 2004). Although

the efficacy of the CISD is not the focus of the current discussion, the

efficacy debate is nonetheless contingent on the issue of the so-called

rescue personality and its consequent existence. If the rescue personality

is not a definable and evident aspect of those who choose to participate in

the emergency response services, one of the primary principles that comprise

the foundation for the CISD will be abandoned." She concluded, " The

existence of a rescue personality is a fundamental tenet for a very

controversial method of intervention. Given this personality type's

important role within the field of emergency service mental health, it is a

serious detriment to researchers, practitioners, and emergency response

service workers alike, that the question of its existence has not been

adequately addressed. The potential effectiveness of the CISD with fire,

emergency medical, and police service workers is theoretically dependent on

these individuals being a homogenous, but independent, group. Specifically,

within the emergency services this homogeneity is, in part, assumed to be

reflected in the rescue personality, a personality that is purported to

characterize the type of individual who chooses to perform rescue-related

work. Currently, there is little evidence for a distinct personality type

that is reflective of emergency service workers as a whole."

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The facade of that fairy tale we call CISD continues to crumble under scientific scrutiny. Now the Canadians (bless their souls) are getting in on the act and denouncing it as bull$hit.

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Worked a ped code recently as primary paramedic but had another truck as backup (we run 2 on codes) Myself and the medic from the other truck were fine with this call and were trying to get our truck back in service at the ER while my partner (EMTB) was crying saying she needed CISD and doing the whole drama thing. I'm not coldhearted and yes I do have 2 boys under the age of 2 and see this as my job!!!! This same partner has requested CISD at least 3-4 times this year. I am going to slip eventually and tell her to get another line of work because she just plan and simple can't handle it. I've been doing this for many years and never have needed CISD. I have needed however to talk about a call afterwards with those of us WHO WERE ACTUALLY THERE and this is very theraputic but I don't need some guy or gal who wasn't there to tell me what to feel. I must get off my soap box. By the way they tried to force me to go to a CISD after this call and I just walked out.

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The one time I went to a CISD, I walked out of there feeling more angry than I did when I walked in. For one thing, one of our lieutenants kept telling me I was violating the patient's right to privacy and breaking confidentiality rules...I wasn't saying anything that everyone there didn't already know. The first person on scene, who ended up seeing most of the horror was crying so hard she was literally screaming and shrieking at the top of her lungs...it scared me to see how upset she was. And then...when I had to pee, one of the leaders wanted to go with me...I guess that is pretty standard practice, but I had no desire to pee in a 3' x 4' bathroom with someone staring at me. They also told us we were not allowed to swear...I know swearing isn't nice and it isn't that big of a deal, but I had some choice words for one of the people involved and somehow calling her a mean lady just didn't feel the same as calling her a F****** B****! LOL.

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I've been doing this for many years and never have needed CISD. I have needed however to talk about a call afterwards with those of us WHO WERE ACTUALLY THERE and this is very theraputic but I don't need some guy or gal who wasn't there to tell me what to feel.

That is exactly why CISD is BS. It attempts to force every individual to cope in a specific manner which pleases the facilitators instead of letting the individual's natural coping process to occur unmolested. Consequently, the natural process is derailed, inducing stress which was not already there as a result of the incident.

In addition to all the normal mayhem I experienced in my career, I worked seventeen commercial airliner crashes, with thousands of fatalities. Seventeen times in fifteen years I walked and crawled through knee deep burned and eviscerated human corpses. After only one of those incidents did I experience any difficulties whatsoever. After one crash, I had recurring nightmares in which I kept going back inside the charred remains of the fuselage and crawling over dead bodies. Each time, the dream would end with me waking up in chills and barely making it to the bathroom in time to vomit. Sometimes I didn't make it that far. Guess which incident it was that caused me the problems. Yep, the only one that I was forced to attend CISD for. There is no doubt in my mind that CISD caused the PTSD from that incident. And thousands of other responders will tell you the same thing happened to them.

The only people still holding on to this CISD thing are those who are ignorant, stupid, or financially vested in the system. Hopefully, the ignorant will eventually read the evidence and get a clue. But unfortunately, the stupid don't read, and the financially vested won't give up til they have milked it for its last dime.

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I understand and may even agree with some of the comments above... but for a select few CISD's or CISM's have been a saving grace. Statistics may show that it doesn't work for everyone, but for some it's all the venting they ever get. My best advice... do what works best for you.

Happy Holidays All!

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Jo, venting is great. And if it is something you feel the urge or need for, then by all means it is exactly what you should do. And yes, agencies should provide an outlet for that. The problem with CISD is that it is a cookbook approach which forces everybody to confront stress in the same way, flying in the face of all scientific evidence and knowledge. It's as if we decided that all people between the age of 40 and 60 should be defibrillated today just in case they are in v-fib. It simply makes zero scientific sense, and will ultimately cause great harm to many people.

We are not questioning the value of professional psychological counseling or even sharing your experiences with your peers. What is being questioned is the prudence of inducing stress on already stressed people by forcing people to conform to some quack's spurious notion of how everybody should handle stress.

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I was forced to attend a CISD'S about 4-6 years ago after a truck load of kids hit a train that left 2 dead and 2 hurting. It was a compleat waste of my time attending a CISD'S it did not help me at all. Then in August of this year we had a plane crash about 6-8 miles north of me that left 15 dead and 2 injuried. CISD'S was to take place the next day but i did not go. My personal thought is CISD'S is good for some people and not worth a damn for others.

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My personal thought is CISD'S is good for some people and not worth a damn for others.

That is very true. Unfortunately, we have no way of knowing who "some people" are, which is the point of the article I posted. See, the originators of CISD theorized that we are all the same. That we all react the same way to the same stress and therefore all need the same treatment for that stress. Obviously, there is zero evidence to support that theory. In fact, the very fact that most people do NOT have stress reactions and some people do is proof positive that there is no rule or predictability to who stresses out and who does not.

CISD was designed to be a sort of vaccine against PTSD. Inoculate everybody and nobody will get it. Well, it worked out about as well as Bretylium. The numbers didn't decrease. They increased. Steadily higher and higher as CISD became more prevalent. Yeah, CISD was a vaccine alright. Unfortunately, the batch was bad and -- just like the TB vaccine of the 1950's -- it ended up causing the disease it was intended to prevent.

Moral of the story? Simple. In fact, it rates right after scene safety in important concepts taught in EMT school. That is,

  • If your patient isn't having a heart attack, don't treat him for it. Likewise, if he is not having a stress reaction, don't try and treat him for one!
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