EMS Myth #3: Critical Incident Stress Management (CISM) is effective in managing EMS-related stress

EMS Myth #3: Critical Incident Stress Management (CISM) is effective in managing EMS-related stress


Like most, I did not give Critical Incident Stress Management (CISM) much thought when it was introduced into EMS in the 1980s. Intuitively, it seemed like a good idea. Although I was unsure whether stress was more severe or different in EMS than in other occupations, CISM seemed like a benign method of mitigating EMS stress. CISM was integrated into the EMT and paramedic curricula, and we included it in our textbooks. Without looking into it significantly, I made CISM mandatory for all agencies I served as medical director. In fact, I attended a CISM session following a bad accident where two adult women and a six-year-old child burned to death in their car following the impact. I had been at the accident scene and was not particularly distressed following it, but attended the CISM session to show solidarity with the field personnel. The session seemed to go well, although I felt most there were uncomfortable with the process. A few weeks later, I received communications from several firefighters, who basically threatened to get the union involved CISM continued to be mandatory. They provided research that made me question whether CISM was beneficial. When I looked into it further, I found that CISM in EMS may not hold the promise of continued emotional well-being that its proponents believe.1, 2

CISM History
      CISM was introduced to EMS in 1983 through an article by Dr. Jeffrey Mitchell published in a trade magazine.3 The process was called Critical Incident Stress Debriefing (CISD) and was described as "an organized approach to the management of stress responses in emergency services. It entails either an individual or group meeting between the rescuer and a caring individual (facilitator) who is able to help the person talk about his feelings and reactions to the critical incident." Later, the goals of CISD were expanded to include prevention of disorders that may develop as a result of traumatic stress, such as post-traumatic stress disorder (PTSD). It also came to serve as a tool to help identify personnel who should be referred for further treatment; to facilitate verbalization of experiences; to normalize reactions to stressful events; and to improve peer group support and cohesion.4–6 The name of the process was changed to CISM, purportedly to reflect these more global objectives.7

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