Psychological disequilibrium in pedatrics (Kids see bad stuff and freak out)

[chiles]

So, in a recent meeting the issue of a cadet who came upon a crash site on a mission and had a bit of a bad reaction to it came up. There was a discussion about how teenagers perceive a disaster and cope with its effects. More pointedly, it was discussed whether cadets can handle seeing a smoking hole. Granted, put a twelve year old in this situation is probably a bad idea. The literature shows that adolescents up to the age of 16 can be vulnerable due to cognitive development and the capability to cope with the state of psychological disequilibrium we all feel when we see something that far out of the norm.

Considering that a lot of people were able to give anecdotal evidence showing 17 year olds who couldn't handle it and 14 year olds who did just fine, and the fact that I just got done writing a sizeable research paper for my masters on the very topic, I've decided to pony up and distill that sizeable paper into a useable briefing for senior leaders. My question is what, as commanders and ground team leaders, would you like to know about the subject? There's literally tons of research on this subject, but what would be really helpful to you all?

I'm looking for questions, best practices, and a few anecdotes. The anecdotes are to be used as supporting evidence to best practices or pitfalls. I don't want the document to turn into a long discussion on what happened to people so much as a way to prevent future occurrence or mitigate the effects. Also, out of common decency and a sense of non attribution, please do not relay an anecdote on the board that can be tracked back to a single person by a particularly savvy reader. If information needs to be spread of this nature, PM me directly.

I will post this on cadet stuff later (both in the adult board and the general access boards). Thanks in advance for all your help!

[lordmonar]

Just recently we had a ground team of cadets and one senior member come across an accident scene while on a training ELT mission.

The senior member had to stay with the vechicle and never saw the victum.  The cadets (ages 14-19) did great!

I have seen grown adults at similar accidents completely loose it.  Everything from freezing up to  going into screaming histerics.

If you need specifics....PM me and I will give you details.

[Eclipse]

So...

You had a team of cadets operating alone in a field situation because the senior member had to watch the car?

[lordmonar]

Yes...

The location of the incedent was in a comm shadow....the SM had to drive up the road about 1 mile to make comm contact with mission base then drive back to where he could talk with the ground team.  Who were about 3/4 miles off the road up in the hills.

My point was that cadets are capable of working in a high stress environment and be exposed to blood and body injuries with out "loosing it".

We did a CISM debreif after the mission.

[chiles]

Perhaps I should be a little more specific about some of the points I intend to make in this document. I know that adolescents have different levels of tolerance and that adults are just as likely to suffer the ill effects of a traumatic event. The anecdote above is a great one to include as an example of someone who witnessed the strength of two cadets and they utility of a CISM debrief.

As for the whole leaving cadets alone thing, please feel free to start another thread on that. I don't want my thread to get derailed when I am in need of information.

[flyerthom]

Numerous states restrict EMT-B training to age 16. I can say for me I began doing volunteer EMS at age 18. 28 years later I am a flight nurse. A significant portion of how a rescuer deals with the traumatic is in how that individual is trained. Someone who is prepared, drilled and really ready will do better than someone who has had a class and is turned loose. In a non medical sense look at the air force and navy experience in Vietnam. The lack of aerial combat training had a significant cost. After Red Flag and Top Gun losses drop sharply and other issues also. Training aids prevention.

[Eclipse]

IMHO...

Cadets should never be allowed to operate independent of direct adult supervision in the field, and the minute there is any chance of encountering catastrophic injury or death, they should be removed to a point out of view immediately.

Whether or not they "can" or "should" be able to handle it is immaterial - they should not be discovering their  personal tolerance by accident at 14.

I am in my mid-forties, and have been exposed and desensitized to this type of thing as much as anyone who doesn't encounter it on a regular basis, and was terrified of both my immediate, and long term, reaction should we encounter such "unpleasantness" while down in Mississippi.  To this day I don't believe I haven't fully processed what we saw, and we were not in the hardest hit areas from a loss of life standpoint.

I have the utmost respect for our cadets, but at the end of the day they are not adults, and should not be exposed to anything which may cause them emotional harm - ESPECIALLY when you consider they are acting on a volunteer basis.

[lordmonar]

Then we might as well just exclude all cadets from all ES activities.

If we followed your view....then someone would have died....and I am not exaggerating....on that mountain.

I have BTDT and we often sell our cadets short on what they can and can't handle.  Letting them find their limits early is not necessarily a bad thing.

[Ned]

IMHO...
I have the utmost respect for our cadets, but at the end of the day they are not adults, and should not be exposed to anything which may cause them emotional harm - ESPECIALLY when you consider they are acting on a volunteer basis.

Bob,

1.  Many cadets (especially GT members) are adults.

2.  Why is it OK to "emotionally harm" senior members, but not cadets?

I would have thought that it was probably a bad thing to emotionally harm any of our members.

Ned Lee

[chiles]

I was kind of scared of this. I didn't want this to be a discussion of limitation of adolescent capabilities based on opinions. I wanted to know what information a commander or GTL would find useful in determining whether a cadet in their stead is ready, what symptoms to look for in traumatic exposure, and mitigative efforts. Please give me at least a few things you'd like to know before this degrades into an argument of capability (noting that this is an issue of concern I will address).

[Whocares]

1.  Many cadets (especially GT members) are adults.

Another good reason why the cadet program should stop at the age of 18 and the SM program start at 18 instead of having this 3 year overlap.

2.  Why is it OK to "emotionally harm" senior members, but not cadets?

While yes it is bad to "intentionally emotionally harm" any one, but let us face it.  In general, (reading not always true, not always false) we do not prepare cadets (or any one for that matter) of the reality of ES.  Most training, while pretending to be in the mind set of actually finding someone, is really done in the mind set of false alarms. 

We as a program are so bogged down in getting people trained so that way each squadron has a ground team, that we loose site of the reality.  How many Squadron Commanders sit there and truly say to themselves "Can Cadet X truly handle a real situation?"  In fact, how many commanders truly say to themselves "Can SM Y truly handle a real situation?"

In the end, the emotion impact, in general, is going to be worse on a 12, 13, 14, etc year old children than 18 year old.  The mind is different causing the person to handle situations differently and understand the reality of death.  While yes, there are some 16 year olds that perform excellently as opposed to some 40 year olds and vice versa.  I am speaking in general and know there are many examples of both sides of the issue.

Personally, I think we should limit ES to the age of what the state sets as an appropriate age for EMT training.  If a state says they have to be 16, then to participate in ES, you must be 16.  If 17, then ES training is 17.  Or at least on real missions.  They can train, but just cannot participate on real missions.

Unfortunately, I know this will be met with resistance of the fact that it is hard in general to even field a team.  I know, I have experience, this problem many times.  But hey, it is not like anything is truly going to change anyway. 

[Whocares]

I was kind of scared of this. I didn't want this to be a discussion of limitation of adolescent capabilities based on opinions. I wanted to know what information a commander or GTL would find useful in determining whether a cadet in their stead is ready, what symptoms to look for in traumatic exposure, and mitigative efforts. Please give me at least a few things you'd like to know before this degrades into an argument of capability (noting that this is an issue of concern I will address).

personally, I do not think most commanders even have the ability to answer what you are looking for.  Commanders and GTLs, while get very little training on CISM and PTDS, are not exactly an expert to make some decision based on symptoms of traumatic exposure.  Oh sure, they could probably ID some of the basics, change in attitude, change in participation, etc, but the more advanced items are probably going to be IDed by their parents and family health care providers.

Lets think about some commanders, they are pressured to get and field an ES team due to state budgets and "advertising".  Or are pressured as to why they are not sending any one to a weekend SARX, training school, etc.  They simply look for people that have all the requirements signed off and sign the ES card so that way they can say they have an ES team. 

[SARMedTech]

Just out of curiosity, what happened to the regs stating that cadets (for this very reason) do not approach crash sites for any reason other than providing "site security?"

I understood that this was still in force, and if so, makes the discussion at least moderately moot and possibly makes a "white paper" on the subject somewhat redundant unless you are doing it with the goal in mind of increasing the functions of cadets at crash/emergency scenes.

[chiles]

Just out of curiosity, what happened to the regs stating that cadets (for this very reason) do not approach crash sites for any reason other than providing "site security?"

I understood that this was still in force, and if so, makes the discussion at least moderately moot and possibly makes a "white paper" on the subject somewhat redundant unless you are doing it with the goal in mind of increasing the functions of cadets at crash/emergency scenes.

Part of my research for my class actually shows that adolescents hearing about a scene is enough to set them off. However, noting the quote for the regulation would be a useful addition. Can you cite it?

[SARMedTech]

Unfortunately I would have to dig for it much more than some of our experienced members. I am pretty strictly ES involved and that involvement is limited at best these days. I have never had anything considerable to do with cadet matters other than what is required.

NOTE: I have nothing against cadets or those who deal with them, it just isnt my bailiwick.

[Ned]

Chris,

Here are some serious question that might be posed by a commander:

"What research supports the notion that a 16 year old trained ground team member is significantly more psychologically vulnerable than a similarly trained 22 year old adult when exposed to human remains?"

"Are there alternatives to the methodology utilized in CISM that are equally effective?"

"What research supports CISM as measurably mitigating pyschological harm in adults and/or adolescents?"


FWIW, I used to order teen-aged drunk drivers to participate in a morgue visitation program, but discontinued the practice after reviewing a few studies that suggested no significant differences in recidivisim rates by the teens despite exposure to human remains.  Turns out the "hoped for effect" existed mostly in the minds of the adults working with the teens attempting to change the teens' risky behaviors.

Ned Lee
DCP, PCR

[Whocares]

"What research supports the notion that a 16 year old trained ground team member is significantly more psychologically vulnerable than a similarly trained 22 year old adult when exposed to human remains?"

A different question, Is there research that support the notion of a 12 year old GTM vs. a 22 year old adult?

After all, I believe most states allow EMT training at the age of 16 and in theory, a 12 year old can participate on ES missions.  Thus, at what age does the pyschological effect becomes the least impactable. 

[SARMedTech]

"What research supports the notion that a 16 year old trained ground team member is significantly more psychologically vulnerable than a similarly trained 22 year old adult when exposed to human remains?"

A different question, Is there research that support the notion of a 12 year old GTM vs. a 22 year old adult?

After all, I believe most states allow EMT training at the age of 16 and in theory, a 12 year old can participate on ES missions.  Thus, at what age does the pyschological effect becomes the least impactable. 

I believe you will find that the majority of states requires an individual to be of the age of 18 before they can enter an EMT program. I know for certain that not ALL do, but I frankly don't want someone who just got their driver's license  trying to shock someone back to life. Also, I believe that the participation of a 12 year old cadet in ES is limited, and if not, it should be. A 12 year old has no business participating in any ES related function other than possibly SAREXs, especially when the possibility exists of coming into contact with disturbing scenes or even hearing those scenes related from the site via radio communications.

[sardak]

There is currently nothing in the regs about cadets not approaching crash sites except to provide site security.  There was a letter from the previous national commander titled "Cadet Participation in Emergency Services Missions" dated 24 July 07.  The draft CAPR 60-3 includes parts of that letter with some modification:
Cadets under 18 shall not be exposed to conditions in which their health is jeopardized by exposure to decomposing bodies and hazardous materials. Nor, absent parental permission, may they be exposed to widespread suffering. That does not exclude cadets from qualifying and serving in specialties with a potential for exposure, but rather requires adult leaders to be cognizant of the dangers associated with the missions being undertaken and taking appropriate action to protect all members involved, especially cadets.

The letter is posted as a sticky in the Emergency Services section of CAPTalk.  Both the letter and draft 60-3 have been removed from the NHQ website.

Mike

[SARMedTech]

Perhaps these are part of the legacy of He Who Shall Not be Named which deserves a revisit. A 12 or 14 year old cadet has no business approaching a crash or other emergency site where casualties and/or fatalities exist.