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

Started by chiles, April 21, 2008, 02:36:14 PM

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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!
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

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.
PATRICK M. HARRIS, SMSgt, CAP

Eclipse

So...

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

"That Others May Zoom"

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.
PATRICK M. HARRIS, SMSgt, CAP

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.
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

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.
TC

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.

"That Others May Zoom"

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.
PATRICK M. HARRIS, SMSgt, CAP

Ned

Quote from: Eclipse on April 21, 2008, 09:40:53 PM
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).
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

Whocares

Quote from: Ned on April 21, 2008, 10:33:57 PM
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.

Quote2.  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

Quote from: chiles on April 21, 2008, 11:07:41 PM
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.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

chiles

Quote from: SARMedTech on April 22, 2008, 01:16:11 AM
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?
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

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.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

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

Quote from: Ned on April 22, 2008, 01:41:23 AM

"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

Quote from: Whocares on April 22, 2008, 01:49:08 AM
Quote from: Ned on April 22, 2008, 01:41:23 AM

"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.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

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.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

Whocares

Quote from: SARMedTech on April 22, 2008, 03:08:04 AM
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.

You may not, I may not, but until it is changed at NHQ, the choice is up to the GTL, GBD, or IC.  The question that comes is where and how do you draw the line? 

At the same time, we are only talking of crashed airplanes, what about DR, Missing persons, etc.  How do you limit the scope of cadets participating in ES?

How do you measure or otherwise determine if a person (cadet or SM) is capable of handling real world ES?  What happens when the only SM freaks out?  What happens if every one freaks out? 

Should we mandate a release signed by the parents stating that is possible for their child to see and partiicpate in possible hazardous situations? 

Out of curiousity, who exactly is responsible for pyschological care if someone does break down?  Does the USAF pay for it since it is one of their missions?  the member?  I wonder.

SARMedTech

Another interesting question. I suppose if a SM saw something so horrific that they ended up needing mental health care, you could say to CAP " I got this way doing your missions for America." But I also suspect that their answer would be "Well..thanks...but you knew what you might be facing and weren't REQUIRED to go."

To paraphrase what Barack Obama said in Pennsylvania last night: get in trouble, and you're on your own.

I do like the line of your thinking though.  As for me, being involved with a Composite Sqdn, Im going to do my utmost to keep cadets away from things which could do them mental or emotional harm, and having been a mass casualty EMT for several years now, I know there are lots of things I would rather not have seen, let alone if I had been a 14 year old.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

flyerthom

Quote from: chiles on April 21, 2008, 11:07:41 PM
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).

How they are trained. Not just CAP but outside of CAP. As I remarked previous, training is mitigating. Also if you can get a copy of Mitchell's CISM books they can give you signs/ symptoms of stress issues. A perusal through articles in JEMS magazine as well as Firehouse and ENA's journal should have some good resources.
TC

Eclipse

Quote from: Ned on April 21, 2008, 10:33:57 PM
Bob,

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

Legally, yes. In the eyes of the program, no.  A cadet, regardless of age, is preparing to accept the responsibilities of adulthood, but for whatever reason (opportunities, inability, inertia, etc.) has chosen
not to accept those responsibilities.  Within the program, they must be protected equally, whether 12 or 21.  If they don't like that, it is time to transition.

Quote from: Ned on April 21, 2008, 10:33:57 PM
2.  Why is it OK to "emotionally harm" senior members, but not cadets?

"Adults", by whatever definition you choose, are legally able to accept personal responsibility for themselves, cadets are not "adults" in the eyes of the program, therefore they cannot.

With a note to lordmonor above, the fact that someone would have died is besides the point.  And yes, if we do not have enough senior members to properly staff our ES teams, then its time to stand down until we do.

"That Others May Zoom"

lordmonar

This is all off topic...can we get a split...because I think this particular issue should be discussed.
PATRICK M. HARRIS, SMSgt, CAP

sandman

Quote from: chiles on April 21, 2008, 02:36:14 PM
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!

Capt. Hiles

I think you have a good topic here and could be a good tool (if and when developed as such) for CAP health service officers to use to better advise GTL's and squadron CO's. Perhaps a screening tool for cadet participation?

/r

LT
MAJ, US Army (Ret)
Major, Civil Air Patrol
Major, 163rd ATKW Support, Joint Medical Command

chiles

I figured I'd write two versions of it. One for the HSO, the other for the commander. Like most CAP documents (or CAP sanctioned documents), I'll have to walk that fine line between doctrine and suggestion. I wanted to include a tool, as well. Preferrably something written by a specialist and in the public domain (I've found a couple). I'll post whatever I develop up here for comment. I hope to have them posted on my Wing's website once completed and signed off on by all the legal and command folks. I appreciate the comment and encouragement!
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

sandman

Sounds good. You have a big project ahead of you if you really follow up on this. Perhaps even a doctorate thesis!

Keep up the good work!

/r
LT

PS

Add link to your wing website when you have this up and running!
MAJ, US Army (Ret)
Major, Civil Air Patrol
Major, 163rd ATKW Support, Joint Medical Command

flyerthom

Quote from: sandman on April 22, 2008, 05:32:39 PM
Sounds good. You have a big project ahead of you if you really follow up on this. Perhaps even a doctorate thesis!

Keep up the good work!

/r
LT

PS

Add link to your wing website when you have this up and running!


Ask over here too:  http://groups.yahoo.com/group/CAP_HEALTH_SERVICES/
TC

chiles

I've been on that list for about 2 years (and it's been dead save for Penny's CDC updates). I'm going to hit them up when I have a first cut of it so I can get specific comments.
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

flyerthom

Quote from: chiles on April 23, 2008, 02:19:00 PM
I've been on that list for about 2 years (and it's been dead save for Penny's CDC updates). I'm going to hit them up when I have a first cut of it so I can get specific comments.

Yea, it was pretty active when it began but since the specialty track got sidetracked (rimshot) it's slower than an ER waiting room. This might kick start it. If Dr Greenberg is still about he had some stuff on Suicide prevention started.
TC

chiles

Just an update, I've finished researching the subject and there is a lot of material out there. Once I knock out the last two papers for one of my masters classes, I'll focus on this project and will have a draft completed soon after. If anyone wants to be a guinea pig... errr... reviewer, please PM me with your information. Thanks!
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

ThorntonOL

Not being nitpicky here but 21 is considered adult in CAP from either aspect. (cadet or senior)
18-20 would be cadets.
Former 1st Lt. Oliver L. Thornton
NY-292
Broome Tioga Composite Squadron

TEAM SURGE

If you ask me, everybody in life is going to see death at least once in there life. I don't see how seeing a dead body is such a big deal!
C/Msgt. Messman
PCR OR-114
Northwest Coastal Flight

-Eagle Talon 3
-Cascade Falcon X

"You only Live Once"  

mikeylikey

Lets also not forget that some 17 year old kids are currently fighting a war.  So I can see where coming upon a dead person at 12 years old could be more traumatic than doing the same at 18.  

I hope no one here ever has to come upon a crash scene where there were no survivors.  However in our line of volunteer work, that is a big possibility.  That is why there is a system in place to immediately address members that do walk upon that scene.

I am very interested to read your thesis.      
What's up monkeys?

mikeylikey

Quote from: TEAM SURGE on July 11, 2008, 08:03:32 PM
If you ask me, everybody in life is going to see death at least once in there life. I don't see how seeing a dead body is such a big deal!

It all depends.  Some handle it well, while others do not.  You can not honestly know how you will react until you actually react.

I had 50 year old NCO's breakdown and cry after two weeks in Afghanistan, while I had 18 year old Privates appear not even phased. 

What is more important is the attitude after the traumatic event.  If the person goes out in search of more of the same bad experience, they are messed up in a real bad way.  If they show emotion and a sense of afterthought that is expected of civilized people, they will most likely overcome the experience. 

Immediate attendance to the traumatized individual is so important.  I think that is something CAP has been proven to do very well for Cadets. 
What's up monkeys?

TEAM SURGE

Quote from: mikeylikey on July 11, 2008, 08:13:55 PM
Quote from: TEAM SURGE on July 11, 2008, 08:03:32 PM
If you ask me, everybody in life is going to see death at least once in there life. I don't see how seeing a dead body is such a big deal!

It all depends.  Some handle it well, while others do not.  You can not honestly know how you will react until you actually react.

I had 50 year old NCO's breakdown and cry after two weeks in Afghanistan, while I had 18 year old Privates appear not even phased. 

What is more important is the attitude after the traumatic event.  If the person goes out in search of more of the same bad experience, they are messed up in a real bad way.  If they show emotion and a sense of afterthought that is expected of civilized people, they will most likely overcome the experience. 

Immediate attendance to the traumatized individual is so important.  I think that is something CAP has been proven to do very well for Cadets. 

Well true, like my dad deployed 3 times to Iraq, he says it's not that bad.

Your right it does depends on who sees it. I mean personnally I can walk up to a crash sight, no problem. Younger, or more sheltered or, cadets who have never seen anything traumatic like that will break down, cry. It really just depends on who and what you have experienced.

I just recently learned about the programs that CAP has to offer cadets who were traumatized by something like this. For a volunteer program, thats impressing!
C/Msgt. Messman
PCR OR-114
Northwest Coastal Flight

-Eagle Talon 3
-Cascade Falcon X

"You only Live Once"  

SARMedTech

Quote from: TEAM SURGE on July 11, 2008, 08:03:32 PM
If you ask me, everybody in life is going to see death at least once in there life. I don't see how seeing a dead body is such a big deal!

Yes, youre right. Most people will see death at some point and for most, it will probably be in a funeral home. Most people just dont have to get up close and personal with it.  I'll be starting my paramedic training in September and if its anything like EMT school, we will get part way through and then when we stop looking at simulations and photos of mocked up injuries and  get to the part of the training where we are having state troopers stand with sheets around a dead body on an interstate so no on sees the casualty that doesnt have to,we will probably start losing people whose stomachs and/or psyches simply will not allow them to process the kinds of things that we have to deal with regularly.

Most of the people in my class will be above the age of 21 and about 50% will have some kind of medical experience under their belts.  There just isnt any valuable, learning based reason to expose 12 or 14 year olds to the kind of "gore" that older and more mature emergency responders might have trouble with.  A good suggestion:  if it makes a SM turn grey and/or puke, its a good idea to keep kids away from it. They simply do not have to coping mechanisms to turn that kind of thing off after a couple of days.  In fact I have met alot of SMs and other responders of various kinds that dont have the required type of fortitude for it or are not able to "situationally numb" themselves to get through the task at hand and then go have a good cry or talk to their priest of whatever it is that they do.  Personally, what does it to me are disaster scenes involving babies and children. But what I have that a 12 year old doesnt is a wide variety of options in terms of how I may choose to handle the "film that wont stop playing."

When you start playing with the minds of young teenagers just because there arent any regs that say you cant, sure as shooting you will have a problem, a lawsuit or both.  Exposing CHILDREN to the most horrible things that the world has to offer has nothing to offer in terms of helping them grow and develop as mature and well adjusted adults and has EVERYTHING to offer in terms of stunting their development or winding them up in a state home for a stint dosed up on Vitamin "H". No, I dont believe they are wilting flowers, but there are kids in Columbine that never went back to school and they closed the building where the shootings happened at NIU and those "youngsters" mostly had a few years on the theoretical 12 year old cadet.
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

Fireball

     Different people react differently. Period. I have had cadets that were not phased by anything in ES (on beginning training I have painted a worst  case encounter scenario to them and their parents). On the other hand, I've seen adults blanch at the mere mention of blood.
     In addition to my job as a machinist, one of my duties is a volunteer First Responder at work. I have seen more than my share of lacerations and broken bones, so I've become pretty thick skinned. I had an experience the other day that really brought home the fact that everyone reacts differently. A couple of other Responders and I were sitting with other machinists at break. We started discussing the most recent "event" (bad cut, severe bleeding)  from the aspect of clean up, no mention of names or specific details. All was well, we talked of bleach and disposal, then I mentioned that blood seeped into a machine panel, necessitating the removal of the panel to properly cleanup. On the mention of blood, one of the other machinists (non responder, a tough biker type) abruptly got up, threw his snack in the trash and left the break room. We did not go into gory detail, all I said was "if we had not removed that panel, blood would have seeped out the rest of the day". Just one word, blood, and a 42 year old went off. Now I have always made a concerted effort to be polite and not upset non emergency personnel with lots of detail.  That just emphasised to me that everyone reacts differently and not to judge a book by its cover or age.
R. N. Brock, Maj, CAP
NCWG

Flying Pig

Ive dealt with this in the manner of being a cop and having explorers ride with me.  I have been on several gnarly accidents, some involving children.  Sometimes, because I may the the first or second unit on scene, a 14 year old explorer may end up standing right next to me dealing with someone screaming in pain, or completely smashed in the seat of their car.  If I have any control over where the explorer goes, its at the intersection laying down flares or something.

Ive never had one break down on me, but I had a couple ask to be done for the night. You can see it in their face.  They try to play the part because they all want to be police officers some day, and don't want to look like a "kid" in front of the guys.  But you realize, they just seem to be in deep concentration, while all of the officers are headed off to their next call, or telling jokes over a cup of coffee.

As a training officer, a primary training tool is to take every call you can squeeze in.  This involves going to traffic accidents. I had a trainee who was older.  We rolled up on a roll over accident of a car load of High School kids who were pretty badly injured, all laying in the street.  The driver was pinned in and the gas tank was ruptured.  (Yeah, I know sounds like a made for TV movie)  He jumped out of the car, paused for a second and  said "Oh S$%^!"  He then shook it off and got the job done.

So as far as cadets dealing with trauma, I don't know how many here have actually seen a plane crash with bodies before, but its almost surreal.   I mean, there are pieces of people everywhere!  Not that it doesn't affect adults, I think we have just developed our ways of dealing with what we see to where it less obvious that we are affected.  This is where the famous "sick sense of humor" cops and EMS people get.  Outsiders see it as insensitive,   but I think its more of a way to talk about it with your buddies and vent ad still be able to not loose it.

I tell newer officer now, that when it comes to accidents or trauma situations, that they need to go on them to get over the shock of it.  They need to be able to know what to expect for the times when they are the first on scene.  After they are familiar with it, go if you are needed.  There is no need to rubber neck because someday you are going to see something you wish you hadn't.

ThorntonOL

I know this might seem off-topic but some of the recent horror movies that on their own free time watch (talking cadets here, older cadets) (Don't ask me how they are able to watch them, I don't have a clue) could they be dulling the shock of seeing someone injured?. (I'm just asking.) I use to work for a meat packer and didn't have a problem with the blood, still could eat beef after I worked there.
Former 1st Lt. Oliver L. Thornton
NY-292
Broome Tioga Composite Squadron

mikeylikey

It was shown a few years back that if a person had to kill their won cow and process their won meat, they most likely would give up eating cow.  MSNBC had a special on vegetarians about 5 years ago. 
What's up monkeys?

Flying Pig

I don't know about horror movies though.  It may dull your senses to other horror movies.  Im by far not an expert, but nothing can compare to standing right next to someone who is screaming in pain, or standing over a body of someone who was killed traumatically.  I was on a pin in accident where I was talking to the passenger trying to reassure him when his eyes rolled back and he started making the gurgling sound common of someone who just gave it up.

I think even the most hard core horror movie nerd would agree that it doesnt compare.



mikeylikey

Lets just say, we hope our Cadets nor our Senior Members never have to be in the situation we are discussing.  If they want to later make the decision to have a career or job that may introduce them to those things, lets let them make it then.  CAP is not supposed to introduce Cadets to death. 

Honestly, I think there should be a minimum age to take Cadets out on a mission anyway.  I think 15 would be a perfect age.  There is a difference between the mind of a 15 year old and a 12 year old.  (Now there are 12 year old kids that are more mature than some 15 year old kids, I will give you that, but the majority of adolescents are almost fully developed by 15.....mentally)
What's up monkeys?

Tubacap

^locally we decided  *potential bad thing being posted* that we are not going to take cadets under the age of 14 on actual missions.  They can train to the specialty, and attain it at SAREX's so that they are ready by 14, but they will need to wait till they go on an actual.
William Schlosser, Major CAP
NER-PA-001

mikeylikey

^ Best practice most likely.  Oh....and congrats on the Captaincy!!
What's up monkeys?

SARMedTech

If anything, we are losing the types of youngsters who might be able to handle an MCI to their current culture. When we have college bound kids, as so many cadets are, using internet slang and texting codes in their admissions letters, it speaks volumes about their overall maturity level and also why they should be nowhere near where a terrible injury or death may have occurred.  Also, there is a difference between a cut hand and the type of injuried likely to be incurred in a plane crash or the condition of a deceased search victim after having been in the woods for several days. 
"Corpsman Up!"

"...The distinct possibility of dying slow, cold and alone...but you also get the chance to save lives, and there is no greater calling in the world than that."

John Bryan

Capt Hiles,

I think if you are going to do research on the effect of trauma on teens you should not limit it to CAP. As has been stated police and fire cadets/explorers, CAP cadets on GT, teenage life guards, etc all see bad things.  Is the effect less, equal or greater then those over 21?  I know where I am from we have EMS first responders as young as 14 and we have teens working as volunteers in our ER. We have teens in school vocational classes ride with the ambulance and see whatever call they get. We have teens as life guards at pools and  lakes, even Lake Michigan. We have teens working as CNAs who see long suffering death....side question is that a larger impact on a teen or less then a trauma related death.

I think it would be interesting to see if the Army or VA has any records of the effects of the Civil War on soliders as young as 11?  Did a 13 year old drummer boy suffer greater harm then a 22 yr old solider? Did a 14 yr old cabin boy have a reaction to battle at sea equal to , less then or greater then the 26 yr old sailor.

Anyway, my 2 cents.

Thanks

hatentx

I want to fist off say that I have not been through any CAP ES training.  I am not sure what it all consists of.  however I would suggest that training be conducted worse case and real life senerios.  I do not know a good age and that stuff let the head shrinkers figure that out.  but for the training I received in the Army in my two classes I took made a huge difference.  the first time I took the class it was book stuff and simple check the block style teaching.  the second time taking the same class was different.  we use fake blood, real people acting out and had to do everything we could to make the save. 
how this makes the difference was while in iraq a buddy and I were on guard.  we are really similar in age upbrining and the such.  he took the first style class I both.  we got hit by mortars people went down.  he froze while I started what had to be done.  I ended up having to talk him though what he needed to do.  train as you would fight.  or to real life worse case situation.  no matter what the age this training I would think would limit the negitive impact on a cadet

Rotorhead

When did this become a Big Deal?

CAP's been around for six decades and has used cadets on SAR missions for many years.

Now all of a sudden (well, starting about 15 years ago), our poor little snowflakes can't handle it, but they could before?

Capt. Scott Orr, CAP
Deputy Commander/Cadets
Prescott Composite Sqdn. 206
Prescott, AZ

jimmydeanno

Quote from: Rotorhead on August 14, 2008, 01:06:23 PM
When did this become a Big Deal?

CAP's been around for six decades and has used cadets on SAR missions for many years.

Now all of a sudden (well, starting about 15 years ago), our poor little snowflakes can't handle it, but they could before?

Perhaps the same time that PTSD was "invented" by those soldiers that can't "hack it."[/sarcasm]
If you have ten thousand regulations you destroy all respect for the law. - Winston Churchill

flyerthom

Quote from: Rotorhead on August 14, 2008, 01:06:23 PM
When did this become a Big Deal?

1983.

Driving mechanism was loss of civilian Emergency Services Personnel related to stress. The seminal event was probably the Robert O'Donnell suicide in 1995. While CISD (then) was out, it was this event that brought critical focus to Critical Incident Stress.  The stress of the Baby Jessica rescue and subsequent media furor were the stressors that led to his death. O'Donnell was a seasoned field provider.   The focus is now seems to be moving towards cumulative stress.

For CAP the focus is to prevent traumatic imprinting on inexperienced minds. That should not be limited to just cadets. Just because someone is 16 or 61 doesn't mean it can't scar. Member care means member retention.
TC

Rotorhead

Quote from: flyerthom on August 15, 2008, 03:56:20 AM
For CAP the focus is to prevent traumatic imprinting on inexperienced minds. That should not be limited to just cadets. Just because someone is 16 or 61 doesn't mean it can't scar. Member care means member retention.
We could do the necessary training rather than simply saying, "Don't let them see anything."


Capt. Scott Orr, CAP
Deputy Commander/Cadets
Prescott Composite Sqdn. 206
Prescott, AZ

chiles

That's where I'm going with it. I have no intent of making the training I'm developing be a unilateral effort to restrict or support cadet involvement. I intend on making it a guide to working with all members in the field and discussing the differences between kids' and adults' reactions. It's not designed to remove a force multiplier, just to take better care of our people.

Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

John Bryan

Capt Hiles....

I would recommend you speak with Lt Col (Dr) Sam Bernard, PhD the NHQ/CIS......I think he would have a lot of good info and resources for you to use. This is what he does for a living.

Good luck

DNall

What do I want answered? I know there's different reactions based on age as well as a lot of other development factors (physiological & environmental). I'd be interested in:

1) Sound policy & directive guidance on age mins for various quals. For example, 14 for GMT3, 16 for GTM2, 18 for GTM1 & GTL. And teams more strictly typed at GTM level (of least qual'd member) with a requirement that GBD set required team level for the sortie in the planning process as part of the ORM. In other words, if I need a team to line search over the probable position where I think this guy is drilled in, then I want a GTM1 team for that versus less experienced folks. Leader quals/experience/etc & number of people to do the job have to come second in that equation. I structured policy on effecting that practice would be nice.

2) Alter GTM training. A 17-18yo kid comes thru basic training and in some cases is in Iraq seeing jacked up stuff in a matter of literally a few months. The stresses we're exposed to are not that bad, and can be scaled to allow participation by 14-16-18yo cadets. The training process also needs to be scaled. Completing a bunch of technical tasks doesn't prepare that person to encounter the situation. This is the one place I think NESA & Hawk have an advantage on locally conducted training, but certainly it's doable at the local level. I would like to see a better more structured training program - actually a standardized course to do in addition to the tasks. Figuring out exactly what that needs to be in order to achieve the mission ready level requires some of the expertise you're talking about.

3) Alter GTL training to include assessment of stress exposure & mitigation. It needs to be a structured planning & execution process. It's checklist leadership at this level. They need the training though & they need it enforced on the ground. That may also be a course in addition to tasks situation. It should also include CISM elements.

I think we need solid study of all those issues, and they need to be translated to policy. Leaving it for the guy on the ground to figure out on a by-case scenario is just not responsible at all.

chiles

Hey everyone. The Maryland Wing Conference has come and gone and I've finished and piloted the Psych Mitigation course. If you'd like a copy, I'll send the document and support slides. PM me with your email and I'll forward it on.
Maj Christopher Hiles, MS, RN BSN, CAP
Commander
Ft McHenry Composite Squadron
Health Services Officer
Maryland Wing
Mitchell: 43417
Wilson: 2878

Kerrbie

Hey, I can't seem to find my copy of the packet from that class. It would be great if I could get another copy of it! ^.^
C/2nd Lt Katheryn Kerr, CAP
Cadet Deputy Commander, Group 2
Carroll Composite Squadron, MD Wing, MER