CISM

[SDF_Specialist]

I can't seem to find very much information on CISM. How do I become CISM qualified? Is this a classroom, or online training session? Is anyone else CISM qualified?

[floridacyclist]

It is a 14-hr (2-day) training session taught by a certified instructor. In CAP, we follow the ICISF (International Critical Incident Stress Foundation) curriculum/methodology and most of our classes are taught by Lt Col Sherry Jones, a self-proclaimed trauma junkie from up North. Once you get the certificate, your wing CISM director should be able to get your qualification documented.

[SDF_Specialist]

It is a 14-hr (2-day) training session taught by a certified instructor. In CAP, we follow the ICISF (International Critical Incident Stress Foundation) curriculum/methodology and most of our classes are taught by Lt Col Sherry Jones, a self-proclaimed trauma junkie from up North. Once you get the certificate, your wing CISM director should be able to get your qualification documented.

To my knowledge Gene, Ohio Wing doesn't have a CISM director. I think that this is why I am most interested in it. I like what it stands for, and would like to be involve in this. Do you have any idea who I could contact to find out about it?

[BillB]

Gene,  look at a map.  From where you and I are (Except for Kach)  EVERYONE is up north.

[floridacyclist]

Check out http://glr.cap.gov/cism/

Don't forget to go through your chain of command before contacting someone outside it...they may also have information on existing programs or people that are working on the same path as you are.

CecilDP is a local too...I met him at Patrick a couple of weeks ago

[SDF_Specialist]

Great info! Never thought to look at the Region website. Thanks Gene!

[floridacyclist]

That is actually listed as the Civil Air Patrol CISM Homepage. There is another one at www.capcism.com that just doesn't seem to have anywhere near as much info on it.

With Col Jones in your region, you might have an easier time getting info and training than someone in Oregon.

The patch still freaks me out a little.

"If you want to talk, we're here to help. But until then, remember:

I'm watching you"

[SJFedor]

That is actually listed as the Civil Air Patrol CISM Homepage. There is another one at www.capcism.com that just doesn't seem to have anywhere near as much info on it.

With Col Jones in your region, you might have an easier time getting info and training than someone in Oregon.

The patch still freaks me out a little.

"If you want to talk, we're here to help. But until then, remember:

I'm watching you"

It was originally the patch for the Black Van From Maxwell squadron (BVFM).

[SDF_Specialist]

That is actually listed as the Civil Air Patrol CISM Homepage. There is another one at www.capcism.com that just doesn't seem to have anywhere near as much info on it.

With Col Jones in your region, you might have an easier time getting info and training than someone in Oregon.

The patch still freaks me out a little.

"If you want to talk, we're here to help. But until then, remember:

I'm watching you"

It was originally the patch for the Black Van From Maxwell squadron (BVFM).

So the CISM originally stood for "CAP Is Spying on Member"? 

[SJFedor]

That is actually listed as the Civil Air Patrol CISM Homepage. There is another one at www.capcism.com that just doesn't seem to have anywhere near as much info on it.

With Col Jones in your region, you might have an easier time getting info and training than someone in Oregon.

The patch still freaks me out a little.

"If you want to talk, we're here to help. But until then, remember:

I'm watching you"

It was originally the patch for the Black Van From Maxwell squadron (BVFM).

So the CISM originally stood for "CAP Is Spying on Member"? 

Yup. And the scroll used to read "Harassing Those Who Serve Others"

[floridacyclist]

To me, it's not so much spying or harassing it just seems spooky to me. CISM workers have a hard enough time earning the trust of those around them without a big ol' eye on their chest saying "I'm watching you (for signs of an impending crackup)". To me, an assigned CISM worker needs to be able to blend in as well as possible while making themselves useful around the mission base...fixing coffee, running errands, maybe even giving the radio operator a break if they are qualified. They need to be seen as part of the furniture and just a normal part of a mission if they are to be accepted and trusted when their services are needed - and yes, I do believe in the value of CISM, having been on both sides of a debriefing.

Having a big ol' eyeball on your chest watching everyone just doesn't seem to accomplish that objective.

[Chaplaindon]

The actual heraldic symbolism of the CAP CISM emblem, as described by the original artist is as follows, "the eye represents always being vigilant, the dove and olive branch represents peace of mind or consoling ..."

To my mind, all good qualities that are normatively representative of CISM and not at all "spooky" except to the easily spooked or those persons looking for the nefarious.

I, for one, can't imagine a better way for CAP members to be with one another than to be viliglantly and compassionately looking out for the well-being (and piece of mind) of another ... kind of a "golden rule" put in practice. Imagine what kind of a CAP we'd have if we really cared about each other.

[floridacyclist]

Speaking as an operations person (which is precisely where you're supposed to draw your CISM peer debriefers from), I can vouch that most people don't want to be watched over that closely...especially by someone that they may consider to be some kind of pseudo-shrink. You saw the remarks earlier about spying and harrassing others...good intentions aside, that is how many view CISM.

Many field people who are unfamiliar with CISM truly resent having big brother watching over them. They may not realize the trouble we can get ourselves into emotionally with some of the things we do. A friend of mine who was a GTL in MS after Katrina told his team when they were sent into the de-briefing "just nod your head politely and say as little as possible so we can get the hell out of here". With attitudes and walls like that, it is gong to be very difficult for CISM workers to get the kind of trust and connectiveness they need to do their job.

Having a big eye on your chest like you are watching everyone just doesn't seem compatible with that goal.

[sardak]

National just issued a memo and guidelines for CISM officers.  I understand the seriousness and need for CISM, having been through a number of debriefs, the latest last week after we recovered a woman who apparently committed suicide by drowning.  But that logo reminds me too much of this:



Mike

[SDF_Specialist]

It almost sounds as though CISM workers are Mission Chaplains. I've done some research on the CISM program, and it is something that I'm really interested in. Don't get me wrong. Mission Chaplains are great, and I would not feel half as safe on SAREX's that I do without the prayer. But I think we need more CISM people there for those of us who get nervous on their first SAREX, or for anyone on a SAREX. I can imagine that they are even more valuable on an actual, but I've never had to go on an actual, which is a good thing. We just need more CISM people in general. I have intensions on inquiring as to why this training can't be offered within every Wing rather than through the Regions, and at specific times. This is a qual that I would love to have. It gives yet another sense of assistance.

[Chaplaindon]

"I have intensions on inquiring as to why this training can't be offered within every Wing rather than through the Regions, and at specific times. This is a qual that I would love to have. It gives yet another sense of assistance."

The training CAN be provided at the Wing level. It has been offered to wings in the past.

Really the only issue has to do with funding. NHQ has reduced the funding for CISM so that it cannot be offered as easily as in years past. By that I mean that the costs for the travel/lodging and course costs cannot usually be funded by NHQ anymore --that includes Region courses.

However, with adequate numbers of interested students (and with an increasing number of CAP volunteer instructors) the travel/lodging costs for the instructor and the course costs (e.g. textbooks and ICISF course fee) can be spread out to keep the cost to each member quite affordable.

Contact your Wing CISM officer and express your interest in attending the training. My guess is that it will require a bare-minimum of 25 students to warrant a class. Furthermore, Lt Col Sherry Jones usually will offer a CAP-funded CISM:Group Crisis Intervention Course at the annual National Board meeting.

[SDF_Specialist]

"I have intensions on inquiring as to why this training can't be offered within every Wing rather than through the Regions, and at specific times. This is a qual that I would love to have. It gives yet another sense of assistance."

The training CAN be provided at the Wing level. It has been offered to wings in the past.

Really the only issue has to do with funding. NHQ has reduced the funding for CISM so that it cannot be offered as easily as in years past. By that I mean that the costs for the travel/lodging and course costs cannot usually be funded by NHQ anymore --that includes Region courses.

However, with adequate numbers of interested students (and with an increasing number of CAP volunteer instructors) the travel/lodging costs for the instructor and the course costs (e.g. textbooks and ICISF course fee) can be spread out to keep the cost to each member quite affordable.

Contact your Wing CISM officer and express your interest in attending the training. My guess is that it will require a bare-minimum of 25 students to warrant a class. Furthermore, Lt Col Sherry Jones usually will offer a CAP-funded CISM:Group Crisis Intervention Course at the annual National Board meeting.

Thanks Chaplain. To my knowledge, Ohio Wing doesn't have a CISM, but I could do some snooping and ask questions. Maybe my best bet is to contact the Wing Chaplain to see if he knows anything. When in doubt, contact the Wing Chief of Staff though!

[Chaplaindon]

"To my knowledge, Ohio Wing doesn't have a CISM, but I could do some snooping and ask questions"

According to the capcism.com website, the OHWG/CIS is Capt Gary Eno and his email is listed --publicly-- at http://www.capcism.com/contactus.html.

[SDF_Specialist]

"To my knowledge, Ohio Wing doesn't have a CISM, but I could do some snooping and ask questions"

According to the capcism.com website, the OHWG/CIS is Capt Gary Eno and his email is listed --publicly-- at http://www.capcism.com/contactus.html.

I actually just got a response from the Ohio Wing Chaplain. He forwarded my email to the Wing Assistant Chaplain who apparently is the CISM guy for Ohio. Maybe now I can get the ball rolling, and start working on this. Thanks again Chaplain!

[Eclipse]

Many field people who are unfamiliar with CISM truly resent having big brother watching over them. They may not realize the trouble we can get ourselves into emotionally with some of the things we do. A friend of mine who was a GTL in MS after Katrina told his team when they were sent into the de-briefing "just nod your head politely and say as little as possible so we can get the hell out of here". With attitudes and walls like that, it is gong to be very difficult for CISM workers to get the kind of trust and connectiveness they need to do their job.

Having a big eye on your chest like you are watching everyone just doesn't seem compatible with that goal.

Link http://tinyurl.com/2symm6

Pictured is one of the evening CISM discussions during Katrina operations at Stennis Airport - Lt. Col. Sherry Jones can be seen at about the 2-O'Clock position in the photo.  The gentleman to her right in the flightsuit is the other coordinator that stayed with us.  To my embarrassment I do not know his name.

CISM is important, especially in real-world situations.

The challenge for CISM people in CAP is that it requires specialized training, mindset, and application to be effective, and in most cases is treated as an afterthought.

Speaking from my personal experience, I did not have any issues while down in MS, however >AFTER< was a different story.  The primary issue for me (and others from my team), was the quick ramp-down of ops tempo back in the "real" world - I had difficulty sleeping (I was doing sortie planning in my sleep, and would wake up several times a night thinking it was morning) and a sense that although I really wanted and needed to talk about what we did and saw, the realities of "real" life would not permit people up this way to spend the time it takes just to chill and let things flow, nor would they "get it" if and when they did spend the time. Expecting this stuff to just flow out on command is not realistic.

We can joke about and downplay our activities, but the reality is that the average Joe CAP Suburbanite drives to work at 8, is home for dinner at 6 and watches a little tv before bed.  The stress placed on this same member when he is thrust into an Armageddon-like environment with 24 hours notice and told he will be depended on for the safety and even the life of both himself, his team, and members of the general public should not be minimized.

NHQ and Lt. Col. Jones were genuinely concerned about us and followed up several times to see how we were doing - I discussed the above with her and it helped, along with the knowledge that if things got "real', she would be available to help.

Thankfully, for me at least, a week or so of normalcy and I was back to annoying people with my arrogant, uninformed opinion(s) on Captalk and other places.  Interestingly, though, during a recent situation in my home area where we had wide-spread power outages and flooding, the noise of the generators was all it took to bring back a tinge of that mission-environment anxiety.

[floridacyclist]

It almost sounds as though CISM workers are Mission Chaplains. I've done some research on the CISM program, and it is something that I'm really interested in. Don't get me wrong. Mission Chaplains are great, and I would not feel half as safe on SAREX's that I do without the prayer. But I think we need more CISM people there for those of us who get nervous on their first SAREX, or for anyone on a SAREX.

The job of CISM is really much more directly targeted than a Mission Chaplain. While the Chaplain is there to help and comfort everyone including the victims and families, the CISM worker is specifically there for the benefit of the responders....kind of like a Medical Unit Leader under Logistics (which is probably where I would assign a CIS Team) vs an EMS Branch under ops.

While many chaplains do put in for CISM training, I would think they would gravitate more towards the Mental Health Professional (MHP) level of training as much of the training they have already received would put them more in line with Mental Health Professionals than Peer Debriefers although they can usually fill either role with ease since most folks know and trust Chaplains as part of the normal mission base staff. The peer debriefers should be Operations people who have already been there and done that. Nobody wants to share their deepest feelings and potentially embarrassing reactions with Suzy Social Worker in a frilly dress, high-heeled shoes and absolutely no clue as to what goes on in a SAR, DR, or other emergency response mission.

At least one of the debriefers (called the peer debriefer for a reason) needs to be from a similar background to the group being debriefed. BDUs with all the bling (GT badges, ES/Hawk Mountain/NESA patches etc....the normal stuff that folks in Ops earn after a while) all go much further toward convincing this group that you really are one of them than a set of slick-chested blues.

Speaking from my personal experience, I did not have any issues while down in MS, however >AFTER< was a different story.  The primary issue for me (and others from my team), was the quick ramp-down of ops tempo back in the "real" world - I had difficulty sleeping (I was doing sortie planning in my sleep, and would wake up several times a night thinking it was morning) and a sense that although I really wanted and needed to talk about what we did and saw, the realities of "real" life would not permit people up this way to spend the time it takes just to chill and let things flow, nor would they "get it" if and when they did spend the time. Expecting this stuff to just flow out on command is not realistic.

I experienced that after Charley. We were in and out in 3 days and it all seemed so surreal to be back home in AC with a cold beer while folks down there were still trying to figure out where to sleep or eat that night. Ditto for Mississippi...I cried like a baby when we got on 10 to come home. New Orleans wasn't so bad...we were sent to doa specific job, we did it, then were glad to get the heck out of Dodge.

We can joke about and downplay our activities, but the reality is that the average Joe CAP Suburbanite drives to work at 8, is home for dinner at 6 and watches a little tv before bed.  The stress placed on this same member when he is thrust into an Armageddon-like environment with 24 hours notice and told he will be depended on for the safety and even the life of both himself, his team, and members of the general public should not be minimized.

We see the same thing in ARES and I am trying to get CISM information included in Emergency COmmunications training. The average Ham with a desk job is just completely unprepared emotionally for the effect of a large-scale disaster that they may often find themselves in near the first waves of responders.

NHQ and Lt. Col. Jones were genuinely concerned about us and followed up several times to see how we were doing - I discussed the above with her and it helped, along with the knowledge that if things got "real', she would be available to help.

She did the same thing with us. Several of us in our FL class had seen and done some interesting things without any sort of intervention, and the class brought back some very vivid flashbacks. Col Jones clued in on that quite well.

[Chaplaindon]

Capt Floyd,

A few observations:

" ... the CISM worker is specifically there for the benefit of the responders....kind of like a Medical Unit Leader under Logistics (which is probably where I would assign a CIS Team) vs an EMS Branch under ops"

Actually, the ICS placement of CISM personnel would depend significantly upon when they become involved in an operation and what they will be doing. IAW USCG (and others), as an IC myself, I'd prefer to have an on-scene support (OSS) CISM officer on my command staff from nearly the beginning of the mission, much like I'd have a mission chaplain and a safety officer there as well. On the other hand, if CISM personnel are called upon later (e.g. AFTER a stressful event such as finding a grotesque crash scene, etc) they'd likely be either under medical or agency liaison. This would be especially true if, IAW CAPR 60-5, a non-CAP CISM team is utilized.

The basic difference would have to do in many ways with whether they are in position prospectively or responsively.

IMO, an OSS CISM officer could do wonders for helping design operations and facilities to mitigate stress as well as share pre-exposure preparation (a USAF term) briefings to help our personnel to expect and therein normalize stress reactions even before deployment.

Mission Chaplains can do amazing good for our personnel and all involved in a mission as well. Their role is VITAL/ESSENTIAL and mustn't ever be underestimated. Inexplicably, during JTF-Katrina, no CAP chaplains were deployed as chaplains (1 or 2 may have been sent as GTMs or aircrew) to assist field operations. Ostensibly, this was by action/decision of either 1AF and/or the NOC. I, and a number of other Mission Chaplains, were on alert to deploy ... but never allowed to launch.

As a result no one was directly tasked with morale and spiritual support for our personnel --and CISM personnel weren't deployed for almost 2 weeks post landfall (by the decision of 1AF, not the wishes of CAP CISM). Minor morale issues, that should have been handled by chaplains were left to fester with no assistance and needlessly became issues for CISM personnel later. Not even the National Chief of Chaplains was permitted to respond.

CISM and the chaplain service should (and usually does) serve one another --and the broader membership-- in a symbiotic relationship.

You wrote that, "While many chaplains do put in for CISM training, I would think they would gravitate more to-wards the Mental Health Professional (MHP) level of training as much of the training they have already received would put them more in line with Mental Health Professionals than Peer Debriefers ..."

Many chaplains DO receive CISM training, however, most are --like me-- peer members of the CISM teams. Peers, however, are the essential "backbone" of Dr. Mitchell's model ... they are what makes CISM really so effective, NOT the MHP (or Col Jones' favorite old nemesis "Suzy Social Worker").

CISM has credibility with real-folks, from paramedics (as I used to be), to firefighters (like me too, formerly), pilots, GTMs, ICs, police officers, chaplains, etc. BECAUSE the peers relate to these folks and validate the MHP in their eyes. In short, as you have seen, CISM works because of the peers.

The MHPs do play a vital role nonetheless in supervision (not unlike an EMS medical director or base station, medical control, MD) and guidance of the peers and in the assessment and followup/referral role. But, as you know, most CISM interventions are peer interventions anyway.

"I would think [chaplains] would gravitate more towards the Mental Health Professional (MHP) level of training as much of the training they have already received would put them more in line with Mental Health Professionals than Peer Debriefers ... "

Actually, there's not much specific, didactic mental health training within the scope of most ATS-approved Master of Divinity programs, at least at Christian seminaries, (the M.Div. being the benchmark academic requirement for non-waiver chaplain appointment). The M.Div. curriculum is already inflated to over 80 semester hours with the biblical, theological and church leadership courses so there's little room for mental courses except as brief, stand-alone, electives ... if the seminary  even has the faculty to teach such elective courses.

CAP is blessed with a number of chaplains who have ADDITIONAL training and professional credentials in mental health, and the requisite license(s) to practice in their state. This is not a minor investment of time or training (or $$$$) either. For example, in my state, likely similar to others, a MHP-candidate would have to complete several THOUSAND clock hours of supervised clinical practice (OJT, if you will) atop their academic courses to be eligible for licensure.

Thus, most of our chaplains, while they have great qualities/faculties/gifts for listening and compassion , lack the academic training, clinical practicum, and state licensure for a CISM MHP.

But, again peers --not MHPs-- (per CAPR 60-5) are the "backbone" of CISM.

Besides, who would lead the CISM interventions of a mission chaplain ... who'd be their peer? No less than another chaplain ... trained as a CISM peer.

Thanks for your insight and your involvement in CAP CISM.

[Conical]

Chaplain Don;

  You presented a very good summary of CISM and how chaplains fit in.  I do disagree to a degree on your statement that only chaplains can adequately act as peers to chaplains.  At least two of the more successful interventions I am personally aware of have involved a CISM responder who did not have the same level of advancement or mission qualifications that the subject had.  While it is preferred to have equally qualified CISM personnel for the person(s) being assisted, it can be impractical to strictly follow that concept.  By way of example, if an IC1 requested CISM assistance, how many CISM personnel have an IC1 qualification?  Or if a Region Commander requested assistance, how many region commanders are CISM qualified?  I do not have the figures, but my guess is that there are not many for either.

  I am a firm believer in CISM.  I've seen it work countless times in my region.  I supported the first CISM team in the region and helped arrange for the first CISM course for the region the summer after I met Lt Col Jones at the Philadelphia NB meeting.  I am encouraged by the interest and knowledge of CISM that has been shown on this thread.  As some one stated the CISM training sponsored by NHQ has been restricted due to lack of available funds.  Lt Col Jones has been gracious enough to put on sessions for us for the cost of her plane ticket and housing plus the cost of the course books.  we have been fortunate to have a donor, who requested anonymity, who picked up the cost of the travel and housing.  If you were to take the ICISF courses "on the economy" or outside of CAP it is expensive.  It usually costs in the neighborhood of $400-$500 just for the course and doesn't include billeting.

[Chaplaindon]

Chaplain Don;

  You presented a very good summary of CISM and how chaplains fit in.  I do disagree to a degree on your statement that only chaplains can adequately act as peers to chaplains.  At least two of the more successful interventions I am personally aware of have involved a CISM responder who did not have the same level of advancement or mission qualifications that the subject had.  While it is preferred to have equally qualified CISM personnel for the person(s) being assisted, it can be impractical to strictly follow that concept.  By way of example, if an IC1 requested CISM assistance, how many CISM personnel have an IC1 qualification?  Or if a Region Commander requested assistance, how many region commanders are CISM qualified?  I do not have the figures, but my guess is that there are not many for either.

  I am a firm believer in CISM.  I've seen it work countless times in my region.  I supported the first CISM team in the region and helped arrange for the first CISM course for the region the summer after I met Lt Col Jones at the Philadelphia NB meeting.  I am encouraged by the interest and knowledge of CISM that has been shown on this thread.  As some one stated the CISM training sponsored by NHQ has been restricted due to lack of available funds.  Lt Col Jones has been gracious enough to put on sessions for us for the cost of her plane ticket and housing plus the cost of the course books.  we have been fortunate to have a donor, who requested anonymity, who picked up the cost of the travel and housing.  If you were to take the ICISF courses "on the economy" or outside of CAP it is expensive.  It usually costs in the neighborhood of $400-$500 just for the course and doesn't include billeting.

Col. Casler,

Thank you for bringing up your point of disagreement. I mis-spoke. For clarity, let me restate my point ... one that applies equally to Wing & Region/CCs, IC1s, chaplains, etc.

Although non-chaplains CAN be (and likely often are) effective CIST peers for chaplains, just as non-IC1s are likely peers for 1C1s (because of the lack of CIST-member IC1s), etc. ... it would likely be OPTIMAL to have a direct peer on the team for that individual/group.

By that statement I do not wish to proffer that only a direct peer can be a CIST peer for someone. In fact, considering that CISM is a senior member only program that also serves cadets, we have to function otherwise.


Thanks again for bringing up the point.

[Conical]

Chaplain Don,

  Thank you for the clarification.  I see that we are on the same page after all.  Take care.

[isuhawkeye]

CISM is a very interesting and controversial topic across the Emergency Services Industry.  I have been involved in several incidents involving CISM, and I have watched with great interest as CAP's CISM network has grown.  I am even more thrilled to see that CAP has adopted a nationally recognized standard for CISM programs.  I have to give Col. Casler credit for taking on this charge in the North Central Region.

Here the Iowa CISM Network staffs 14 different teams operating in all 99 counties of our state.  All of these teams are coordinated through a central clearinghouse.  These teams are developed, established, and have many Incidents under their belt including deployments across the country during times of disaster.  These teams are trained to the same program standards as the CAP CISM providers.  I look forward to the day that a CAP CISM team can integrate into the Iowa CISM network. 

[fyrfitrmedic]

CISM is a very interesting and controversial topic across the Emergency Services Industry.  I have been involved in several incidents involving CISM, and I have watched with great interest as CAP's CISM network has grown.  I am even more thrilled to see that CAP has adopted a nationally recognized standard for CISM programs.  I have to give Col. Casler credit for taking on this charge in the North Central Region.

Controversial enough that some of the commercially-available EMS program texts recommend against its use.

Here's one interesting anti-CISM view:

http://www.bryanbledsoe.com/pdf/handouts/PowerPoint/CISM%20(Revised).ppt

[Dragoon]

CISM is a very interesting and controversial topic across the Emergency Services Industry.  I have been involved in several incidents involving CISM, and I have watched with great interest as CAP's CISM network has grown.  I am even more thrilled to see that CAP has adopted a nationally recognized standard for CISM programs.  I have to give Col. Casler credit for taking on this charge in the North Central Region.

Controversial enough that some of the commercially-available EMS program texts recommend against its use.

Here's one interesting anti-CISM view:

http://www.bryanbledsoe.com/pdf/handouts/PowerPoint/CISM%20(Revised).ppt

Very interesting briefing.  I had no idea that there was that much documented controversy over CISM.  And this guy isn't anti-intervention - he's just found a fair amount of evidence that the CISM approach isn't the best one.

His conclusion is very provocative "You're doing this to avoid being sued.  But based on a lot of studies, you may end up being sued for providing something that might actually hurt folks!"

Interesting to see if his prediction comes true in court.

[Hoser]

CISM is controversial no question. I won't say it's the silver bullet nor will I say it's knuckle bones and rattles either. My experience in 30years of EMS/Fire Service has shown me one thing that I think everyone either overlooks or doesn't give credence to and that is that a terrible death and dismemberment raging fire at the plate glass truck hitting a bus load of hemophiliac children type incident is required to induce a critical incident stress episode. While obviously an incident of that type can and does induce CIS, often it does not. I was at the Kansas City Hyatt collapse in 1981 and all that was for me was a really long tiring messy night. What did induce a CIS reaction was something rather inocuous in the context of professional EMS, a run of the mill garden variety overdose. An 18 year old ate a bottle full of amytriptiline and eventually was harvested after declaration of brain death. Why did this do that to me? I don't know. I do know I dealt with it by writing an account of the call for an English class. What I do think is dangerous about CISM is not the theory or intent behind it, but often times the people who do the debriefings. Psychologists and chaplians for instance really aren't the best to do this because I have yet to meet one or the other who has had to write off a six year old at a multi casualty incident or scrape some 22 year old's brains off the freeway. In my opinion, they can't understand until they have been there and as such are ill equipped to deal with these matters. There is no doubt in my mind that any one on this board who works in EMS ( and I know there are several) will know exactly what I mean when I mention the smell of blood and alcohol. Those that have never been there are nearly incapable of understanding, of relating to what we say about such things, no matter how pure and honorable their intentions. The analogy is sex, until you've had it you won't understand, and once you have you can't explain it to someone who hasn't. Am I poking sticks at those who utilize the CISM services in their work or here with something they experienced on a CAP mission? Absolutely not. Am I poking sticks at those who give of their time and selves to help the helpers? Again, absolutely not. I am merely pointing out what my 30 years of EMS/Fire Service has shown me, and that is CISM is something that needs careful and thoughtful implementation because we are dealing with people's psyches and emotional wellbeing and a mistake can do more harm than what brought that person to seek help. I also feel that mandating CISM to anyone in an organization is wrong. I know what I need to do for my head better than someone else, especially policy makers, who IMHO often have the best interests of the organization at heart, not the worker bees. The Workman's Comp doctor has the interests of Workman's Comp at heart, not mine.

That is my opinion, I could be wrong

Hoser

[fyrfitrmedic]

 Hoser:

You've summed up my own personal views re: CISM very succinctly.

[floridacyclist]

You bring up a good point Hoser....everything we experience is relative to our own experiences. For a paramedic, it really takes another paramedic to even have a clue as to what you may be feeling and for you to feel you can be open and upfront. Ditto for a firefighter, cop, or disaster volunteer. The feelings are all caused by very different stimuli, but they often affect you and are treated in similar ways.

The opposite can be seen when you sit some disaster volunteers down in front of a professional firefighter/CISM worker and expect them to open up about how bad they feel knowing that the FF has seen it 20X worse. It's just not gonna happen.

One thing to think about before you get too upset about having to go through an intervention; you may be dealing with events just fine, but your buddy may be in his own living hell. You never know when it might be someone else you can help by talking it through. Of course, he's not going to go against you if you don't want to, in fact he'll probably just hold it in rather than risk appearing weak.

[Chaplaindon]

Hoser you wrote,

"Psychologists and chaplians for instance really aren't the best to do this because I have yet to meet one or the other who has had to write off a six year old at a multi casualty incident or scrape some 22 year old's brains off the freeway. In my opinion, they can't understand until they have been there and as such are ill equipped to deal with these matters. There is no doubt in my mind that any one on this board who works in EMS ( and I know there are several) will know exactly what I mean when I mention the smell of blood and alcohol. Those that have never been there are nearly incapable of understanding, of relating to what we say about such things, no matter how pure and honorable their intentions."

While I do not presume to challenge the allegations regarding psychologists capabilities or inabilities as you proffered (I'll leave that to them), I will say this ... since " [you] have yet to meet [a chaplain or psychologist] who has had to write off a six year old at a multi casualty incident or scrape some 22 year old's brains off the freeway," perhaps you need to know a bit about me (a chaplain) ...

   *In EMS for more than 30 years, only allowed my paramedic license to finally expire due to time constraints in my parish, and the lack of adequate opportunities for continued ALS practice.

   *Flight Paramedic for a hospital-based helicopter EMS program for almost 20 years.

  *EC paramedic at the same level-1 Trauma Center in a major metropolitan area.

  *Volunteer firefighter and paramedic (before and after leaving full-time paid-professional EMS employment).

   *CAP Incident Commander, GTM1, etc. etc.

I beleive that I have "been there and done that." I have earned my bona fides in the civilian and CAP emergency services and I am proudly also a chaplain.

And, while I disagree vehemently with your position on the efficacy of CISM (in general) remember this it is the POLICY of CAP per CAPR 60-5. Whiel we may disagree on whether it should be or not (or the number of angels that can dance on the head of a pin) I doubt seriously that the program is going to do anything but continue to grow in CAP.

I enjoy a good spirited academic disputation on any number of points, CISM included, but -while we debate intillectually, CISM-- lets not make the mistake of dismissing all aspects of CISM anymore than the ES bona fides of all chaplains.

Shalom.

[Slim]

Ryan,

If you're not having any luck getting CISM contacts in Ohio, let me know.  Sherry's a very good friend of mine, and I can hook you up with an email address if you need it.

She's not in GLR anymore, unfortunately.  She's out in Las Vegas now, but I've kept in touch with her about CISM, and the role she played in bringing it into CAP.

[SDF_Specialist]

Ryan,

If you're not having any luck getting CISM contacts in Ohio, let me know.  Sherry's a very good friend of mine, and I can hook you up with an email address if you need it.

She's not in GLR anymore, unfortunately.  She's out in Las Vegas now, but I've kept in touch with her about CISM, and the role she played in bringing it into CAP.

Thanks Chris. I've been in touch with my Wing Chaplain, and his Deputy. They are working on getting me set up, but I could always use additional information. The better prepared I am to go about this, the less overwhelmed I'll feel while I'm training for it.

[Hoser]

ChaplainDon, You apparently are an exception to my observation, I wasn't poking sticks at you personally. Nor am I saying CISM isn't useful. I am saying I question the efficacy of it, especially as it relates to me. If someone feels they need CISM to deal with the terrible death and dismemberment incident, more power to them. I will go out of my way to find them the resources they need to keep from becoming a depressive drooling in their shoes drunk. In my case, I know how to APPROPRIATELY deal with things that bother me. I will however not back away from my premise that without actual hands on experience a CISM person has far less credibility than one who does. The simple matter is they just don't understand on a level necessary to be truly effective. That's not a poke at them, it's just how it is. That you have 30ish years in the field would in my book make you far better equipped to deal with a screwed up care provider than a garden variety psychologist or minister. You have seen the 14 yr old with three gunshots to the chest, and heard him plead, "please, don't let me die." You understand. Most don't That is the jist of my position.

[Chaplaindon]

Hoser,

You wrote ...

"I will however not back away from my premise that without actual hands on experience a CISM person has far less credibility than one who does. The simple matter is they just don't understand on a level necessary to be truly effective. That's not a poke at them, it's just how it is."
That's exactly why CISM is a PEER-DRIVEN systematic crisis intervention. That's the genius, the beauty -if you will-- of Dr. Mitchell's model (he being a former firefighter/paramedic as well).

The potency and efficacy (I argue) results from the peer, who DOES (in fact) "understand [the situation and the people involved] on a level necessary to be truly effective." Optimal CISM intervention for police officers comes from other police officers, likewise fire service with fire service and EMS with EMS.

CAP CISM strives to as closely as possible match peers with peers (e.g. GTM/GLTs with GTM/GTL peers, flight crew with flight crews, ICs with ICs, chaplains with chaplains, etc.) ... people who've already "walked a mile in their moccasins."

At the same time, the role of the MHP cannot be underestimated. These individuals have unique training to provide professional supervision and referral (if needed) analogous to the EMS medical director or online medical control physician. A paramedic may provide lifesaving, even heroic, interventions in the field ... BUT ONLY with the online or offline (verbal or standing) orders of a licensed physican (MD or DO). The MDs SHARE their practice (and absorb substantial liability in the process) to ALLOW paramedics, EMTs and FRs to practice their skills in the street. They have the schooling to supervise the EMS even if they are not skilled at vehicular extrication or ALS skills by flashlight inside a crushed car (etc.). They ENABLE the EMS provider's practice.

Likewise the MHPs in CISM enable the peer practice while --conversely-- the peers validate the MHP in the eyes of their lay clients. Additionally, the MHPs can assess (on a much higher plain, if you will) the persons we're intervening with looking for signs of stress-inducd psychosis (etc.) and the potential necessity for skilled, professional, intervention above the "first aid" level of CISM.

You also wrote that "If someone feels they need CISM to deal with the terrible death and dismemberment incident, more power to them. I will go out of my way to find them the resources they need to keep from becoming a depressive drooling in their shoes drunk. In my case, I know how to APPROPRIATELY deal with things that bother me." That's fair. CISM is voluntary ... no one MAKES you attend a debriefing. As I like to say, "it's a semi-free country."

One POTENTIAL flaw in your assessment of the situation could be derived from the phrase, "If someone feels they need CISM to deal with the terrible death and dismemberment incident, more power to them." The problem is that Critical Incident Stress (CIS) --stress that overwhelms one's usual coping mechanisms-- can --not unlike the impairing qualities of drugs or alcohol-- cause someone to misjudge their own feelings and needs. Like the drunk whose sure he/she is fit to drive; their judgement and self-assessment skills are impaired. A CIS reaction can do the same thing. Someone may exihibit dissociative symptoms and yet, when questioned, say they are "just fine." This is especially true with cadets. If questioned about their status in virtually any situation, a cadet's immediate reply is so often "outstanding sir/ma'am."

You, like many emergency services providers, likely have excellent and fruitful coping skills. Many others, especially our cadets (some as young as 12) don't. However, your willingness to attend a CISM intervention, and to share about yourself, MIGHT be the stimulus needed to get another member (with less developed coping skills) to needed help. That would be a selfless --and even heroic-- act too, in my book.

Also, you may have not YET exeprienced that one SINGULAR stress event (or cummulative stressors) that has overwhelmed your excellent coping skills ... I pray you never experience it. I have -- at least twice. I tend to believe that if one works long enough in the emergency services he/she will, sooner or later. You may be lucky ... or a "better man than I."

A final thought ...

Diverse opinions about CISM, as part of an academic discussion are fine --I recall many similarly controversial debates about the benefits and efficacy of EMS ("firemen shocking hearts, intubating and giving drugs") from the early 1970s, well into the 1980s, too.

We must not allow our personal opinions cause others to refuse help or forget to follow CAPRs. CISM is the policy of CAP, controversy or not.

[fyrfitrmedic]

 One of the key problems regarding CISM has been, from my own personal observations and experience, its misuse. On more than one occasion I've seen attempts at making attendance at defusings and debriefings strictly mandatory - bad news.

This is my greatest concern regarding its use in CAP as well.

[RiverAux]

I was once involved in a non-CAP incident where a person died and my agency decided that me and several others involved need to go through a CISM meeting.  The incident wasn't all that bad and my involvement in the worst parts was pretty limited, so I didn't get much value from it.  However, I did think that one of the others who was much more into it may have actually gotten some value from the meeting. 

So, I would say I am somewhat ambivalent about the concept overall.  I do think that there is some buzzworditis involved in the spread of the program in CAP -- meaning that a lot of folks jump on the bandwagon because it sounds good. 

[Slim]

Good points from all, and some good discussion.

I too am a long time firefighter/EMT (just over 17 years now), and doing the job isn't what taught me how to cope with situations like those described by my brother Hoser.  BTDT, got the ghosts in my head to prove it. 

No, I learned how not to cope with an overwhelming situation as a 17 year old CAP cadet while on a DR mission for a crashed airliner.  Look in The Lobby for a thread called "The Good of CAP" for a brief synopsis of the story.

I don't know if CISM would have benefitted me back then or not, and we'll never know because it just wasn't done in 1987.  Back then, the treatment was to "Suck it up and deal."  With one notable, drunken exception in 1989 (don't do the math on that one ), it's only been within the last year that I've opened up and talked about it.  And that was brought on by close, trusted friends recognizing what was going on and getting inside my inner walls.  And this summer was the first time I've been able to bring myself to go back to where that crash took place.

Shortly after, I sent an email to a few friends (including my wing commander), describing the experience of going to that vigil and meeting some of the family members.  Well, my wing commander shared it with a few people, to include Sherry and Bill Charles (Bill was MIWG/CC when Sherry presented the idea of CISM to him, the two of them took it to national, and here we are today), as well as a few other people who were on that mission.  Since, I've been approached by several veterans of that mission, thanking me for having the courage to move on and get it behind me, and motivating them to do the same.

Knowing what that did to me has helped me deal with things in the fire/EMS world, and helped me recognize it in others.  I've been through many debriefings, some formal but most across the cab, or standing on the apparatus floor.  A good friend of mine deployed to New Orleans right after Katrina hit (part of a FEMA EMS task force), for two weeks.  I called him several times, just to check in on him and the rest of the folks from my company.  Several of them were grateful that I thought enough to call and just talk/BS with them, and listen when they told me about finding and cleaning out the notorious nursing home of death, or going into the convention center, or the Superdome, and seeing what was going on in those places.

If used properly (peer based, and definitely not mandatory), debriefings can be very helpful to some.  Some of us deal with things better than others; but for those others, talking to someone who knows what you're going through can make a world of difference for years to come.

[DogCollar]

This has been an interesting, and timely, thread, as I have agreed to become the CIS Officer for the VAWG.  The powerpoint that is critical of CISM has some good, and important information.  The most important is (and I'm paraphrasing the critique), CISM should never promise results that the process cannot deliver.  I get nervous when I hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD.  I also get nervous when institutions require their workers to participate in a CISM debriefing.  A debriefing will be benficial for some, not for all, and those that are their against their will could actually be harmed.
That being said, I do believe that the CISM interventions, done by well trained persons, with a little sensitivity can be helpful for some persons facing a traumatic response crisis.  It is interesting, that a lot of the recent training I have received from ICISF has suggested that debriefings, in most situations, may not be necessary.  Demobilizations and Critical Management Briefings, where information is shared and general elements of self-care are passed along, can be all that is needed by most.
Hoser is correct in your criticism...a CIS Team that is NOT made up of at least one peer that can say "I've been there and I've experienced that" will most likely fail the purpose of the debriefing.  On the otherhand, I can argue that a team that doesn't include a MHP and a chaplain will not be nearly as effective as it could be.  Chaplains and MHP's can be extrordinarily effective in one-on-one interventions, demobilizations and CMB's.
So, after this long rambling, what is it that I'm trying to say?

1.  CISM should not make claims that cannot be delivered.
2.  CISM, done within its' scope of care, by trained and sensitive persons, can be helpful to some in mitigating some perceived negative stress reactions, and can help persons effected draw upon new or existing healthy coping skills.

[Chaplaindon]

"The powerpoint that is critical of CISM has some good, and important information.  The most important is (and I'm paraphrasing the critique), CISM should never promise results that the process cannot deliver.  I get nervous when I hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD.  I also get nervous when institutions require their workers to participate in a CISM debriefing.  A debriefing will be beneficial for some, not for all, and those that are their against their will could actually be harmed."

Chaplain Boldin, I suspect some of the criticisms, such as you mention, can be based upon semantical subtleties taken in different ways. What I mean by that is that (for example) when you speak of the assertion that you "hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD" that CAN be true ... the use of the word can means that "it MAY" (in certain cases) and/or "it HAS" in cases, done so.

Such is a fair and completely true way of using the word. Sadly, it can (note my usage here) likewise be taken to proffer some sort of promise of success.

Can a CISM intervention prevent symptoms (note I said "symptoms," not the condition) of PTSD ... I would say certainly it CAN. Does it always prevent such symptoms ... NO.

Also, stating that an intervention can "prevent the symptoms of PTSD" is far different than asserting that CISM can prevent PTSD. I am unaware of any ICISF literature that asserts such a silly idea. It's certainly NOT in any of the courses I've taken.

With that being said, however, one needs to realize that many of the symptoms (a feeling, sensation or physical manifestation that someone tells you they are experiencing) of a CIS reaction CAN (note my usage again) ALSO be symptoms of PTSD.

Normally the "differential diagnosis" (between PTSD and CIS reaction) is determined, NOT by the symptoms themselves, but by their duration (usually persisting more than 30 days).

For example, nausea and vomiting, loss of appetite, sleeplessness, nightmares, inability to concentrate, loss of faith, and so forth CAN BE symptoms of BOTH CIS reactions (which can be, at least normalized in many cases, by CISM interventions) and PTSD. Actually, I suspect these could be symptoms of many diverse conditions including clinical depression.

The fact, also, that these symptoms (and related "signs" e.g. dissociative behavior, etc.) can be produced by a variety of conditions from the minor to the dangerous, is another reason for the presence of the MHP. They can help assess, at a professional level, and ensure a referral if needed, and hopefully the best possible outcome for all.

It's a bit like my former career in EMS. The symptom of "chest pain" can describe many possible conditions. Can it be a symptom of a heart attack ... you bet. Can/could it be a symptom of something else (absolutely too) ... a physician in a hospital is the best person to make the differential diagnosis.

Like EMS, CISM is a "first aid" provider. We leave the definitive care to those qualified and equipped for it.

Is CISM the "one shot" CURE for CIS and/or PTSD? Absolutely not. Can CISM help many people deal with issues related to CIS? I believe it can.

In other words, it MAY be helpful, but not always.

[DogCollar]

Chaplain Boldin, I suspect some of the criticisms, such as you mention, can be based upon semantical subtleties taken in different ways. What I mean by that is that (for example) when you speak of the assertion that you "hear from some in CISM that a debriefing or a one-on-one intervention can prevent symptoms of PTSD" that CAN be true ... the use of the word can means that "it MAY" (in certain cases) and/or "it HAS" in cases, done so.

Like EMS, CISM is a "first aid" provider. We leave the definitive care to those qualified and equipped for it.

Is CISM the "one shot" CURE for CIS and/or PTSD? Absolutely not. Can CISM help many people deal with issues related to CIS? I believe it can.

In other words, it MAY be helpful, but not always.

Chaplain Don,

I find that you and I are in complete agreement.  In my work as a hospital chaplain I have come to appreciate that symptomology can produce a myriad of diagnoses!  It takes training, an experienced "eye," and a level of trust in the relationship to come up with "the" correct diagnosis.

It is my hope that all of us who believe stongly in CISM, as I do and I know you do, will listen to the critiques that are out there.  The main critique I would have is to recognize that the "model" has a lot of built in flexibility.  The debriefing model will not work in some situations.  I find that the literature is now suggesting that a debriefing should be offered only when other options have not been effective.   This makes a lot of sense to me. 

I hope that you are well?  I appreciate all that you do.

[Chaplaindon]

Ch. Boldin,

Thanks so much. Your work and devotion to CAP CISM is a blessing.

Ch. Don

[ltcoltsayler]

We don't just need directors.  That's great if someone can get to that status, then provide the opportunity at Wing level.
It's the "peer" thing we need to think about as well, as a director or chaplain may not always be a peer.  They can help, but not as much as a peer.
I took the course (paid by my employer - gave them the benefit of sending me in case something happened at work) from the State CISM conference being held near me.  It can run a few hundred $$.
So, I applaud those that are volunteering thier time to teach others, from National on down.
The most significant impact of taking the course at a joint First Responder conference is realizing exactly how important peer CISM folks are.  More trust, better results.