Dr. Bryan E. Bledsoe – debunking CISM (and responses)

I came across a Powerpoint deck by  Dr. Bryan E. Bledsoe, an emergency physician and former EMT, who reviewed many studies of CISM/CISD with a critical eye.  I’m not sure of the date on this, but I think it is from around 2002.  As much as those of us involved in CISM might not want to look at criticism, we’d be foolish not to.

My take on his presentation is that it all makes a lot of sense… except his conclusion that agencies should stop doing debriefings because of liability exposure, because there isn’t enough evidence that it helps – and there is some evidence that it can do harm.

First, I’ll say that I have zero doubt that badly run debriefings can do harm.  I don’t think there is any question about that.  But my response is to train, train, train.

I was relieved to see that the points Dr. Bledsoe targets seem to be aligned with those that the Bay Area team consistently promotes:

• Your primary source of support is not the CISM team, it is your own network – family, co-workers, church, etc.
• CISM is peer support (“been there, done that”), not an outsider fixing things.
• Voluntary participation – zero pressure to speak.  Our entire approach needs to be an invitation.  Erase “should” from your vocabulary.
• Never, ever probe or dig for a reaction.
• Early intervention is better.
• Focusing on post-traumatic stress response (you may have the following symptoms…) is not particularly helpful and may trigger it!  Go easy on the education phase.  I wonder if we should be forward-looking about this at all – why try to normalize something that hasn’t happened yet?
• Give people control over their stress response – this is so much about control, which may be where the process  fails most often, given the nature of responders to try to control things.
• Encourage ongoing stress management as part of organizational culture.
• Occupational stress often is the worst.
• Operational debriefings are part of stress management.
• One-on-one debriefings are questionable; the power is in the group of peers.

P.S. Found a good response to Bledsoe’s analysis, written by a Texas fire chief: What we Can Learn from the Criticism of CISM