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"It didn't bother me," he says of the accident. "But the policy was that for anything like that you do a debriefing." As he sat through his first session, he says he thought, "This is really inappropriate." The counselors, he says, "were trying to draw feelings out of people without much regard for how they'd react to it or how they wanted to deal with it."
After that, Bledsoe started researching trauma on his own. He began publishing a series of articles critical of CISM in EMS Magazine, a periodical for first responders. In response, he says, people started sending him death threats. You're trying to hurt people by saying this, a typical one would begin. If people listen to you, paramedics will suffer, read another.
"The World Health Organization had already taken a stand against CISM," Bledsoe says. "And I wrote a CISM article for the journal Prehospital Emergency Care, doing a systematic review of the research, pro and con. The thing was that there wasn't much pro except for articles in journals published by people who invented the practice. But the idea that this is what we're supposed to do — it takes such a hold that it's like killing a vampire."
Bledsoe's research led him to Gist, who had similar interests and concerns. In Virginia, Vickie Taylor was having doubts about trauma debriefings, too.
During the early '90s, when Prince William County used large-group debriefings, it was common for those involved to have performance issues later. For police, that could mean use of excessive force and sporadic attendance.
Many of the counselors were offering services that they didn't have experience in, Taylor says, and it was becoming less clear that the methods actually delivered on their claimed benefits.
The problem with something like the group prayer circle at Ground Zero, she explains, is that it disrupts the emergency responder's mental focus. "You're in this state of mind: 'I'm going to work,' and you don't need this [people butting in]. What we needed to have in place down there was every skill for distancing instead of bringing it all in close." Taylor says that workers in the middle of such situations have to "reframe the event" so that they believe what they're doing has meaning. Stopping work to talk about how bad they're feeling interrupts that necessary focus.
On April 16, 2007 — the same day as the Virginia Tech shootings — a firefighter in Vickie Taylor's county was killed in the line of duty. Just as she had seen during her team's 9/11 cleanup, a swarm of people wanted an opportunity to round up the firefighters and force them to talk about their feelings.
"They came out of the woodwork. We had many, many calls from people who wanted to come and help us. They find out about these deaths because they'll watch the message boards on firehouse.com, or they'll troll community Web sites. It was our first line-of-duty death, and the people calling to help had never been involved in a line-of-duty death. So they would've shown up to do — what?"
Back then, Taylor says, the fire department would have allowed the counselors. "It was the best we knew to do at the time," she says. "Now I just say, 'No, thanks.'"
Gist's trepidation with trendy trauma counseling has roots in one of the worst disasters in Kansas City history.
At 7:05 p.m. Friday, July 17, 1981, two aerial walkways collapsed into the lobby of the Hyatt Regency Hotel during a "tea dance." Such dances had been weekly events for a couple of months, hosted by the hotel and attracting revelers from all across the metro. It's estimated that 2,000 people were present when the walkways fell. Of those, 111 were killed, and more than 200 were injured. Victims were trapped for more than 10 hours beneath 90 tons of steel and concrete. The rescue effort eventually involved perhaps a thousand responders, including firefighters, police, paramedics, physicians, nurses and volunteers.
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