Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Comment on A Response to Three Children Dead, Four Hospitalized After Houston Daycare Fire

In the comments to A Response to Three Children Dead, Four Hospitalized After Houston Daycare Fire, which was in response to a post at EMS Outside Agitator, is the following from russ reina


Just want to make it clear that I used your original post as a springboard to take a look at the overall situation. I had no intention of challenging you on what you were saying; just reflecting on it.

When dealing with topics of what we should feel when dealing with death, and how we should deal with death, responses can be more emotional, than rational.

Your statement; “Again, I never stated any such thing.” leads me to believe you felt challenged or misunderstood. This, also, made me a little concerned; “In other words, if I do not demonstrate that compassion in this one post, I never do.” In no way did I say that you did not show compassion in this post. Quite the opposite. Just for emphasis, this was in my post as well::

Let me be clear, I’m not ragging on Rogue. I’d much prefer to honor him. First for the fact that he was willing to exhibit some of his own vulnerabilities and second for making it easy to reflect on what I’m about to say when he continues….

I apologize for the misunderstanding.

How do we get them to understand? (referring to our loved ones at home)

If we do get them to understand, how can we ever apologize for bringing that pain into their lives?

Why would we want to bring that kind of pain into the lives of those we love?

I’m not being facetious here but can you feel Rogue’s pain? He identifies having THAT kind of pain as something that inflicts pain on those he loves.

What if…

What if we in EMS took each other seriously first? What if we made space for our peers to WORK THROUGH some of the emotions of being a human being? Do you think, having helped each other take the edge off — because NO ONE DOES understand this territory better than us — we could possibly take home impressions that we could share with our loved ones as an act of love!

We don’t do a very good job of helping ourselves. We do such a poor job, that we have come up with a merit badge course to attempt to address our response to grief/horror/pain/things we don’t cope with well.

The CISM (Critical Incident Stress Management) approach is seen as something to be imposed on us, for our own good.

Any time someone tells us that something is for our own good, we should be very suspicious.

Is this approach any more effective than telling someone to just snap out of it?

Probably not.[1]

It does seem to satisfy those who feel that there needs to be a standardized process for everything and that we cannot help ourselves or our coworkers without a process.

I hope you see this was NOT about you; though you accurately portray some of the dilemmas faced by those in EMS. It was about how we, in EMS choose to share our experiences, with whom and how.

Not about me?

You mock my narcissism!


As an afterthought, I was not criticizing your paying attention to the mechanics of putting out fires with a fire extinguisher. I was observing that that’s what most of us do; give mention of our internal experiences and then get right back to work.

I just wonder if there aren’t other ways, as well.

There are always other ways, but at some point we do need to get back to work. Getting back to work also helps us to deal with the grief/horror/pain/things we don’t cope with well.

I try to find ways to make things better by looking at the ways that we make things worse. If we can avoid making things worse, we can be much better off for ourselves, for our families, and for our patients.


[1] Critical Incident Stress Management (CISM): Benefit or Risk for Emergency Services.
Bledsoe BE.
Prehosp Emerg Care. 2003 Apr-Jun;7(2):272-9. Review.
PMID: 12710792 [PubMed – indexed for MEDLINE]

Free Full Text PDF from Dr. Bledsoe’s website http://www.bryanbledsoe.com/