Specialists in stress management and disaster psychology have learned new approaches in helping emergency response personnel to reduce the emotional impact of having responded to major negative events. A major event or critical incident is defined as “any situation faced by emergency service personnel that causes them to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later. All that is necessary is that the incident, regardless of type, generate unusually strong feelings in the emergency response worker”.

Critical Incident Stress Management are interventions specifically for dealing with a major event or critical incident. Interventions are strictly confidential and structured to assist emergency responders who have experienced a traumatic incident. There are a number of interventions, however the most requested and used are:

Defusing: held within hours after the incident to offer support to the responders, assist with determining if further assistance is needed.

Debriefing (Critical Incident Stress Debriefing (CISD)): a psychological and educational group process designed to accelerate the NORMAL recovery of NORMAL people who have been exposed to an ABNORMAL event. A confidential discussion and sharing of involvement, thoughts, and reaction resulting from the response and held 24-72 after the incident.

One-on-one: usually using the same timeframe as a debriefing for just one emergency responded and provided by one CISM Team Member.

The CISM program was founded by Dr. Jeffrey Mitchell, PhD, psychologist, firefighter, and medic. Dr. Mitchell also founded the International Critical Incident Stress Foundation (ICISF). The newly reconvened North Carolina CISM Advisory Committee, under the auspices of the North Carolina Office of Emergency Medical Services (NCOEMS), advocates this model as a standard for the State.

North Carolina CISM Advisory Group

The CISM Advisory Group is charged with standardizing the provision of CISM service delivery and training for the state. The purpose of the Advisory Group is to provide recommendations and direction for the provision of CISM services, whether through training or other means of support. The Advisory Group will act in an advisory capacity to the NCOEMS.

Members of the Advisory Group are representatives from all the teams identified in the state (NC CISM Teams attached).


Membership on the team is voluntary. There is no financial consideration for participation in debriefings or ongoing team training or meetings, nor is professional liability insurance provided. However, team members receive tremendous satisfaction in helping to provide support, reassurance, and comfort to public safety, hospital and other emergency services workers suffering from the physical and emotional aftershocks of providing emergency care.

NC CISM Assessment

CISM has been in existence in North Carolina for 25+ years. Over these years the program has gone through some changes, enhancing service provision and team makeup. An assessment was done in North Carolina a year ago. (Assessment results attached.)

NC Approved Instructors

Because NC has endorsed the ICISF model founded by Dr. Jeffrey Mitchell, the Foundation has its own criteria for endorsing personnel to teach courses provided through the Foundation. Interested persons go through a rigorous vetting process and training. (NC ICISF endorsed instructors).