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These 6 key components of critical incident stress management (CISM) are why you need a formal training

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Critical incidents result in critical levels of stress

Critical Incident Stress Management (CISM) is a set of interventions and techniques designed to help individuals and organizations deal with the stress and trauma that can result from critical incidents.

Critical incidents can be anything from a natural disaster or an emotionally traumatic event, like witnessing a crime or suffering child abuse. These critical incidents can have “carryover effects” in the form of secondary exposure on first responders, physicians and nurses, medical professionals, emergency medical services, mental health services, forensic interviewers, and law enforcement who spend all day exposed to trauma.

The six key components of CISM include:

  1. Pre-incident preparation
  2. Crisis intervention
  3. Debriefing
  4. Follow-up support
  5. Organizational support
  6. Resilience-building

Pre-incident preparation

Pre-incident preparation fully prepares individuals and organizations for the possibility of critical incidents through training, education, and awareness-raising. 

Some have obvious pre-incident preparation needs, like ER physicians or first responders. Others are more subtle, like receptionists at a hospital exposed to people’s immediate stress reactions to a crisis, financial strain, or poor mental health.

Crisis intervention

Crisis intervention provides immediate support and assistance to individuals and groups affected by a critical incident. This may include psychological first aid, crisis counseling, and other supportive interventions. 

CISM interventions done well can reduce turnover and help patients and teams avoid psychological harm.


Critical incident stress debriefing is often the most overlooked component. The military recognized decades ago that proper debriefing allows individuals and groups to discuss and process their experiences and emotions related to the critical incident in a structured and supportive environment.

This can be done with or without a mental health professional in the room. This is especially helpful for emergency workers who routinely see people’s worst days but may not see gruesome or traumatic events on every shift. 

Psychological debriefing expands upon this by not merely noting what went wrong or what went well but what people need to move on.

When organizations are properly trained on debriefing techniques, we routinely hear from people involved in future debriefs that their teamwork, peer support, camaraderie, and approaches are more robust, supportive, and helpful.

Follow-up support

The right follow-up support provides ongoing help and assistance to individuals and groups affected by the critical incident, such as counseling, therapy, and other resources.

An intervention’s success may be most effective when a team can recognize someone in their care or on their team is at risk, especially if they are dealing with stressful life events like a death, divorce, or severe illness.

Organizational support

Organizations that deliver support and resources to organizations affected by critical incidents are more responsive and have reduced turnover versus those that don’t. 

These supports can include training, policy development, and crisis planning. For instance, an urban hospital that prepares for domestic or terrorist attacks may consider prehospital emergency care, pre-crisis preparation to stock supplies or equipment for primary victims, and establish crisis management briefing sessions during and after the attack.

Organizational support can also include crisis interventions designed to reduce post-traumatic stress disorder and trauma exposure, such as community support programs. 

We recognize there are multiple components to organizational support, and a strong CISM plan will help you address what works best for you and your co-workers.


Resilience-building is a relatively new name to an old idea: Equip individuals, small groups, and organizations with the support services, systems, and resources they need to cope with future critical incident stress. 

Support services and “resilience” is a broad, catch-all term. But it generally means helping teams and groups improve peer support amongst each other, noticing stress reactions among colleagues and yourself, and having access to robust mental health professionals when necessary.

CISM helps people deal with and recognize their job’s challenges

Sometimes referred to as “stress medicine”, CISM aims to help individuals and organizations cope with the stress and trauma associated with critical incidents and promote resilience and recovery in the aftermath of these events.

VPC has conducted hundreds of hours of CISM courses, audits, services, and trainings proven to:

  • Improve critical incident stress debriefing sessions.
  • Expand or improve critical incident stress management techniques.
  • Allow for crisis intervention that works for your team and organization.
  • Manage future crises.
  • Recognize de-escalation techniques and proper stress management.

Like many of our other trainings and classes, CISM services are evidence-based, informed by the needs of emergency responders and services, recommended by state and federal agencies, and taught by veteran instructors who have worked through hundreds of traumatic events. VPC tailors each Critical Incident Stress Management course with the right approach for your team, work, budget, and facility.

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