PST or CISM? What’s in a Name?

The Fall 2017 edition of Carolina Fire Rescue EMS Journal contained two very important articles, both on the same page. Perry Hall, in a follow-up to a previous article, pointed out that “everyone has a breaking point.” And while there are those really critical calls that can result in immediate psychological trauma, it’s not usually the “big one” that gets you. It’s the cumulative effect of call after call after call, some with not-so-text book results, that takes a toll on first responders. Perry points out the need for pre-incident education so responders can have an understanding of possible reactions to a critical incident before it occurs.


Similarly, Jeff Dill discussed the importance of peer support in emergency response agencies. In his article, he also talked about Critical Incident Stress Management (CISM) programs and how successful they are. I want to emphasize however, that peer support teams and CISM teams are neither independent nor mutually exclusive. A good, comprehensive CISM program has peer support built in.

By whatever name you call it, peer support is essential. It must be available to anyone at any time. But the key is to have peer support team members who are well selected and well trained. Jeff suggested two possible methods of member selection. His option one is to have team members selected by management — half by the union and half by the department. Option two is selection by a survey process. That is, the members of the organization select their peer support team. I like this one.

It is vital that peer support team members be volunteers who are first screened by senior staff in concert with a mental health professional. Not everyone volunteers for the right reasons. And, as Jeff said, they can’t be dealing with unresolved personal issues themselves. So, some of them need to be screened out. The rest should be surveyed by the membership. The most important issue for members of the peer support team is the trust of the members of the organization and their ability to maintain strict confidentiality. 

History has taught that the best “first line” support following critical incidents are peers.  They have credibility. They’ve “been there, done that, got the t-shirt.” But in addition to credibility, it is vital that they are well trained.

What often gets untrained peers in trouble, along with the person they are trying to help, is not knowing what they don’t know. In their zeal to provide good peer support, there is a tendency to hang on too long when referral to a mental health professional should have taken place. A further issue is called countertransference, when the helper’s baggage gets in the way of proper support. These issues, and more, are covered in the ICISF courses Assisting Individuals in Crisis and Assisting Individuals in Crisis, Advanced Principles and Practices. Both of these courses are recommended for members of a CISM/Peer Support Team.

The bottom line is this: every emergency services agency — fire, EMS, and law enforcement — should have a comprehensive CISM program in place, with members trained to ICISF standard. Such a program by definition includes a peer support component. It will save careers. It will save marriages. It will save lives. Remember, “everyone has a breaking point.”

Thanks for what you do.  And be safe out there.

A Certified Trauma Specialist, Dr. Jim Baxendale has over 35 years of experience in the mental health field, 25 of which have been focused on post-traumatic stress disorder and providing Critical Incident Stress Management services to emergency services personnel. As a paramedic, in addition to his mental health credentials, Dr. Baxendale brings added credibility to his consulting practice. For more information visit

Contact Us

"*" indicates required fields

This field is for validation purposes and should be left unchanged.