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Critical Incident Stress Management

The National Ambulance Service Critical Incident Stress Management (CISM) Programme

Ambulance Personnel have a unique and pressurised role in society; they conduct pre-hospital emergency care under highly demanding circumstances and very often face the harsh realities of society. Over the last 10 – 15 years most emergency services internationally have implemented a Critical Incident Management System where Peer Support Workers (PSWs) provide peer support to colleagues to assist with trauma interventions including management of Critical Incidents. They form an important element of the Critical Incident Stress Management (CISM) system which also comprises stress awareness training programmes. The CISM system is co-ordinated by a Regional Coordinator in each of the three NAS regions.


The Ambulance Service Critical Incident Stress Management System was established in 1997 as a partnership between the then regional health boards, ambulance service staff representative bodies and the Department of Health & Children. The Programme is led by the National Co-ordinating Committee which includes representatives of all the stakeholders. From the beginning, there have been very close links with the National Ambulance Services College (NASC). The College has provided the Committee's secretariat and CISM training has been co-ordinated and delivered through it.

The core components of the CISM Programme are

  • A stress awareness training programme which includes a significant component on critical incident stress and information on how to access assistance if effected by it. This programme is delivered locally to all ambulance service personnel and is refreshed at appropriate intervals. It also forms part of new recruit training at NASC.
  • Support for ambulance service personnel effected by critical incidents is provided by a corps of specially selected and trained Peer Supporters.
  • Peer Supporters have also been trained as Stress Awareness Trainers.
  • To be accepted for training as a Peer Supporters, a member of the ambulance service must have at least three years service experience and be nominated by colleagues.
  • A 'person spec' for the role has been developed which guides selection. Peer Supporters are volunteers, receive no additional remuneration and undertake to be available to colleagues, if needed, outside rostered hours.
  • Ambulance Service personnel who have more complex or enduring problems arising from critical incident stress can be referred to mental health professionals.
  • Within each Health Service Executive area there is a designated member of the Ambulance Service staff, accountable to the area's Chief Ambulance Officer, who co-ordinates the delivery of the CISM programme in that area.

Types of Support

The peer support system provides a forum where staff can discuss stress related issues arising in their work with a view to learning from and providing support to each other. All peer support in the ambulance service is conducted on a voluntary and confidential basis. PSWs take part in a seven day training course which is followed up with regular ‘refresher’ courses. They commit to being available to their colleagues, both within and outside working hours, to support them in the aftermath of difficult or emotionally distressing 'calls'. These are called critical incidents because of their psychological impact on those involved. When necessary, they are in a position to facilitate colleagues in accessing professional mental health support. HSE Employee Assistance Programme

Since the implementation of the CISM programme, a group of trained Peer Supporters has been working on a voluntary basis to assist ambulance service staff affected by Critical Incident Stress. Most consultations are informal and the PSW talks through the incident in question with their colleague. You can consult your local Peer Support Worker or any of the persons listed on the CISM website ( and we recommend that you contact them if you require any help and advice. There is a poster in each ambulance base with local numbers and contact names. In addition the HSE staff support services are available at the following link: CISM Support Contacts