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Call (606) 864-2922

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The London Fire Department’s Critical Incident Stress Management Team was developed to address acute stress situations and potentially decrease the likelihood that PTSD will develop after such an incident.

Our position in the stress management process is to confront stress responses, diffuse them, and direct our local first responders and their families toward an emotional equilibrium by providing a support system. Our support system is tailed or to the individual(s) under stress. It can don formally through a debriefing for those present at the time of the event or can occur as part of stress management during an ongoing scene. Examples of On-Scene CISM include:

  • When personnel are assessed for signs and symptoms of distress while resting
  • Before reentering a scene
  • During a scene demobilization in which personnel are educated about the signs of critical incident stress and given a buffer period to collect themselves before leaving.

CISM Process:

  • Defusing session
  • Debriefing session

If CISM is ineffective for an individual or is not an option for an individual, a referral to a mental health professional may be made for private counseling, Joint agency training will be encouraged and facilitated to help with scene management. The Team will facilitate and help coordinate continued education for first responders surrounding stress management during and after events.

Physiological Responses:

Eustress and Distress have the same physiological manifestations. These include:

  • Increased respiration and heart rate
  • Increased blood pressure
  • Constricted venous vessels near the skin surface
  • Dilated pupils
  • Tensed muscles
  • Increased blood glucose levels
  • Perspiration
  • Decreased blood flow to the gastrointestinal tract

Situations that are considered stressful for first responders include:

  • Dangers situations
  • Physical and psychological demands
  • Critically ill or injured patients/victims
  • Dead and dying patients/victims
  • Overpowering sights smells and sounds
  • Multiple patient situations
  • Angry or upset patients, family, and/or bystanders
  • Unpredictability and demands of Emergency Response Systems
  • Noncritical/non-911 patients
  • Hospital wait times

Physical symptoms of cumulative stress:

  • Fatigue
  • Changes in appetite
  • Gastrointestinal problems
  • Headaches
  • Insomnia
  • Hypersomnia
  • Inability to concentrate
  • Hyperactivity or underactivity

Psychological symptoms of cumulative stress:

  • Fear
  • Dull or nonresponsive behavior
  • Depression
  • Guilt
  • Oversensitivity
  • Anger
  • Irritability
  • Frustration

Cumulative stress has been proven to contribute strongly to heart disease, hypertension, cancer, alcoholism, substance abuse, and depression. Cumulative stress can also be a result of an accumulation of seemingly insignificant stressors.

Some events can be usually stressful, even by Emergency Standards, these are typically sudden and severe. Some examples of such incidents are:

  • Mass casualty incidents
  • Serious injury or traumatic death of a child
  • Crashes with injuries, caused by an emergency services provider while responding to or from a call
  • Death or serious injury of a coworker in the line of duty
  • Sudden death or serious injury of a family member

Warning signs of stress:

  • Irritability towards co-workers, family, and friends
  • inability to concentrate
  • Difficulty sleeping, increased sleeping, or nightmares
  • Feelings of sadness, anxiety, or guilt
  • Indecisiveness
  • Loss of appetite (gastrointestinal disturbances)
  • Loss of interest in work
  • Loss of interest in sexual activites
  • Isolation
  • Increased use of alcohol
  • Recreational drug use
  • Physical symptoms such as chronic pain (headache, backache)
  • Feelings of hopelessness

Help Lines

Safe Call Now: (206) 459-3020 or 1-877-230-6060
A confidential, comprehensive, 24-hour crisis referral service is for all public safety employees, all emergency services personnel and their family members nationwide.


National Volunteer Fire Council (NVFC)
Fire/EMS Helpline: 1-888-731-FIRE (3473)
A confidential and 24-hour, the Fire/EMS Helpline was created for first responders by members of the fire service. This program is specifically designed to meet the unique needs of firefighters, EMTs, rescue personnel and their families.


Copline: 1-800-267-5463
A confidential, 24-hour law enforcement officer hotline manned by retired law enforcement officers trained in active listening.