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In this episode of the Prehospital Paradigm Podcast, Scott Wildenheim, Wes Green, and Dr. John Hill sit down with Susie Forgues, RN, Paramedic, Assistant Fire Chief, EMS educator, and longtime Critical Incident Stress Management (CISM) team coordinator, to discuss mental health, peer support, and stress management for first responders.

Key Topics Discussed

What is CISM?

• The evolution from Critical Incident Stress Debriefing (CISD) to Critical Incident Stress Management (CISM).

• Why modern programs focus on support, education, and resilience rather than mandatory emotional disclosure.

• The role of confidential "defusing" sessions following stressful events.

Why Peer Support Works

• Firefighters, law enforcement officers, dispatchers, EMS providers, and healthcare professionals often respond best to peers who understand their unique culture and experiences.

• Mental health professionals remain an important part of the team, but peer-to-peer conversations frequently help reduce barriers to seeking assistance.

When to Request Support A CISM response may be appropriate after:

• Pediatric deaths or serious injuries

• Incidents involving coworkers or family members

• High-profile or prolonged events

• Officer-involved shootings

• Major operational incidents

• Any event that significantly affects responders, regardless of outcome

Importantly, support is not limited to incidents involving death. Successful resuscitations and positive outcomes can be equally stressful.

The "Backpack" of Stress The panel discusses how responders accumulate stress from work, family, finances, relationships, and daily life. Sometimes a seemingly routine event becomes the final burden that exceeds a person's ability to cope.

Recognizing When Someone Needs Help Warning signs may include:

• Changes in sleep patterns

• Changes in appetite

• Social withdrawal

• Irritability

• Difficulty concentrating

• Behavioral changes noticed by coworkers or family members 

How to Support a Coworker

• Listen without judgment.

• Show genuine concern.

• Avoid trying to "fix" the problem immediately.

• Check in regularly.

• Encourage use of peer support and professional resources when needed.

Take-Home Message

Mental health challenges are common among first responders, and seeking help should be viewed as a sign of strength rather than weakness. Building a culture where conversations about stress, depression, PTSD, and wellness are normalized can help keep responders healthy, resilient, and engaged in the careers they love.

Quote of the Episode

"We don't want to lose people. We want to keep our responders healthy, functioning, and in the job. If there's any doubt, call the team. We'd rather be called and not needed than needed and not called."