Is It Finally Time to Ditch Critical Incident Stress Debriefing?
A firefighter’s reckoning with a colleague’s suicide drives a hard look at whether the fire service’s debriefing ritual actually protects those it was meant to help
Critical incident stress debriefing (CISD) is a structured, brief intervention for an individual or group, guided by either peers or trained mental health professionals, and performed ideally immediately after exposure to, or direct experience of, acute trauma.¹
“Mike shot himself last night.”
That sentence is why I am writing this article.
To protect the family’s privacy, I won’t share every detail of the story, but it involves suicide, a truly painful experience for the surviving family, so I’ve changed his name and deleted key elements.
It is a seminal story for me. It revealed the true character of some of the people I worked with, but more importantly it sparked a career-long search for better mental health resources, first for myself in trying to stem the tide of PTSD-induced depression, and then later in advocacy for faster access to real, appropriate care for my fellow first responders.
When Duties Collide With Loss
While on light duty, I was assigned to retrieve spinal backboards our crews had left behind at area hospitals after dropping off trauma patients. By coincidence, the same morning I learned about Mike I was also informed that a scheduled CISD refresher training was still going ahead. That training consisted of two hours delivered by the senior captain who ran the program.
After training was done, I set out to retrieve the backboards. It was at the first hospital that I found the board Mike was brought in on the night before. Our crews had responded to the gunshot call at his house and, following trauma protocol, strapped him to a backboard for transport.
It was covered in his blood and brain matter.
When I was a rookie, Mike was my guide and mentor, and eventually a friend. Standing there, holding that board, everything inside me turned upside down. Parts of Mike, my friend, were still stuck to the board. It wasn’t that I was physically ill. Instead, I felt a set of emotions I did not yet have the language for. My brain was trying to piece together what suicide meant, why Mike, and the raw physicality of the act.
Back at the station, while cleaning and decontaminating the board, I looked up and saw the same CISD training captain from that morning walking across the parking lot. Here was an ally, I thought, someone who would understood and listen.
I got his attention, and then stumbled through the words, barely able to speak, trying to verbalize these feelings. The captain paused, looked away, then looked back at me and said, “It is what it is.”
It is what it is.
I had just been given my debrief.
History
In 1974, Dr. Jeffrey T. Mitchell, a paramedic and psychologist, developed the Critical Incident Stress Management system, or CISM. It was a broad approach based on Crisis Theory and influenced by military practices. Crisis Theory suggests that people who experience a significant trauma naturally need to share the experience and the emotions associated with it. CISM was a spectrum of care developed to address the psychological harm that experiencing these traumas could cause. The idea was to help people process the event to minimize any potential symptoms of traumatic stress, depression, and anxiety. ¹
By the early to mid-1980s, CISM and its CISD component were being adopted within first response and military settings.² In the fire service, it landed in the form of fellow firefighters providing CISD debriefs to their affected peers.³
Delivery
CISD interventions haven’t changed much since their inception. For a fire department the need for it is triggered when there’s been a recognized significant traumatic exposure, usually on duty at an incident, though off duty traumas are often addressed as well.
Interventions are initiated one of three ways: a firefighter self-identifies a need; a fellow crewmate with knowledge of the incident reports the concern on behalf of another, (since firefighters are often stoic in asking help); or a senior officer or a department policy automatically activates CISD based on the significance of the event.
The actual construct of an intervention ideally follows this trajectory:
intro → facts → thoughts → reactions → symptoms → teaching → re-entry:
Introduction –Debriefers state their roles and the purpose of the CISD. Confidentiality is overtly assured, ground rules are laid, and voluntary participation is emphasized.
Facts –Each person gives a role-based “who/what/where” summary – no graphic detail.
Thoughts –First thoughts/impressions at the time (“what struck you first?”) are shared.
Reactions – Themost stressful moments are described and are safely facilitated for emotional venting.
Symptoms – Any noted reactions are normalized and named (sleep disturbances, intrusive images, irritability, etc.).
Teaching – Coping skills, sleep and substance guidance, normal vs. red flags, support options are offered.
Re-entry –Q&A, takeaways, handouts/resources provided, next steps outlined, including informing of follow-up check-ins.
Sometimes, and not included in this list as it’s not a part of the formal CISM model, the first action of a CISD team is an informal “Defusing” – a brief screening process and check-in to look for those initial opportunities to stabilize the exposure and offer support.3 Often called a “hot wash,” defusing is not a detailed processing.
Importantly, in those departments with inadequate CISM systems, the hot wash has become the whole intervention, seen as “good enough” by the CISD team or the trauma exposed firefighter themselves.
Finally, a point of clarity amidst the acronyms and information – simply:
Debrief “hot wash” is a short, informal, initial check in only.
CISD is the formal debriefing process only
CISM is the whole continuum of care – defusing, debrief, access to professional care, possible accommodations for the affected employee, follow up, etc.
Questionable Effectiveness
When CISD was developed 40 plus years ago, that “you good?/suck it up” approach was about the only level of post-incident intervention provided. Even then it was evident that not only was that approach not enough, it was potentially harmful. Hence the creation of CISD teams.
Those teams, (often mistakenly called CISMteams – again, CISM is the system, usually mispronounced “sizzum,” CISD is a part of that system), quickly saw widespread acceptance. But by the 1990s, soon after their initial deployments, their effectiveness was already being debated. Early studies suggested that forcing a responder to re-live the trauma further embedded the trauma, sowing the seeds for PTSD. This concern was echoed in subsequent work, including a 2003 aggregate, broad-spectrum critical review of several studies, concluding that “single-session debriefings (like CISD) are often ineffective and can be harmful in some cases.” 4
It’s important to note that, because the data is mixed, it’s likely there are CISD recipients who have experienced meaningful benefits from it. But the problem doesn’t lie with the positive outcomes. It lies in the fire service’s assumption that when a trauma-exposed person gets an intervention, the outcome is automatically positive.
That assumption is where tradition rears its head in the face of much needed progression: even with questionable outcomes, CISD remains embedded as part of the fire service’s mental health culture.
There’s an irony here. Many modern-day fire service leaders recognize the need for mental health initiatives, and understand that progressive approaches need to be developed and deployed. Yet, while acknowledging that need, those same leaders allow the tradition-based culture of the North American fire department to hang on tight to CISD’s questionable efficacy. Dr. K Wheldon (Psychologist and subject matter expert in First Responder psychology), describes the reasons why, best: “For many, confronting the idea that a method they’ve relied on may not be effective or could even be harmful, brings up deep moral distress. It means facing the painful possibility that their well-intentioned efforts might have inadvertently caused harm. As helping professionals, that’s a hard truth to sit with.” 5
Sidenote:Though always well-intentioned, by CISD teams mistakenly calling themselves “sizzum,” (the acronym is typically fully spelled out C-I-S-M), it speaks to a greater problem: if the debrief process can’t even be properly named or pronounced, how can we trust it to handle PTSD-inducing trauma management at all?
How Are We Doing?
How are we doing at mitigating trauma exposures? The honest answer: it depends.
First, to use psychological jargon, there is “poor intervention fidelity” – a fancy way of saying, “The way it’s done? Not so good.” If we look at the diagnosis rate for PTSD in first responders alone, the very thing CISD is meant to mitigate, we’re not doing well at stepping in when it matters most – one Canadian study found between 17% and 32% in firefighters.6
The fire service would also get a poor grade if state- or province-specific policies or legislations were reviewed. Wording in those policies is loose, not providing clear guidelines. One example that best illustrates this is one Canadian jurisdiction that dedicates only a single paragraph to the training requirements in its entire province-required PTSD mitigation policy. There, reliance on the guidance and foundational training of non-clinicians mostly comes from an organization called the ICISF – International Critical Incident Stress Foundation, (the only apparent core organization offering the curriculum, with courses offered at a significant price point).
Success rates matter too. The data lands, at best, at a 50/50 split, where several studies offer only mixed positive reviews of CISD’s effectiveness. And a 2015 survey of Utah EMS personnel not only found that between 11% and 18% of respondents who participated in CISD stated it “didn’t help much,” and less than half described it as even helpful at all.7
Culling my own anecdotal data from conversations with teams across North America, I’ve found that CISD debriefings are often triggered as a knee-jerk reaction without any rigor (bad call = automatic CISD), are often viewed as a “shoulder shrug” effort (“it’s something we do”), or are delivered by peers who have not had current, frequent, robust, or even adequate training.
Training Without Standards
Training is a fulcrum here – those training deficiencies make the best case against using CISD, with the most glaring deficiency being that there doesn’t appear to be any solidified standard. There are policies, yes, and policies’ close cousins, legislated requirements, like the Ontario Workplace Safety and Insurance Act of 1997. In Ontario, as with many other jurisdictions, training guidelines come from the aforementioned ICISF, which offers paid, asynchronous video training, (apparently with access to facilitators). And neither state nor provincial policies, nor the ICISF, strictly enforce refresher training – they are suggestions only. ICISF-Canada’s own guiding document merely suggests that peer instructors take refresher training every three years.6 That’s the instructors, the ones teaching those that actually deliver the interventions. Whether organizations are compliant with training and how compliance is enforced is unclear. (For comparison, the equally vital CPR training, is required every 6 to 12 months, depending on jurisdiction).
It appears that many jurisdictions have punted to the ICISF. To be fair, the ICISF holds an impressive array of subject matter experts on its faculty, and is still associated with Drs. Everly and Mitchell, the original authors of the CISM framework we all work under. But it also appears that in the ICISF jurisdictions saw an organization that has already done the curriculum development and delivery heavy lifting and simply deferred to it. Whether the ICISF itself goes through any sort of rigorous review of its material and delivery methods from a third party remains to be seen. More simply, it appears that ICISF-driven CISD development has come down to, “Take this course. You’ll be good to go”, without enforced follow through or follow up. (It should be noted that there are a significant number of CISD teams that have not even taken this coursework.)
All of this is to say that jurisdictions may or may not have policy or guidance framework for CISD delivery, the training requirements usually come from a third party that appears to be pay-to-play, and key training issues like frequency, currency or efficacy are not clear. It seems that peers delivering the CISD debriefs work under questionable training standards. Not a good thing for a training-first culture like the fire service.
If Not CISD, Then What?
Unless all of CISD’s recognized inadequacies – quality of training, little to no enforcement, long-standing questions surrounding its effectiveness – are fully addressed through rigorous reviews followed by policy re-writes, and in some cases new legislation, and it continues to be embraced only because it’s familiar and comfortable, other methods must take its place for the sake of the first responders we’re looking to help. And there are options, with a few gaining traction, like Psychological First Aid and Trauma Risk Management (or “TRiM”). These options rely on current academic and clinician informed practices, and have a much stronger basis and reliance in both required frequent training and in current fire service best practices.
One of the benefits of CISD was its immediacy. First responders need that timely access, and new offerings are emerging, with resource-rich platforms like Siento and apps like Lighthouse**.**More promising still are organizations such as the Responder Assistance Program and Public Safety Crisis Solutions, organizations that work to shorten the distance between a struggling first responder and an appropriate, trauma-informed clinician.
There’s also forward motion in first responder organizations towards requiring greater rigor in peer-based risk assessments, skills development and maintenance, all coupled with solid clinical treatment.
Possibly the most important shift is the fire service embracing a true care culture – any trauma mitigation system needs to be delivered in a culture of authentic psychological safety.“Care culture” is admittedly a tough sell in a business where grit is foundational, military jargon is stolen from special operations units (“adapt and overcome”), and the masculinity/physicality combo remains embedded. For it to happen, the fire service must harness the current momentum towards having psychologically safe workplaces.
And there is momentum: departments are actively working in this direction, there is signaling coming from media discourse and communications from organizations like the Canadian Association of Fire Chiefs and the International Association of Firefighters (IAFF), individual firefighter associations are beginning to demand it, and there programs like “Resilient Minds”, (which aims to “build psychological strength”), and “Battlemind Debriefing”, (originally a military CISM-like system, but with a greater focus on today’s first responder challenges) are gaining traction.
The Shift We Owe Our People
In the 1980s, CISD’s introduction to the fire service was a significant step forward. It was the era of the “you good?” standard for post-incident care, and any offering beyond a chin wag across the apparatus floor was welcome.
But CISD sits differently today than it did back then: the fire service has a fuller embrace of training-first culture making it apparent that CISD training lacks vigor or consistency; the standards to guide and enforce its use are vague even with recent legislative wins for first responder mental health; and most importantly, evidence for its long-term benefit in mitigating potential PTSD is, at best, mixed.
The fire service is still deploying this tool largely because it’s familiar and easy to reach for – a move away from caring for our people to simply maintaining a ritual. And with PTSD and the adjacent suicide rates in first responders outpacing the general population, ritual is not enough.
If we’re serious about protecting our people, we have to be serious about replacing habit with rigor. The firefighters that sit in those rooms trying to defuse the trauma are already telling us that. As one career firefighter put it, “… the defusings didn’t help me… They actually made me more angry…” 8 That gap between intention and impact is exactly why we need to shift away from one-off debriefs, as CISD typically plays out today, and towards systems that combine structured peer assessment, ongoing skills development, and rapid access to trauma-competent clinicians. It also means doing this work inside a genuinely psychologically safe culture, where speaking up about psychological injury is an expectation, not a risk.
CISD was built for another time. Our responsibility now is to build and demand something better: a modern, evidence-based, and authentically safe approach to mitigating trauma. We need to build something worthy of the people that carry the weight of the hardest calls.
References
1. Mitchell, Jeffrey T. “When Disaster Strikes: The Critical Incident Stress Debriefing Process.” Journal of Emergency Medical Services 8, no. 1 (1983): 36 to 39.
2. Mitchell, Jeffrey T. “Critical Incident Stress Management.” Journal of Emergency Medical Services 9, no. 1 (1984).
3. Mitchell, Jeffrey T. “Teaming Up Against Critical Incident Stress.” Chief Fire Executive 1, no. 1 (1986).
4. Rose, S. C., J. Bisson, R. Churchill, and S. Wessely. “Psychological Debriefing for Preventing Post Traumatic Stress Disorder.” Cochrane Database of Systematic Reviews (2003).
5. Wheldon, K. LinkedIn post. October 2025.
6. Carleton, R. N., et al. “Mental Disorder Symptoms among Public Safety Personnel in Canada.” Canadian Journal of Psychiatry 63, no. 1 (2018): 54 to 64.
7. Taillac, P., R. Hammond, and K. Miller. “At Risk EMS Employees: A Model of Assessment and Intervention.” International Journal of Emergency Mental Health and Human Resilience 17, no. 2 (2015): 453 to 458.
8. Davis, Jeri. “First to Mind.” Reno News and Review, October 23, 2019.
