Editor's Note: Critical Incident Stress Management is a well established practice in EMS, designed to help rescue personnel cope with exposure to death and injury. The following article discusses how C.I.S.M. principles are utilized the U.S. Coast Guard, whose rescuers experience many of the same issues in the field.

Imagine being a young man or woman in high school mowing lawns in the community, and while mowing a neighbor's lawn you encounter a dead body. Visualize being a waiter at an upscale restaurant when a car accident occurs and victims need help escaping flames with gasoline leaking on the asphalt. These hyperboles paint a scary picture of something you may see in a movie, but not in real life. Young people traditionally are not expected to witness such things. However, young men and women barely out of high school do join the Coast Guard, and as their job description changes, so does the graphic nature of their lives.

The Coast Guard is and will always be a service that responds to tragedy. Notorious plane crashes like TWA Flight 800 and Alaska Airlines Flight 261, natural disasters such as Hurricane Katrina and the terrorist attacks on September 11, 2001, represent the horrific extremes handled by the Coast Guard. Yet the majority of cases involving devastation, injury and death are the kind that Coast Guardsmen deal with everyday. Many cases often go unnoticed in the public eye because they are routine and do not carry a major headline presence of the more noteworthy responses in Coast Guard history. To deal with psychological response of Coast Guard operations, the service has in place an important program designed to address potential mental health issues of Coast Guard men and women performing missions in traumatic situations. The program is the Critical Incident Stress Management, otherwise known as CISM. It is a comprehensive system of services and programs designed to achieve several objectives such as preventing and alleviating the symptoms of traumatic stress disorder. Critical Incident Stress Management exists for Coast Guard crews that encounter a line of duty death or serious injury, multi-casualty incident or disaster, significant events involving children, suicide, acts of terrorism, search and rescue cases involving serious injury or loss of life, and victims of violent crimes.