Supporting the emotional well-being of members of our Ambulance Service.

The National Ambulance Service Critical Incident Stress Management Programme

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.

Funding for the programme came from the Department up to 2004 but is now provided by the Health Services Executive.

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 CISM Programmes Core Components

• A stress awareness training programme which includes a significant component of critical incident stress and information on how to access assistance if affected 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 of 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.

A Peer support Worker is a volunteer colleague who provides opportunity for staff
to 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

  • Stress is the normal mental and physical response resulting from exposure to any demand or pressure in our lives.
  • The greater the demand the more intense the stress reaction.
  • Prolonged or excessive stress can can cause distress. 

Listed below are some common indicators.

  • Feeling overwhelmed
  • Loss of motivation
  • Dreading going to work 
  • Impaired concentration 
  • Racing thoughts 
  • Becoming withdrawn 
  • Impaired memory
  • Feeling of: Anxiety, Depression, Anger, Guilt


CIS is the stress caused by an event or series of event, which is of such severity that has the capacity to overwhelm our usual coping mechanisms, thereby creating significant distress and impaired functioning.

Ambulance personnel are more commonly exposed to smaller scale traumatic events such as road traffic accidents, suicides or COT deaths. AN event may occasionally be so traumatic or overwhelming that emergency personnel may subsequently experience a signification stress reaction.

  1. If you feel you cannot handle intense feeling or body sensations.
  2. If your stress reactions do not lessen in the weeks following the event.
  3. If you continue to have nightmares and poor sleep.
  4. If you have no-one with whom to share you feelings.
  5. If your relationships seem to be suffering badly.
  6. If you become clumsy or accident prone.
  7. If after the event, you smoke, drink or take more medication, or other drugs.
  8. If your work performance suffers.
  9. If you are tired all the time.
  10. If things get on top of you and you feel like giving up.
  11. If you take it out on your family.
  12. If your health deteriorates.

Latest News

A thank you to each CISM team and all PSWs

NAS staff have been supported by access to PSWs and where required professional support from Clinical Psychologists. As these interventions are confidential, the numbers and details of such interventions are

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Download of Critical Incident Stress Management Committee Constitution