When there's a crisis, emergency personnel are on the scene immediately to help the victims.

But once the crisis is past, who helps the helpers?

Personnel from area police, fire and emergency medical services, counseling services and area hospitals, met Wednesday at Southeast Missouri Hospital to discuss critical incident stress management (CISM).

CISM is a process for teaching emergency personnel to cope with job-related stress, said Jim Lawrence of the SEMO Critical Incident Stress Debriefing Network.

Emergency personnel deal with a variety of horrific events daily, from car accidents and fires to child abuse to murders and suicides.

Stress for police, fire and emergency medical personnel is "more of a cumulative thing," said Debi Oliver, a registered nurse and reserve officer with the Cape Girardeau Police Department. "It's not so much the second suicide or the third suicide as finding the fourth suicide, and then they've had it."

Oliver volunteers as a peer counselor with the department to talk to officers about the stresses of their jobs, and refer them to other services, if needed.

Emergency personnel are "viewed as someone who handles all these problems, not someone who has all these problems," she said.

More and more emphasis is being placed on CISM worldwide, but it's only been a concern in this region for a few years, Lawrence said.

"It really didn't hit home until we started looking at some of the things that had been happening in Southeast Missouri," he said.

A "tremendous turnover ratio" among emergency personnel was noted throughout the region, Lawrence said.

"We finally realized we've got a major stress problem we weren't dealing with here," he said.

At that point, several agencies began training personnel to be peer counselors and began setting up a process to allow personnel involved in critical incidents to talk about the emotional impact of those incidents.

More trained debriefers are needed, Lawrence said, and the network will be sponsoring two workshops in October at the Cape Girardeau Drury Lodge for interested personnel.

A basic training session will be held Oct. 2 and 3, with an advanced session offered Oct. 4 and 5. A fee will be charged.

CISM programs are well worth the cost of training, time lost for debriefing and contracting with counseling services, said counselor Bob LeFebvre, when balanced against the cost of higher health insurance premiums for stress-related illnesses, higher absenteeism and disciplinary incidents and training new staff to replace employees lost to turnover.

Art Stumpf, a CISM officer with the St. Louis Metropolitan Police Department, said the process can be adapted to include spouses and family of emergency personnel, who are also affected by job stresses.