[Constitution for the United States of America] [1] We the People of the United States, in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America. Article. I. Section. 1. All legislative Powers herein granted shall be vested in a Congress of the United States, which shall consist of a Senate and House of Representatives. Section. 2. The House of Representatives shall be composed of Members chosen every second Year by the People of the several States, and the Electors in each State shall have the Qualifications requisite for Electors of the most numerous Branch of the State Legislature. No Person shall be a Representative who shall not have attained to the Age of twenty five Years, and been seven Years a Citizen of the United States, and who shall not, when elected, be an Inhabitant of that State in which he shall be chosen. Representatives and direct Taxes shall be apportioned among the several States which may be included within this Union, according to their respective Numbers, which shall be determined by adding to the whole Number of free Persons, including those bound to Service for a Term of Years, and excluding Indians not taxed, three fifths of all other Persons [Modified by Amendment XIV]. The actual Enumeration shall be made within three Years after the first Meeting of the Congress of the United States, and within every subsequent Term of ten Years, in such Manner as they shall by Law direct. The Number of Representatives shall not exceed one for every thirty Thousand, but each State shall have at Least one Representative; and until such enumeration shall be made, the State of New Hampshire shall be entitled to chuse three, Massachusetts eight, RhodeIsland and Providence Plantations one, Connecticut five, NewYork six, New Jersey four, Pennsylvania eight, Delaware one, Maryland six, Virginia ten, North Carolina five, South Carolina five, and Georgia three. When vacancies happen in the Representation from any State, the Executive Authority thereof shall issue Writs of Election to fill such Vacancies. The House of Representatives shall chuse their Speaker and other Officers; and shall have the sole Power of Impeachment. Section. 3. The Senate of the United States shall be composed of two Senators from each State, chosen by the Legislature thereof [Modified by Amendment XVII], for six Years; and each Senator shall have one Vote. Immediately after they shall be assembled in Consequence of the first Election, they shall be divided as equally as may be into three Classes. The Seats of the Senators of the first Class shall be vacated at the Expiration of the second Year, of the second Class at the Expiration of the fourth Year, and of the third Class at the Expiration of the sixth Year, so that one third may be chosen every second Year; and if Vacancies happen by Resignation, or otherwise, during the Recess of the Legislature of any State, the Executive thereof may make temporary Appointments until the next Meeting of the Legislature, which shall then fill such Vacancies [Modified by Amendment XVII]. No Person shall be a Senator who shall not have attained to the Age of thirty Years, and been nine Years a Citizen of the United States, and who shall not, when elected, be an Inhabitant of that State for which he shall be chosen. The Vice President of the United States shall be President of the Senate, but shall have no Vote, unless they be equally divided. The Senate shall chuse their other Officers, and also a President pro tempore, in the Absence of the Vice President, or when he shall exercise the Office of President of the United States. The Senate shall have the sole Power to try all Impeachments. When sitting for that Purpose, they shall be on Oath or Affirmation. When the President of the United States is tried, the Chief Justice shall preside: And no Person shall be convicted without the Concurrence of two thirds of the Members present. Judgment in Cases of Impeachment shall not extend further than to removal from Office, and disqualification to hold and enjoy any Office of honor, Trust or Profit under the United States: but the Party convicted shall nevertheless be liable and subject to Indictment, Trial, Judgment and Punishment, according to Law. Section. 4. The Times, Places and Manner of holding Elections for Senators and Representatives, shall be prescribed in each State by the Legislature thereof; but the Congress may at any time by Law make or alter such Regulations, except as to the Places of chusing Senators. The Congress shall assemble at least once in every Year, and such Meeting shall be on the first Monday in December [Modified by Amendment XX], unless they shall by Law appoint a different Day. Section. 5. Each House shall be the Judge of the Elections, Returns and Qualifications of its own Members, and a Majority of each shall constitute a Quorum to do Business; but a smaller Number may adjourn from day to day, and may be authorized to compel the Attendance of absent Members, in such Manner, and under such Penalties as each House may provide. Each House may determine the Rules of its Proceedings, punish its Members for disorderly Behaviour, and, with the Concurrence of two thirds, expel a Member. Each House shall keep a Journal of its Proceedings, and from time to time publish the same, excepting such Parts as may in their Judgment require Secrecy; and the Yeas and Nays of the Members of either House on any question shall, at the Desire of one fifth of those Present, be entered on the Journal. Neither House, during the Session of Congress, shall, without the Consent of the other, adjourn for more than three days, nor to any other Place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by Law, and paid out of the Treasury of the United States. They shall in all Cases, except Treason, Felony and Breach of the Peace, be privileged from Arrest during their Attendance at the Session of their respective Houses, and in going to and returning from the same; and for any Speech or Debate in either House, they shall not be questioned in any other Place. No Senator or Representative shall, during the Time for which he was elected, be appointed to any civil Office under the Authority of the United States, which shall have been created, or the Emoluments whereof shall have been encreased during such time; and no Person holding any Office under the United States, shall be a Member of either House during his Continuance in Office. Section. 7. All Bills for raising Revenue shall originate in the House of Representatives; but the Senate may propose or concur with Amendments as on other Bills. Every Bill which shall have passed the House of Representatives and the Senate, shall, before it become a Law, be presented to the President of the United States; [2] If he approve he shall sign it, but if not he shall return it, with his Objections to that House in which it shall have originated, who shall enter the Objections at large on their Journal, and proceed to reconsider it. If after such Reconsideration two thirds of that House shall agree to pass the Bill, it shall be sent, together with the Objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a Law. But in all such Cases the Votes of both Houses shall be determined by yeas and Nays, and the Names of the Persons voting for and against the Bill shall be entered on the Journal of each House respectively. If any Bill shall not be returned by the President within ten Days (Sundays excepted) after it shall have been presented to him, the Same shall be a Law, in like Manner as if he had signed it, unless the Congress by their Adjournment prevent its Return, in which Case it shall not be a Law. Every Order, Resolution, or Vote to which the Concurrence of the Senate and House of Representatives may be necessary (except on a question of Adjournment) shall be presented to the President of the United States; and before the Same shall take Effect, shall be approved by him, or being disapproved by him, shall be repassed by two thirds of the Senate and House of Representatives, according to the Rules and Limitations prescribed in the Case of a Bill. Section. 8. The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States; To borrow Money on the credit of the United States; To regulate Commerce with foreign Nations, and among the several States, and with the Indian Tribes; To establish an uniform Rule of Naturalization, and uniform Laws on the subject of Bankruptcies throughout the United States; To coin Money, regulate the Value thereof, and of foreign Coin, and fix the Standard of Weights and Measures; To provide for the Punishment of counterfeiting the Securities and current Coin of the United States; To establish Post Offices and post Roads; To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries; To constitute Tribunals inferior to the supreme Court; To define and punish Piracies and Felonies committed on the high Seas, and Offences against the Law of Nations; To declare War, grant Letters of Marque and Reprisal, and make Rules concerning Captures on Land and Water; To raise and support Armies, but no Appropriation of Money to that Use shall be for a longer Term than two Years; To provide and maintain a Navy; To make Rules for the Government and Regulation of the land and naval Forces; To provide for calling forth the Militia to execute the Laws of the Union, suppress Insurrections and repel Invasions; To provide for organizing, arming, and disciplining, the Militia, and for governing such Part of them as may be employed in the Service of the United States, reserving to the States respectively, the Appointment of the Officers, and the Authority of training the Militia according to the discipline prescribed by Congress; To exercise exclusive Legislation in all Cases whatsoever, over such District (not exceeding ten Miles square) as may, by Cession of particular States, and the Acceptance of Congress, become the Seat of the Government of the United States, and to exercise like Authority over all Places purchased by the Consent of the Legislature of the State in which the Same shall be, for the Erection of Forts, Magazines, Arsenals, dockYards, and other needful Buildings; And To make all Laws which shall be necessary and proper for carrying into Execution the foregoing Powers, and all other Powers vested by this Constitution in the Government of the United States, or in any Department or Officer thereof. Section. 9. The Migration or Importation of such Persons as any of the States now existing shall think proper to admit, shall not be prohibited by the Congress prior to the Year one thousand eight hundred and eight, but a Tax or duty may be imposed on such Importation, not exceeding ten dollars for each Person. The Privilege of the Writ of Habeas Corpus shall not be suspended, unless when in Cases of Rebellion or Invasion the public Safety may require it. No Bill of Attainder or ex post facto Law shall be passed. No Capitation, or other direct, Tax shall be laid, unless in Proportion to the Census or Enumeration herein before directed to be taken. No Tax or Duty shall be laid on Articles exported from any State. No Preference shall be given by any Regulation of Commerce or Revenue to the Ports of one State over those of another; nor shall Vessels bound to, or from, one State, be obliged to enter, clear, or pay Duties in another. No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time. No Title of Nobility shall be granted by the United States: And no Person holding any Office of Profit or Trust under them, shall, without the Consent of the Congress, accept of any present, Emolument, Office, or Title, of any kind whatever, from any King, Prince, or foreign State. Section. 10. No State shall enter into any Treaty, Alliance, or Confederation; grant Letters of Marque and Reprisal; coin Money; emit Bills of Credit; make any Thing but gold and silver Coin a Tender in Payment of Debts; pass any Bill of Attainder, ex post facto Law, or Law impairing the Obligation of Contracts, or grant any Title of Nobility. No State shall, without the Consent of the Congress, lay any Imposts or Duties on Imports or Exports, except what may be absolutely necessary for executing it's inspection Laws; and the net Produce of all Duties and Imposts, laid by any State on Imports or Exports, shall be for the Use of the Treasury of the United States; and all such Laws shall be subject to the Revision and Controul of the Congress. No State shall, without the Consent of Congress, lay any Duty of Tonnage, keep Troops, or Ships of War in time of Peace, enter into any Agreement or Compact with another State, or with a foreign Power, or engage in War, unless actually invaded, or in such imminent Danger as will not admit of delay. Article. II. Section. 1. The executive Power shall be vested in a President of the United States of America. He shall hold his Office during the Term of four Years, and, together with the Vice President, chosen for the same Term, be elected, as follows: Each State shall appoint, in such Manner as the Legislature thereof may direct, a Number of Electors, equal to the whole Number of Senators and Representatives to which the State may be entitled in the Congress: but no Senator or Representative, or Person holding an Office of Trust or Profit under the United States, shall be appointed an Elector. The Electors shall meet in their respective States, and vote by Ballot for two Persons, of whom one at least shall not be an Inhabitant of the same State with themselves. And they shall make a List of all the Persons voted for, and of the Number of Votes for each; which List they shall sign and certify, and transmit sealed to the Seat of the Government of the United States, directed to the President of the Senate. The President of the Senate shall, in the Presence of the Senate and House of Representatives, open all the Certificates, and the Votes shall then be counted. The Person having the greatest Number of Votes shall be the President, if such Number be a Majority of the whole Number of Electors appointed; and if there be more than one who have such Majority, and have an equal Number of Votes, then the House of Representatives shall immediately chuse by Ballot one of them for President; and if no Person have a Majority, then from the five highest on the List the said House shall in like Manner chuse the President. But in chusing the President, the Votes shall be taken by States, the Representation from each State having one Vote; a quorum for this Purpose shall consist of a Member or Members from two thirds of the States, and a Majority of all the States shall be necessary to a Choice. In every Case, after the Choice of the President, the Person having the greatest Number of Votes of the Electors shall be the Vice President. But if there should remain two or more who have equal Votes, the Senate shall chuse from them by Ballot the Vice President [Modified by Amendment XII]. The Congress may determine the Time of chusing the Electors, and the Day on which they shall give their Votes; which Day shall be the same throughout the United States. No Person except a natural born Citizen, or a Citizen of the United States, at the time of the Adoption of this Constitution, shall be eligible to the Office of President; neither shall any Person be eligible to that Office who shall not have attained to the Age of thirty five Years, and been fourteen Years a Resident within the United States. In Case of the Removal of the President from Office, or of his Death, Resignation, or Inability to discharge the Powers and Duties of the said Office, the Same shall devolve on the Vice President, and the Congress may by Law provide for the Case of Removal, Death, Resignation or Inability, both of the President and Vice President, declaring what Officer shall then act as President, and such Officer shall act accordingly, until the Disability be removed, or a President shall be elected [Modified by Amendment XXV]. The President shall, at stated Times, receive for his Services, a Compensation, which shall neither be increased nor diminished during the Period for which he shall have been elected, and he shall not receive within that Period any other Emolument from the United States, or any of them. Before he enter on the Execution of his Office, he shall take the following Oath or Affirmation: "I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my Ability, preserve, protect and defend the Constitution of the United States." Section. 2. The President shall be Commander in Chief of the Army and Navy of the United States, and of the Militia of the several States, when called into the actual Service of the United States; he may require the Opinion, in writing, of the principal Officer in each of the executive Departments, upon any Subject relating to the Duties of their respective Offices, and he shall have Power to grant Reprieves and Pardons for Offences against the United States, except in Cases of Impeachment. He shall have Power, by and with the Advice and Consent of the Senate, to make Treaties, provided two thirds of the Senators present concur; and he shall nominate, and by and with the Advice and Consent of the Senate, shall appoint Ambassadors, other public Ministers and Consuls, Judges of the supreme Court, and all other Officers of the United States, whose Appointments are not herein otherwise provided for, and which shall be established by Law: but the Congress may by Law vest the Appointment of such inferior Officers, as they think proper, in the President alone, in the Courts of Law, or in the Heads of Departments. The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session. Section. 3. He shall from time to time give to the Congress Information of the State of the Union, and recommend to their Consideration such Measures as he shall judge necessary and expedient; he may, on extraordinary Occasions, convene both Houses, or either of them, and in Case of Disagreement between them, with Respect to the Time of Adjournment, he may adjourn them to such Time as he shall think proper; he shall receive Ambassadors and other public Ministers; he shall take Care that the Laws be faithfully executed, and shall Commission all the Officers of the United States. Section. 4. The President, Vice President and all civil Officers of the United States, shall be removed from Office on Impeachment for, and Conviction of, Treason, Bribery, or other high Crimes and Misdemeanors. Article. III. Section. 1. The judicial Power of the United States shall be vested in one supreme Court, and in such inferior Courts as the Congress may from time to time ordain and establish. The Judges, both of the supreme and inferior Courts, shall hold their Offices during good Behaviour, and shall, at stated Times, receive for their Services a Compensation, which shall not be diminished during their Continuance in Office. Section. 2. The judicial Power shall extend to all Cases, in Law and Equity, arising under this Constitution, the Laws of the United States, and Treaties made, or which shall be made, under their Authority; to all Cases affecting Ambassadors, other public Ministers and Consuls; to all Cases of admiralty and maritime Jurisdiction; to Controversies to which the United States shall be a Party; to Controversies between two or more States; between a State and Citizens of another State [Modified by Amendment XI]; between Citizens of different States; between Citizens of the same State claiming Lands under Grants of different States, and between a State, or the Citizens thereof, and foreign States, Citizens or Subjects. In all Cases affecting Ambassadors, other public Ministers and Consuls, and those in which a State shall be Party, the supreme Court shall have original Jurisdiction. In all the other Cases before mentioned, the supreme Court shall have appellate Jurisdiction, both as to Law and Fact, with such Exceptions, and under such Regulations as the Congress shall make. The Trial of all Crimes, except in Cases of Impeachment, shall be by Jury; and such Trial shall be held in the State where the said Crimes shall have been committed; but when not committed within any State, the Trial shall be at such Place or Places as the Congress may by Law have directed. Section. 3. Treason against the United States shall consist only in levying War against them, or in adhering to their Enemies, giving them Aid and Comfort. No Person shall be convicted of Treason unless on the Testimony of two Witnesses to the same overt Act, or on Confession in open Court. The Congress shall have Power to declare the Punishment of Treason, but no Attainder of Treason shall work Corruption of Blood, or Forfeiture except during the Life of the Person attainted. Article. IV. Section. 1. Full Faith and Credit shall be given in each State to the public Acts, Records, and judicial Proceedings of every other State. And the Congress may by general Laws prescribe the Manner in which such Acts, Records and Proceedings shall be proved, and the Effect thereof. Section. 2. The Citizens of each State shall be entitled to all Privileges and Immunities of Citizens in the several States. A Person charged in any State with Treason, Felony, or other Crime, who shall flee from Justice, and be found in another State, shall on Demand of the executive Authority of the State from which he fled, be delivered up, to be removed to the State having Jurisdiction of the Crime. No Person held to Service or Labour in one State, under the Laws thereof, escaping into another, shall, in Consequence of any Law or Regulation therein, be discharged from such Service or Labour, but shall be delivered up on Claim of the Party to whom such Service or Labour may be due [Modified by Amendment XIII]. Section. 3. New States may be admitted by the Congress into this Union; but no new State shall be formed or erected within the Jurisdiction of any other State; nor any State be formed by the Junction of two or more States, or Parts of States, without the Consent of the Legislatures of the States concerned as well as of the Congress. The Congress shall have Power to dispose of and make all needful Rules and Regulations respecting the Territory or other Property belonging to the United States; and nothing in this Constitution shall be so construed as to Prejudice any Claims of the United States, or of any particular State. Section. 4. The United States shall guarantee to every State in this Union a Republican Form of Government, and shall protect each of them against Invasion; and on Application of the Legislature, or of the Executive (when the Legislature cannot be convened), against domestic Violence. Article. V. The Congress, whenever two thirds of both Houses shall deem it necessary, shall propose Amendments to this Constitution, or, on the Application of the Legislatures of two thirds of the several States, shall call a Convention for proposing Amendments, which, in either Case, shall be valid to all Intents and Purposes, as Part of this Constitution, when ratified by the Legislatures of three fourths of the several States, or by Conventions in three fourths thereof, as the one or the other Mode of Ratification may be proposed by the Congress; Provided that no Amendment which may be made prior to the Year One thousand eight hundred and eight shall in any Manner affect the first and fourth Clauses in the Ninth Section of the first Article; and that no State, without its Consent, shall be deprived of its equal Suffrage in the Senate. Article. VI. All Debts contracted and Engagements entered into, before the Adoption of this Constitution, shall be as valid against the United States under this Constitution, as under the Confederation. This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding. The Senators and Representatives before mentioned, and the Members of the several State Legislatures, and all executive and judicial Officers, both of the United States and of the several States, shall be bound by Oath or Affirmation, to support this Constitution; but no religious Test shall ever be required as a Qualification to any Office or public Trust under the United States. Article. VII. The Ratification of the Conventions of nine States, shall be sufficient for the Establishment of this Constitution between the States so ratifying the Same. The Word, "the," being interlined between the seventh and eighth Lines of the first Page, The Word "Thirty" being partly written on an Erazure in the fifteenth Line of the first Page, The Words "is tried" being interlined between the thirty second and thirty third Lines of the first Page and the Word "the" being interlined between the forty third and forty fourth Lines of the second Page. Attest William Jackson Current Best Practices Coping with Major Criticai Incidents By DONALD C. SHEEHAN. GEORGE S. EVERLY, Jr., and ALAN LANGLIEB T he combined tragedies of September 11,2001, have merged into a significant American generational marker not experienced since the assassination of President John F. Kennedy. Nowhere have the cascading consequences of these watershed events impacted more than on the law enforcement profession. Critical incidents are a recognized part of the law enforcement experience. After ail. it is a high-risk profession. Normally, critieal ineidents occur on a small scale, affect only a few people, and cause only short-term burdens on existing organizational resources. The events related to September 11th, however, clearly deviated from the nonn. Proteeting human resources within law enforcement always has been a challenge, but critical incidents, such as those Charles E. Greer experienced on September I 1th, pose extraordinary difficulties requiring extreme responses. From such adversities invariably come innovations, lessons learned, and. ultimately, even greater response capabilities. Reviewing the evolving practices of uniquely experienced organizations, commonly referred to as an analysis of best practices, can prove informative. Therefore, the authors have undertaken such an analysis of September 2004 / 1 Compiling Authors Donald C. Sheehan. George S. Everly. Jr., and Alan Langlleb, from the law enforcement and academic communities of the FBI. Loyola College in Maryland, and Johns Hopkins University, formed an ailiance with the contributing authors to honor the valiant law enforcement professionals who gave their lives in the performance of their duties during the terrorist attacks of September 11. 2001. and to offer assistanoe to those who survived, yet carry not only the physical scars but the psychological traumas as welt. Contributing Authors Ralph Biase. U.S. Secret Service Cherle Castellano. Cop 2 Cop and World Trade Center Rescuer Support Victim Program Bill Genet, Gene Moynihan. and Frank Dowling. New York City Police Organization Providing Peer Assistance Mike Haley. National Fraternal Order of Police Jim Horn and Kathy Thomas. Oklahoma City Critical Incident Project Laura Kelso. U.S. Marshals Service Jeffrey Lating, Loyola College. Baltimore, Maryland Gail London, Paul Susenbach. Cindy Newbern. Pat Joyner. and Sartaj Khan. Federal Law Enforcement Training Center. Department of Homeland Security Alexandra Mahr. Bureau of Alcohol. Tobacco, Firearms, and Explosives James Nestor, New Jersey Attorney General's Office and State Police Researcfi and Coordinating Assistance Heidi Joseph and Julia Finkel. Johns Hopkins University, Baltimore. Maryland some of America's uniquely experienced law enforcement organizations regarding their ongoing efforts to assist their personnel in coping with critical incidents, both small and large scale. As the first sui'vey of its kind, this may represent a significant contribution to the profession. BACKGROUND The practice of providing critical incident stress management and support services to law enforcement personnel has a rich history, but the origins of such assistance actually can be traeed to the militai'y. Wars and conflicts have punctuated this countiy's history since its inception. 2 / FBI Law Enforcement Bulletin Technological advances in weaponiy beginning with the Civil War produced causalities of a type and seale previously not experienced by medical personnel. Out of sheer necessity in the face of incredible, large-scale suffering, they had to add newly constructed intervention principles to traditional treatment practices. In time, the recognition of the importance of immediate intci'vention led to the assimilation of corpsmen and medics into combat units. During the Korean Conflict, the militaiy moved medieal units foiAvard to gain proximity to the battlefields. Hard-won experience produced expeetancy about the types of injuries that medical personnel could treat successfully. By the time the anned forces were engaged in Vietnam, their medical units had instituted triage as a standard practiee that systematically assigned a priority to the treatment of the wounded based on sueh factors as urgent need, the chance of survival, and the amount of resources available. What affects the mind affects the body, and what affects the body affects the mind.' The two are inextricably intertwined and cannot be separated. The shell shock of World War I and the combat fatigue of World War 11 proved Just as potentially debilitating to soldiers as many of their physical wounds. The military discovered that the principles established for treating physical traumas also applied to treating psychological ones. "Nothing could be more striking than the comparison between the cases treated near the front and those treated far behind the lines.... As soon as treatment near the front became possible, symptoms disappeared...with the result that 60 percent with a diagnosis of psyehoneurosis were returned to duty from the field hospital. War neuroses... could be controlled by scientific management, rather than allowing nature to take its course."' "Those on field duty found it to be most advantageous to the soldier, and to the amiy, to recognize exhaustion and the fear but not to remove the soldier to the rear.... By and large, the prognosis...varies direetly with the time factor...the great issue...is not to permit the syndrome to beeome entrenched... the most effective implement is to keep alive the [causal] relation between the symptoms and the traumatic event."^ These military observations became concretized as the three pillars of crisis intervention: proximity (the ability lo provide psychological support wherever needed in the field), immediacy (the ability to provide rapid support), and expectancy (viewing adverse reactions to critical incidents as basically normal reactions of extreme stress and not as pathologieal reactions). The three became known collectively as the P.I.E. Principle"* and formed the historical foundation of crisis intcr\\ention not only for the military but also for law cnforeement. The type of trauma experienced by soldiers in combat is quite similar to that endured by law enforcement officers. In short, the law cnforeement profession adopted the best practices of the military. METHOD The application of best practices can be a highly effective way to deal with complex problems. Law enforcement professionals do not have the luxury of sitting back and theorizing when confronted with catastrophes. They usually have to act immediately to establish public order in the wake of the disorder caused by targe-scale critical incidents. Practical, logistical, and time constraints make it difficult to conduct the randomized controlled trial, which is the gold standard researchers use to compare the effectiveness of intervention. Therefore, eopying Law enforcement professionals do not have the luxury of sitting back and theorizing when confronted with catastrophes. the successful tactics of other agencies that have dealt with similar problems beeomes an effective and efficient strategy. It saves valuable time and resources at the most critical point, the immediate aftermath of an ineident. !n recognition of this concept. Dr. Everly initiated a survey in the spring of 2003 to aseertain what various law enforcement agencies and organizations have done to support their personnel during extraordinary critical incidents. Sadly. New York. New Jersey. Washington. DC, and Pennsylvania were not the only locations affected by mass crisis. The jarring hoiTor of losing so many children in Waeo. Texas, and Oklahoma City. Oklahoma, stand as equally traumatie events. Regardless of geographic location or size, all law enforcement agencies face potential, large-scale incidents. SURVEY PARTICIPANTS The authors included 11 organizations based on accrued unique experience responding to the psychological demands associated with extraordinary critical incidents and mass disasters. They consulted federal, state, and city organizations to provide a balanced perspeefive for dealing with eatastrophic events and obtained information from interviews with program directors and from written descriptions. Many of these programs not only arc innovative but represent prime exemplars of a structured response to the unique psychological needs of those in the law enforeement profession. Bureau of Alcohol, Tobacco, Eirearms, and Explosives The Bureau of Alcohol. Tobacco, Firearms, and Explosives (ATF) initiated its Peer Support/Critical Ineident Stress Management Program in 1989 September 2004 / 3 out of concern for special agents involved in shootings and other critical incidents. Administered via the Office of the Ombudsman, a program manager, who is a mental health clinician, provides clinical oversight. The ATF program serves all 6,000 employees and their families, as well as state and local law enforcement partners who represent 25 to 30 percent of the program workload. The ATF Peer Support Program has four components: peer responders. mental health professionals, chaplains, and trainers. The 43 peer support personnel are not counselors but special agents, inspectors, and other key personnel with over 60 hours of specialized training. Mental health providers make referrals to the agency's employee assistance personnel or to cornmunity resources as necessary. Sixty chaplains provide spiritual support and critical incident stress management interventions. ATF professional development personnel conduct related training. ATF uses a comprehensive, multicomponcnt critical incident stress management model that includes preincidcnt education, assessment of need and management consultations, individual peer support, largegroup crisis intervention, family support services, small-group crisis intervention, chaplain or pastoral care sen'iees, referral 4 / FBI Law Enforcement Bulletin and follow up, and debrief-thedebriefer sessions. Based on the specifies of a particular incident, ATF has tailored its intervention plan to reach and accommodate those directly or indirectly impacted by a critical incident. Cop 2 Cop Cop 2 Cop serves 40,000 law enforcement officers, plus family members, in the New Jersey Port Authority Police, New York State Police, and the Reviewing the evolving practices of uniquely experienced organizations, commonly referred to as an analysis of best practices, can prove informative. New Jersey Urban Search and Rescue Unit. Established in 1998, it became fully operational on November 1, 2000, through the use of a widely circulated, toll-free telephone ntimber (1-866-COP-2COP). The staff consists of 4 retired clinicians with experience treating law enforcement officers, 4 mental health specialists, and 48 retired law enforcement officers who voluntarily answer the telephone hotline. Following the teiTorist attacks. Cop 2 Cop's role expanded to include all New Jersey firefighters and emergency medical service personnel. The program also provided intervention services to Secret Service and FBI agents residing in New Jersey. In the aftermath of September 11th, the program initiated actite traumatic stress leadership training and implemented a unique large-group "reentry program." Cop 2 Cop employs an integrated, multieomponent emergency mental health continuum-of-care approacb, including telephone hotlines, one-on-one crisis intervention, telephone assessments, group crisis intervention, and referrals to mental health resources. Since its inception, the program has received over 9,000 telephone ealls and has conducted more than 450 critical incident stress management interventions. FBI The FBI uses a two-pronged approach in delivering stress management ser\\ ices to approximately 28,000 employees and their families. The FBI Academy emphasizes training and research. It teaehes stress management; examines stressrelated issues, such as domestic violence and suicide/ in televised forums and publications; and is developing an early watning tool for detecting excessive stress reactions by law enforcement officers.'^ The FBTs Employee Assistance Unit, consisting of several mental health professionals and support personnel, became selfcontained in 1993. It coordinates delivery of four primary services and represents an integrated, multicomponcnt continuum-of-care model, including preineident training, assessment, triage, individual crisis intervention, small-group crisis intervention, psycho-educational seminars, family support services, and chaplain referrals. Specifically, 300 coordinators, positioned throughout the organization, provide assessment, short-tenTi cotinseling, and referrals to employees experiencing a wide range of problems. Critical incident stress managementa peerbased, small-group crisis interventionoccurs subsequent to exposure to critical incidents. Peer support/post-critical incident seminars (residential group psycho-educational interventions) follow significant critical incidents, such as shootings and mass disasters. These last up to 4 days and began in 1983 in response to agent-involved shooting incidents. Over 100 experienced volunteer cbaplains provide pastoral counseling, family suppoit. death/bereavement services, and individual or small-group crisis intervention. Federal Law Enforcement Training Center The Office of Critieal Incident Stress Management, Federal Law Enforcement Training Center (FLETC), Department of Homeland Security supports 40,000 students from approximately 76 federal law enforcement agencies each year. It also serves continuum witb specific services, including precrisis education/inoculation; individual, team, mental health practice, and community basic and advanced training: triage/ assessment/referral for initial/ follow-up treatment; individual peer support; small- or largegroup defusing; small-group debriefing or demobilization; individtial traumatic stress reduction management; pastoral/bereavement counseling; employee assistance services; and a wellness program. National Fraternal Order of Police The National Fraternal Order of Police (FOP) originally established its Critical Incident Committee in 1996. But, in 2001, it reformulated this entity as the Critical Incident Stress Management Program to provide affected emergency sei"viee workers with services that mitigated or lessened the impact Mark C. Ida of tbe effects of critical incident stress and accelerated the permanent and detailed staff, recovery following a traumatic participating organizational event. FOP designed the propersonnel, employees, contractors, visitors, and their families. gram to prevent or mitigate the FLETC formally established adverse psychological reactions that so often accompany emerits Critical Incident Stress gency services, public safety, Management and Peer Support and disaster response functions. Program in 1999. Eight teams, Interventions in this program comprised of 50 employees, provide services throughout the are directed toward the mitigation of post-traumatic stress United States and abroad. The center integrates a mul- reactions. Fundamental to the FOP approach is a philosophy tidisciplinary standard-of-care September 2004 / 5 and a belief in the importance and value of the human response, especially within the occupation of law enforcement. Key serviees include consultation to local law enforcement, critical incident education programs, development of a national law enforcement emergency response strike team to assist wherever needed, and the establishment of a central repository for available law enforcement critical incident stress management programs nationwide. FOP uses an integrated, multicomponent crisis intervention system that ineludes precrisis education seminars, individual crisis intervention services, group crisis interventions, demobilizations, defusings. debriefings. ehaplain services, family interventions, organizational consultation, follow-up resources, and referral to formal mental health services as indicated. New Jersey Attorney GeneraPs Office and State Police Established in 2003, New Jersey's Critical Incident Stress Response Program functions within a preexisting employee assistance program. In addition to traditional services, it sponsors a unique command staff leadership series that covers ethics-based leadership, law enforcement family dynamics, terrorism, and psychological 6 / FBI Law Enforcement Bulletin counterterrorism. The New Jersey model offers an integrated, multicomponent crisis intervention system with a full spectrum of employee assistance services. New York City: Police Organization Providing Peer Assistance In 1994 and 1995, the 26 police officer suicides generated grave concerns throughout New York City. In response to this ...copying the successful tactics of other agencies that have dealt with similar problems becomes an effective and efficient strategy. alanning phenomenon, the city created the Police Organization Providing Peer Assistance (POPPA), an autonomous, independent, confidential, and voluntary police assistance ageney. Volunteer peer support personnel received training in crisis intervention and critical incident stress management and began staffmg a 24-hour hotline in March 199^6. Currently, POPPA has an administrative staff consisting of a director, clinical director. peer liaison, consulting staff, and a case manager; a clinical panel of over 120 psychologists, psychiatrists, social workers, and addictions counselors trained and motivated to work with police officers; and 180 peer support officers. Available at all times, these individuals meet with distressed officers in neutral, private locations. They provide referrals only at face-toface meetings. All meetings, referrals, and subsequent treatment remain strietly confidential Since 1996, over 6,500 face-to-face meetings have taken place. POPPA uses an integrated, muiticomponent critical incident stress management intervention system adapted to best meet the needs of law enforeement personnel and the unique demands of each specific critical incident. It operates on the basis of a self-referral system. POPPA key interventions include assessment, triage, individual crisis intervention, demobilizations (large-group crisis intervention), defusings (small-group crisis intervention), debriefings (small-group format), and referral to subsequent psyehological support if required. Oklahoma City: Critical Incident Workshops The April 19, 1995, terrorist bombing in Oklahoma City precipitated a series of critical incident workshops. Estimates indicated that 20 percent ot the 12,384 rescue personnel involved would require some fomi of mental health care. As of October 2002. over 750 rescue personnel, survivors, volunteers, and family members have received direct service from 70 workshops, which use an intensive 4-day fonnat. Intervention teams consist of a facilitator, psychologist, chaplain, and a trained crisis intenention peer support individual. Workshops use key interventions, such as individual crisis intervention, small-group critical incident stress debriefing, family support, education, chaplain/pastoral services, referrals, and follow-up care. The workshops offer eye movement desensitization and reprocessing (EMDR), a highly controversial but effective technique, as an optional treatment. intervention continuum-ofcare approach consisting of assessment, triage, individual crisis intervention, small-group crisis intervention (defusings and debriefings). large-group crisis intervention, organizational development, family intervention services, and referral to psychotherapeutic resources. U.S. Marshals Service In 1991, the U.S. Marshals Service (USMS) initiated its Critical Incident Response Team (CIRT). Staffed by 3 mental health professionals and 51 peer support personnel, CIRT extends services to over 4.200 employees and their family members. Incident-specific response teams consist of an employee assistance representative and one or two peer support marshals. USMS uses an integrated, multicomponent U.S. Secret Service The U.S. Secret Service (USSS) implemented its Critical Incident Peer Support Team in 1985. Administered from its Employee Assistance Program (EAP), the peer support team has expanded to include agents, uniformed officers, and administrative support staff It includes 4 EAP counselors and 86 peer support personnel, who reeeive specialized training in crisis intervention and critical incident debriefmgs. Designated peer support counselors assist EAP counselors with precrisis education seminars for new agents and unifonned officers. Field intervention teams consist of an EAP counselor and one or two peer support personnel. USSS uses an integrated, multicomponent intervention approaeh consisting of assessment, triage, individual crisis intervention, small-group debriefings, precrisis education seminars, family intervention services, follow-up resources, and referral to mental health professionals as needed. World Trade Center Rescuer Support Victim Program Beeause first responders eomprised approximately 400 ofthe 2,800 victims of the September 11th disasters, this program began in 2002 to serve law enforcement, fu'efighters. September 2004 / 7 and emergency medical personnel. It has three primary components: 1) crisis intervention hotline help. 2) crisis intervention training programs, and 3) clinical intervention services. On a pro bono basis, the program provides peer counseling, individual crisis intervention, and individual therapy and uses a structured, six-session, group treatment model The program's main purpose is to give voice to the rescuers. The conceptual framework includes partnership with management, establishment of funding, consultation of nationally recognized experts, collaboration with clinicians, use of peer support, and reliance on logistical and planning flexibility. KEY FINDINGS Five best practices emerged from the many practical, empirically field-tested strategies used to deal with large-scale critical incidents. They almost are universal, and agencies should eonsider them in any organizational approach to effective critical incident stress management. Early Intervention The survey revealed that the law enforcement agencies sampled recognized the value of early psychologieal intervention for those officers responding to critical incidents. This echoed earlier military experience 8 / FBI Law Enforcement Bulletin regarding the importance of immediate intervention in treating physical and psychological wounds. Complete Care All ofthe organizations sampled recommended the use of a phase-sensitive, multicomponent crisis intervention system as part of an overall eontinuum of care. Such a system underscores the necessity of employing strategic planning prior to implementation. mental health (for both peer interventionists, as well as mental health clinicians) prior to implementing such programs. Well-meaning intentions are not enough. Officers exposed to traumatic events need focused assistance by trained practitioners at all levels of care, ranging from hotline assistance to therapeutic treatment. Peer Support Each participant emphasized the importance of peer support and saw it as a virtual imperative to a successful law enforcement program. Consistent with this tactical formulation, not one ofthe organizations viewed crisis intervention as psychotherapy nor as a substitute for it. Tactical Intervention Tactical interventions, in most programs, included the ability to perform one-on-one small- and large-group crisis interventions and family support services, as well as the ability to access spiritual support assistance and treatment resources. The word tactical refers to adroit maneuvering used to achieve a desired objeetive. The military connotation is highly appropriate in any diseussion of psychological trauma induced by critical incidents. Much ofthe psychological assistance given to publie safety and emergency personnel in the domestic terrorism of Oklahoma City and in the international terrorism of New York City was based on lessons learned during conventional wars. Specialized Training All ofthe organizations acknowledged the importance of receiving specialized training in crisis intervention/emergency CORE COMPETENCIES Five core competeneies appeared as features of a best practices model. These elements offer law enforcement agencies The key to optimizing existing programs is to focus on preincident strategies. an effective way to help their personnel deal with critical incidents. Assessment and Triage Agencies need to rapidly evaluate affected officers and provide them with assistance consistent with the resources at hand. Integra! to the process of assessment, however, is knowing when not to interfere with natural coping mechanisms. Simply said, law enforcement often can be a stressful profession, but formal crisis intervention always should yield to the individual's natural coping mechanisms and resources as long as these function effectively. Crisis Intervention with Individuals Officers differ in their responses, and their agencies must remember that mass critical incident care is not a onesize-fits-all proposition. Crisis intervention skills applied to one individual at a time (faceto-face or telephonieally) represent the bedrock of all emergency mental health techniques and always begin with the assessment of their suitability. Small-Group Crisis Intervention Peers supporting each other in a group setting can be highly effective and efficient. The small-group crisis intervention format (e.g., debrietmgs) can be a useful intervention mechanism.^ Care must be taken, however, to ensure that vicarious traumatization docs not occur. This is best achieved by using homogeneous functional groups of individuals who have experieneed the same level of psychological toxicity via their exposure. Similarly, care must Ronald Jeffers be taken so as not to encourage exeessive ventilation, coercive group pressure, or seapegoating (targeting individuals or organizational policy). Large-Group Crisis Intervention A town meeting provides another way for people to process the tumultuous events engulfing them. Typieally employed with large groups, this type of crisis intervention is largely a psycho-educational process designed to enhance cohesion, control rumors. improve self-assessment, and make individuals aware of coping techniques and resources.'' Agencies may apply this method many different ways, including in the format of roll call. Strategic Planning "The process is strategic because it involves preparing the best way to respond to the circumstances of the organization's environment, whether or not its eireumstances are known in advance.... The process is about planning because it involves intentionally setting goals...and developing an approach to achieving those goals."'' Thus, strategic planning allows operational planners to best combine and sequence multiple interventions within an integrated Incident Command System. All strategic planning, as well as tactical intervention, must be predicated upon ongoing assessment. FUTURE DIRECTIONS Large-scale eritical incidents spring from all manner of causes. Some result from upheaval and disruption of the natural order. The air, earth, fire, and water that normally sustain people become the hurricanes, earthquakes, wildfires, and floods that destroy them. Other major critical incidents result from human September 2004 / 9 activity, such as war and terrorism. Both types of critical incidents impact everyone. No group is more affected than those who impose order upon the chaos resulting from major critical incidents. In response to the acute mental health needs of those in crisis, the field of crisis intervention was bom. The majority of law enforcement officers exposed to a traumatic event will not need formal psychological intervention, but that does not negate the obligation to respond to the needs of those who will require acute psychological support. Information regarding critical incidents, common reactions, and sources of support could benefit everyone. An observation about firefighters applies equally well to law enforeement officers. "In all the controversy, crificism, and research debate on the merits of debriefing [i.e., early psychological intervenfion], certain constants are emerging. The most effective methods for mitigating the effects of exposure to trauma... those, which will help keep our people healthy and in service, are those, which use early intervenfion, are multimoda! and multieomponent. That is. they use different 'active ingredients'..., and these components are used at the appropriate time with the right target group/ 'HI 10 / FBI Law Enforcement Bulletin Most of the emphasis of existing programs is on managing the reacfions to mass critical incidents after they occur. This direct approach, while practical and goal oriented, does not encompass the full range of options available. The key to optimizing existing programs is to foeus on preincident strategies. u No group is more affected than those who impose order upon the chaos resuiting from major critical incidents. Preincident Training The study of the current and historical military response to psychological trautna has become quite useful in developing an effective and efficient law enforcement model for mass critical incident stress management. For example, a British military psychiatrist and his colleagues found that debriefing techniques even reduced alcohol use after stressful assignments." However, one lesson remains from the military that the law enforcement profession has not sufficiently incorporated into its programs, the principle of expectancy. Two Israeli psyehologists investigated roles of immediacy, proximity, and expectancy.'- Results indicated that all three early intervention principles contributed to therapeutic outcome, with expectancy supplying the most to posifive outcome. As earlier research noted, to a significant degree, the soldier's expectation of outcome predicted recovery from war neurosis.^^ The military experience demonstrated that the law enforcement profession must do a better job of managing the expectations of officers to ensure their psychological well-being after a major critical incident. To illustrate the apparent importance of expectation management for new and experienced law enforcement professionals, the authors present some real-life examples. Approximately every 2 weeks, 50 agent trainees arrive at the FBI Academy on a Sunday afternoon. On the following Wednesday morning, they are issued the handguns they will carry throughout their law enforcement careers. For 5 years, on the afternoon after they received their weapons, Special Agent Sheehan taught the trainees a block of instruction called Stress Management in Law Enforcement. He always started the 7-hour course by asking how many of them would be surprised if they actually had to use their service weapon. Virtually everyone said it would be a surprise. He then would point out some hard facts. First, while at the academy, they will fire thousands of rounds until they can quickly and accurately fire 50 rounds at targets 25 to 5 yards away. Next, they must qualify with a minimum score of 80 percent four times a year during their employment. Also, every day that they are on duty for those 20 to 30 years, they will have to carry their weapon. In addition, every year, the FBI holds critical incident seminars, and many agents who are shooters or shootees attend. Following a shooting, approximately 79 percent of involved officers have reported time distortion and 52 percent have indicated memory loss for part of the event.'^ And, finally, estimates have indicated that the career of a law enforcement officer is shortened significantly after a shooting incident. Under these circumstances, new employees need to change their expectations about what could happen to them. to address the Association of Chief Police Officers of England, Scotland, Wales, and Northern Ireland about violence in the United States. He asked these experienced and highly accomplished officers what shocked them the most about the events that had occurred at Columbine High School in Colorado. Their answers ranged from gun violence to sudden death. They were partially right, of course, but, in the authors' view, the aspect that ultimately bothers most people about that event was the brutal violation of what their expectation of the school experience should be. Children should be able to go to school in safety without the fear of immediate death. Everyone has expectations. Sometimes, these get violated. In the law enforcement profession, expectations can be destroyed in an abrupt and massive way. In an era of incipient terrorism, agencies must provide proactive training. In 2003, the Institute of Medicine stated, "The committee finds that terrorism and the threat of terrorism will have psychological consequences for a major portion of the population, not merely a small minority.... The stress associated with the direct impact and lingering threat of terrorism raises obvious psychological concerns, particularly for...first responders...."'^ Conducting more preincident education offers the best way to change expectations. Some training is taking place, but not enough. For example, although the FBI provides agent This change in expectations is necessary for the more experienced members of the law enforcement community as well. Several years ago. Special Agent Sheehan went to Belfast, Northern Ireland, at the request of the Royal Irish Constabulary September 2004 / 1 1 trainees with some preincident training, it offers no such regularly scheduled training for journeymen agents in the field. Even flu vaccines are administered on a yearly basis. Critical incident education provides one of the best inoculations available to law enforcement officers facing toxic situations. If they expect something, they are better able to cope with it. The military has firmly established that expectation management saves lives. Universally, the law enforcement community must do a more thorough job of creating realistic expectations through preincident training. Early Warning Screening People differ in their responses to critical incidents. Some officers adjust rapidly, whereas others adapt gradually. A small number adjust poorly and develop an extreme reaction called post-traumatic stress disorder (PTSD). A 2002 study revealed that 13 percent of rescue personnel developed PTSD,"' a significantly higher rate than the I to 3 percent in the general population. This suggested that rescue workers, like law enforcement officers, face elevated risk due to increased exposure to traumatic events. According to the military principle of immediacy, these people need to be identified early. Immediate identification of acute problems allows 12 / FBI Law Enforcement Bulletin for the mobilization of higherordered interventions, which work best before problems become habitual and fully assimilated.'^ Training peers and managers to recognize the first signs of maladaptive responses must occur. When managing critical incident stress, law enforcement agencies need to remember that the sooner they intervene, the better. The type of trauma experienced by soidiers in combat is quite simiiar to that endured by iaw enforcement officers. CONCLUSION A number of occupations are at high risk for psychological distress and morbidity. Law enforcement constitutes one such profession. The corpses of fellow citizens, the ruins of buildings, and the wreckage of all types of conveyances scorch the senses and poison the memories of law enforcement officers. If society exposes them to these harsh aspects of life, it is morally bound to give them the best possible psychological support. Current stateof-the-art early psychological intervention programs within the law enforcement profession emphasize post-incident intervention. Expansion of early intervention services to include precrisis expectation training and early warning screening could move existing programs to the cutting edge of mass critical incident management. No agency has created a perfeet model, but a number of organizations have developed workable programs for dealing with acutely stressful events. Regardless of the size of the department, the men and women who have dedicated themselves to protecting their communities will benefit from adopting these best practices. - The authors offer a special thanks to the survey contributors who made this article possible. Law enforcement officers in their respective organizations benefit from the daily efforts of these dedicated professionals. Now. because of their wiilingness to share such hard-won experience, ail law enforcement officers and their supporters can benefit as weli. End notes G. S. Everly, Jr and J. M. Lating, A Clinical Guide lo the Treatment of the Human Stress Response (New York, NY: Kluwer/Plenum. 2002): and D,C Shechan. "Stress Managemenl in the Federal Bureau of Investigation: Principles for Program Development," International Journal of Emergency Mental Health 1 (1999): 39-42. ' T. S. Salmon, "War Neuroses and Their Lesson," A'ew York Medical Journal 108(1919): 993-994. ^ A. Kardiner, "The Traumatic Neuroses of War," P.sycho.somalic Medicine Monographs 11 ( 1 9 4 1 ) : 1 1 - 1 1 1 . K. Artiss, "Human Behavior Under Stress: From Combat to Social Psychiatry," Mililan- Medicine 128 (1963): 1011-1015. D.C. Sheehan. ed., U.S. Department of Justice, Federal Bureau of Investigation. Domestic Violence by Police Officers (Washington. DC, 2000); and D.C. Sheehan and .I.J. Warren, eds.. U.S. Department of Justice, Federal Bureau of Investigation, Suicide and Law Enforcement (Washington, DC, 2001). ' For additional infomiation, see D.C. Sheehan and V.B. Van Hasselt. "Identifying Law Enforcement Stress Reactions Early," FBI Law Enforcement Bulletin, September 2003, 12-17. ' M. Arendt and E. Elklit. "Effectiveness of Psychological Debrietlng." Acta Psychiatrica Scandinavica 104 (2001): 423-437; A Dyregrov, "Psychological Debriefmg: An Effective Method?" Traiimatoloy vol. 4, issue 2 (1998). see http://www.fsu.edu/~-trauma: and M. Deahl, M. Srinivasan. N. Jones, J. Thomas, C. Neblett, and A. Jolly, "Preventing Psychological Trauma in Soldiers: The Role of Operational Stress Training and Psychological Debriefmg," British Journal of Medical Psychology 73 (2000): 77-85. ^ G.S. Everly, Jr.. "Crisis Management Brietings." International Journal of Emergency Mental Health 2 (2000): 53-57. ^ "What Is Strategic Planning'?"; retrieved on April 6, 2004, from http:// www. nonprofit^, org/npofaq/03/22. html. '" H. Duggan. International Association of Fire Chiefs, "CISM at the World Trade Center: Lessons Learned." LAFC On Scene, January 2002; retrieved on April 7. 2004. from hnp://www.iafc.org. " M. Deahl, M. Srinivasan,