First Responder Involved Critical Incident Services Request

Small first responder agencies may request critical incidents resources from DPS and its provider within 48 hours of the incident for individuals directly involved in a critical incident. The mental health resources may include an assessment and availability to two (2) additional mental health services for personnel directly involved in a critical incident.

This service is for an incident involving the death or serious bodily injury of a first responder or other person(s) during the course of a first responder performing their official duties.

Small first responder agencies are described as having 10 or fewer employees; or are primarily staffed by volunteers; or are located in a county or municipality of the third, fourth, fifth, or sixth class, or a town.

Also contact Critical Incident Stress Management (CISM) for group support.

Directions: Enter the name and information for each first responder who was directly involved in a critical incident (include yourself if appropriate). A mental health provider will contact each first responder within 48 hours of the submission of this form.

    Incident(s) Involved In (Click all that apply)


    Please add the first responders who were directly involved below. To add additional first responders, please select the check box "Add another First Responder."

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