Within a few minutes of the 911 call that sent police to the scene of the shooting rampage in Tucson, Ariz., that left six dead and 13 wounded, responders from the first-due Northwest Fire District also were on-scene.

Four engines and four rescues immediately responded to the scene and established triage. “We had 18 patients on the scene,” Chief Jeff Piechura said. “Five were deceased on the scene. We transported 13 victims, all within 40 minutes.”

As the rescue efforts started to slow down, a team trained in crisis management began de-briefing efforts and later initiated critical incident stress management sessions in the stations. Piechura added that this week, the CISM teams would start working with the families of the responders.

The Northwest Fire District’s Critical Incident Stress Management team was started in the mid-90s and has grown into a well-coordinated and established CISM program, according to Piechura. Besides Northwest Fire District and Tucson Fire, multiple agencies are part of the CISM program, including the border patrol, sheriff’s department, clergy and schools.