Would like to share a couple of thing on this topic. Been involved in some pretty ugly stuff throughout my 10 years with CFS and 8 with SAAS. Couple of standout things have been cutting an girlfriend out of her car after she hit a tree headon. Probably the worst though was driving an Ambulance on a priority 1 case through a green light intersection and having a p plate driver turn in front of us and t boning the other car at 80 kmph. All 3 occupant of that car ended up critically injured, but surviving.
It took me about 6 months after my work accident to decide to talk to someone, but in that 6 months thing certainly were rough! Can't recommend Jill Scott enough!
What we see and deal with is undoubtably stressful. Property loss, Loss of life, injured animals, the list can go on. They way that people deal with this stress is a very individual thing. It's often not the big bad incident that causes people to break at the edges, but the small incident that remiind them of something they've seen, smelt, heard, etc.
I think SPAM or CISD has a place, but no one at any stage should be forced to be involved. I often find it harder to deal with a CISD than dealing with the incident itself. I often think the best debrief for a crew is the informal chat in the truck on your way back to the station or whilst cleaning up at the station with a coffee. In the SAAS world the often long chat that you see the guys and girls in green having at hospital is a similar event. First and foremost though, you've got to have a sense of humour...