CCN’s U.S. Military SURGE Team responds to U.S. Military installations in the U.S. and overseas. The team serves U.S. Military members, their families and others responding to a critical incident on a U.S. Military base.

Specialists serving on U.S. Military SURGE Team must:

• Complete a CCN Network Specialist Application
• Have a Masters or Doctoral degree in a mental health field
• Maintain licensure and/or certification to practice independently in her/his state
• Maintain $1 million/$3 million in professional liability insurance
• Complete CCN’s Online Best Practices Program
• Complete training in a phasic, multi-component approach to critical incident response or psychological first aid such as that provided by CCN, the Red Cross, the ICISF, and, or FEMA. Other related trainings may be considered on an individual basis
• Complete a one-hour, web-based SURGE specific training
• Possess a valid U.S. passport
• Maintain vaccinations (MMR, DPT and Hepatitis B) as directed by physician
• Submit a Medical Waiver signed by attending physician to verify physical readiness to respond

To access applications and other documents related to service on CCN’s SURGE Team, click on the corresponding resource link below. Depending on the type of resource accessed this link may connect to a PowerPoint file, a website for online training, or a PDF document that can be saved and printed.

Unless directed otherwise, applications and forms may be printed, completed and returned as needed via fax to CCN Network Development at 616-257-3515.

Specialist Application
All specialists serving on the SURGE Team must have a completed CCN Specialist application on file. This is CCN’s standard network provider application and it need not be completed for each CCN specialty network the provider serves on. If it has already been completed and is on file it need not be completed or submitted again.

Medical Waiver
All specialists serving on the SURGE Team must have this form signed by their doctor attesting that the specialist does not have any physical limitations that would interfere with his or her ability to provide onsite crisis response services in a physically challenging environment such as a large scale disaster area. Note: This document must be signed by the CCN specialist and mailed directly (not faxed or e-mailed) to Crisis Care Network.

Specialist SURGE Contract
All specialists serving on the SURGE Team must sign and return this contract in advance of deployment in order to be classified as ready to respond.