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How one ED mobilized his department during a mass casualty incident (2017)

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Re: How one ED mobilized his department during a mass casualty incident (2017)

#91

Post by lazyasciiart »

roughly wrote: post #71
biofox wrote: post #5

The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.

I think a key here is recognizing when the expected result is catastrophe and acting accordingly. There's a whole lot of procedures in the hospital that are designed for normal times and are _good_ in normal times(*) - they enforce people double-checking their results, they give radiologists time to make the right call, they make sure the right drugs are going into the right people, they make sure patients are preppe…

"Move fast and break things" is absolutely the right method in some scenarios. The trick is, as you say, identifying if you're in one.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#92

Post by krisoft »

dalben wrote: post #15

Interesting that he had to do so much thinking and improvising. I'm an EMT in Belgium, and every hospital here has to have plans for mass casualty events. Ambulance bays are built to be transformed into a triage ward, spare beds are kept close, often there's a dedicated command room, ...

At the Luton airport they have these big "mass casualty event" supply boxes on the walls. Presumably full of supplies to provide efficient first aid after such an event on the spot.

As I was writing this comment I learned that they were inspired by a bombing which happened in Brussels: https://www.shponline.co.uk/fire-safety-and-emergency/mascal...

One of those things you hope will never need to be used. But if it is ever needed it will be very handy.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#93

Post by pas »

at_a_remove wrote: post #88
eapressoandcats wrote: post #86

Earlier quoted context omitted.

There’s not really a clear tension though. Procedures exist with an intent to get results. Airlines have lots of procedures that are carefully followed and the result is “the plane always arrives safely”. If you asked a pilot the question to “make a choice between procedures and results” they’d think you were crazy. Obviously there can be misguided procedures, but any decision made or operation done can be misguided.

Again, and continuing with the flight safety, all of it was an iterative process, learned the hard way. Flight safety rules did not emerge whole and unchanged with the Wright brothers. Every change was prompted by one or more incidents during which the current procedure was not appropriate. What then? Consider the current thread on the whole "toaster in the dishwasher" topic, during which someone related an incident…

How would you know? How would they know? Okay, sure you will have a hunch based on the answer, but it seems something that only experience can tell. (Okay, you can ask them about their experience.. and who know how forthcoming and honest and relevant their answer will be, right?)

Re: How one ED mobilized his department during a mass casualty incident (2017)

#94

Post by pas »

eapressoandcats wrote: post #86
at_a_remove wrote: post #79

Earlier quoted context omitted.

An irritatingly overlooked issue is the tension between procedure and results . Obviously, a well-refined procedure learns from past issues and evolves, growing ever more adaptable and useful, the way that aircraft rules are "writ in blood." Still, every one of the adaptations was prompted by an event that was Not in the Script. I think, for my next job, one of those questions I will ask when the time comes to ask if…

There’s not really a clear tension though. Procedures exist with an intent to get results. Airlines have lots of procedures that are carefully followed and the result is “the plane always arrives safely”. If you asked a pilot the question to “make a choice between procedures and results” they’d think you were crazy. Obviously there can be misguided procedures, but any decision made or operation done can be misguided.

What's the result of the completely useless flight safety mantra? People will not leave their belongings! The mantra should tell them that they will be compensated if they make it out alive but they will be put down like a mad dog if they hinder others with their packing and packages...

Also people do charge all the fucking time, and don't put their phone into airplane mode. :|

Re: How one ED mobilized his department during a mass casualty incident (2017)

#95

Post by rscho »

ericmcer wrote: post #46
biofox wrote: post #5

The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.

This could be a really cool use for AI. We have so many rules and systems in place to protect normal people from professionals that we have to blindly trust. If I had a reliable AI in my pocket I could be in charge of my own safety again. I did this a month or so ago when a Dr. recommended a cortisone injection behind my ankle. I asked GPT about it, it said consensus recommends against it because it can weaken the Ac…

Every single doc knows about steroids + tendons. Did you ask why steroids were offered ?

Re: How one ED mobilized his department during a mass casualty incident (2017)

#97

Post by planewave »

biofox wrote: post #5

The author's key takeaway is "flow is king", but what stuck me most was giving people freedom to do their job -- e.g., giving the nurses unrestricted access to the medication, letting the CT tech focus on their job, roaming ER doctors, delegating triage to a nurse, etc. -- the success here came from giving people responsibility and trusting them.

These are core principles that are taught to Emergency Managers in the Swarm Leadership method [0].

  Unity of mission – it was for these leaders, Save Lives!

  Generosity of spirit and action – these leaders and people across the community were willing and eager to help one another.

  Stay in your lanes, doing your job, and help others to succeed in theirs. How can I make you a success?

  No ego – no blame. No one took credit for their success together. No one pointed fingers when problems arose.

  A foundation of trusting relations – these leaders knew and had confidence in one another.
[0]https://www.hks.harvard.edu/centers/cpl/publications/swarm-l...

Re: How one ED mobilized his department during a mass casualty incident (2017)

#98

Post by spease »

lazyasciiart wrote: post #91
roughly wrote: post #71

Earlier quoted context omitted.

I think a key here is recognizing when the expected result is catastrophe and acting accordingly. There's a whole lot of procedures in the hospital that are designed for normal times and are _good_ in normal times(*) - they enforce people double-checking their results, they give radiologists time to make the right call, they make sure the right drugs are going into the right people, they make sure patients are preppe…

"Move fast and break things" is absolutely the right method in some scenarios. The trick is, as you say, identifying if you're in one.

“It depends” is certainly the answer more often than people want to believe.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#99

Post by Retric »

pas wrote: post #93
at_a_remove wrote: post #88

Earlier quoted context omitted.

Again, and continuing with the flight safety, all of it was an iterative process, learned the hard way. Flight safety rules did not emerge whole and unchanged with the Wright brothers. Every change was prompted by one or more incidents during which the current procedure was not appropriate. What then? Consider the current thread on the whole "toaster in the dishwasher" topic, during which someone related an incident…

How would you know? How would they know? Okay, sure you will have a hunch based on the answer, but it seems something that only experience can tell. (Okay, you can ask them about their experience.. and who know how forthcoming and honest and relevant their answer will be, right?)

Pilots aren’t limited by experience, they know a great deal about aircraft systems and the mechanics of flight. Procedure is incapable of handling every single edge case because the possibilities are endless.

So when do you deviate from procedure? When the edge case you’re in is well outside the scope of exit procedures which requires detailed understanding of the procedures and their justifications.

Re: How one ED mobilized his department during a mass casualty incident (2017)

#100

Post by bgroat »

I'm not an Orson Scott Card fan generally, but I LOVED his Shadow Series (the world of Ender's Game from the perspective of Bean).

In one of the books in the Shadow Series Bean explains his leadership style as:

"I will always explain why something is important, and why we're doing it this particular way... The reason for this is that if we ever find ourselves in a situation where I CAN'T give orders you know what I prioritize and how I might think of something... furthermore, if we're in a situation where I CAN give orders but DON'T explain you will understand that it's simply because I do not have time, but presumably have good reasons, and will proceed to immediately execute said orders"

It appears this emergency room operated in a similar capacity

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