Closing Loops and Task Management in Emergency Medicine

There’s no getting around the surges and potential chaos of an emergency department. The good news is that these events are predictable, you know they’re going to happen, just not when. So how do you prepare and then navigate the storm once you’re in the thick of it?

In today’s episode, we start with a discussion with Thom Mayer, MD exploring strategies to steel yourself for the inevitable chaos, underscoring the importance of maintaining a positive, agentic, proactive mindset. Drawing parallels to General Theodore Roosevelt Jr.'s decisive leadership on D-Day, the discussion highlights the critical need for quick, confident decision-making. A key focus is on the concept of "energy packets," a methodical approach to managing the cognitive overload in the ED by strategically allocating mental resources to specific tasks. We also delve into understanding individual stress thresholds and how to manage stress without succumbing to a sense of helplessness. 

In the second half of the episode, Chris Hicks, MD gives his approach to managing high patient volumes, communication while managing critical patients, and how to address a direct challenge in the resus bay. 

Guest Bios:

Chris Hicks, MD

Chris is an emergency physician and trauma team leader at St. Michael's Hospital in Toronto.  He has innovated in several areas of resuscitation and psychological skills, including mental practice, stress inoculation training.  These days he enjoys a quieter life, free from the problematic corporate jib-jab of academic deliverables.  In 2018, as a partial rebuke of the status quo, Chris co-created and chaired resusTO, an inter-professional simulation-based resuscitation conference in Toronto with international acclaim.  In 2020, he co-founded Advanced Performance Healthcare Design, consulting with hospitals and industry using simulation to inform the design of systems, spaces and teams.  Chris is an avid speaker and lecturer, staunch #FOAMed supporter, occasional runner and cyclist, fledgling boxer, semi-retired pianist, and proud father of three lunatic boys.

Thom Mayer, MD

Dr. Mayer is the Medical Director for the NFL Players Association, Clinical Professor of Emergency Medicine at George Washington University and a Senior Lecturing Fellow at Duke University. 

Dr. Mayer was named the ACEP Outstanding Speaker of the Year in the second year the award was given and has twice been named ACEP’s “Over-the-Top” award winner. 

On September 11, 2001 Dr. Mayer served as one of the Command Physicians at the Pentagon Rescue Operation, coordinating medical assets at the site.  Dr. Mayer has served on the Department of Defense on Defense Science Board Task Forces on Bioterrorism, Homeland Security and Consequences of Weapons of Mass Destruction. Dr. Mayer also serves as a Medical Director for the Studer Group.

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For full show notes of this episode and all sorts of other goodies, visit our podcast website

We Discuss:

• Setting Yourself Up for Success at the Beginning of a Busy Shift
• Counting Down the Hours Til the Shift is Over
• Energy Packets - Closing the Loop on Open-Ended Attention Vampires
• Identifying Your Stress Tolerance Level
• When You Feel Like You're a Victim and Losing Control
• Multitasking Makes You Stupid
• Systems and Scribes to Mitigate Repeated Interruptions and Breaks in Task
• Don’t Be Boring, Get to the Point, and Stay on a Level Playing Field
• What Stresses Out the Teacher's Teacher of Emergency Department Systems Excellence
• How to Keep Things from Falling Apart When You're Slammed with Patients
• Putting Patients into Orbit
• Taking a Pre-defined Pause to Review and Decide on Action
• Reframing the End of Shift When You're Way Behind
• Starting a Shift with a Ritual
• The Mental Checklist When Walking into the Room of an Unknown Trauma Patient
• The Three Things to Learn (or Teach) for Equanimity in a Crisis
• How to Effectively Answer a Challenge from a Team Member During Trauma Resuscitation
• Making Sure Decisions are Focused on Patient Care and Not Ego

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