As TTL it’s important that you are in the right frame of mind in order to run any complex resuscitation. This means that you should objectively determine whether you are the best person to lead the team. There are a number of ways to do this. These are two well recognised techniques.
- I’M SAFE: This is an internationally recognised series of personal questions to help you understand whether you are fit to work. Some of these are easily preventable, but others such as mild illness may not put you in the optimal position to lead the team. If in answering these questions you are concerned as to whether you are in optimal condition to lead then consider handing the role over to another clinician.
- Illness (even just a headache)
- Medications/Other drugs
- Stress (we all work in a stressful environment, but also think about external stressors that may affect you, are you ruminating about something else?)
- Alcohol (including hangovers)
- Fatigue
- Eating/Elimination (eat something and go for wee)
- BTFS Stress reduction: This involves mentally preparing and managing stress during the trauma call. It’s a way of reducing personal stress and putting yourself in the right zone to think clearly under stressful conditions.
- Breath. Notice your breathing. Consider square breathing exercises to gain control of hyperventilation and stress. This is a highly effective technique in stressful circumstances.
- Talk. Use short, specific, first person, specific positive phrases with intent to motivate yourself. For example ‘I know I can do this, I have done this before’ OR ‘I am placing the thoracotomy in the 5th intercostal space’.
- See. Use visualisation exercises to prepare and perform procedures. For example, visualise the placement of a chest drain before performing it. Imaginary practice is an excellent way of preparing for a task and will help you prepare equipment and complete the procedure.
- Focus. Develop and use a ‘Trigger Word’ to bring your mind into focus. The purpose is to regain attention after a period of stress or distraction. It is personal to you, but is ideally something you can quietly say to yourself to refocus and regain control of yourself.
Remember these techniques to help you control your own stress and emotions. If we are to lead a team then it is vital that we first lead ourselves. Try these techniques out in simulated and real cases.
This is a very brief introduction to these concepts. Please read more on the following links.
Bottom line
Great trauma team leaders don’t just prepare the patient and the team, they prepare themselves first. Take a moment to assess whether you are fit to lead, then use simple psychological skills to stay calm, think clearly and perform under pressure.
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Further Reading
- Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress (West et al.) – The landmark paper introducing practical cognitive techniques for emergency clinicians. https://pubmed.ncbi.nlm.nih.gov/28460863/
- An Englishman in South Africa – Rob Lloyd’s reflections on human factors, performance and preparation from the St Emlyn’s archive. https://www.stemlynsblog.org/englishman-south-africa-robert-lloyd-st-emlyns/
- Beat the Stress Fool – Mike Lauria’s outstanding EMCrit discussion of psychological skills for high-performance teams. https://emcrit.org/emcrit/emcrit-racc-podcast-220-beat-stress-fool-mike-lauria-just-time-performance-enhancing-psychological-skills/
