Lessons From the ER in Dealing With Chaos

Imagine the scene: it’s a Saturday night, around midnight, and you’re in the emergency room of a hospital in a big city. It’s the night of the football World Cup, and the country you’re in just won. It’s also a full moon.

Patients are arriving by ambulance, walking in, or being carried in. Some are drunk, loud, and upsetting those around them. Others are shouting, demanding immediate attention. Some are in agony. Suddenly, someone collapses and has a seizure. There aren’t enough chairs for everyone to sit, nor are there enough beds or doctors to attend to everyone.

Then—and this really happened—a patient puts on a doctor’s coat and begins seeing other patients, shouting at staff, “Bring me epinephrine!” (He made it through three rooms before being caught.)?

It’s chaos.

Chaos is defined as a state of disorder and confusion. It can manifest in various ways:

• A scene like the one described above.
• Global crises, like the COVID-19 pandemic.
• Workplace emergencies, such as a supplier failure, regulatory breach, and major technology outage happening simultaneously.
• Domestic chaos, where the car has broken down, one child is home sick, you’ve been called into a work emergency, and the dog just ate a bar of chocolate.

Even with response plans in place, navigating chaos is challenging. There is so much happening outside our control, coming at us from different directions, it can be hard to know what to do or where to turn.

Those on the frontlines in emergency services offer invaluable lessons for managing such situations. For them, chaos is often the norm, not the exception.

Step 1: Be Calm

Think of the person admitting patients at the ER desk. They don’t get caught up in the chaos, demands, or panic. Or the doctors and nurses treating patients. Paramedics don’t sprint to emergencies, regardless of the severity. They walk, observe, and stay calm, knowing this is critical to maintaining focus, operating at peak effectiveness and making sound decisions. They also know that everyone is taking their cues from them.

Find a way to calm yourself. Take a moment. Breathe deeply, and again. Ground yourself. Having a regular practice of breathwork or meditation will pay off here.

Calmness enables you to respond rather than react. Your emotional state is infectious, especially if you’re in a position of authority or leadership. Staying composed helps others stay grounded too.

Step 2: Don’t Respond to the First or Loudest Issue

The loudest voice or the most dramatic situation might not be the most critical. Begin the triage process.

Start by gathering information.?Like admission staff asking for personal details or a triage nurse assessing signs and symptoms, focus on getting all the relevant information. The drunk and loud person or someone screaming in agony from a fracture may be distracting but might not require immediate attention. Meanwhile, someone quietly dealing with chest tightness could be in a life-threatening situation.

Establish what information matters?to make informed decisions.

Step 3: Prioritise

After gathering information, prioritise. In the ER, not every patient can be treated immediately. Staff assess cases against the primary goal of minimising early mortality and complications. They have established criteria to categorise and prioritise to achieve this goal. Their categories can include: resuscitation, emergency, urgent, semi-urgent, or non-urgent.

To prioritise effectively:

• Be clear on the objective, your “north star,” or primary goal.
• If that’s not established take a step back to define what’s critical.
• Use objective criteria to assess severity, urgency, and consequences. In a workplace, if you have a risk team they can assist.

Step 4: Create and Execute an Action Plan

Doctors and nurses follow established procedures for various conditions, from heart attacks to broken bones. In the workplace there are often already response plans, processes and continuity plans that can be executed. If no plan exists, perhaps form a task force (an equivalent SWAT team) to generate options.

• Don’t rush with the first idea.
• Get different perspectives.
• Agree on the best solution.
• Develop a clear plan and execute it.

Step 5: Debrief

Hospitals and other emergency services conduct post-incident debriefs, especially after extraordinary events involving multiple people. These sessions are crucial for growth, learning, and improving outcomes. They’re brief and resemble the military’s After Action Review.

In a debrief:

• Invite everyone involved.
• Ask open-ended questions: What happened? Why did it happen? Who was involved? What worked, and what didn’t?
• Determine if changes are needed for future responses.

Don’t let the next incident distract you?from learning from the previous one. The lessons could make all the difference in future outcomes.

Underlying Principles

A couple of things that help make the ER run smoothly and will help when dealing with chaos.

1. Clear Roles and Responsibilities:?ER staff have defined roles, with individuals possessing the necessary skills and experience.
2. Single Sources of Truth:?They avoid multiple, conflicting lists or input. Objectivity is maintained through set criteria for assessment.

When chaos strikes, following structured steps helps avoid being overwhelmed by the storm. It ensures not just the achievement of desired outcomes but also the wellbeing of everyone involved.

It all begins with one simple action: Just breathe.