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United Hatzalah Incident Commander Handbook: 5 Rules For Effective Management in Chaotic Situations
by Dovie Maisel, Vice President of International Operations
Everything in life I compare to my experience in EMS. I tackle every mission in life, every challenge in life, like I do in the world of EMS. It’s about being like a commander in the field, in the army, treating a mass casualty incident (MCI).
Incidents are chaotic. You can’t control the chaos because incidents have dynamics of their own. There are many different elements that get involved whether its people, media, all sorts of things that develop, especially when it is terror related. So you’ve got to understand, you can’t control the whole thing. What you’ve got to do is make sense of what’s going on, target the mission within it, understand what you need to get done, and work within the chaos to get the job done.
Here are five general rules I follow that help me stay effective when I need to step up and manage a crisis situation.
Rule 1: Understand You Can’t Control Chaos
You will never ever be able to control all the pieces of a crisis situation. Whether it’s a mass casualty incident related to terror or whether it’s a challenge that you’re tackling in life. Incidents have dynamics of their own with many different elements. Life has dynamics of its own. You’ve got to understand that you can’t be God. If you try to control the chaos you’re going to get sucked in to the chaos and lose control of yourself. What do you need to do? This brings us to rule number two.
Rule 2: Evaluate the Situation and Identify What Needs to be Done
If I have 20 injured at an MCI, I need to ignore the smell, the sirens, the alarms, the screaming people from all around, the media pounding me with their cameras. If you are an incident commander, when you first come to a MCI you don’t treat any patients. Take a step back, take a deep breath, and temporarily detach yourself from what’s happening around you in order to evaluate the situation. If the incident commander starts treating patients, more people will die, because the incident is not being managed. I need to disconnect from everything and then identify what is the target and what are the missions I need to accomplish on the way to that target.
When we’re looking at the world of EMS I’m looking at saving lives. My job is to treat as many people, save as many lives as possible and get the job done. An incident command system is about creating a system that enables you to take control of what can be taken control of in the incident. You do triage. What is triage? It’s deciding which people are treatable, which are not treatable, and which we’ll treat later. So I’ve got to see within that crisis to what’s the bottom line. Distinguish between what is the fluff and the emotions and what is actually the seed here that actually needs to be treated. Make sense of what you can control and a make a quick plan. Then, target yourself on that. It’s the golden path through the chaos.
Rule 3: Prioritize and Delegate so you Can Stay in The Macro
Now that you know what the missions are that need to be accomplished, you prioritize and delegate. The view is always better from on top than from the bottom. If we are in a mass casualty incident I’ll be delegating to my chain of command, to my chief of operations, to the medical director, to the logistical manager, to whoever it is. If it’s in life, I’ll be delegating to work colleagues or family members and if I’m on my own, I’m prioritizing. I’m prioritizing the missions that need to be accomplished and I try to stick to the plan leading me across the golden path. If you don’t know your priorities is easy to get sucked in which is why rule number four is…
Rule 4: Don’t Get Sucked Into the Situation
You’re not part of the situation. You’re trying to make sense of it. Don’t be distracted. Stay focused. Don’t get sucked into the tunnel vision. Don’t get sucked into the single patient, don’t get sucked into the specific problems in the field, stay in the macro because once you get sucked in, your gone, and the chaos will take over you.
Remember the evaluation you did. You’ve tasked yourself, you know what needs to be done. The dynamics of incidents are not steady, it’s not regular. Things change. But you know your mission. Stick to the path, manage the tasks, make sure the people who you delegated are doing their job, be accountable and responsible, and get the job done.
Rule 5. Debrief After the Situation
Always debrief. You have to learn from your experience. You have to look back at what you did, see what you did right and see what you did wrong. There is a saying, ‘those who don’t do don’t make mistakes’, as long as we’re doing, we’re human, we might make mistakes. We’ve got to look back and try to see what we can make better for next time.
About Dovie Maisel – Dovie is United Hatzalah’s Vice President of International Operations. He is a senior paramedic and instructor with 25 years of experience in EMS. A tactical combat medic in the active IDF reserves. Dovie led emergency response missions to Haiti Nepal and Japan has treated and responded to almost all terror attacks and MCI’s (mass casualty incident) in Israel in past 25 years. He is also the inventor of the Micro BVM, a portable bag valve mask that has been adopted by the US special forces.