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Key points
- Emergencies across all fields involve uncertainty, pressure, high stakes, complexity, and liminality.
- Identifying real emergencies helps match the right tools for problems and avoids catastrophizing.
- When faced with a crisis, look for these features and ask yourself, “Is this really an emergency, or does it just feel like one?"
When you first encounter them, many situations feel like emergencies, but few actually are. Learning when you can safely take the time and space to slow down and think through a problem—and conversely when you must act immediately—is one of the most critical skills junior doctors learn when they start training in emergency medicine. It’s also a critical skill for any team, in or out of the emergency department.
Consider an example from a recent ER shift where multiple people complained of “trouble swallowing.” Did they have tonsilitis, a severe reaction to something they unknowingly ate, or just a viral sore throat?
If you miss a true emergency—fail to recognize that one life-threatening allergic reaction—you risk facing a rapidly deteriorating problem that might quickly become unsolvable. But if you treat every one of them as an emergency, rush them to a resuscitation room, and set up to place them on a ventilator, you risk overwhelming your team and wasting resources that might be critically needed elsewhere.
Separating the actual emergencies from other problems that merely seem to be emergencies lets your team deploy the right tools for the right problems, focus your effort where it’s needed the most, and preserve the capacity for efficient “normal” operations and potential future crises. So, how do you do it?
Here are five characteristics that emergency problem sets typically share.
Uncertainty
During an emergency, you typically don’t understand the scope or details of the problem, the optimal action to take, or, most often, both. Is the potential bug a customer just reported a critical flaw that will take down your project and your company, or is it a harmless mistake with no real consequences? How many developers should you switch from other projects to investigate and patch it?
Pressure
The requirements of an emergency problem are significant and may often threaten to overwhelm the resources you initially have available. Frequently, pressure has to do with timing: you don’t have as much time as you need or want to study an emergency problem before having to commit to a response.
When the car in the front of you on the highway swerves unexpectedly and the person behind you is already driving too close. You can’t stop, get out, and study the position of other cars on the highway—there’s just not enough time. You have to decide what to do now.
Impact
There are significant consequences to the decisions you face during an emergency, often involving life, limb, or catastrophic failure. Potential impacts are readily apparent in the emergency department, where correctly identifying that allergic reaction might save a child’s life.
Outside of the emergency department, correctly reacting to a chemical spill might prevent significant environmental damage or protect a town’s water supply. Decisions that are easily reversible—like choosing between dark or light roast coffee in the morning—don’t have enough impact to really be an emergency, even if we don’t know which one our friend wants (uncertainty) and there are people behind us in line (pressure).
Complexity
Complex systems like emergencies have multiple parts that interact in non-obvious (and frequently non-linear) ways. For example, during a recent shift my team worked in parallel to resuscitate several critically ill patients in shock. A standard answer—for example, to rapidly deliver IV fluid—might work in some cases (like shock from infection) but fail wildly in others (like shock from poor heart function).
In this case, treating all causes of shock the same way ignores the complexity of the way the components of the cardiovascular system interact. In general, simple cause and effect models may fail to accurately capture the reality of an emergency, and higher-order thinking is frequently required.
Liminality (AKA “Stickiness”)
Once you’re in an emergency, you can’t simply back out of it—you have crossed a threshold and now you need to press forward and solve the problem. For example, troubleshooting an engine failure while flying a plane is very different than handling one you identify while still sitting on the runway. One plane has crossed a threshold (takeoff) and is in a liminal (sticky) space, the other has not. For the airborne plane, you cannot simply walk away from the situation and return to it later. One way or another, that plane is going to come back to the ground. It’s up to you to hopefully figure out how to land it safely.
A simple way to start putting these ideas into practice is just to start asking yourself “is this really an emergency, or does it just feel like one?” If you find the situation lacks several of these factors, do you have to bring ramped-up levels of resources, stress, and attention to it, or could you slow down, step back, and re-evaluate? If it is an emergency, you’ve succeeded at identifying a potentially unstable situation, and you know where to focus your energy next.
