Learn to Get Ready for Chaos

Source: Camilo Jimenez/Unsplash

Your team in the emergency department has just been activated. There’s a patient incoming who suffered serious trauma on the nearby highway, and it’s going to be up to you and your teammates to save his life.

You’ve made your plan, and everyone is standing by ready to jump into action, but there are a few moments left before the patient arrives. What do you do? How do you mentally manage the moments before a crisis starts? How do you set yourself up for success in the pressure you’re about to face?

In this post, we’ll look at three ways you can mentally prepare during the moments before a challenge starts.

Make Sure Your Oxygen Mask Fits Well

Paradoxically, the best thing to do when you are just about to start a crisis might be nothing. Take a moment to slow down, pause, and, in the words of the airline emergency cards, make sure your own oxygen mask fits well.

There’s a lot that you can accomplish with a brief moment of pause before starting a critical case. First, you can quite literally make sure that your protective gear is working. Jumping into a scenario where you are unprepared and become a second victim is counterproductive and can be quite dangerous. The more chaotic the environment, the more likely it is we make a mistake assembling our own kit, so this moment of intentional pause can be critically important.

Other times, it’s more of a figurative oxygen mask. If you are about to be completely occupied in this one case, consider taking a moment to review the rest of your responsibilities. Are there other situations you’re currently involved in which might become critical while your attention is elsewhere? What if a second emergency happens while you are dealing with this one? Are there resources you can reallocate now, or backup plans you can make now to prepare?

Leveraging a brief moment of pause like this can make a huge difference for yourself, your team, and the rest of your responsibilities. Consider having a brief checklist of questions or developing a standard operating procedure to make this more automatic.

Try to Break Your Own Plan

In the ER, we know that no plan is perfect and that sometimes no matter what you try, failure might be the outcome. That said, we try very hard to fail as cheaply as possible. Searching for cheap failures means breaking (and then improving) ideas and systems in low-stakes environments before we rely on them in real life.

So, in the moments before starting a critical case, pause and run a mental simulation of what you’re likely to encounter. In other words, try to break your own plan.

If your role in the team is to execute a specific procedure—say, a chest tube in the ER or a close multi-lingual negotiation in the boardroom—you can mentally visualize moving through its key steps. If you have more of a leadership or command/control role, you can mentally visualize our team moving through the key phases of their plan and how you might likely respond at various decision points.

Along the way, take serious note of any potential failures that your “virtual self” encounters. Is vital equipment you might need kept behind a closed door? Is a shared resource your team might want to utilize currently being devoted to another group? Is your team missing a player who wasn’t alerted to the crisis?

You can start working on these issues now before the situation really starts and before you absolutely need that equipment, that resource, or that person. In doing so, you can eliminate unnecessary opportunities for things to go wrong. You fail cheaply in mental simulation to help yourself succeed in real life.

Adjust Your Tuning

Managing your internal mental state is key to successfully performing under pressure. Whatever task you’re going to try to accomplish, the goal is to balance the tension and put yourself into the mental space that lends itself to optimal performance.

The basic intuition here is one of a stringed instrument like a guitar. Too revved up, activated, or tight, and the string breaks. Too loose, reserved, or slowed down, and the string can’t sound a note. You need to get the tension just right to play the music like you want to. The trick (really the skill) in these moments before performance is to measure and adjust your internal state to find that optimal amount of tension.

Leadership Essential Reads

"That Is Why We Need You"

Focusing on Making the Weak Links Stronger

Well before you’re about to encounter a crisis, spend time considering some examples where you performed at your best and times when you were either too loose or too tight. What did you feel like internally during these performances? Were there changes in your posture, the tension you felt in your muscles, the emotional tone you experienced, or something else? Build up your own personal database of how you feel in each type of situation.

Then, in the moments before the action starts, look inward and see what state your current signals most closely match. Are you too tight? Too loose? Just right? Once you have a good idea of how you’re “tuned,” start making adjustments.

Learning how to best change your state will take time and practice, but a good starting idea is to use physical movements to anchor the mental changes you want to make. If you’re too loose and slow, consider doing a small set of air squats, or clench and release various sets of muscles to speed yourself up. If you’re too tight or revved up, try a series of two to three deep breaths where you sequentially lengthen your exhale period with each breath.

As always, remember that bringing new processes online under pressure takes practice, so try starting in lower-stakes scenarios to get the hang of how they work. Additionally, it might help to keep some sort of a “lab notebook” where you can record and evaluate your experiments. What did you try to do, and how did it affect your performance? What will you try next?