amateurs discuss strategy; experts discuss logistics
–Napoleon?
This Part I of the Mind of a Resus Doc Series, in which we delve into the philosophies that make a good resuscitationist.
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EMCrit Podcast 49 – The Mind of a Resus Doc: Logistics over Strategy
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Hi, my name is Scott Weingart. 
This topic really hit home. As a paramedic I’m big on logistics, and mainly trained in strategies. And the minute you started talking about it, I knew exactly what you mean. I’ve had many of the same thoughts while working in the ER and assisting with procedures. Now as a med student, I’m seeing this difference even more. I gotta say, one group that has mastered logistics (at least where I’m training) is the neurosurgeons in the OR. I shadowed them for awhile and all the residents and attendings seemed to know the logistical application of everything that was going on in that OR. I was impressed, and knew then that I want that kind of knowledge in my field. Your technique of visualization that you talked about, I’ve been teaching that to EMT students for years! Glad to hear someone else talk about it, and using it. So important and useful.
Anyway, great stuff. Keep it coming.
Excellent podcast!
One comment. I would argue that simulation can facilitate good logistics. In addition to its usual benefit of providing immediate reflective learning in the company of other resuscitationists, it can act as a rehearsal (not mental, but physical) to work through processes, find equipment, etc.
There is a growing enthusiasm for simulation in-situ. You place the manikin in a resuscitation bed, present a critical patient, and have a multi-disciplinary team provide care using the equipment in your department rather than in a simulation laboratory or a few toys brought to an auditorium. They will have to make processes work in their department. These processes, understanding the equipment and how to make critical actions occur rapidly can be explored in a debriefing session which can improve the knowledge of the resuscitationist.
They can still run through the logistics of resuscitation individually in their mind at other times, but I believe simulation can provide a good supplement to this learning process and can result in the development of more resuscitationists who are more highly skilled within the department.
Henry-I absolutely agree. In-situ Sim seems an ideal way to tackle this.
s
HI Scott
could not agree more with you! ONly 3 days ago I helped out our retrieval registrar who was bringing in a lady with septic shock and renal failure from an outlying hospital 2 hrs flight away. I met the aircraft when it landed and when the doors opened the registrar looked a total wreck and promptly told me the woman was about to die!
Anyway he had had to deal with two VT arrests inflight and was totally unprepared for running a code at 30000ft in the back of an aircraft with only him and a flight nurse. He did not remember where the gear was kept or how much resus drugs we carried despite my orientation training! He said we was used to running a code in a ED resus bay with 4 other people helping and a cupboard full of drugs.
So goes to show , as you say experts talk logistics and we discussed what he might have done better in retrospect ,like taking more resus drugs with him in a patient with acute renal failure.
QUite a coincidence how your post highlighted this issue around this case!
keep the faith, mate
Minh, Perfect story for this post!
Scott,
Agree that logistics is key! I imagine you are going to get into this but logistics also includes planning the future moves of the patient and what will be required to make those moves occur.
Mike
Proactive vs. Reactive is absolutely essential as you say
This podcast is being referenced at the Bedside Critical Care Conference in Australia today. Goes to show that the relevance of these podcasts lives on and the audience will continue to grow. Great work as usual Scott…
Hi Scott-
I´m an anesthesiologist/intensivist from Berlin and a new fan of your fantastic site.
I´m also a sailor with some 30000 nm in my personal wake, and most of my “resus philosophy” comes from the concept of “seamanship”. When I have new crew on the boat, I teach them how to prepare for foul weather with a similar approach as you describe here. One thing that comes to my mind when I see the image of the resus bay that comes with the title of your show: When you prepare for a storm, clean up the cabin and make sure no loose gear flies around when the boat starts to shake – and when you prepare for a resus, make sure you have at least three large trash cans by the bed. Physical chaos (books and food piling up on the cabin floor or large piles of wrappings, syringes and vials on your resus equipment) creates mental chaos, also known as panic. Avoid at all costs!
Thank you for your great work.
Scott,
This one is one of my favorites.
Cheers
Damon
thanks, Damon