“Three little words…..”

As I wrote this, there was some very sad news that @docjohnhinds had died. So I am dedicating this post to him. He had inspired so many people in PHEM/EM community. Sorely missed but never forgotten….

Apologies, it’s been a while since I have posted anything primarily as I’ve been trying to get my head around sorting through the sudden increase in work emails (thanks @fratdoozle) and achieving  the nirvana status of “inbox zero”.


Im hoping after reading this you will learn a technique of improving the way you manage teams in a  stressful situation where the patient is sick. It can be applied to working in hospital and pre-hosptally. I haven’t invented this, I only really learnt it after I finished my EM training whilst working with HEMS. Its something I have used in the hospital environment though with great success, and I really believe in it. Those that have worked with me pre-hospitally  (especially the paramedics) know I had an “eventful” pre-sign off period with some interesting moulages! Scenes would “run away” from me and the moulages got more and more stressful.

We’ve all been there. A stressful situation where you lose control. Very quickly the patient  and your CRM starts deteriorating. The rest of the team have no idea what is going on and they start losing confidence in you and your ability to lead. It doesn’t have to be a patient either. It can relate to how you manage your department when there is overcrowding, or how the senior nurse manages their resus room when patients are queuing to get in.

Individual commitment to a group effort – that is what makes a team work, a company work, a society work, a civilization work.

Just before I got signed off, I was in a dark place. I thought I wasn’t cut out to be a HEMS doctor. A HEMS paramedic I was working with said “Neel, you’ll have a light bulb moment where suddenly it’ll all fall into place and you won’t look back…”

Three little words…. That was my “light bulb” moment.

Three little words….. “ Lets huddle in….”

“Lets huddle in…” simple, clear and extremely effective.

The paramedics I have worked with (and keep me in line!) hopefully realise after I do my primary survey, I say those three little words. I also say it when managing trauma in the ED. Why do I and many others do it? It brings everyone in. It ensures everyone is on the same page and you can disseminate your plan clearly to people.

Remember saying “ we need to get going (or get to theatre) in the next 5 minutes.” isn’t necessarily useful. Saying “ we need to get to theatre in the next 5 minutes by Tom doing this, and Alan doing this etc” is more productive and effective. When people are stressed, they wont remember much information so giving them specific small tasks is much more useful.

29A2B22600000578-0-image-a-70_1434981759825(DailyMail 2015)

I will often have several huddles when managing a code red patient either pre-hospitally or in hospital, particularly before the paramedic and I do an RSI. It allows everyone to re-group and focus in on the patient and you can reiterate what the plan is. By breaking the job up into smaller parts, signposted by  huddles,  a complicated scene or resus bay can become manageable.

If you have ever been involved in a major incident or a multi-casualty situation, having regular huddles with the Fire, Police, Ambulance incident officers helps ensure everyone is on the same page. One of the most useful ways I’ve used it is managing paediatric cases. If you include the parent in the huddle, it allows you to talk to them directly about what you think is going on with their child and what your plan is. It involves the parent. At the same time it indirectly tells the rest of the team what the plan is as well.

I recently listened to Michael Vaughn (Ex England Cricket captain) talk on a podcast on “The Art of Captaincy”. He talks about having huddles before the match starts to talk about his plan. He also says that he would stand at mid-off so he can have an overview of the game situation and talk to the bowler especially if they are underperforming. Remember a huddle also allows the team members to voice their opinions and ideas. It brought me back to jobs where things weren’t going to plan and where a huddle got everyone to regroup. It enabled me to deal with any CRM/ clinical issues there and then. Now if you are leading a team where people don’t feel they can raise concerns/ideas, that in itself should tell you something about your style of leadership. If you are a nurse in resus and notice things are going awry, tell the the team leader to “get everyone in” in order to verbalise their thoughts. Almost like a reset button. Believe me, I’ve had HEMS paramedics say that to me to great effect!

Screen Shot 2015-07-04 at 14.13.27

No job is managed perfectly, but the important thing is to be able to reflect on things that went wrong and on how you could improve. For me, the huddle was a big learning point and an invaluable tool in being able to manage sick patients. Remember there are plenty of experienced clinicians out there, some of which I have been lucky enough to learn from, who have their own thoughts  and ideas on how to manage complex cases. My blog is merely my own thoughts on topics and how certain things have helped me in my current practice.

Try using the huddle next time you are in a stressful situation at work and see it do wonders!

I Hope this has been useful!

 #deathisawanker RIP @docjohnhinds



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