Resuscitation Minds Notes

Emergency Mind 

Key Themes

1. Silos of Resuscitation

• Many specialties encounter resuscitation (EM, anesthesia, internal medicine, hospitalists).

• Often low frequency for each → limited expertise.

• Goal: consolidate into smaller dedicated group → develop deep skill.

• Analogy: “resuscitationist” similar to acute care surgeon in the US.

• Some clinicians drawn to resus work, others stressed by it → system should support both.

2. System Design: RACE Team

• Provincial program: Critical Care Response Team (called RACE at their hospital).

• Team = physician + RT + nurse.

• Activation: by anyone (nurse, porter, attending, patient, even self-activation).

• Key principle: low barrier + welcoming response, regardless of perceived severity.

• Builds trust, resilience, and responsiveness.

3. Team Structure & Training

• Multiple teams (cardiac arrest, trauma, RACE) → overlapping but distinct.

• Learners included → balance between autonomy and patient safety.

• Continuous cycle: respond, teach, reflect.

• Fellowship created: dedicated training in resuscitation medicine.

  • Recognized cognitive/decision-making skills as central.

  • Goes beyond EM/CCM training content.

4. Joy and Flow of Resuscitation

• Some clinicians find flow state: clarity, slowed perception, comfort in chaos.

• Not “happy” but rewarding, purposeful.

• Goal: help those who experience only stress reframe and improve performance.

• Ethical tension: we don’t wish crises on patients, but if they occur, we want to respond.

Training Under Pressure

Skill vs Trait

• Performing under pressure: partly inherent, partly trainable.

• Everyone can move along the spectrum; degree varies.

• Growth through deliberate practice, reframing, and feedback.

Why Learners Struggle

• Causes vary → needs “diagnostic workup”:

  • Learning disabilities, psychological stressors, substance use.

  • Knowledge deficits (rarely the only issue).

  • Application under pressure (cognitive load problems).

• Executive function buckets:

  1. Inhibition (suppressing emotional/system 1 response).

  2. Working memory.

  3. Cognitive flexibility (creativity, adaptability).

• Many learners overwhelmed by emotional suppression → no reserve left to think.

Comparison to Other High-Stakes Teams

• Other professions: rigorous selection under pressure → weeds out those unfit.

• Medicine: gate entry to specialty, then mostly training & support → “elevate everyone.”

• Challenge: some residents attracted to image of EM/CCM, not actual work.

• Need better systems to redirect people to niches where they thrive.

Emergency vs Critical Care Mindset

• EM/Resus: rapid decision-making with incomplete info.

• Critical Care: slower, precise, incremental gains.

• Experienced clinicians learn when to switch “gears.”

• Greatness comes from playing to strengths, but resuscitation requires both fast and slow modes.

Big Questions Raised

1. How to identify early-career physicians’ natural strengths (fast vs slow decision-making)?

2. How to train opposite skill set to ensure flexibility?

3. How to teach rapid switching between modes (fast ↔ slow thinking) during crises?