What Mass-Casualty Medicine Teaches You About Decision-Making

Plan for the worst and hope for the best.

Photo by Niklas Bischop on Unsplash

Multi-car pileups, a helicopter crash, burning buildings…

These are mass-casualty incidents.

Taking a wilderness first responder course is one of the best things I’ve ever done.

In fact, the learned ability to triage might be the most versatile skill in my toolkit.

Emergency medicine teaches triage as a structured process to evaluate and prioritize treatment for victims.

If there are 10 victims, for example, triage is used to assess who needs life-or-death attention and in what order.

• Life or death? Stop and fix.

• Stable? Find out who’s next.

• Not stable anymore? Decide who needs to wait.

Navigating a mass-casualty incident requires a team. Their ability to triage victims effectively relies on clear definitions of roles and responsibilities.

Most importantly, there has to be a leader overseeing the team.

They’re the decision-maker.

Stress exposes our fatal flaw — logic and emotion compete.

It’s not that they don’t like each other, it’s just that decision making tends to pick one at a time by default.

I was reminded of this while playing the Worst Case Scenario card game recently.

“if stuck in an elevator is a 5, how is trapped in a sinking car NOT a 5???”

That was a fair point, they’re similar enough.

See, players take turns in this card game.

And each round it’s up to someone else to determine the worst scenario of the 5 available cards on the table. Points are earned when you correctly guess their ranking of the scenarios.

A pattern emerged during the game. It crystalized when Jenny confronted Isobel’s ranking of the sinking car scenario.

We learned something fascinating: the psychology of the decision-maker, compared to that of the other, guessing, players differed in one, very major way.

Logic.

• Logic did not matter to the decision-maker at all. Emotion did. All they could think of was how they’d feel if caught in one of the scenarios.

• Logic mattered very much to those trying to guess how the decision-maker would feel about the options. Emotion did not. Players ruled out and prioritized cards by the objective severity of the scenario.

Stress is our body’s biological response to becoming the decision-maker. Your stress increases with the intensity of the decision being made.

The way to defuse intensity is to use triage.

Pressurized decision-making is the best skill to develop.

My training in wilderness medicine and my experience as an outdoor educator made me an exceptional guide.

Managing groups of people effectively in high-risk environments is the ultimate way to exercise the decision-making muscle.

You’ve heard of herding cats, yes?

Well, let’s say it’s your job to wrangle a group of 15 teenagers. Let’s give them 50lbs of gear and put them on the side of a mountain. Oh, and you have to teach them how to use the gear. Without getting hurt. And they HAVE to have fun or you don’t get paid. And, for the sake of the argument, you’re responsible for this group for 2 weeks.

That’s a lot of decision making, hoss.

Making decisions under pressure is great for responding to bad situations, but do it enough and you unlock the multiplier — preventing bad situations.

Triage is meant to be temporary. The phrase “firefighting” gets thrown around a lot in the business world.

I don’t like it.