Slow is Smooth – Task Management on High Acuity Calls

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Slow is Smooth – Task Management on High Acuity Calls

High-acuity calls are the ultimate test of an EMS provider. In these moments, the environment is chaotic, stakes are high, and the urge is to move fast. But rushing leads to errors. This course introduces the “Slow is Smooth, Smooth is Fast” methodology for deliberate, controlled, and highly effective action.

Understanding Cognitive Load

Cognitive load is the total mental effort being used in your working memory. On high-acuity calls, your brain is bombarded with inputs: monitor alarms, patient vitals, bystander questions, radio traffic. This can quickly lead to cognitive overload, where your decision-making ability degrades.

Three Types of Cognitive Load:

  • Intrinsic Load: The inherent difficulty of the task (e.g., interpreting a complex 12-lead EKG)
  • Extraneous Load: Distractions and non-essential information (e.g., chaotic scene, poorly designed equipment)
  • Germane Load: Mental effort used to process information and build situational understanding

The “Slow is Smooth, Smooth is Fast” Principle

This military maxim does not mean moving slowly. It means being deliberate.

  • Slow is Smooth: Act with economy of motion and thought. Take a fraction of a second to ensure accuracy.
  • Smooth is Fast: When every action is precise and correct, you eliminate wasted time and motion.

Task Prioritization: The Fix-It First Pyramid

  1. Immediate Life Threats: Massive hemorrhage, airway obstruction, apnea, pulselessness
  2. Critical Interventions: Tasks needed in the next 1-2 minutes to prevent deterioration
  3. Enabling Actions: Tasks that support critical interventions or gather data
  4. Logistics & Secondary Tasks: Preparing for transport, getting history

Delegation and Team Coordination

  • Assign Clear Roles: “You are on airway, I am on compressions and monitor”
  • Use Closed-Loop Communication:
    1. Give clear command: “Jan, please draw up 1mg of Epinephrine 1:10,000”
    2. Receiver confirms: “Copy, drawing up 1mg of Epi 1:10,000”
    3. Receiver reports completion: “Epi is drawn up and ready”

The 3-Second Pause Technique

Combat tunnel vision by physically stepping back, taking one deep breath, and scanning:

  • Patient: Look head-to-toe. Is their color changing? Is the chest rising?
  • Monitor: Scan all numbers, not just the one you were focused on
  • Team: Is everyone performing their role? Does anyone look overwhelmed?

Managing Your Stress Response

Tactical Breathing (Box Breathing):

  • Inhale for a 4-count
  • Hold for a 4-count
  • Exhale for a 4-count
  • Hold for a 4-count
  • Repeat 3-4 times

Key Takeaways

  1. Slow is Smooth, Smooth is Fast: Deliberate action is more efficient than rushed movement
  2. Master Your Mind: Use prioritization frameworks and mental checklists
  3. Pause and See: Fight tunnel vision with the 3-Second Pause
  4. Communicate with Clarity: Use closed-loop communication for all critical tasks
  5. Lead Your Team: Delegate effectively and foster a shared mental model
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