Slow Is Smooth: Task Management Under Stress

Task Management Under Stress

The tones drop. Multi-vehicle collision, highway, reports of multiple injuries, one person entrapped. You arrive to controlled chaos. Firefighters are cutting the car apart, law enforcement is managing traffic, and you are faced with three patients and a chorus of sirens. Your heart is pounding. The temptation is to run in and start doing everything at once.

Do not. The most important thing you can do in that moment is stop.

This is the core principle of high-stress task management, borrowed from special forces: “Slow is smooth, smooth is fast.” Rushing leads to mistakes, missed steps, and duplicated effort. A calm, methodical approach will get more done, more safely, than frantic energy ever will.

Practical Tips for Managing Chaos

Your first action on a complex scene should not be to grab a monitor. It should be to take a deep breath and a mental step back. For 10 seconds, just look.

• What is the biggest, most immediate threat? (Scene safety, an arterial bleed, etc.)
• How many patients do I actually have?
• What resources do I have, and what do I need?

This initial pause allows your brain to catch up with your adrenaline. It is the difference between reacting and responding.

Avoiding Task Saturation

Task saturation is that feeling of being completely overwhelmed. The monitor is beeping, your partner is asking for a drug, and a firefighter is yelling vitals at you. You cannot process it all. The cure is delegation. You are the team lead, not the team.

• Assign clear roles: “You are on airway. You are on hemorrhage control. You are getting vitals and IV access.” Be specific.
• Focus on one thing at a time: Your primary job as the lead is to think, not do. Direct the scene. If you have to perform a skill, hand off the leadership role temporarily.

Communication That Actually Works

Under stress, communication breaks down. The solution is closed-loop communication.

• Give a direct order: “Sarah, get me 1mg of epinephrine.”
• Receiver repeats the order back: “Copy, getting 1mg of epinephrine.”
• Receiver reports when the task is done: “Epinephrine is ready.”

This simple loop prevents drug errors, ensures tasks are completed, and keeps the entire team on the same page.

The Power of the Reassessment Pause

Every few minutes, especially after a major intervention, pause again. Is the plan working? Did that fluid bolus help the pressure? Is the patient’s breathing improving? What is the next most important thing? This prevents you from getting tunnel vision on a single task while the patient deteriorates from something else.