JUN
14

The Medic Minimalist

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The minimalist lifestyle has a stereotype of either some hippy world traveler to a one-upping hipster bragging about how they live on only pour over coffee. That’s not usually the picture most people have of the average medic. Probably because they’re too overworked and can barely afford the free coffee from Dunkin’. 

But what’s your picture of a healthy medic? 

The medic that has everything together mentally and physically. They’re so subtle that you barely notice them until that one moment when everything is going to $hit and they exude comfort.

Comfort in the chaos.

Further examination into how this person operates is surprisingly unimpressive. Yet, their demeanor will often peek further curiosity into what they do; leading to why they do it. Doing a deep dive into their mindset you would likely find that they are very intentional, are insatiably curious, and provide eloquent value. They are a Medic Minimalist.

A Medic Minimalist is an out of hospital provider who intentionally develops tools, habits, and systems that reduce excess in favor of value- so that they can find happiness, fulfillment, and provide healing to others.

The principles of being a Medic Minimalist are versatile yet tenacious.   

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Principle 1: Clutter and consumption are costly

Cognitive pressure is amplified by decision making, environmental factors, and interpersonal emotions. Excess creates noise to the rock concert of stimulus during a resuscitation. This stimulus continues to add weight to our lives like a pile we carry in the backpack called life. We carry that heavy backpack home with us only to drown it out in the quick dopamine hits of Facebook/Instagram or the emptiness of a bottle. We try to get our lives back together by getting more involved or listening to 10 podcast on ketamine (boy those were the days) only to keep feeling like we’re missing out. That backpack keeps getting heavier.

The amount of information, content, and education is so enormous that you would have to read almost 200 books an hour 24 hours a day, 365 days a year just to keep up. That doesn’t include any news articles, podcast, Facebook post, emails, or FOAMFrat blogs. 

Nobody can maintain that pace for a sustained period of time and everyone is missing out on something. 

Having a fear about missing out on a crazy call, party or moment fuels the fire of anxiety that smolders until its out of control. The clutter and consumption of the professional and personal lives cost us the most important thing in our lives; it cost us our self.

The Medic Minimalist is comfortable not being the smartest person in the room because they’ve consumed content that makes them better leaders and resuscitationist. They’ve consumed the right content in a better way. They’re just not consuming everything.

Principle 2: Optimization improves outcomes

The intention of a Medic Minimalist is captured by how they optimize their systems to improve outcomes related to both self and patients. When optimizing, the Medic Minimalist blends human factors and metacognition to provide critical examination of inefficiencies and obstacles that inhibit their ability to provide high quality resuscitation. Although improved resuscitation is the outcome it is not what their mind focuses on.

Critical examination is the focus of the Medic Minimalist following the intentional process of decluttering and cultivation of their physical and mental space. This examination leads to optimization in multiple parts of their life that allows them the capacity to handle stress and the cognitive load needed to effectively run the resuscitation. This optimization though starts with self.

Principle 3: Strength builds compassion and resiliency

The goal isn’t to be the best paramedic. Shouldering the responsibility of the community and world on your solo performance will build resentment and contempt within you. Resentment and contempt rip you apart causing a wake of destruction and pain. The pain of resentment is like a corkscrew churning in your chest. Everyday asking the world to stop turning the corkscrew. Yet there is no relief; until you look in the mirror to find out you’re the one ripping yourself apart.

Paramedic school taught that being the best and the brightest was the way to succeed and rewards that performance. In school, strength was taught to mean right answers, task performance, and beating the clock; yet that definition of strength made you weak when your partner confided that her marriage was broken and didn’t know how to save it. 

Medic Minimalism rebukes superiority and condemnation by offering compassion and strength through gracious words and action. The Medic Minimalist offers compassion that meets individuals at their current situation in life and empathizes with them. They are beacons of resilience and compassion built upon unshakable core values. 

Having true mental strength allows psychologically safe environments where hard conversations about life and medicine can be discussed without harsh wit and cutting words. Instead, these conversations can focuse on serving the other person and building people up.

Only the strong can help the weak.

This is not only mental strength but also physical strength. Medic Minimalist recognizes life is made of uncomfortable events and that a resuscitation is extremely uncomfortable event. Being physically unwell makes those events even more uncomfortable. The Medic Minimalist curates the proper nutrition and exercise to allow them to be compassionate and resilient in the the face of choas. They choose to be a better person by cultivating a life of discomfort becoming comfortable in the chaos.

The Medic Minimalist is in the development stages and would love to hear how you are a Medic Minimalist. Tag me on Twitter, @vamedic

PS. I’ve wrestled writing this blog trying to capture the enormity of wellness, organization and minimalism. Ultimately that failed and will always fail. The nuances are numerous and the possibilities endless for one post to capture. Further analysis and thoughts needed to support this topic.

1
MAR
31

Going Nuclear: Crisis Standards of Care

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Splitting vents, DIYing facemask, and having a blanket DNR are nuclear options that agencies and providers cannot immediatly jump to because there is a shortage or pandemic. Organizations and providers that carte blanche change the standards of care without strong planning and consideration can face serious legal ramifications. The process to develop crisis standards of care takes considerable planning to ensure that the healthcare system can provide reasonable care to limit the morbidity and mortality for the public at large.

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It’s important to be mindful that the experience and resources may vary widely among geographical areas and systems. Noticing that some hospitals within NYC are splitting ventilators doesn’t mean that your agency can do that at this time. Utilize their experience as an indicator to begin discussions and planning on developing and implementing crisis standards of care (CSC). 

Standard of Care Spectrum

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Conventional: capacity states that the space, supplies, and staff are consistent with daily practices operations, business as usual. The goal is to provide individuals with the best care possible.

Contingency capacity is not consistent with daily practices, but is functionally equivalent. Contingency capacity is our disaster triage plans that are implemented when demand exceeds community resources. Currently this contingency capacity would include not transporting low risk COVID-19 patients or reusing PPE.

Crisis capacity states that even the adaptive space, staff, and supplies are not consistent with daily operations, but sufficient to provide care to the population and requires a significant adjustment to the standards of care. Some examples would be utilizing DIY mask, splitting ventilators, or reallocating life-sustaining resources. CSC is an extreme option that cannot be utilized because of fear and is only utilized when the healthcare system is forced to. The goal is to provide the population with the best care possible.

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The spectrum may be in contingency mode while others are in conventional. An example is that your ambulances are staffed but providers are reusing PPE for the cycle.

States, and agencies even within the state, may vary on what stage of the spectrum they are at. The healthcare system should work toward recovery and getting back to conventional standards of care as soon as possible.

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Other Terms

When planning it is important to utilize specific indicators and triggers to enter into CSC. The indicators would could be predictors of change or availability of resources. Triggers are decision points about making adaptations. Developing the appropriate indicators and triggers allows agencies and systems to move between standards of care with the appropriate communication, resources, and legal defense.

5 elements of Crisis Standards of Care

These 5 elements have several associate components to them which are explained in further detail in the Crisis Standards of Care Guidance. Meeting these elements ensures that the CSC are ethical, legal, and consistent across localities and states. To meet these elements the healthcare system needs to develop a consensus among public health, hospitals, EMS, primary care, and healthcare coalitions. Some states may have very clear guidance such as Minnesota.

  1. A strong ethical grounding that enables a process deemed equitable and just based on its transparency, consistency, proportionality, and accountability;
  2. Integrated and ongoing community and provider engagement, education, and communication;
  3. The necessary legal authority and legal environment in which CSC can be ethically and optimally implemented;
  4. Clear indicators, triggers, and lines of responsibility; and
  5. Evidence-based clinical processes and operations.

There are many more resources available at ASPR Tracie and through your state’s public health department. Be tempered in your response. 

Moving to Crisis Standards of Care is by force not by will or fear.

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