Some places are coming out of the first wave of the COVID pandemic, while others are starting to see it peak. There will be long-term leadership lessons for everyone as we look back at this time:

“In February, we were watching COVID unfold, but we did not take it that seriously here. We acquired some extra PPE, purchased a vehicle decon system, and reviewed our infectious disease policy. It was much too little, too late.

By this point, at the PPE was already gone and back-orders were piling up. Our decon system got redirected and we were not able to obtain a replacement. Our infectious disease policy was great on paper, but it was not real guidance to our staff, especially with the scarcity of actual PPE.

We learned a few lessons:
1) A policy is a piece of paper – it’s not a plan until you practice it in the real world
2) Base your decisions on real-time information, and act as early as you can in preparing and purchasing
3) You need to blow the dust off your PPE, and practice donning and doffing, more often than every few years.
4) Complacency causes high-risk”

Just because a law or regulation does not mandate it does not mean that we should not be doing it. Even when regulations require it, we often find the cheapest and easiest way to comply with the regulation, and too often we reap what we sow.

Mark Bober, Director of EMS at HMH JFK Medical Center, leads one of the organizations that have been through the first wave. He has some observations on preparedness for the next wave, and the next major event. “I think this is a common feeling right now among EMS leaders, but also a healthy one. Since 9/11, we have all slowly watched grants and funding related to emergency preparedness dry up year after year. Our stockpiles have slowly dwindled, our educational preparedness programs have been offered less frequently, and our reserves have been “leaned” out over time. Major events like this pandemic are seemingly the only way these avenues for resources are refreshed and replenished, but as this article states, it is almost always too little too late.”

Mark continues, “As the stewards of our profession, our organizations, and the safety of our people, we need to weave this lesson deep into the fabric of who we are and how we operate. It cannot be enough to only pursue these endeavors when resources are plentiful and opportunities are spoon fed to us. I am the first to admit that justifying spending for something that might be needed is a difficult argument to make, especially if it involves postponing the purchase of something that is definitely needed. But this is the difficult space in which we all need to get comfortable. With no clear picture of what the future holds or if we will find ourselves in this position again soon, tough decisions are going to be the only norm we can rely on.”

“Now is the time to identify par levels and procure an effective internal stockpile for PPE and other hard-to-obtain pandemic supplies. Now is the time to create regular emergency preparedness training schedules. And now is the time to plug in to support services and resiliency programs for front line providers. If we ignore history, we will certainly repeat it. And history is doing its best right now to help us reorganize our priorities.”

As we lead our organizations through the COVID pandemic, the stress on leaders is just as acute as the stress on providers. Here is a leader who took it out on their staff, and how they responded:

“I was in a stakeholder meeting and yelled at someone. I was on day 32 without a break. Broke down crying after that. I recognized my need for a day off and started giving my team a day off per week starting then, and quickly tried to move to a “normal schedule” as quickly as we could.”

Raphael M. Barishansky, EMS thought leader, had some observations. “It’s hard for us to disconnect from our workplaces in normal times, and the pandemic has made it even harder. We are constantly answering telephone calls, emails, and texts no matter where we are and what we are doing. The stakes with COVID are so high that now we feel like every message could be life and death. As leaders, we need to let the folks who work for us know that they are allowed downtime, and even go so far as to enforce it. Disconnect personnel for periods of time and avoid sending them messages during these periods. As employees, we have to learn how to manage ‘up’ as well, triaging the things we respond to and putting off things that don’t need to be dealt with right away. It’s hard to break the habit of responding immediately to get it off our plate and move on to the next issue.”

Michelle Kobayashi, Administrative Director of EMS at Hackensack University Medical Center, suggests using the tools you already have. “Don’t wait until your team is overwhelmed to establish operational periods. When running a long-term major event, we know that we quickly establish lines of responsibility and clear handoff of that responsibility. This pandemic is just a very slow-moving, very long-term ICS event.” Michelle notes that mental health and resiliency need to be part of your planning for your leaders, in addition to your front-line team members. “The hardest part is protecting your downtime. With an incident of this size and scope, as a leader you may feel the need to always have your finger on the pulse. There will be times when only you have the information needed by other team members. Triage communication needs just like you would triage multiple patients. Give yourself permission to not respond immediately unless it’s absolutely necessary. Know which of your team members can handle the different aspects of your program so you can delegate effectively.”

To everyone fighting the pandemic, please take care of yourselves. This is the hardest thing that any of us have ever done, and we will be measured by how we rise to this challenge. There is nothing wrong with taking a breather, stepping back and regrouping, and coming back to the table. No matter your role, be honest about how you’re doing, talk to your peers for support, and don’t be afraid to ask for help.

Use the link here to tell us about a decision or action that you wish you had handled differently.

 

The healthcare response to Coronavirus is a challenge that is occupying all of our efforts right now, but there are other impacts as well. Christen Kishel, Ph.D., a licensed Psychologist who has previously commented for this blog, has offered some positive and constructive thoughts on our mental health during these challenges. If you have any lessons that you’ve learned as a leader during this evolving crisis, please submit them here anonymously.

The other pandemic: Anxiety. For emergency responders and others who have to remain in close contact with potential carriers of Covid-19, here are some thoughts from your friendly neighborhood shrink:

First of all, get the facts. Accurate information is the first thing we all need in order to manage anxiety. We may not know the long-term course of this virus, but we do know a few things, and can put our focus there:

1) As of March 18, 2020, the CDC reported:

a. 0 deaths among people under age 19
b. 9 deaths among people age 20-64 (only 9 deaths among people in the age group of most Firefighters, EMTs, etc)
c. 20 deaths across all of US among 65-84 year olds (that’s a few of you)
d. 15 deaths among 85+ year old US citizens
e. Approximately 80% of people who contract the virus have only mild symptoms.
f. Around 15% require hospitalization at present, which is a high number, but still not the majority.

2) Remember to read the above statistics with your logical mind, not your emotional brain! Your emotional brain (limbic system) will tell you that these numbers are awful and we will soon be experiencing the terrible conditions and choices citizens of Italy are currently facing. This is still an evolving crisis, and fear does not help us!

3) We have a few things going for us:

a. While social media can exponentially increase fear, social media is also helping spread the message to the citizenry to stay home and help flatten the curve. This is happening in many ways, from matchstick diagrams to probability tables that reinforce social distancing as an effective strategy for flattening the curve. Many people are posting fun sites with resources for kids and families, virtual tours of cool places, creative things they are doing to weather the storm, etc.

b. We are grownups who have the ability to get off social media if we want to stop the flood of anxiety-ridden posts. Or we can choose to stay on it to laugh at and shake our heads at all the memes about what might alternately be dubbed the Cornholio virus (since apparently we need excessive amounts of TP for our bungholes!). If you want to stay informed, call the official hotlines or visit the informational sites your departments, states, and national evidence-based entities are posting with daily updates.

c. We are smart enough to make smart choices. We know to wear N95 masks and safety glasses, to glove up, and to wash our hands and sanitize often. Those who have been in the health care industry have the most practice in using proper PPE – and IT WORKS! PPE recommendations are evolving on a daily basis, including based on availability, so use your trusted sources to stay up-to-date on today’s best practices. Consider making a checklist for your PPE practices to help you remember!

4) And now for a little good old-fashioned psychology.

a. One of the best strategies for defeating or at least mitigating anxiety is to know what is it that you cannot control (the virus) and what you can (your thoughts, focus, and actions). Let’s start with the basics.

b. The two best things we can do for ourselves to battle emotional distress, from everyday worries to fears of impending doom are exercise and sleep. Just because the gym isn’t open (it was probably gross in there long before Covid-19!) doesn’t mean you can’t exercise. In fact, it’s been shown that fresh air and sunshine are two of our greatest allies in beating any pandemic – especially the one between our ears! Take your dog for a walk, take your spouse for a walk, take yourself for a walk. Deep clean the house to get it sanitized for the form of exercise known as elbow grease (great therapy for me this week!). Try to learn some tik-tok dance videos and laugh at yourself, then film yourself doing them to make your kids laugh. Or maybe try one of the fancier YouTube dance tutorials. Hell, just walk laps around your house if you want. Remember the story of the 86-year-old African American woman who lost 120 pounds that way? (Check it out for yourself!)

c. Worry and anxiety disrupt sleep, which begets more worry and distress. Exercise earlier in the day helps with better sleep at night. Some tips to help with sleep disturbance:

1) Set up your environment. Remove TV, laptops, tablets, and non-essential communication devices from the bedroom. Limit the electronics in the bedroom to music, white noise/nature sounds, guided meditations, and clocks that are as dim as possible. The body needs to have a clear association between the bed and the 3 S’s: Sleep, sex, and snuggles!
2) Room darkening curtains or eye masks help.
3) Unless you are one of those people who have a sensory issue that means you need no sheets or covers at all, use heavier blankets and a cooler room (68 degrees is recommended by researchers).
4) When not on the job, go to bed and wake up at the same time every day.
5) Alcohol is your frenemy. The deep (delta) sleep and REM sleep are where your body clears out toxins via cerebrospinal fluid. Alcohol can make you sleepy but disrupt your ability to get to those deep sleep states.
6) Also watch out for caffeine. As a coffee addict myself, I know how hard this is. Preaching not teaching!
7) Use a “happy light” (about $35 on amazon) for 30 minutes in the morning.
8) Nap as much as you can or at least 30 minutes a day.
9) Find a meditation app like Insight Timer, Headspace, and Calm apps to find something that works for you. Those who know me know that I am a metal head when it comes to concerts with a wide palate in between, but at night, for decades, my body knows that Enya = bedtime.
10) If thoughts are getting the best of you and panic is setting in, get up and away from the bedroom and distract yourself with stupid tv, funny stuff, etc. No need to sit in bed and stew and suffer. Refer to #1 for what bed is actually for.
11) Melatonin and other sleep remedies can help during times of distress. I personally use things like Alteril or Sleep 3 that have melatonin, valerian root, and tryptophan because they work for me and don’t make me groggy. You have to decide for yourself. I would recommend staying away from Ambien. Talk to your doc to see what might help.

d. Mindfulness is powerful. And it’s not woo!

1) No need to chant OM if that is not your thing. Real mindfulness means returning to the present.
2) If you have one foot in tomorrow (anxiety) and one foot in the past (depression, resentment, regret) you are pissing all over today!
3) To stay in today, ask yourself a simple question: “Where am I now?” While snuggling between snooze alarms this morning my mind was on everything there is to worry about, including myself, my family, my friends, and the emergency responders I care about deeply. But I need take care of me if I am going to take care of you. So, I asked myself, “Where am I now?” and gave Shadow (my little granddog) another belly rub!
4) If I am doing dishes, I am doing dishes. If I need something in the background to minimize some of the 500 tabs that are always open in my brain, I make it something I can learn from or entertained by (not news!). Jeopardy, Master Chef Junior, Cash Cab, and the like are shows that I can pay some attention to if I want to while doing whatever is at hand.
5) Nutrition matters. When we are not serving people in the community, we might be spending a lot of time indoors. Take your vitamin D. Other supplements recommended by others more educated than me include Magnesium and Omega 3’s. Idiots might be buying up all the TP. But things like Swiss Chard are still readily available at most grocery stores!
6) You already know how to eat healthy. It’s up to you to make your menu what you want it to be. Involving your family in the process can be a lot of fun, and a connecting activity.

e. When you are at home, what do you think does your family more good: fretting about whether you carried something home (worry = cortisol = immune impairment = more likely to catch something), OR knowing you did the best you could to maintain high standards with PPE and cleanliness, and then focusing on relationship once you are home? I don’t think you need my PhD to know the answer! Even if you can’t let go of the worry, Take Positive Action! Remember that worry is like rocking in a rocking chair. You move a lot but get nowhere.

5) In the meantime, watch the video “Rocks, Pebbles, and Sand Story” on YouTube. What are the rocks in your life? Chances are your family is top of the list. How do you make the most of family time?

a. Kids being home from school means a golden opportunity for family team building. You might not do an escape room right now, but you can order a murder mystery online for the family to work on together! If you have siblings with kids, consider things like having all of them watch the same virtual zoo or museum tour or other educational activity and have a facetime chat about it amongst everyone.

b. Get creative! What do you wish you and your significant other, family, etc, always say they want to do but never have time for? Is it learning to change a tire, cook a meal, or watch a show? Do it!

c. Do you and your spouse dream of traveling? This pandemic won’t last forever, so plan for adventure when it passes! We are personally looking into a New Zealand trip with our friends. Our inner nerds need to do the LOTR tour at the very least!

6) If you are single, no need to despair! You can connect with friends online to play games like WordFeud or Words With Friends, read books that libraries are making available online and discussing them together, playing 20 questions, or texting/calling/face-timing to whine or collaborate!

7) Pets are indispensable. Research shows again and again that there are actual biological and neurological benefits to petting and snuggling with your pets. And some need walks that are good for you too! If you don’t have a pet but need a warm fuzzy, consider a cuddle buddy, a microwaveable stuffed animal that can warm your heart center. Pillows are good too (though not as warm). Even emergency responders need cuddles now and then!

The point is, we can let the virus win or we can win. We win by living our best lives and keeping the problem at hand in perspective. We learn the facts and take the precautions, and when we are off duty, we put our focus where it belongs. Not on the virus but on the relationships with ourselves, our families, and our friends that matter most. We give ourselves permission to indulge in connection, laughter (including dark humor), exercise, and creativity. You have no control over the presence of the virus and your exposure to it (though if you have symptoms, stay home! Let admin worry about coverage!). You DO have control over where you invest your energy, your thoughts, and your time. As long as you are alive, I recommend that you really live!!

 

This EMS Dashboard Confessional demonstrates the importance of having trusted sources who can guide you through difficult situations, often called a Personal Board of Directors:

“Recently I made a massive blunder in leadership; actually, it took some time for me to recognize and overcome this failure. It’s been a long road that I’m still actively recovering from, and I would love to share this so others may learn from it too.

When I joined the department, I met with all of my staff directly to discuss things we needed to sustain and areas to improve. One thing that was universally noted that everyone wanted to keep in place was our shift schedule.

Our department had some operational changes, and one of those involved our shift schedule. I was not supportive of this change, but it was made very clear to me that I had no input on the matter. I became very vocal because I felt there was still an opportunity to negotiate, and if that didn’t work I could lay down the trump card of threatening to quit. During this time, I became disgruntled and was nonproductive. One day my father (a mentor) randomly asked if he could swing by and visit. He had never seen our headquarters and so I showed him around. During this time, he quickly picked up on my negativity.

We sat in my office and I laid everything out for him. He listened intently and then let me have it. The first thing he said was that I’d forgotten my priorities. The department comes above everyone else, and he accused me of placing myself above the department. If he were chief, he would have accepted my resignation!

Second, he told me that I needed to suck it up! He said “so what, your ego got crushed….” If he had a dollar for every time his ego got crushed, he’d have enough for a decent dinner. But instead of pushing through it and making a decision, I’ve decided to sulk and bring others down with me.

Which brings the third point. He glared at me and said this is the hardest one to process and started to tiptoe around, and I told him just to let me have it. That’s when he said, not only are you being a wimp as a leader, but you’re a liar! This one rocked me to my core. He said it with love, but he said that when I started here, I made a personal and professional commitment to be the best boss possible and to lead your people to the best of your ability through the good AND THE BAD! He then asked, in the last 3 weeks, have you been the best boss you can? I said no, to which he then reminded me that nobody likes a wimp but they really don’t like a liar!

He gave me three options: I can put on my big boy pants and lead through these difficult times, which is really, why they need me. I can leave and go be the boss somewhere else and have people not like decisions I make. Of course this still involves answering to someone. Or I can get back on the truck and leave leadership

Obviously, I chose to lead through this but it’s been a challenge. My ego has been hit, my word can’t be trusted, my bosses are frustrated with me, my staff is frustrated with me. Despite all this, I’m here. So how am I getting through this?

For starters I had to embrace the mentality I share with our field providers which is to own your mistakes! On the clinical side we’ve started to change the course and actually get people to admit their mistakes so everyone can learn from them. I ask my staff to champion those mistakes and share so others may learn. So I did just that, during an all hands in person meeting I turned off the recording device and had a real and vulnerable conversation with my staff. I laid everything out and admitted that I had failed as a leader. I explained everything that had happened and told them that even leaders make mistakes, I do not expect them to bat 1,000, and I hope they do not expect me to. I cannot undo some of the changes in motion but we will get through this together. I wanted them to see that you will not always agree with decisions being made but we have to see the big picture and do what is best for the organization as a whole and despite my initial reservation, I feel this is what is best. I let my ego and unwillingness to change the schedule blind me to the benefits for the organization as a whole.

I forgot my priorities – the mission, the men, and me (it’s from a book). I got this one wrong, and I got it wrong because I got the priorities wrong.

Michelle Kobayashi, Administrative Director of EMS at Hackensack University Medical Center, has these comments for improvement:

“When dealing with something tricky, whether it’s high stakes or not, it’s always good to run it by someone you trust. Is this a hill to die on? You may not realize you have blinders on and it may take that second (or third) person to help gain perspective. A good indicator for this “pulse check” is when your emotions are running high. When you’re ready to quit over something, go talk to someone you trust. They may agree with you, or they may help talk you in off the ledge. Either way, don’t live in your own head.

My second piece of advice – don’t create your own echo chamber. The person to talk to about this isn’t someone who is also affected by the issue. Find someone who isn’t involved at all. This way, their own emotions on the topic are less likely to influence your thoughts and decisions. In this conversation it’s all about you.”

Use the link here to tell us about a decision or action that you wish you had handled differently.