TEDx: Creating calm within chaos

Kris Kaull relates his most memorable call, and how practice, and a mindset to control what you can allows EMS providers to provide help and calm during the chaos


EMS1 co-founder Kris Kaull presented this talk at a TEDx event independently organized by the Bozeman, Montana, local community using the TED conference format. Learn more about TEDx and watch the video below. 

It was early October. The fall leaves had turned colors and the air was brisk. Bob and his family finished dinner, watched TV, and scooted off to their own rooms for the night. They were all in bed by 11.

A calm normal night, until it wasn’t.

Just past 1 in the morning, this peaceful night turned chaotic. 1:16 a.m. to be exact. Bob stopped breathing. His heart stopped. He was in cardiac arrest.

Bob was young. Younger than I am now. He was 42; happily married; three kiddos.

“BOB! BOB! Are you ok?” his wife Dianne asked. Just guttural noises.

“BOB! Wake up!”

Dianne, a math teacher, jumped into classroom mode. Quick. Call 911.

“HELP ME! My husband isn’t breathing.”

“Yes, I know CPR. I’ll do that now.”

Dianne started CPR. 1 and 2 and 3 and 4 and … alternating between rescue breathing and compressions.

I was the second responder to arrive. With the heart monitor hooked up, I shocked Bob. We got a heartbeat back, but he still wasn’t breathing. Continue rescue breaths.

What would you do in this situation?

For 25 years, I’ve worked in chaotic scenes like this. I’m a critical care flight paramedic on a helicopter. It’s a job most people respond by saying either:

“What’s your most memorable call?”

OR

“I freeze when things get crazy. I could never do what you do.”

But you know what? The truth is ... handling emergencies – making order out of chaos – is something everyone can learn to do.

Medics bring order to chaos

People think medics are lifesavers. But really, we’re simply fantastic at bringing order to unplanned circumstances.

And, with the right systems in place, you can not only endure … but actually thrive … in times of chaos.

See, when it comes to stress and chaos, there’s a bell curve.

It’s called the Yerkes-Dodson Law.

This law suggests that elevated levels of psychological arousal can actually improve your performance and effectiveness … but only at a certain middle point.

If your stress levels increase too much, your effectiveness diminishes.

And If there isn’t enough stress, you won’t perform well either.

The key to making order out of chaos is to put systems in place to help you stay in the middle of that bell curve – where your senses are heightened, but not clouded.

Use these tips to help you stay in the center when chaos hits.


Tip 1 – Change your mindset

As responders, we know that calmness ultimately changes the trajectory of an entire event. Why? Because we’ve changed out mindset.

It’s not our emergency.

It’s our job to slow down the crazy.

Fun fact: Emergency personnel never run onto scene. There’s a reason for that. Instead, we move with just the right amount of urgency.

“What if – when you called 911 to report an emergency – the ambulance crew panicked? Who would they call?”

Imagine this …

You call 911. A few moments later, the ambulance comes screeching around the corner on two wheels, driving onto your lawn. A paramedic hastily leaps out, running frantically toward you, tripping over untied shoelaces. His partner screams mayday, mayday, mayday into the radio. As they arrive at your door, the ambulance starts rolling away because they forgot to put it in park.

Unsettling, right?

Consider Dianne as she gives her husband CPR that fateful morning. She was very worried, but she also maintained her cool. Dianne changed her mindset. She slowed down, focused and took action. She did what she could do to help.

More often than not, it’s our inaction that gets us in trouble.

We are scared to make a mistake, so, we do nothing. But the truth is, doing something is better than doing nothing.

Working on changing your mindset – slowing down, focusing, doing what you can tangibly do – helps in chaotic situations ... but it is also helps in normal, everyday life.

Have you ever had a morning where everything starts out perfectly and then goes crazy? Maybe you got up early, completely ready for an important presentation at work. You made coffee, got the kids dressed for school, made the perfect lunches. But then, just as you’re heading out the door, a pipe bursts under the kitchen sink. And – as you attend to that – one of your kids throws up their cereal. Your perfect morning is suddenly gone.

But now, let’s fast forward to the weekend. Over a glass of wine, you are retelling the story to your friends.

But this time, the faucet is like Old Faithful … and so is the explosion of cereal from your sick child. But you’ve got this. You’re holding it all together. You’re calm and focused. You have the plumber on the phone and the cereal cleaned up and your child comforted, and you still make it to work where you crush the best presentation of your life!

In fact, as you tell the story, your friends are envisioning you as a member of the Coast Guard – hanging from a helicopter hoist, reaching down yelling, “G-I-V-E M-E Y-O-U-R H-A-N-D.”

You’re a true hero indeed.

But in reality, nothing happened that morning you couldn’t handle – and you didn’t leave for work completely exasperated. You managed the stress and made order out of chaos.

You changed your mindset.

Tip 2 – Practice makes … better

A fellow colleague had a saying … “Practice makes perfect … er, I mean better.” It is one of my favorite quotes.

It is so applicable to our lives.

When I was in paramedic school, I learned the steps of CPR and how to treat a patient. At the beginning, it was about the skills: do compressions. Ventilate. Learn how to read ECGs. Start IVs. Administer medications. Each skill was its own isolated class.

But as I progressed, skills turned into scenarios – learning how to treat the patient while managing a chaotic scene.

Then came my final exam.

I was in a 10’x5’ equipment closet with a mannikin. The scenario placed me in a simulated elevator. As the “elevator doors” closed, the patient started having chest pain and I need to assist and treat … all by myself. Then the “power” went out as the instructor turned off the lights and then handed me a small penlight – you know, the one that the doctor uses to check your pupils.

“Keep going,” he said.

Despite anything I did, the scenario got worse. The patient went into full cardiac arrest. I needed to do compressions. I needed to manage his airway. I need to hook up the heart monitor and shock the patient. All in the dark while holding a penlight with my teeth.

And then, the chaos really started.

My instructor turned up blaring music and started bouncing a ball by my head … all while asking test questions.

“That was brutal,” I said when I was done.

But he asked me, “Was it any more brutal than managing a scene of first responders while performing CPR on a father while his wife and kids stood by?

It drove the point home. I was never going to perform one isolated skill at a scene. Every 911 call was going to be chaotic. I needed to practice so I got better at managing it.

After Dianne called 911, she started CPR. Was it perfect? Who knows? But, more importantly, who cares? It wasn’t about being perfect. It was about taking action. It was about breathing air into Bob’s lungs and then circulating his oxygenated blood around his body to keep him alive.

By taking CPR classes as a teacher, she learned a skill. A skill that she never planned to use. But she did.

Practice makes … better.

Tip 3 – Control the things you can control

When I go to work, I never know what will happen. I don’t know what patients I will encounter – or even where we’ll need to fly.

Despite all of the day’s unknowns, I follow a plan. I manage the things I can manage. I organize my flight suit, my jacket, my helmet, my gear. I check out my equipment. I check in with my crew and we brief for the day. Is anyone feeling tired? Any aircraft maintenance? Expected weather considerations?

These are all actionable, tangible, steps that we take in order to be prepared for the unknown.

Where can you put controls to make your life simpler? Planning out your meals for the week? Lying out your clothes the day before and prepping the coffee?

It turns out, Dianne and the kids did just that. That evening, they focused on the things they could control, and on the things that mattered – Bob and each other.

Dianne and the kids huddled on couch that early morning praying that Bob would be OK. The youngest, 11-year-old Elizabeth asked, “Is dad going to die?”

She was the only one brave enough to voice what everyone was thinking.

When he arrived at the hospital, Bob was placed in a coma for 36 hours. The future was unknown. As the medical team slowly brought Bob out of the coma, the nurse asked, “Bob, can you feel your wife’s hand?”

He squeezed her hand.

A tear rolled down Dianne’s cheek.

Dianne, did something. Dianne found the calm in chaos. That was the defining moment of this call.

When chaos appears – and it will – use this story and these tips to find your calm.

How is Bob?

It’s been over 20 years since that night in October and Bob is doing great!

He’s seen his kids graduate high school … and college.

He walked one daughter down the aisle and recently officiated the wedding of his other.

And then – on Valentine’s Day – they witnessed another miracle added to their grandparent collection.

Oh, and as for the question, “What is one of my most memorable calls?”

Well, now you know.

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