Podcast 118 – EMCrit Book Club – On Combat by Dave Grossman - a podcast by Scott D. Weingart, MD FCCM

Editor's Note 6/4/20: In the wake of the devastating incidents of police violence, many with racially biased overtones, the kill or be killed attitude endorsed by Dr. Grossman has justifiably come under fire. A few folks have asked (some, not so nicely) that this episode be taken down. While we sharply disagree with that aspect of Dr. Grossman's work, none of those aspects are discussed in this podcast. We feel it would be a loss to the resus community to take down this episode. Instead, please separate the things discussed here from other problematic facets of his recommendations.



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Today I am joined by the master of all things Mind of the Resuscitationist, Cliff Reid of resus.me and the Rage Podcast. In the first ever EMCrit Book Club, we discuss a book I read years ago and recently reread:







On Combat by Dave Grossman has enormous relevance to resuscitationists. I feel the entire book is worth reading, but we zoned in on the really juicy bits.

Section I - Physiology of Combat

Chapter Two - Stress Responses to Combat

We briefly discuss bowel and bladder control as they relate to stress

Chapter Three - Sympathetic & Parasympathetic Responses

Parasympathetic backlash-a time of cognitive danger

"The moment of greatest vulnerability is the instant immediately after victory" --Napoleon

Adapt a 360 degree visual sweep for threats (keep looking at all of your patients vitals and remember to bag)



SWAT Team Acronym-L.A.C.E. liquids, ammunition, casualties, equipment; For us--check your team, immediate reset of resus bay, drink something, debrief



Burn off the adrenaline dump



Conflict with colleagues. Exercise, Punching Bags? If a horrible call is reported on the EMS phone, but never shows--run a sim to burn the epi.



Sleep Deprivation-Caffeine can be our friend, nicotine not so much. If you are too exhausted to perform, tell a colleague and take a nap.

Chapter Four - Colored Conditions

originally from Bruce Siddle, Sharpening the Warriors Edge



Heart rate and task performance: heart rates are a guide, getting there by exercise is not the same as by fear/stress, so HR is merely an associated marker

Yellow 90-120, Over 115 and fine motor skills performance degrades significantly

Red 120-150, a 145 HR seems to be the break-point for optimal performance of complex skills

Black >150 and badness ensues, (or >175 in the highly trained, they get a gray zone)



* Fine motor skills-precision tasks

* Gross Motor Skills-ape skills

* Complex-a combination of maneuvers or use of multiple body parts



SWAT team breaking down door function in condition red (or gray), but they have trained until the necessary tasks that require fine motor have been practiced till automaticity



Unified Model of Stress and Performance















 



We need to train how we fight

Stress Inoculation Training and (Academic Medicine 2009;84(10):S25)



We are currently wasting high fidelity simulation, it should purely be for stress training. Perhaps, we should create a hell week for our 2nd years.



Stay in yellow (alert, but with fine motor control) - yellow dot stickers to...

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