10:Overtrain then Let Go, with Bret Whitman
Mental training for big waves and deep dives with freediver, spearfisher, big-wave-surfer, and all-around great dude Bret Whitman.
Many non-crucial details of emergency medical cases, like when a case happened or the age or gender of the patient, have been changed randomly to preserve patient confidentiality. As always with the Emergency Mind Podcast, the goal is not to provide medical advice or commentary on medical care, but to explore best practices and ways that we can all improve how we think during an emergency and apply knowledge under pressure. Additionally, the views expressed on the podcast are personal views and do not represent the views of the employers or organizations at which we work.
05:50—I really like this small discussion about the difference between a static breath hold (where you are sitting perfectly still holding your breath), and a dynamic breath hold (where you are exerting yourself and therefore consuming oxygen) since it is indicative of the broader point of The Emergency Mind, that there’s a difference between knowledge and being able to apply that knowledge under pressure. Also, never practice breath holding in any sort of water or potentially dangerous environment without a partner / safety buddy. We talk about this again at around 13:30.
07:04—Trying the same thing harder is not always the answer, especially when resources like oxygen are in short supply and trying harder increases your oxygen consumption. Panic, in particular, never makes things better. Prof. Gustavo talks about this in Episode 08 at about 42:00
07:25—“To perform at your maximum, you have to let go.” Love this idea, that getting out of our way and relaxing into it is what will let us hit our best potential.
09:30—Premeditatio Malorum is a frequent concept on this podcast. I really like the way that Bret has described it here – you know that you might get pinned by a wave, so you think through how long you would likely be pinned, then practice holding your breath for that long. At about 10:30, he gives another example about bench pressing 300lbs to be able to create distance from the largest person he would likely be facing in football. In both cases, the idea is to find where you have leverage and overtrain that area – you can’t control getting pinned by a wave, but you can control how long you practice holding your breath for.
11:30—This section is so crucial. If you panic, you will drown. To avoid this, your goal is to do everything possible to prepare as best as you can, and to lean into this training to calm down and think clearly when things do go bad. This is some of the essence of The Emergency Mind
15:50—Microskills in emergency medicine is a really interesting concept – I was first introduced to this idea from this video from EMCrit about microskills in central line placement, which is 100% worth a watch.
18:30—This is one of the most important parts of this episode. There are things that you’re never going to be able to fully simulate or prepare for – the wind coming up the face of a big wave, the rush of blood the first time you cut someone’s neck for a cric, etc. What you can do, though, is train and overtrain all the skills that surround that so that very other part of your process is rock solid and locked in. We talk about it again at about 32:30.
23:50—Confidence comes from preparation. From identifying everything that you can control and training it.
27:40—“You can’t fight the water.” This story is an excellent example of applying The Emegency Mind – Bret describes in detail accepting the reality of the situation, acting where he has control, deploying sangfroid, and (by telling this story!) playing for the future.
35:15—“All I can do is what I know how to do, so why freak out?” Bret’s discussion here about how he was trained in field medicine is really on target – you’re trained to have a certain set of tools, then you deploy those tools under pressure. No matter the circumstances (people yelling at you that the patient is going to die, for example), you just deploy those tools to the best of your ability. Anything that is not that, anything that spends time and energy elsewhere, is fracturing your concentration and syphoning your resources.
37:15—Dr. Hildreth was featured in Episode 03.
39:30—Dr. Griffin Meyers is the chief medical officer at Oak Street Health, a super innovative medical organization focused on high-quality primary care. The case I describe here was really formative to my own development as an ER doc and is one I quote often to the people whom I now train.
41:40—In no way am I Sherlock Holmes. The scene Bret is referencing though, is really good, especially because it starts with Holmes saying “This musn’t register on an emotional level” before doing what he does.