Tool: The Art of Triage


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Friday, September 9, 2016

Addressing Chaos

Years ago when I worked as a Fire Intelligence Coordinator at “South Ops," I set about finding some tools to help me organize and prioritize.  South Ops is the country’s busiest interagency operations coordination center, and is reputed to be the busiest such center center in the world.  It covers response coordination between dispatch centers for all of southern California, from Sacramento south.  The incident load was (and remains) high and persistent.

I was working in a job that three people probably should have been doing.  When I left the position, two people were hired to replace me… although the second position had been planned for some time.  In any case, there was always way more work to be done than could realistically be accomplished.

I needed some ideas to make it work.  I had read Stephen Covey’s book “7 Habits for Highly Effective People” in college, so that’s where I started.  I quickly found that those ideas were nice, but maybe not super-effective in an emergency operations environment.  More specifically, the examples Covey gave were for a more static and traditional-type corporate office setting.

I focused on the section about putting “First Things First,” and also read the book with that title (excerpt in this blog).  I started to get the hang of navigating the chaos.  It started with prioritizing. 

I learned to have conversations with my bosses about priorities.  More importantly, I learned to maintain an ongoing dialogue about our regularly shifting priorities.  It went without saying that incident support was a priority, but the other areas were less clear.  Since I got a new "this is your top priority" every few days (or weeks), I became skilled at asking about how the new priorities ranked in reference to the other "top priorities" from the weeks and months before.  The ever-evolving dialogue was an excellent communication tool that paved the way for many other things.

The Core of the Challenge:  Limited Time

Wildfire people, like many emergency response folks, are not always great at work-life balance.  I mention this because we were authorized a seemingly endless amount of overtime.  The potential to work a LOT of the time was ever-present.  This played into the prioritizing discussions, because it was easy to let the overtime availability fool you into thinking that you could just fit all of this other stuff in during some overtime hours somewhere.  The reality is that in an emergency operations center, dealing with the actual emergencies took a lot of time.  We always said that we would be better prepared to put out the wildfires if we didn't have so many wildfires all the time.

The end result is probably not far from any prioritizing situation:  there is still only so much time, and often many competing priorities.  You need triage when there is some urgency or heavy complexity, and no realistic way to address all of the existing priorities.

Once I got the hang of knowing and managing constantly shifting priorities, I got much better at triage.  Especially during emergencies.

Triage as a Tool

In my last job, I was the local technical contact for the National Capital Region’s emergency notification system in the Washington, DC area.  By the time I started the job, I had prioritizing down.  And, I got better.  This was a high-complexity and high-urgency situation:  I needed to triage.  I hate to do it, because it typically means that some things get left behind.  That being said, triage can be a godsend when it comes to keeping your own sanity, meeting critical goals, and succeeding within set constraints.

Emergency management is the perfect place to hone the art of triage, because something is always competing for your attention.  For a group’s attention.  For political attention.  Sometimes the priority is obvious:  protecting life and safety… NOW

A high-paced, high-pressure environment is the perfect place to work on triage.  For example, you may have a major, complex event planned with many moving parts and pieces that has taken months to orchestrate.  When a tornado warning happens just prior to event execution, you prioritize.  You deal with the tornado warning.  And everyone involved understands.

In some ways, public safety prioritizing is easier than other areas.  When life, safety, infrastructure, and property are at risk, the priorities are somewhat intuitive.  In everyday life, priorities are not always so clear.  We may have to do some thinking on what the actual priorities are.  That’s half the battle when it comes to triage.  You can’t do triage effectively if you aren’t sure what the priorities are. 

Triage starts with clarity on your priorities.  If you don't have that, the place to start is in figuring that out.

Triage is about applying scarce resources – like your own time or money – to your identified priorities.  It is super useful when there is some urgency or limitation.  I tend to use it when I am in crisis mode, or when I am doing a huge project.  When I am in triage mode, I put most of my time, energy, and resources on whatever is the priority.  Other things can get left behind... often deliberately.  But I meet the mission.  Most of the time, anyway.

I’m not saying I am a triage expert, by any means.  I have gotten pretty damn good at it, though.  It’s a huge key to how I have navigated the past few years.  I have gotten very, very good at putting the high-priority things first.  Sometimes too good.  Sometimes I’m much better at operating in triage-mode than in balance mode.  I have been known to put things like my own health, house chores, paperwork, and the like on hold in order to make other priorities work.

Triage-mode can be a phenomenal tool for getting through a crisis, a huge project, a life transition, a major disruption, or even a busy week.  I think that the trick to this is to not use it all the time.

Triage: The "Art" Part

My own experience has shown that the trick to operating in triage-mode is to stop operating that way at some point.  We all go through rough times, where triage-mode may be the most useful thing for us.  Where we need to operate like there is an emergency, or where we need to survive an actual crisis.  It is a fantastic tool.

It's not the best thing, though, for the "steady-state," or what some emergency managers call "blue skies."  If we want lives with some balance, I reckon the goal ought to be to get out of triage-mode at some point.  To get there, you may have to up your triage game even more - which is a little counterintuitive.  You may need to hyper-focus to get out of the crisis, or the pressure, or whatever the situation is. 

It is easy to slip into triage mode, and not slip out.  Once you get the hang of it, you can make tremendous progress where you set out to do so.  After a while, though, you may start to notice some signs of neglect in a few areas of your life.  Whether it's a pile of laundry, a growing mystery about what in the heck is in an overly full closet, friendships that fade, or new health issues... there can be side-effects.  We need balance.

How do you avoid this? 

Recognizing you are even in triage mode is the first step.  The second step would be to check in with yourself occasionally while you are in triage mode.  You can set a calendar reminder, do a regular check-in on yourself, or work with the people in your life to maintain some accountability. 

I had a neighbor who routinely gave me crap about the neglected parts of my life, because she could see what others often did not.  It kept me conscious of it.  I also had a friend at work who would report back to me on the state of my life... after hearing my crazy stories.  "Your life is a circus," she told me one day.  I was a little shocked to hear it, but it was useful feedback.  It definitely gave me pause:  I didn't think my life sounded crazy in that moment - until I took a few steps back.

Sometimes we are so deep in chaos that we don't realize how absurd it is.  My friend's comment helped me make some changes.  Sometimes those are boundaries... but that's a different discusssion.

One other thing we can do is to recognize when people in our lives are operating in triage mode - and check in with them.  We may not be able to help with everything - but we can probably help with something.  Solidarity and support are force multipliers.  We can hold space for each other.

We usually hear of triage in reference to emergencies.  That's good, and it makes sense, because that's what it's rooted in.  It's about managing chaos.  Hopefully we don't need it all the time.

Triage is a tool we can use.  We can use it to counter our own fear... when the pressure is severe.  When we're in a tight spot.  When we're not sure how to navigate a tight situation.  Or how to navigate disruption.

The art of triage is in knowing when

Epilogue:  The Blog Pause

This blog post came about as I have realized this year just how much I have been relying on triage.  When I think about it, I've probably been using it to some extent since sometime in the fall of 2012.  That would be about the time that I figured out that my job was in fact about immigration, and not about incident management as my official job description described.  Right around there, I lost a very close relative.  I reckon it was the combination of the two things that sent me into triage mode.  I do believe I've mostly been there since. 

I started out by switching teams in the office I was in; moving from immigration and border security, to cybersecurity.  That swap still wasn't sustainable, so I transferred to a different part of the department... hoping to do some good for first responders.  Many long stories later, and it became clear that there was another path.

This blog will eventually tell the stories, but the main point here is not to digress.  It is to say that this past year has been a little bit in survival mode.  I have settled in to a new normal after a move across the country.  Sometime in the spring - after all the moving chaos - I realized that I had been in triage mode for quite some time.  No surprise to my friends and neighbors... they knew.

I decided I might like a different way of being.  I might like to settle down.  I might like to have a life where there weren't so many unknowns; where I could get a little comfortable.

The thing about this planet is that we never know.  It is a fluid place.  It is full of risk and reward and mystery and grace.

In my own life, the evolution continues.  For now, I remain in triage mode... but I have found a certain balance to go along with that.  I am in many ways embracing the chaos.

One of the things that has happened as a result of this is that I put my blog on hold.  I stopped writing new material, and I stopped publishing the huge volume of material that is near-ready to be posted.  The writing includes something like 100 counterfear tools that are in outline or draft... but not yet posted.  This post here today represents a return.  It is time.  I followed the flow, and it led me to this moment.

I think a critical part of triage mode is to find the flow, and to follow it.  I made the conscious decision as part of triage to stop working on the blog, for the time being.  After I did, some pretty unbelievable things have come into my life that I would have never expected. 

Those things led me back here.

I say all of this to say this:  triage is a useful tool.  It is not the be-all-end-all.  At some point, we have to live, and live deeply.  Some of us might want that, anyway.  I do.

At some point, we can put our faith first.  We can embrace the chaos.

Fighting the chaos is one thing, and there is a time and a place for it.  Triage can help with that.

Embracing the chaos is another thing altogether.  I think if we could get the hang of that... well, then maybe we wouldn't need to triage.

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