2 min read

Cognitive Bandwidth and Managing Yourself Before the Patient in EMS

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The pager buzzes across the table as the lights flash and the tones drone through the crew room. You sit up straight, pulling on your boots and quickly making your way to the ambulance. It is time to go to work. 

From the moment the page drops, or the patient hits the ED door,  you as a human being undergo a change. No matter how seasoned you are, your body goes on full alert. Your heart rate goes up, and your brain begins cascading hormones like cortisol and adrenaline. You are now knocking on the door of fight or flight mode. Why is this knowledge important?

When our brain begins the cascade into fight or flight, we both gain new skills and lose old ones. As our stress level increases, however, a few of those skills we once sharpened begin to fade in the adrenaline of the moment. The cortisol kicks in harder and the adrenaline begins to weaken our cognitive bandwidth. 

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How hard is it for you to tie your shoes today? It is second nature. Even if you are in a rush you can still tie your shoes perfectly. Why? Because you have done it over and over again. Your brain has mapped that specific process repeatedly. It has become hardwired. How about a math problem...how much is two plus two? 

The answer is instantaneous because it is a simple problem. If you were running and someone asked you to solve it, you could. 

But let’s say you are still running and somebody asks you to solve seventeen times thirty-four? Unless you are a math genius, it is going to be hard to work out in your head while also focused on running. This is cognitive bandwidth in action. We have a limited amount of brainpower to dedicate to any task, which includes stress response. 

When working on a critical patient, we have skills that need to be at their absolute best. How do we prevent ourselves from losing them to cognitive bandwidth saturation? 

"Practice makes perfect" is not a saying just for the sake of it. As a child, tying your shoes is frustrating and difficult. But as you repeatedly perform the task, it becomes second nature even under duress. We must practice our skills as providers. Even something as simple as spiking a bag of saline is important to have muscle memory in. Muscle memory takes up significantly less room in our bandwidth than if we were otherwise unfamiliar. 

Secondly, utilize the resources around you. If you are working on one task, clearly assign a different task to someone else. If you are doing math, use a calculator, or an app! The calculator is not stressed and will do it faster than you. That is bandwidth you can hand off to a machine instead of trying to manage yourself. Use your first responders, use your ED staff; leverage the team around you. 

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However, as our stress continues to rise, we continue to lose bandwidth. Not only do we need to reduce the bandwidth required to perform tasks, we should also work on reducing the bandwidth our stress response pulls from our system. Building confidence in our skills and knowledge is important. Learning never stops, no matter how competent you are. Continuing to educate yourself arms you with the tools you need to mitigate stress. 

Learn to breathe. We tend to breathe fast and shallow as our stress increases. Learn to breathe slowly and deliberately, even if you are under duress. This slows your heart rate, calms your mind, and frees up room in your brain to care for your patient. 

Finally, take care of yourself when you are not at work. Learn to decompress. Stress stacks, and continuing to carry the weight of chronic stress will impact your life—not only at work, but beyond. Take care of your mental health, exercise, eat right, and cry when you need to. We owe our patients to be our best when we meet them at their bedside.

So breathe easy, use your team, practice your skills, and...remember to take a spa day. 

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