Emergency Preparedness Is a Leadership Mindset: Lessons for Clinicians from the Combat Zone to the Boardroom (with Travis Kaufman, DMSc)

<p>hello everyone welcome to the clinicians and Leadership podcast series put on by the American Journal of healthc care strategy this podcast series is specifically focused on clinicians and Leadership specifically focused on empowering clinicians from the bedside to the boardroom today we have the unique opportunity to welcome a very special guest Mr Travis Kaufman Travis Kaufman has a wealth of experience not just in a clinical setting but also in the lead leadership setting um Travis do you mind taking a second to introduce yourself and just telling us a little bit about your experience hey Zach thanks a lot for having me on and I really appreciate being on the American Journal of healthc care strategies podcast I'm super excited to be here um just a little bit about me about my background I've been a PA now for about 12 years I currently am an active duty PA I had the pleasure to serve um in the combat environment um deployed in support of operation Iraqi Freedom as well as inherent resolve and then prior um or after the serving in that realm I was able to serve at the White House medical unit for five years where I worked as the chief medical operations officer and the lead PA and it was kind of interesting because I got to work under three presidential administrations including President Obama president Trump and President Biden um so thinking about those times I was able to uh work as the co coordinator throughout that um we supported many operations I believe we traveled to 43 countries and I supported 4 and I believe it was 52 conus missions supporting president vice president travel um and I've been fortunate to take that experience and over the last three years I've worked as a medical adviser in 17 different countries of of NATO North American Treaty Organization and I've advised about 32 Nations on emergency preparedness and disaster medicine situations to make sure that if something does happen in a combat environment or disaster situation we can all work together and in addition to that I teach at the University of lindberg's doctor medical science program and I lead the Emergency Management and Global Health concentration thanks so much for having me [Music] today well if that resume doesn't excite you just to hear from just this wealth of experience and knowledge uh I'm not sure what will so Travis I can't imagine more experiences that require emergency preparedness than uh working at the White House serving in the military um and doing so especially over the course of covid so just just for our listeners can you can you tell us just a little bit about why emergency preparedness is so critical for healthcare organization ations yeah that's that's a great question so really the biggest thing when you think about the importance of emergency preparedness for healthcare organizations you really want to think about the safety and Welfare of your patients right that's that's your number one the safety and Welfare of your patients and then you think about your staff I mean your staff are going to support taking care of those patients and then also the community during crisis and you know we've seen that recently with the the Hurricanes that's happened in North Carolina and Florida um and we have to think about a wide range of emergencies incling natural disasters like I talked about the hurricanes and of course the pandemic that just we really just live through everybody and unfortunately you know we're seeing this a little bit more in America as mass casualty events and that's when we're thinking about those actor of shooter drills so that's really why it's so important for um organizations to be prepared um when we talk about preparedness we want to talk about mitigating risks um minimizing disruptions to care right so if a hurricane does strike that hospital has that hospital made a plane to have a backup generator so the ICU can keep running taking care of those patients right that's something they have to think about that critical infrastructure right so I can tell you just from from experience I had the pleasure and the opportunity to work with the white house and we responded after Hurricane Maria and hurricane Irma in Puerto Rico and you know it was really the infrastructure of the hospitals was devastated really is's no way to prepare for that and one thing we noticed is when they brought their ambulances that you know you know when you bring your ambulance in that area it was all destroyed it was no safe way to bring patients into the emergency room but really they had thought forward and thought ahead and they also worked with FEMA and they had brought in tents and they had actually brought in bulldozers and really cleared a path so they could bring um emergency vehicles in to take care of those patients that was a really thoughtful way to do that um so that's that's really the biggest thing is why that's so important when it's talking about the infrastructure but then we think about things inside the hospital like blood storage right um and we think about it from a hospital situation you know there's a lot more rules and regulations of storing blood how do you get the blood but then we also think about that from a more austere combat environment so in you know more auster combat environment we talk about blood drives we actually will before deploying we will crossmatch and check every soldier that deploys and that way if there is a mass casualty event on a military base say it's a disastrous situation and we're taking care of the local population we can call all those designated donors and bring them in and plus up our blood supply to take care of those traumas so that's kind of when you're looking at the infrastructure versus what's also going on inside and then lastly we think about Personnel right um because that's our that's our best asset we can have all the great equipment we can have all the great you know plans but if we don't have the Personnel to really back us up so we really have to make sure that we look at our shift work our sleep rest Cycles those are things important to have your personnel ready to go in case that does happen so that's kind of everything together to be prepared well and I just I think about I mean no one no one to my knowledge enjoys going to a hospital um on a normal day it's I can't I can't imagine during a mass casual event or some some sort of emergency setting you just your entire world has been Ro you are looking for stability and if the place where you are going to look for that stability is not providing that stability then everything else is crumbling and so um I think I think that that that answer is really helpful um so what role we're talking about emergency preparedness and just the ways that healthc care facilities can be prepared for emergencies what role does leadership specifically play into making sure that those healthc care facilities are prepared so you know the biggest thing is having a culture of preparedness right when we're we're thinking about preparedness it's it's the leader has to get in the front and say hey this is how we're going to do it and that's not barking orders that's talking about really prioritizing emergency preparedness and strategic planning also allocating resources training and drills and also fostering collaboration among departments right so it really starts right there at leadership and you also have to watch out for timing because everyone's you know working in the ER they're being very busy the ICU is very busy um so really what you do is when you're doing those huddles in the morning you could talk about an example and saying hey um you know we have a Hur if it's in Florida you know we have a hurricane coming to the area this is how we're going to prepare and you could just do a quick little drill it could just be a quick 15minute drill saying hey we have a mass casual event let's test out our radios real quick let's go out into the parking lot make sure our triage stations are up up to par and then let's go ahead and call the ICU let's go ahead and call the blood bank um let's go ahead and call general surgery and say hey we're just testing out these system so in case this does happen everybody's ready to go and we're all talking right because I'm gonna be 100% honest with you when when things get really kind of crazy the first thing to go down is communication communication can kind is the first thing to go down and and when we think communication we're always thinking okay maybe we're sending something through a digital system possibly we are calling by radio or maybe our phone system right so it it's really up to the leader to build that culture of preparedness right up front make sure that it's important um that's that's what's going to be big but also when you're talking with staff you can ask them you know why don't we go ahead and set up some some annual by anual or quarterly drills right so um say you're living you're in an Urban hospital it's a level one trauma center and you have a mass Decon area or you know most of those hospitals have a mass decontamination area that's going to be in their ambulance Bay but they're also going to have a small decontamination area and you'll say I think that we should probably really work this out and do a drill quarterly and if if you establish that culture where you come in you you work that quarterly then everybody's familiar with that Decon system so in case something does happen you're ready to go right um and that can also be triage and mass casualty events say let's look at this quarterly let's just work on our mass casualty um incidents and make sure that we know what we're doing and just bring some ambulances through practice taking patients off how you're going to communicate that you know you you've seen a really busy ER there's patients in hallways the you know the trauma room can be full so how are we going to really put these patients in store them and make sure that they are getting taken care of and not forgotten so that's that's you know allog together that's what leadership has to do is really put that up front and just keep a culture of preparedness well and you just the couple things you mentioned just stood out to me I mean the one just the importance of drills and practicing because the first time that you should the first time that you are a healthcare organization is enacting these protocols should not be when an emergency is happening it your staff should just resort to the training that they have received and that training is LED and guided by that leadership and the other thing that stood out to me is just the the importance of communication and how I mean we've heard a lot communication is that that is one of the key components of just leadership across the board if you can't commu communicate you cannot be an effective leader and so just the way that communication can break down during Emergency Settings contrasting that with just the importance of leadership building that culture of preparedness I love that term love the way you described that and also just building that culture of communication is just is fantastic and Zach you bring me back to a really important something really important too about leadership it's also taking feedback from your your subordinates and your peers right so when you do those drills they're great and important but if if you don't accept the feedback and the after Action reviews then you can't improve right so I can give you a a great example um we're working out of an ambulance we're getting ready for the inauguration of the president and we're working out of the back of this ambulance when we're working out of our bags and we notice it's getting kind of messy in the back of the ambulance as we're practicing so you know when we we thought about how how to improve we're like okay let's do let's put together a system on the walls of the ambulance to make this care and improve it and we feed that to our leadership to make sure that it could get improve approved and happened and our leadership list listen to us and and we made it better so that was just an example of how my leaders listen to me and it was good for me as I progress as a leader to make that better that's fantastic so talking emergency preparedness um emergencies don't happen every day and that I mean one that' be terrible if they did but they they they don't happen every day and just the nature that they don't happen every day catches is what catches everybody off guard and so how do or how does a healthcare organization balance your day-to-day operations while maintaining this Readiness for emergencies yeah that's that's a tough one right because everyone's doing their their their workday they're getting after it so um I think as going back to those drills establishing that culture um another thing to look at is we really need to um prioritize resource allocation right so when you're thinking about resource allocation you're thinking about okay let's look at Co for example Co kind of hit us all we we were back on our heels we weren't ready um and I think that was really a great example to show us we need to keep thing in more of a strategic Reserve in our in our Health Care system and that could be all the way at the hospital and that could be on on an ambulance right so if if we make sure they have resource allocation appropriate um for both everyday operations but also those emergency preparedness operations so if we know that we're going to have a mass casualty event you should probably have some trauma bags ready to go that you can you can pull out the trauma bag it's got all your triage Tools in it if you got a decontamination bag or box that you can just pull out and it's ready to go now with that it's great to have all that but you do have to make sure that it gets inventoried right because if you haven't looked at it in a year pull it out and there's cobwebs and things are falling apart obviously that's an issue so I think I think um establishing kind of a clear schedule for training and preparation inspecting that equipment that goes back to those quar of Leach reels um but also Mak someone responsible right so within our hospitals we have you know your Emergency Management person um you know we're talking with Pas we're talking with doctors and nurses maybe if you're the lead AP you have a couple APS with you um that say you're going to you're going to be in charge of the Emergency Management for this department let's put together these systems and let's educate everybody so that's that's kind of how you have to manage it to make sure everybody's on board but also able to do their day-to-day task well and just thinking about what we've talked about so far the I mean responding to an emergent situation should never be a one man or one woman show it it is requires intense coordination and communication and I just I loved what you mentioned at the end how a a a leader empowers other leaders to assist in the overall unified goal um which in this case would be responding to whatever that emergency situation and ensuring that you're prepared for those situations um one of the things you mentioned that I thought was you mentioned that I thought was interesting you mentioned resource allocation and so uh I I we have a very and I'm sure you have very practical applic for this having been serving in uh the White House over the co pandemic uh but how how does an organization approach balancing resource allocation when demands exceed that your capacity you know that's a that's a really tough one right so and that's really where you're you know we talk about the term triage and everyone's like yeah we got triage but but when we think about really like real Liv serious triage in an emergent situation that's when we sometimes have to make those hard decisions right so if you do if you say you have 25 casualties that come to your door right and you know that you only have so much blood you only have one neurosurgeon there's going to be some triage that's going to come into play and um you have sometimes you have to keep those patients comfortable but you have to know that this this patient and their injuries it may not be compatible with Life um this could be especially if you're working in that disaster medicine scenario and and you're in you're in a tent you're in a hurricane stricken environment and you've only got so many supplies right so that is where that tree but but you can also look at your evacuation systems too and this goes back to the communication and that resource allocation so if you know that you're about to receive all these patients this is where collaboration with other entities really really comes into play and this could be other Hospital Systems in the community this could be the local EMS this could be the firefighters um and this really is when it really is important for Community involvement and when I when I say community involvement that means know all your local firefighters and you know this could go to you know you as the AP and you have a lot of experience in emergency medicine maybe you go to that fire department and you give them some stop to bleed some tactical combat casualty care training um you go to the local EMS and you you volunteer with them some time you talk with the local community you do that stop the bleed training that's where that Community buyin all comes together so if this happens you may not have to make those hard decisions in triage because the community comes together you can collaborate with other um entities and other Hospital Systems if that's who you're working with u when when it's a disaster situation um you may have other nonprofits that you know had the resources that you can say hey I can get this patient to you or can you get this patient to to me right we do that in the military all the time you know we're thinking about helicopters and um front you know forward light ambulances and how are we going to allocate we're not going to send a helicopter to every patient right so that's really when that's important but that comes with allocation Community buyin right up front before it happens so just recognizing you have a wealth of experience in a wide variety of settings both from the clinical side and the administrative leader ship side how do you how do you feel as if your clinical experience has helped your leadership or administrative uh has helped in those leadership or administrative roles well you know one thing I I can really tell you about like all the clinicians and we I think for us is our brains sometimes I think our brains work a little bit different than most regular people right so as we're getting trained as clinicians you know we're we're talking to our patient we're getting that history and physical right we're already thinking about our differential diagnosis that's really helped me a lot in leadership right so when I'm thinking through those problems I'm really listening to the local community or I'm really looking at this situation and I'm saying okay I I hear you and I'm I'm extrapolating those really important details just like a patient right patient's going to give you a couple details that you're like that's really important for the diagnosis um but it's also but also it's that human touch as well right so we don't just have a patient we don't have that broken leg right in front of us that's Mrs Sally with the broken hip right or you know that's that's that's Joe with the heart condition so that's how we also have to approach it from that human touch as well and that's really helped me with leadership um when I when I'm talking with people I really want to hear them and see them and let them know that I that I I feel what they're what they're telling me and I want to do the best for them to make sure we can you know do the best for the patients the community however we're working that's that's something that's really helped me um in the long run as a clinician kind of bringing that empathetic brain and that problem solving to help me in leadership so there's there's a lot of different ways organizations and leaders can be prepared for emergency situations what are some technological innovations either that you have used in the field in an emergency setting whether that's in the military or the White House uh just just some techn technological innovations or technologies that help improve emergency preparedness oh gosh yeah that's a great one I mean technology it's it's hard for us to keep keep up right I mean look at us with artificial intelligence right now I say one of the most important things is is real-time communication systems right so like I said the first thing to go down is Cal so really looking at those communication systems and when I'm saying that you know we're looking at radios um and I'm tell you we worked with the Ukraine refugees when I was in Romania um and I had I had a colleague that worked with some of the Afghanistan refugees when she was in Kuwait and I tell you what we're really adopting starlink starlink is one of those those Technologies where you're having that internet right there real time and it really helps you with communication so that's that's a technology that really got on board with and it's really helping us out because I may not necessarily be able to call you on a radio or call you the cell phone because some of those areas we've worked in if you put off a heat signature you do put yourself out there to possibly a casualty from bombing or something like that right um with the starlink you can kind of keep a smaller signature and you can send messages through the computer right um that that's something I've really adopted recently and I think it's I think it's great and you saw recently in the hurricane starlink was being used so those are those are really some great communication systems that and emergency systems I think really have to adopt right those are big ones um and that takes me to Tele medicine um you know you can pull up your phone and you know overseas we use the WhatsApp or we use signal sometimes we call on the phone but there's also tele medicine that you can pull up you know me as a PA if I know I I have a really really critical patient and I'm I'm about to to do a chest tube or I'm about to do a surgical procedure that is life saving but it's very high high risk tele medicine is really great I can get that surgeon on the line talk me through it or or make a recommendation against it that's something I've used um quite a bit in my practice that's really really helped in some of those really auster situations um so communication tele medicine and then a big one is data analytics and this one is one it's not one of those super sexy ones but you know after covid you know we've had Hurricane Katrina we've really had time to go back and look at those data analytics and they really help us predict and prepare for patient um issues based on historical data so if if you're not looking at that data and to be prepared you're you're kind of you're working with one hand tie behind your back okay but you also use that and we I take it back to allocating resource if that data shows you this is how we should have allocated these resources um that's that's something you have to do right and then um lastly we're looking at these mobile health applications and when we're saying mobile Health I've seen it when I've uh worked in Israel they have um an em basic on a motorcycle and they will go out and respond on their motorcycle first and then usually you can bring in u the doctor that's going to be on the ambulance but but that you know when you got some of those really congested cities that's something really important to think about and that's a mobile health application you've You've Really Got That life-saving entity they're really fast and the patients not um not uh not waiting I'm going to tell you the future looks really awesome and we're seeing this a lot on the battlefield in Ukraine we're talking about drones right we're seeing drones bringing whole blood to patients drones able to evacuate patients off the battlefield so really adap adapting to the drones uh and looking at that I think that's going to be the wave of the future to really help us out in healthcare so those are some really Forward Thinking ideas and things that we have right now well that's fascinating I especially the uh I mean all the all the technology you mentioned the the drones has always been fascinating that's just a component that has really taken off in the last couple years um but that that is that Israel's usage of EMTs on motorcycles is just that what a what a fantastic idea um not only just from the perspective of getting care to the patient right away but but also so the perspective of when those Advanced providers show up on scene they have someone who is aware of the situation more so so they are not coming in totally blind and deaf but rather they are coming into a scene that is maybe a little bit more controlled or at least there's been an initial assessment made and so you're able to initiate some of those more life-saving interventions quicker and so yeah um that's awesome so as as we start to wrap up just one of the final questions I had for you is just as you are looking ahead towards the future what what are some emerging threats that Healthcare organizations should prepare for and and how can they stay ahead of those threats yeah that's you know that's a great one and that goes back to that data analytics always looking at your data and see what's going on you know we're always looking at these pandemics and these infectious disease outre breaks I think Co really reminded us that's an issue so I think that's something that we always stay on top of we we really look at it and we're looking at the data that's going on like recently I've seen an uptick of pusis and that's kind of an interesting one that you can see um when you're looking at kind of global health over in in Africa actually um because they have the prep therapy that's so good for HIV they're actually seeing a rise in sexually transmitted infections because um the local population thinks it's safe to have unprotected sex um and you're seeing a rise in STI because prep is so good so that just comes down to education but that's one of those pandemics we really have to look after and that's in a that's in a global environment right um another big one is cyber security threats I think that's really a big one um Healthcare people we probably don't always think about it and our cyber people are like hey look out for those fishing emails you know we got to do our annual training but we're like yeah but that's that's a big that's a big deal right so because Health Care Systems we rely on the electronic medical record I mean how many Hospital Systems have you seen at that if that goes down we might not be able to see patients so also like really really looking at our Roots so we can still make orders on paper and work that way if we need to but also having an a backup that that cyber security issue comes up um and then climate related disasters you know climate's always a big one for everybody we've seen the Hurricanes recently um and with those hurricanes you know in North Carolina we had flooding so it's one thing to have the hurricane come through destroy some systems we've we've been really good about evacuating people um and getting our systems back up and running but when there's a flood with the flooding comes a lot of other things that more disease more infections come with that so really thinking about those climate related disasters um I can tell you um earlier this year I worked in the Dominican Republic and they had a major hurricane several years ago and there's this whole dis displaced population in San cryistal ball Dominican Republic where they all live in kind of like the metal the metal Shack you know the houses are made out of wood just because the infrastructure wasn't there the hospital system is still trying to catch up so you know I think from a Global Perspective is really look at those climate disasters and and how we can help with that as well and then lastly you know this is the one that we we all hate to talk about but we know what happens that's those mass casualty incidents and that's those active Shooters you know how how to be prepared for those and that's you know we're training our children in schools which is unfortunate but that's we have to do but also having those local Hospital systems and that's where that collaboration with the EMS the firefighters um you know the police officers you know something as simple as a you know usually the police officers are the first one to be there right or your firefighters something as simple as throwing on a tourniquet that saves a life and or just your general population you know a mom that's going to pick up kids and they they're in this situation if she knows how to put on a tourniquet if there's you know because we we already doing aeds on walls stop the bleed is so important so I think that's really emerging thr that we really have to watch out for well thank you Travis for for joining us today on the uh clinicians and Leadership podcast series hosted by the American Journal of healthcare strategy um I I know I personally have benefited from just this conversation with you and I and I can trust that our listeners have as well so grateful for your experience and your oversight and the different ways that you have served um and thank you again for your service for our country uh we greatly appreciate it great Zach thanks for your time</p>