Sign in

Emergency Doctor. Applying knowledge under pressure. The Emergency Mind Book:

Building Your Emergency Mind

How to work toward mastery when chances to practice are limited.

Progress in almost any discipline requires deliberate repetitions with feedback loops. Experts across disciplines talk about building constant and never-ending improvement into your daily routine, or about the value of marginal gains compounded over time.

This is excellent advice when we have long times to practice and can repeatedly train in stable environments, but what about when there’s not enough time on target available to really tune your algorithms well?

For example, if you are an emergency provider and your attempts to place a breathing tube during a crisis are unsuccessful, you may need to cut into your patient's neck…

Knowledge Under Pressure #24

Welcome to Knowledge Under Pressure #24.

Here is what we’ve built, what we’ve been taking in, and what we are thinking about at The Emergency Mind. If you have ideas or questions I would love to hear from you:

// output

Podcast EP 33: Bryan Hayes for Building Systems of Mastery
Emergency pharmacist, toxicologist, and professor at Harvard medical school Bryan Hayes PharmD, DABAT, FAACT, FASHP joins the podcast to talk about owning your role in difficult situations, iteratively building ways to improve, how to embrace tough feedback, and much more. Dr. …

Knowledge Under Pressure #23

Here’s what we’ve been up to at The Emergency Mind over the last bit — I hope you find it useful and enjoy.

If you have ideas or questions, I would love to hear from you- either reply here or email me at

// Output

The Emergency Mind: Open Questions List
Resource / database of the open questions we’re working with right now about how individuals and teams can optimize their performance under pressure. These questions range from the personal — how can I best return to life after a challenging / horrific shift — to the team and system based —…

Knowledge Under Pressure #22

Here’s what we’ve been up to at The Emergency Mind over the last bit — I hope you find it useful and enjoy.

If you have ideas or questions, I would love to hear from you- either reply here or email me at

I hope 2021 brings good things for you and yours.

// Outputs

The Emergency Mind: 2020 Inputs List
In 2020, we put out 21 editions of the Knowledge Under Pressure newsletter. In this resource, we brought every input from these newsletters together in one place for your enjoyment and learning. They’re linked, tagged, and ready to dig into. Feel…

Building Your Emergency Mind

Advice from a Navy bomb squad expert on better decision making during times of emergency

Recently, I interviewed Navy Explosive Ordinance Disposal (EOD — read “bomb squad”) expert Ryan Anderson for Episode 14 of The Emergency Mind Podcast. At the end of a deeply interesting conversation about things like preparing to perform complex tasks under fire and how training your most basic skills will save lives, I asked Ryan what I thought was a joke question. His answer was striking.

The (admittedly not super intelligent) question I asked was this: If I had to disarm a device, should I cut the red wire or the green wire? …

Building Your Emergency Mind

An ER doctor’s reading list for handling uncertainty and stress and improving performance during a crisis

With social distancing full effect as we all band together to fight the COVID-19 pandemic, it’s a unique time to put some mental work in and upgrade the way we process and respond to stress and crisis. No matter what our primary role is, all of us are being called upon to handle new and potentially difficult things as we change (and hopefully improve) the ways we work together as a species. Our ability to handle uncertainty and stress will continue to be crucially important as we move forward through this pandemic and beyond.

So, here are 10 books that…


A study exploring the links between expert performance in music and surgery.

The Quick Look

The Evidence

Enhancing surgical performance by adopting expert musicians’ practice and performance strategies.” Rui M, Lee JE, Vauthey JN, Conrad C. Surgery. 2018. PMID: 29336812. Find it here.


Surgery and music are both performance arts requiring the ability to successfully and consistently execute sophisticated techniques with precision and grace despite stress, fatigue, and other forms of pressure. …

Building Your Emergency Mind

How to recover from and start to process being the caregiver in a crisis.

The Question

“How can people working in a crisis situation — for instance in an emergency department — come down from the adrenaline that can last after the situation has passed? I was briefly a volunteer community liaison officer for my local fire brigade when a bushfire was at a great risk of impacting my community — I really enjoyed the two days I was in this role and it reaffirmed my desire to work in crisis situations — however, particularly after the first day I found it hard to come down from that adrenaline that night after finishing. It was a…

Emergency Mind Evidence

A study exploring how (and why) time pressure makes us worse at diagnosing things correctly.

The Quick Look

The Evidence

Factors underlying suboptimal diagnostic performance in physicians under time pressure” ALQahtani, DA, et al. Medical Education, 2018. PMID: 30302783. Find it here.


Time pressure (the pressure we feel from things needing to happen right now) impacts our ability to think and perform optimally — knowing exactly how this works could help us figure out how to build training to mitigate and overcome these effects. …

Training your Emergency Mind

Start work now on the moves you’ll need to rely on when things get truly tough.

That’s a great move, but can you do it when you’re tired?

It’s the start of your shift in the ER. Your coffee is fresh, your mind is clear, and you’re ready to rumble as you pick up the chart for the first patient. Things are looking up.

10+ hours later though, when a truly critical patient comes in, the situation might look different. Your coffee is gone and your scrubs are bloodied. More that that though, you’ve been under significant cognitive and physical load for hours. Maybe, maybe you’re even a little bit tired.

When you’re stressed, and your resources are taxed, how well do your mental processes work? What algorithms…

Dan Dworkis, MD PhD

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store