It was a drill. We all knew it was a drill. The accident had been staged so the Life Squad, Fire Department and Police Department could practice working together.
We got to the scene to find a car in a ravine with victims spread around the car. We worked our way down the embankment to the first victim and turned him over.
The paramedic in charge of triage recognized that victim as her husband. She literally took her white triage helmet off, laid it next to her husband, and started treating his imaginary injuries.
Triage: the assigning of priority order to needs in order to guide the allocation of resources to maximize the likelihood of success.
Since the rest of us knew the objective (secure, extricate, and transport victims) and knew what to do, we fanned out, found the other three victims, treated their most pressing injuries, and worked with the Fire Department to get them out of the ravine and into the waiting ambulances.
20 minutes into the drill, the imaginary mother woke up in a real ambulance and asked:
"Where's my baby?"
"Both of your daughters are in the other ambulance."
"No. My baby. My 3 month old baby."
We went back down the ravine, scoured the bushes and found the baby, cold, wet and not breathing. In reality, a big part of why the baby wasn't breathing was because it was a plastic doll. But, in the context of the drill, we'd missed the baby.
What choices direct action
Triage is strategy. In a disaster, triage is about directing resources towards the victims to treat first, later, and not at all. The hard part is deciding which victims have needs that are so minor that they can wait, and which have needs that are so major that treating them is a waste of resources. Triage is about making the choices that direct others' actions.
In this drill, our triage officer checked out before completing triage – before making the choices that would direct our actions. We all knew what we were trying to accomplish. We were all acting as best we could. But with no choices directing our actions, we tried to do everything at the same time and completely missed a treatable victim.
This is why it's so important for strategy to precede tactics. It's not that people can't act without direction; it's that they may not focus on the most important things. Somebody must keep a broader strategic perspective and make the choices that direct others' actions.
A critical part of that is deciding what to do later or not at all.
Warren Buffet suggests that one of the keys to good management is learning to say "No" more and more frequently.
"People think focus means saying yes to the thing you've got to focus on. But that's not what it means at all. It means saying no to the 100 other good ideas that there are. You have to pick carefully. I'm actually as proud of the many things we haven't done as the things we have done.” Steve Jobs – Fortune, 3/17/08
This is why strategy is triage. It's all about the choices that direct others actions away from the less important and towards the more important things.
John Hall
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