My earlier article on the critical differences between strategic, tactical, and crisis leadership talked about the need for clarity of roles. That still makes sense. However, when time is of the essence, strategic thinking must enable, not delay time-sensitive tactics. Sometimes moving faster is about doing things more efficiently. Sometimes it’s about skipping steps that are just in the way.
Triage is strategic by definition. Essentially, it’s about deciding which patients to treat now, later, or never. Previously, triage officers were told not to treat anyone themselves, but just focus on the triage sort to guide other care providers. Now, triage officers are told that if someone needs urgent life-saving interventions like a tourniquet, they should deliver those before moving on – merging strategic and tactical when it makes sense.
At a broader level, the American Red Cross moved from a sequential to parallel approach to reduce their response time in disasters from six to two days. Past protocols had the initial team on the ground taking three to five days to assess the situation and put in place a strategy and plan to deploy money, people, and equipment, triggering that deployment. Now the Red Cross tactically sends an initial tranche of money, people, and equipment as they deploy leaders on the ground and then adjusts those levels up or down as appropriate over the next few days.
One shining example of merging strategies and tactics is how the Israeli Defense Force (IDF) reduced their combat Case Fatality Rate (CFR) from 15 percent in Lebanon in 2006 to 6.5 percent in Gaza in 2024. Their Surgeon General at the time, Dr. Elon Glassberg took me through five things they did to get the injured the help they needed faster.
1 Advance care at the point of injury (front line)
The IDF changed from Battalion Aid Stations serving 1200+ soldiers to adding physicians and paramedics at the company level serving 200+ soldiers, reducing the time from injury to treatment to under four minutes. Those medical professionals had the equipment and supplies they needed provide that immediate treatment including replenishing lost blood. And they did faster triage with a bias to “over-triage” to get more of the injured more help faster.
2 Rapid Evacuation
The IDF deployed armored “Evacuation Capsules” to move the injured directly from the front line to either a helicopter or across the border to pre-positioned ambulances for further transport to a fully-functioning trauma center, skipping intermediate steps. They reduced the average time from injury to trauma center from 180 to under 50 minutes, saving far more of the “savable” lives as 90% of trauma injury deaths occur in the first, “Golden” hour.
3 Blood products for out-of-hospital resuscitation
The IDF switched from commonly used, but less effective saline (salt and water) blood replacement to freeze-dried blood plasma – which is now carried by all of their forward medical personnel. Then, they enabled whole blood to be distributed in Evacuation Capsules, helicopters, and by Battalion surgeons/medical officers.
4 Adjusted Protocols (to do less)
The IDF cut out less valuable treatment protocols and Battalion Aid Stations as those steps and stations added time on the way to getting the injured the help they needed and, in some cases, hurt more people than they helped.
5 Rapid adaption & implementation
Dr. Glassberg and his team drove a massive culture change with:
A single-minded focus on one goal – reducing Case Fatality Rate.
“Leveraging every excuse and example” to get, publish, and discuss data on a regular basis, encouraging everyone to challenge everything, no matter their level.
Communicating in the way most appropriate for their young medical providers fulfilling their national service requirements. It turns out today’s youth learn differently than their more “experienced” leaders, gravitating to things like AI-generated videos more than acronyms and lists. Who knew?
Implications for you
Do think in terms of nested leadership: cultural, strategic, tactical; but merge them when time is of the essence.
Continually look for process, systemic, and technological ways to challenge current practices and do things better, more efficiently, and faster.
Find ways to accelerate things by moving from sequential to parallel approaches.
Like today’s triage officers, let your people do things that make sense when the opportunity or need arises.
Like the American Red Cross, deploy vaguely right resources faster, knowing you can adjust along the way.
Like the IDF, get critical resources closer to the decisive point so people can do some things immediately, while also finding ways to change your culture, challenge everything, and cut less valuable steps out of processes to get to the most impactful activities sooner.
John Hall
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