I have always found that there are two predominate mindsets on training to respond to a disaster. The one I favor is the “Macgyver” Mindset: Try to improve a person's skill at responding to difficult situations by effecting generalized cognitive enhancement. The other: Train people to respond to the most likely threats they will face.
I had the opportunity to talk with Rorke Denver (former head of basic and advanced SEAL training and author of- DAMN FEW: making the modern day seal warrior) and Lt. Col Dave Grossman (Author of On Combat) last week. As I have suspected, the military response is very similar to the response in medicine regarding training for crisis intervention. That is, you should train individuals to react to the most likely events they will face. Having said that, I did get some intense pauses when I asked what is an inexperienced commander going to do, if his team encounters something they were totally unprepared for and have no prior experience to turn to. Have they had training on analyzing that situation, gathering information, developing a plan based on the information at hand and acting in a matter of seconds? It is a perplexing but not too uncommon problem. Frequently experienced providers can turn to past experience and develop a plan based on what they have seen before and hope it works. Novices hope to find that experienced provider to bail them out. Without a concrete method of sorting thru the facts presented in an organized fashion and shelling out a plan with discrete tasks, failure is a potential outcome. As Dave Grossman said, “he who plans for everything, Plans for nothing”, which I personally take as the opposite of what I believe the author meant. We can try to teach to plan for a multitude of different scenarios but inevitably we will always come across something we never dreamt of and we have to have the ability to think that thru in a calm manner and live (see my prior comment about the US Airways Flight as an example).Kenneth A. Lipshy, MD, FACS