RESILIENCY-LESSONS ON
LEADERSHIP THROUGH THE EYES OF DANIEL LINSKEY, BOSTON POLICE CHIEF AND INCIDENT
COMMANDER DURING THE 2013 BOSTON MARATHON BOMBING-
A few months back, a couple of papers
were published assessing resident response to catastrophes and how surgeons go
through the process of "risk taking" behavior based on positive or
negative experiences during their career. I was fortunate to talk with Dr.
Moulton about their paper on risk taking but still attempting to reach Dr.
Bernstein on their paper on how residents feel about their training to respond
to catastrophes. My conclusion, was that we continue to do a disservice to our
trainees by not providing them with sufficient skills to process an untoward
event so that it won't overshadow their positive experiences thereby reducing
their willingness to tackle difficult problems. Instead we teach quite the
opposite. 'Suck up and don't talk about it' seems to be the going mantra we
portray to them and our colleagues. And no, it's not just a surgeon trait. As
in my prior post on this subject, an ASA study showed virtually all anesthesia
providers continued to work after a loss of life in the OR. The ACS survey
series in 2010, showed a direct relationship between making a mistake and
subsequent burnout. We do have a long way to go.
On that note, Daniel Linskey was
gracious to talk to me about his role and response during the Boston Marathon Bombing
April 15 2013. He is the former Chief of Police Boston, a retired Marine and
the Incident Commander during the Boston Marathon Bombing so I believe that
anyone who has to learn to function during a catastrophe should listen closely
to what he had to say. This completely resonated with my ongoing
"research" in how we address crises in surgery. I sincerely
appreciate his honesty on what happened and how he responded.
I will just cut to the chase on his
advice and go from there: "Realize you WILL be overwhelmed…
learn how to control yourself quickly, take in cues, so you can open your file
cabinet and then control the team." He said that you have to understand
that under extreme duress the amygdala response will "hijack you".
This conversation brought to mind the 2014 commencement speech by Admiral William H. McRaven to University of Texas Austin graduates (Retired ninth commander of
U.S. Special Operations Command* and Chancellor at The University of Texas).
“Every SEAL knows that under the keel, at the darkest moment of the mission– is
the time when you must be calm, composed—when all your tactical skills, your
physical power and all your inner strength must be brought to bear. If you want
to change the world, you must be your very best in the darkest moment.” Police
Chief Linskey's conversation reminded me that it takes an abundance of training
to achieve that degree of resilience. Very few humans can withstand that degree
of pressure and maintain focus without significant training. Even then, you
just do not know what your response will be.
Chief Linskey noted that on the day of
bombing in 2013, they felt prepared but alert. By this point he had already
successfully led several full action city-wide disaster rehearsals -known as
the "Boston Urban Shield". Turns out though nothing prepared him for
what he was about to face. He was a boots-on-ground Chief so he was out there
in the field. He began his routine by making his way in front of the Forum.
However, his pattern of surveillance was thrown off by a seemingly innocent
conversation. An officer on the beat stopped him to chat about how he moved
five houses from the Chief’s house. That twenty-minute conversation may have
thrown his routine off. As he made his way down the street he had a nagging
feeling that he had missed something during the distraction. Later, that office
was injured when the second blast occurred.
He was a mile down the street when the
first bomb went off, but immediately jumped into his patrol car and drove back
to the forum. He recalls that the scene
was overwhelming as he spotted an eight year-old child ripped in half right at
the spot he had earlier been conversing with the other officer. He then
realized he was totally thrown off by that conversation. It hit him “the uneasiness I felt was that there were
backpacks around and I should have had the team evaluate the security of those!
I just got distracted”. As he tried to stop the child's exsanguination, all
he could think of was that he missed the backpack. He felt that he was
responsible for that boy's death. “I had extreme guilt and doubts until I saw
the video Wednesday morning showing I didn't miss it. It was only there for 6
minutes.” The guilt was just a part of the scene that began to overwhelm him as
he quickly became overloaded. He recalled “I
kept thinking -here is the top Police
officer and I had no control'. He felt himself hyperventilating, shaking
and getting even more out of control. His instinct took over as he began to
respond directly to those in need. He was able to start the process to control
his fight or flight response “I began to
think more clearly”. Instead of becoming the strategic leader, he began to
help the first responders tend to the victims. He realized on later reflection
that “it was easier to not be the leader
in this situation. Subconsciously I felt overwhelmed and was hoping someone
else would take charge”.
After what seemed like an eternity, a
State Trooper, who he knew well, grabbed him and began to yell at him - “Chief! We need you out there in the street”.
The Chief's first response was to cuss out the Trooper- Chief Linskey told me, “I
wasn't pissed at Mark for putting his hand on me I was pissed at myself that he
had to remind me to be the boss”. “The Trooper said ‘Chief I’m just trying to…’ I
cut him off ‘Mark I know what you’re
trying to do, just give me a F….g minute.” Chief Linskey
understood that the trooper sensed that the Chief had taken the responsibility
of the injuries personally and was not able to process the scene in a
productive manner. The Trooper relayed that he also knew that deep in the
Chief's brain was the trained instinct to control the scene and lead the
response, so he was simply trying to find the commander in there. The Chief had
always had the reputation as the calm one in the midst of adversity so
somewhere deep under that cussing yelling ball of fire was a true leader and he
just needed to get that man out. It worked! That triggered his innate
leadership and police skills. “I took the deepest cleansing breath sighed
and began to run the scene”
The Chief described a wave of realization
that hit him at that moment. He became extremely calm and began to know exactly
what he was going to say before he said it.
He knew he had a head packed with a vast library of experience and
training and that opened before him- everything was clear- 'what to do and what
not to do'. The cognitive processes which Gary Klein and I recently discussed
slowly unraveled in his mind. The Chief's brain went thru the motions: #1. Understand
that a problem exists 'CHECK! we have a problem!' #2 determine
what the problem is-"This is a crime Scene". #3 Analyze
the problem-think! "what do you do in a crime scene?". #4 Brief
the team, get information (see below about information pitfalls) and Get a plan
out to the responders- start your process you trained to do- “this is a
crime scene, you need to investigate and control” "give people jobs to do
so they will assume their roles, feel they are taking some control and
establish order".
Things quickly took a turn for the
better. He quickly reestablished some sense of order amongst the chaos. As the
rehearsed sequence of steps came back to him he calmly provided instructions:
a. 'we need to
prepare for secondary incendiaries'
b. 'we Need bomb
squad to look for other backpacks'
c. 'We need to
look for the perpetrators of the crime'
d. 'we need to
sweep the streets for suspects and clear them of bystanders before more people
get injured'.
e. 'We need to hold
the bars and restaurants to keep people off the streets until everything is
clear'.
f. 'Need social
media to inform folks what was going on so people can report suspicious
behavior'.
g. 'We need to think
now about what to do ahead.' Chief Linskey says that this process felt like it took place
over a very long time period, but on review, in real time it occurred much
quicker.
In the end of
our conversation he passed on several valuable lessons:
1. No matter how
much you prepare, you can never be ready for a terrible catastrophe- Even with
simulation/rehearsal, people will need reminders what to do when they are
scared. So we need to make our simulation as real as it can get and provide
trainees with the skills to be resilient and survivors.
2. No matter how
much training you have under your belt, you will always have self-doubt. At the
moment the crisis hits it does not matter if you are confident in your ability
to lead or not. What matters is how you can convince your team you are in
control. You must Project calmness! You may have guilt from your personal
direct or indirect actions or inactions….. GET OVER IT. PEOPLE are relying on
you. YOU may have a personal injury or witness someone you know well or love
injured…. The team needs you right then, so while it sounds easy to say, you
need to lead if you are the leader.
3. Don't
overload people- Always keep priorities to less than five goals or people will
have too much information to manage and it will only complicate matters.
4.
"Information" management - Be extremely cautious about information
you receive surrounding the incident. That is, your initial response may be to
accept the information or to reject it. You probably just want to believe the
information, since you have limited time but likely either sparse resources of
information or too much information. Your reaction may be to just accept it for
fear if you don't you could be liable - you feel you will be held responsible
for not reacting on that information and if things take a turn for the worse,
then you will look bad. In addition, you just don't have the time or energy in
your mind to analyze everything. Therefore, you need to train yourself and your
team how to manage information. That is, you must rapidly decide what
information means- as in, will this exacerbate the problem or improve things?
You need to find out immediately Who provided it, what was said, when in the
series of events did that information come about (is it now too old to be of
benefit) and how was this information gained?
5. In a crisis
we need solutions not a procedure- in a crisis if we rely on procedures and
worry about violations instead of what we really need to do, then there could
be disastrous delays. Too much information can be deadly.
6. Under duress
people will act differently than they did during rehearsals and briefings so
you better learn before a crisis about what people will do, or things can end
up disastrous. One example was that in spite of prior discussions about using
tourniquets, people were very leery about them. They learned what would go
wrong with tourniquets and frankly were typically told to never use them
before. In many cases people would look at the tourniquets but not tie together
the mental response that in their hands they had life-saving equipment so they
failed to actually use them.
7. Finally when
you have a moment, you must decompress your emotional load as soon as possible-
As a leader, you have to know when and how to dump your emotional battery and
recharge. It may be that in the midst of the battle when you have a chance to
breathe, you steal a spare second to scream to the air or cry. When the dust
settles, you must assure all involve, including yourself, are provided
counseling. In police actions, in response to tragedy, teams are trained in
critical incident crisis psychological management and those teams come in
immediately. The people in the field have immediate access to Trained staff
that work with them there and over time to help them debrief and work for
future problems. This is extremely rare in medicine.
Needless to say
I am very humbled by this conversation and extremely gracious for Chief Linskey
taking time to talk with me. THANKS CHIEF!
KENNETH A. LIPSHY, MD, FACS
