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Friday, October 24, 2014

Why we all need a little Project FIRST AID

[Also available as a podcast]

I recently attended an Outdoor First Aid course at Camp Waingaro, which is an old scout hall nestled in 19 hectares of New Zealand bush. Quite a long way from anywhere - or at least it felt like it when I found that I could no longer get a cellphone signal. It was a beautiful site, surrounded on three sides by a creek that wound its way down the valley.

I initially thought it would be something of a refresher course, as I had attended first aid courses before, but in many respects this was an entirely new experience.

Granted, the last in-depth First Aid course I took was over 30 years ago - but as it turned out I had remembered most of the basic concepts I needed to know over all of that time. The first day of the course was a lot of theory - with some practical exercises using CPR dummies, various bandages, how to deal with choking and so on. Of course, some practices and techniques have changed over the years - in fact, some first aid practices seem to change every few years as they learn more and best practices change.

On occasion, I have had to use my first aid skills in the past - beyond the basics of blisters, small cuts, splinters and burns. One was a full-out mountain rescue involving a victim 200 feet (61m) down a steep slope, his near-vertical evacuation and the treatment for scrapes, lacerations and embedded gravel. Years after that, I had to deal with a victim who had become engulfed in flame. It was a long drive to hospital as we worked to cool and protect his burns. Fortunately, both victims fully recovered.

As it had been a long time since my initial training, I was nervous when I first arrived at the course, but I grew progressively more confident throughout the day as we covered familiar topics. However, things changed when we got into the practical outdoor scenarios the next morning.
(c) 2012 Mathew Frauenstein

When it all hit the fan, I felt like I knew almost nothing.

Not all practice is the same

In fairness, I had retained most of the basic first aid knowledge I had learned. How to splint, how to bandage, how to check for shock - and the dozens of other key things you need to be able to do when you come across an injured person. I am reasonably confident that if someone came up to me with a moderate injury, I would be able to do an acceptable first-aid treatment on it - hey, I had done it before, a number of times. All good, right? Bring on the scenarios!

It was not quite so easy.

The scenarios were setup for us on the fly - and even though the accident makeup was pretty basic, the situations themselves were common ones - and so by their nature, disturbingly believable. We all took turns playing the role of victim and rescuer/first aider. 

If that had been all there was to it, it would have been relatively simple - in theory, anyway. 

But - as we all learn sooner or later - theory falls down flat when you hit the practical stuff.

Note: It is very hard to remain "unconscious" while you are getting numerous bug bites, lying face down in the gravel. However, if I had moved, I would have spoiled the scenario - and affected their treatment response. Ouch!

Our scenarios did not involve one victim or even two. The first scenario involved four victims with various injuries, and two bystanders who caused more problems - with one quickly becoming another victim. Pretty messy - and the dozen would-be first aiders frankly botched the overall situation pretty badly.

Time to regroup, and go back into class for a lessons learned session. 

It's not just "First Aid"

What we were beginning to learn was not just the first aid skills for helping a victim - but the management and coordination of a team while in an emergency situation. We were practicing trying to keep things together until higher-level medical help could arrive. That, or evacuate to a safe point; in the bush you could be a long way from help - hours or sometimes days depending on the conditions.

What occurred to me as I was driving home from the course and scratching my bug bites was that many of the same skills we were required to exhibit under pressure were the same ones we use on projects.

In fact, when you get right down to the bare bones of it, every one of those scenarios had the characteristics of a project.

Each scenario had:
  • Requirements (Scope) - "Help the injured victims, and do what we can to keep them safe and alive." 
  • Time  - There was not a lot of it, as we had to stabilize the patients quickly. We needed to get them to help as soon as possible- which in reality could also involve a lot of waiting. Time will run fast - and slow - while you are waiting for help to come.
  • Uniqueness- every scenario was unique, and outcomes were unpredictable. Victims had been advised to change their reactions throughout the 20-30 minute scenarios, depending what the first-aiders did to treat them.
  • Planning - We had to constantly plan and re-plan on how we were going to deal with each victim, how to manage the rest of the group, what to do if we had to wait for hours or days for help, and so on. No gantt charts, but it was planning just the same.
  • Scope Creep - for example, in the shape of a rapidly rising creek or river, where everyone suddenly needed to be moved to higher ground. Conditions do change, so you need to be able respond. For once, no formal Change Requests needed to be signed off by the Project Board!
  • Stakeholders - The victims, the other members of the group and witnesses (who all may be distressed and either interfere, help or become another victim), and Emergency Services (who were hopefully on the way soon after being contacted).
  • Assessment of skills/Task Assignments -  Who is the best person for the job? Don't use your best first-aider as a runner, and if someone vomits at the sight of blood, get them to help the one with the sprained ankle instead of the amputee.
  • Leadership - A key element of handling any situation - and as we found out in our first couple scenarios - if you are missing this, the whole situation can fall apart fast.
  • Prioritization (triage) -  Who was injured the most badly? Who needed help the quickest - the one gushing blood, the one with a sprained ankle, the one who chopped off his arm, or the one with a head injury? At first glance it may seem obvious, but you also need to take a second look (a secondary survey) to make sure you didn't miss something serious. Re-prioritization may often be required.
  • Communication - With the patient, with each other, with the leader, with emergency services. Regular updates were required throughout the scenario, between the first aiders and to all the stakeholders.

    Note: The lack of communication in the scenarios was just as important - today we live in such a connected world it it hard to imagine not being able to make a cell phone call. However, the geography of the camp and the lack of cell signal was a visible reminder that you need to be prepared to communicate in other ways - and that you will probably need to send the fastest runners to go for help.
  • Cost and Resources - We had limited supplies and people to help, and the the primary currency for cost was in saving lives - though you won't always be able to save them all.
  • Execution of the plan (not the patient). 
In addition, we had to deal with:
  • Stakeholder engagement - If there are people milling around not helping (or getting in the way), get them involved with something they can do to help - or keep them out of the way. Keep them occupied and in a safe area away from the emergency scene - so they don't become (or create) another victim.
  • Coaching/Positive encouragement - Everyone responds better with a clear head and a sense of optimism - both the patients and the first aiders. "Hey buddy, we saved your arm and are keeping it cool so they can try to sew it back on later" or "That splinter's not too big, we'll get that cleaned up."

    The situation might also require you to bolster the spirits of your team - First Aid is hard, draining work. If they wear out and get discouraged, the patients will be at risk - and so will your team.
So yes, in a very real sense, we were dealing with projects. Certainly not Waterfall (though you might have someone fall over one), and not exactly Agile - but high-urgency, unplanned, emergency projects where conditions can and do change from minute to minute.

It was a thought-provoking weekend, and I took a way a few essential lessons that you can apply to any project. All it takes is a little FIRST AID.

F.I.R.S.T. A.I.D.

Every project needs a little First Aid - and you might argue that some projects need it more than others. So let's open up our kits and begin.

[F]ind out what the problem is - and if there is more than one problem. You may be able to clearly see the challenges in front of you, but what about the guy behind the tree with an axe in his leg? 

On your projects, this is all about determining the scope / requirements - what it is we are trying to do, what are our goals, what are the pain points and problems the project is intended to solve. Do you have a clear handle on what you need to do? Better check the bushes to make sure you didn't miss something important. In other words, you need to validate your requirements.

[I]dentify who is the best leader for the situation, and who can take charge of each case or patient. This might not be pre-determined, as your regular "leader" may be incapacitated or unavailable. 

On your project, leadership roles can and do change. Sure - you are the Project Manager, but you need other people to take on different leadership roles as well - each of your team leads focused on different deliverables, for example. Besides, I am sure you will want to take a vacation some time, or might be down with the flu. In those situations you will need to have a second-in-command to keep things running while you are away.

[R]ecognize your limitations. You can't solve every problem or fix every situation, at least not on your own. You need the skills of a competent team around you, and you need to share the load.

When administering CPR they recommend you take turns every 200 compressions - that is a change-over every two minutes

"Pah! That's not very long - I can do it longer!"

Warning - If you 'tough it out' and stick to it for 10 minutes, it will take you 20 minutes to recover. If you swap every two minutes, it will take you only two minutes to recover. If you only have two rescuers including yourself, two-minute stints can keep the patient alive for a long time. With only the two of you taking ten minute stints, in twenty minutes you will both be exhausted - and your patient will be at a greater risk of dying because you over-did it.

Don't be a 'hero' - let others help, and you will collectively avoid burnout. You may even save a life - or your project.

[S]tabilize the situation,any which way you can. If your project is running off the rails, it is essential that you regroup, assess the situation and re-plan. When you identify what the current burning issues are, you have a better chance of dealing with them. Letting things run along un-checked is definitely not acceptable - and the best way to get back into some semblance of control is to gather your team together to tackle it.

In an emergency situation, it is not only the patients you need to stabilize - it is the whole situation and all the people in it. If you have other [healthy] people you are responsible for (children or adults), it is important to make sure that they are care for - and most importantly, keep them out of trouble. Boredom can kill - sometimes literally.

[T]ake a deep breath. One or two, or maybe count to ten. Taking a moment to pause and reflect will reduce stress in any situation. Smell the roses, take a short breather when things get overwhelming on your projects. You will find that things are not necessarily as bad as you think.

Tip: Those deep breaths are good, but not too many too close together. (In other words, don't hyperventilate - or you may need some First Aid yourself!)

[A]ssign tasks to others. Unless your project is very, very small, you will have a team of people to work on your project. It may be big or small, but it is essential that you delegate and assign responsibility for various project tasks to be completed. You can't do it all on your own, and it is a delusion to think that only you can do it the best.

In an emergency situation, it is critical to have an assigned 'patient leader' for each patient, even if more than on person is required to assist. The patient leader will be helping the patient but also keeping track of vitals and other information about the patient, ready to pass that on to the situation leader, so they can communicate with emergency services and get you any additional items or help you may need.

If you have a complex scenario with multiple locations, you need to extend that a level further, and add a site leader who is keeping up to date on the status of all of the victims in a specific area. They then report back to the main situation leader on a regular basis. Sounds a lot like a project team, right?

The key is to be very specific in the assignments, so there is no uncertainty around what you have asked them to do - and by when.

[I]nspire confidence in your team and stakeholders. If you are supposed to be in charge but look like you are falling apart (or don't know what you are doing), you won't be doing anyone any good.  Fumbling with a bandage and dropping it in the dirt in front of a bleeding victim may not give them much confidence in your ability to keep them alive.

Confidence is good - but it requires careful balance. If you act over-confident a lot of the time, it can come across as arrogance. Conversely, a person who is a fumbling, quivering mess is not well-suited for the leadership requirements of that role.

Note: We are all human - and in some non-emergency situations not being afraid to show your weaknesses can actually develop a stronger team. That is why you build up a team after all; each person has different skills and strengths, and the combination makes a stronger whole. 

If you have the strength and confidence to share some of your weaknesses - and show you respect the corresponding strengths in your team members - you can go a long way together.

[D]o your best. If you can't remember what was on page 57 of the "what you should do" manual, use your common sense, best judgement and make some stuff up to get you through.

At the time, we were all so busy trying to do the right things right that we didn't have time to think about anything other than making it through each scenario with (hopefully) "live" patients at the end. We made lots of mistakes - so I am glad we were not actually dealing with real victims. But that is what practice is for - to learn what to do before you need to use your new skills in earnest.

The point is to be as prepared as you can, and keep on trying.


The outdoor first-aid scenarios that followed were increasingly complex, but we began to work a little better together as a team as the day went on. It was also obvious that we were a long way from being experts, and we could all use a whole lot more practice.

The 'textbook' over-confidence from the classroom was long gone, and the reality of the situation was beginning to sink in. You don't know what you know until you actually try to do it, and hopefully you will learn from your mistakes and move on with more confidence in your abilities as you practice.

Probably the most important lesson, however, was that of recognizing your limitations - none of us were as good at responding as we thought we would be, and we all had a lot more to learn. 

The same can be said of our projects - just as you have 'practicing Doctors', we should really consider ourselves 'practicing Project Managers'. We will never be perfect, but with practice we can all hope to improve and apply those lessons learned on the next project.

Good luck with your projects, practice those skills, and keep your First Aid kit handy.

 Email: Gary Nelson, PMP