Leadership and Teamwork in Emergency Medicine: Navigating Chaos with Precision

​Leadership and Teamwork in Emergency Medicine: Navigating Chaos with Precision

The Emergency Department (ED) is often described as a VUCA environment: Volatile, Uncertain, Complex, and Ambiguous. In this high-stakes setting, clinical knowledge alone is insufficient to guarantee patient safety. The bridge between medical competence and successful outcomes is built on two non-technical skills: adaptive leadership and disciplined teamwork.

This article explores the mechanics of high-performance teams in Emergency Medicine, focusing on Crisis Resource Management (CRM), communication protocols, and the psychological architecture of effective leadership.

1. The Foundation: Crisis Resource Management (CRM)

Originally adapted from aviation (Crew Resource Management), CRM in emergency medicine is the framework used to manage human error and optimize decision-making during resuscitation and trauma cases.  

• Resource Utilization: Effective leaders do not just manage medical equipment; they manage cognitive bandwidth. They identify who is overloaded and redistribute tasks accordingly.

• Situational Awareness: The ability to perceive elements in the environment (the monitor, the nurse’s concern, the patient's pallor), comprehend their meaning, and project their status into the near future.  

• Fixation Error: A common pitfall where a team focuses on a single distracting injury (e.g., a gruesome open fracture) while missing a life-threatening airway compromise. A leader’s primary role is to prevent this tunnel vision.

2. The Anatomy of Communication

In the noise of a "Code Blue" or a mass casualty incident, ambiguity is the enemy. High-functioning teams rely on rigid communication structures to cut through the chaos.

Closed-Loop Communication

This is the gold standard for ordering interventions.

1. Sender: "Sarah, please administer 1mg of Epinephrine IV."

2. Receiver: "Administering 1mg of Epinephrine IV."

3. Sender: "Correct."

4. Receiver (after action): "1mg of Epinephrine IV given."

The "Shared Mental Model"

A team cannot function if the nurse thinks the goal is stabilization for CT scan, while the surgeon thinks the goal is immediate transfer to the OR.

• The Huddle: A 10-second pause to align the team. "Team, we have ROSC. The priority now is post-arrest care and stabilization for transfer. Anesthesiology, please secure the airway."

3. Leadership Styles: The "30,000-Foot View"

A common mistake in emergency leadership is the "working leader"—the physician who attempts to intubate the patient while simultaneously running the code.

The Hands-Off Leader

Ideally, the team leader should stand at the foot of the bed. By physically stepping back, the leader:

• Maintains a global view of the room.

• Monitors the team’s fatigue and stress levels.

• Avoids task saturation.

Situational Leadership

Leadership in the ED is not static; it is dynamic.

• Directive (Autocratic): Necessary during immediate crises (e.g., cardiac arrest) where seconds count. Commands are short, specific, and non-negotiable.

• Collaborative (Democratic): Used during complex diagnostic dilemmas. "I’m concerned about this abdominal pain. Dr. Smith, what are your thoughts on a CTA? Nurse Jones, have you noticed any changes in vitals?"

4. Psychological Safety and Hierarchy

The traditional medical hierarchy can be lethal in an emergency if it silences junior team members. If a junior nurse notices a medication error but is afraid to speak up, the patient suffers.

• Flattening the Gradient: Great leaders explicitly invite input. "Does anyone see anything I have missed?"

• The "Two-Challenge Rule": A safety protocol where any team member is empowered to voice a concern twice. If the concern is not acknowledged, they are authorized to stop the procedure.  

5. Debriefing: The Engine of Improvement

The work does not end when the patient leaves the bay. The "hot debrief" is critical for emotional processing and system improvement.  

• Immediate (Hot) Debrief: Occurs minutes after the event. Focuses on immediate reactions, equipment issues, and team performance.  

• Structured (Cold) Debrief: Occurs days later. deeply analyzes the root causes of success or failure without assigning blame.

Conclusion

In Emergency Medicine, we do not rise to the level of our expectations; we fall to the level of our training. Leadership is not about being the smartest person in the room—it is about being the conductor of an orchestra, ensuring that every specialist plays their part at the right tempo. By mastering CRM, enforcing closed-loop communication, and fostering psychological safety, EM leaders transform chaotic noise into a symphony of lifesaving care.

When My Heart Beat in Rhythm with the Nation 🇮🇳

​When My Heart Beat in Rhythm with the Nation 🇮🇳

Today, as India celebrates its 77th Republic Day, I experienced a moment that will remain etched in my soul forever.

I was bestowed with the distinct privilege of unfurling the National Flag at Meitra Hospital, receiving the Guard of Honour, and addressing our dedicated security and hospital staff. In my entire life, this was a first. As the Tricolor unfurled against the sky, I didn't just see a flag; I felt a profound synchronization. My heart was truly beating along with the heart of this great nation.

It was, without a doubt, the most exhilarating moment of my life.

I stand here today, bursting with pride—Proud to be an Indian. I am witnessing our vibrant culture fly high and our great country travel boldly towards self-sufficiency. It brings me immense joy to see talent recognized, especially with 7 Padma Awards coming home to Kerala this year. It is a testament to the brilliance that thrives in our soil.

Just as our nation marches forward, so does my second home. Meitra is travelling towards excellence. As we move into the coming year, we are stepping into the next level of expansion. With our JCI accreditation, the introduction of new specialties, and the commencement of our second phase of development, we are soaring to new heights.

I am deeply proud of my identity today—Proud to be an Indian, and proud to be a Meitraian.

My gratitude to my Nation and my Institution knows no bounds.

Jai Hind. 🇮🇳

എന്റെ ഹൃദയം രാജ്യത്തിന്റെ താളത്തിനൊത്ത് തുടിച്ച നിമിഷം 🇮🇳

ഇന്ന്, ഭാരതം 77-ാം റിപ്പബ്ലിക് ദിനം ആഘോഷിക്കുമ്പോൾ, എന്റെ ജീവിതത്തിൽ ഒരിക്കലും മറക്കാനാവാത്ത, ആത്മാവിൽ തട്ടിയ ഒരു നിമിഷത്തിനാണ് ഞാൻ സാക്ഷിയായത്.

മൈത്ര ഹോസ്പിറ്റലിൽ ദേശീയ പതാക വാനിൽ വിടർത്താനും, ഗാർഡ് ഓഫ് ഓണർ സ്വീകരിക്കാനും, നമ്മുടെ സുരക്ഷാ ഉദ്യോഗസ്ഥരെയും സഹപ്രവർത്തകരെയും അഭിസംബോധന ചെയ്യാനുമുള്ള അസുലഭ അവസരം എനിക്ക് ലഭിച്ചു. എന്റെ ജീവിതത്തിൽ ആദ്യമായാണ് ഇത്തരമൊരു ഭാഗ്യം എന്നെ തേടിയെത്തുന്നത്. വാനിലുയർന്നു പറക്കുന്ന ത്രിവർണ്ണ പതാക കണ്ടപ്പോൾ, എന്റെ ഹൃദയമിടിപ്പ് ഈ വലിയ രാഷ്ട്രത്തിന്റെ ഹൃദയതാളവുമായി ഒന്നാകുന്നത് പോലെ എനിക്ക് അനുഭവപ്പെട്ടു.

അതായിരുന്നു എന്റെ ജീവിതത്തിലെ ഏറ്റവും ആവേശഭരിതമായ നിമിഷം.

ഒരു ഇന്ത്യക്കാരനായതിൽ ഞാൻ ഇന്ന് അങ്ങേയറ്റം അഭിമാനിക്കുന്നു. ഇന്ത്യൻ സംസ്കാരത്തിന്റെ വളർച്ചയും, സ്വയംപര്യാപ്തതയിലേക്കുള്ള നമ്മുടെ രാജ്യത്തിന്റെ കുതിപ്പും എന്നെ ആവേശഭരിതനാക്കുന്നു. ഇത്തവണ 7 പത്മ പുരസ്കാരങ്ങൾ കേരളത്തിലേക്ക് എത്തി എന്നത് ഏറെ അഭിമാനകരമാണ്.

രാജ്യം മുന്നോട്ട് കുതിക്കുന്നതിനൊപ്പം, എന്റെ തട്ടകമായ മൈത്രയും മികവിന്റെ പാതയിൽ മുന്നേറുകയാണ്. അടുത്ത വർഷത്തോടെ മൈത്ര വികസനത്തിന്റെ പുതിയ തലങ്ങളിലേക്ക് കടക്കുകയാണ്. JCI അക്രഡിറ്റേഷനും, പുതിയ സ്പെഷ്യാലിറ്റികളും, രണ്ടാം ഘട്ട വികസനവുമെല്ലാം മൈത്രയെ പുതിയ ഉയരങ്ങളിലെത്തിക്കും.

ഒരു ഇന്ത്യക്കാരനായതിലും, ഒരു 'മൈത്രയൻ' (Meitraian) ആയതിലും ഞാൻ ഇന്ന് ഒരുപാട് അഭിമാനിക്കുന്നു. എന്റെ രാജ്യത്തോടും ഈ സ്ഥാപനത്തോടുമുള്ള നന്ദിയും കടപ്പാടും ഞാൻ അറിയിക്കുന്നു.

ജയ് ഹിന്ദ്. 🇮🇳

#RepublicDay2026 #IndiaAt77 #ProudIndian #MeitraHospital #JaiHind #GuardOfHonour #Kerala #HealthcareExcellence #Meitraian #Patriotism #Gratitude

The Ghosts of Overhead Projectors: A Doctor’s Journey Through Forty Years of Scientific Presentation-The Weight of a Single Slide

​The Ghosts of Overhead Projectors: A Doctor’s Journey Through Forty Years of Scientific Presentation-The Weight of a Single

It’s easy to open a laptop today, click a button, and watch a flawless Google Slides or PowerPoint presentation appear. But for those of us who started our careers decades ago, "presentations" meant something entirely different—something arduous, expensive, and deeply personal.

Old Overhead Projector

My journey began in the era of the overhead projector, with those thin, crackling plastic films that we’d write on using marker pens. Primitive, yes, but they held the weight of our professional credibility.Then came 1990. I was at the Nizam Institute in Hyderabad for the South Zone conference of ISA, presenting on “Thoracic Epidural Anesthesia for high-risk abdominal surgeries.” This was a leap into a new, more frustrating technology: the slide and projector.

Projector and Slides

The sheer effort was crushing. To create a slide, I first had to type the content on paper. That paper was photographed, and the negative converted into a positive slide. The only place in Calicut that could perform this precise, specialized darkroom work was Lucos Block. And the cost? A single slide was 10 rupees. My 20-slide presentation cost 200 rupees—a staggering one-third of my entire 600-rupee stipend.

Prof .MR Rajagopal and Dr Santhikumar 

Imagine that: a single typo, a minor correction, and the whole painful, expensive process started again, from scratch. It taught me a respect for every word, every comma, that young presenters today may never know. I must pause here to thank my great teacher, Prof MR Rajagopal, for the trust to present such a vital topic, and Dr. Santhi Kumar for allowing me to build the paper from his thesis. Their faith was my greatest fuel.The Storm Before Turkey

The year 2000 brought a collective sigh of relief with Microsoft PowerPoint. The barriers to entry for professional presentations crumbled, and suddenly, we could breathe.

Dr. Boby Kapoor, Dr. Tintinelli Mr.John and Dr.George Abraham 

Seven years later, in 2007, I was in charge of emergency medicine at MIMS Calicut, starting India's first structured international emergency training program. This led to an invitation: my first international faculty appearance at an EM conclave in Antalya, Turkey. I was thrilled, terrified, and utterly focused. I painstakingly crafted my PPT on “Detecting methods of ETT positions” on a Dell laptop.

But the real terror wasn't my "Indian English" accent; it was the looming deadline. Ten days out, my Turkish visa secured, I took the train to Trivandrum to meet my mentor, Prof Rajagopal, for his final blessing. He went through every slide—from the title to the "thank you"—and suggested corrections. I scribbled notes frantically, feeling his wisdom pour onto the page.

That evening, I was satisfied, energized, and ready for the global stage. I boarded an overnight KSRTC bus back to Calicut. Twelve hours of dark road ahead, with my dream—my presentation, my visa, my passport—all secured in my laptop bag.

Around 2:30 AM, near Thrissur, I woke up. My bag was gone. In its place, a stranger’s bag. Looted.A Race Against Time and Bureaucracy

The shock was a physical blow. The complaint was raised immediately, followed by a frantic rush to the Nadakkavu police station back in Calicut. My mind was already cancelling Turkey. Police protocol meant formal inquiry, newspaper ads, closing the FIR, then applying for a new passport. I had 8 days. After a new passport, the visa would have to be re-applied for.

The mental exhaustion was paralyzing. I was ready to surrender.

But then, the universe repaid my years of service. My work in emergency medicine, public BLS, and police first responder training became my lifeline. The Circle Inspector knew me through the training programs. The Passport Commissioner had attended my programs. The red tape—the crushing, bureaucratic weight that would have defeated anyone else—was cut.

"6 days of rapid processing of Duplicate passport, Turkish visa, and international presentation" 

In under 24 hours, the passport issue was closed. In another 28 hours, a new passport was fast-tracked and ready. Riya Travels worked miracles with the Turkish embassy, and my visa was restored.

Everything was done just one day before my flight. It was a period of ultimate tension I have never experienced since. My commitment to yoga and meditation was the only thing that kept me from crashing completely. Finally, I was able to implement Prof. Rajagopal’s corrections and fine-tune my presentation with the help of his article, “Dos and Don’ts of an international presentation.”A Look Back from Heaven

Versatile modern presentation apps- You can do any wonders that you want, everything at your finger tip or even with your voice command

Today, in 2026, we are in presentation heaven. We have the sheer versatility of Microsoft PPT, the elegance of Mac Keynote, and the accessibility of Google Slides. Creativity, video, and animation are no longer hurdles, but tools. AI is now a personal co-pilot, ready to generate an outstanding deck for anyone.

Microsoft ppt, Google slides and Mac Keynote are my favourites 

We didn't have cloud storage in 2007; our backups were physically locked onto a hard disk. Today, my work is safe in the digital ether, a luxury I deeply appreciate.

New gen LED projector 

Video walls - complete computer-based solutions

I still encounter minor frustrations—like the Keynote-to-PPT conversion hassle at conferences—but they are trivial. They are simply ghosts of the past. click.

My first international Faculty presentation at Antalya, Turkey, and I met many new friends there 

The Final Note: The hard days I passed through, the financial sacrifice for a single slide, the trauma of a stolen future, the grace of my mentors, and the kindness of professionals who fast-tracked my crisis—all of it shaped me. It is this journey that allows me, today, to guide hundreds of residents in preparing prize-winning presentations.I tell them: Respect the slide. Respect the word. Never forget the effort that came before the

 

The Suitcase and The Silence: Remembering Dr. Abdul Rahman and Dr. E.K. Ummer

​

The Suitcase and The Silence: Remembering Dr. Abdul Rahman and Dr. E.K. Ummer

By Dr Venugopalan P P

There are wounds that time heals, and then there are voids that remain largely unfilled—spaces once occupied by giants whose shadows gave us shade. As I look back at the history of healthcare in Kerala, specifically the rise of critical care and emergency medicine, two faces emerge from the mist of memory. They were my mentors, my guides, and the architects of a medical revolution.

Sadly, they were also the casualties of a war we fought in PPE kits and makeshift ICUs. This is the story of Dr. Abdul Rahman and Dr. E.K. Ummer—and the "what ifs" that still haunt the silence of the aftermath.

The Visionary: Dr. Abdul Rahman

To call Dr. Abdul Rahman a physician is an understatement. He was a force of nature. Long before corporate healthcare took root, he was redefining what it meant to serve a community.

In the 1990s, in the semi-rural setting of Korambayil Hospital, Manjeri (Malappuram District), Dr. Rahman was already ahead of his time. He didn’t just treat patients; he built systems. He established a critical care setup in Manjeri that saved countless lives and initiated basic training to empower junior doctors and nurses in casualty management.

His heart, however, beat for the marginalized. He was deeply embedded in charitable trusts supporting educationally backward Muslim communities and was a pillar of the palliative care movement in Malappuram.

The "Triple A" Victory

When Aster MIMS (Calicut) began its journey in 2002 as the first corporate hospital in Kerala, Dr. Rahman was its heartbeat. He was the best companion to the passionate Medical Director, Dr. Abdulla Cherayakkat. Together with the Chairman Dr. Azad Moopen, they formed the "Triple A"—Abdulla, Abdul Rahman, and Azad. This trio was the engine behind the phenomenal, historic growth of Aster MIMS in its first 15 years.

Dr. Rahman was the "live wire" who brought the Indian Society of Critical Care Medicine (ISCCM) to Calicut in the early 2000s. But for me, his legacy is personal. He was the driving force behind the MIMS School of Resuscitation. Because of his vision and support, I had the fortune of serving as the Director of this school for nearly a decade, overseeing massive public BLS training initiatives.

He was a mentor who didn’t just lead; he pushed. He supported me in launching the first Mobile ICU in Kerala (2005) and the first nurse-based EMS course at Aster. He was a true entrepreneur, administrator, and born leader.

Most poignantly, Dr. Rahman was a man of ethics. He had crystal-clear concepts regarding End of Life Care. He was a staunch advocate for DNR (Do Not Resuscitate) status in futile cases and was vocal against placing patients without medical hope on advanced ventilation.

The Strategist: Dr. E.K. Ummer

If Dr. Rahman was the architect of critical care, Dr. E.K. Ummer was the strategist of disaster management. A renowned General Practitioner from Nilambur and a senior leader of the Indian Medical Association (IMA), Dr. Ummer was a man of immense stature—State President of IMA, National leader in the IMA Disaster Management Cell, and a dedicated Rotarian.

But to me, he was a friend whose hospitality was unparalleled. I remember the many visits to his home in Nilambur, surrounded by his love and affection.

We worked side-by-side during his tenure as IMA State President. He was the wind beneath my wings during the formation of the ANGELS network (Active Network Group of Emergency Life Support). As an office bearer of the Angels Malappuram unit, he was instrumental in creating a cohesive ambulance network across the district. He was a strategist, a mentor, and above all, a great human being.

The Arrival of the Suitcase

The tragedy of their departure is marked by an eerie, heartbreaking parallel.

It was the tail end of the first COVID phase. One morning, Dr. Abdul Rahman walked into the Emergency Department. He had come straight from the airport, suitcase in hand, returning from the Middle East after visiting his daughter.

"I am suspecting I have COVID," he told me.

We did the initial evaluation. He was admitted to the Medical ICU. That was the last time I saw him as the man I knew. He deteriorated, requested a discharge to IQRA Hospital, and later suffered a stroke. He was shifted to Meitra Hospital and placed on a ventilator.

The irony broke my heart. The man who spent a lifetime advocating against futile ventilation for patients with no hope ended his journey on a machine he viewed with such ethical caution. He succumbed to the virus—a massive loss for the medical fraternity.

Shortly after, the nightmare repeated itself.

One morning, Dr. E.K. Ummer walked into the ED. Like Dr. Rahman, he was carrying a suitcase.

"I think I have COVID," he said, his voice laced with anxiety.

I took him to the acute care area. His SpO2 was already beginning to drop. We started oxygen, but by evening, he was shifted to the ICU on the second floor. It was the early, brutal phase of the second wave. He deteriorated rapidly, was intubated, and very shortly after, he too succumbed.

The Shock and The Regret

Writing this now, I am still gripped by the shock of those dark days. My favorite mentors were killed by a virus we were struggling to understand. I still have bad dreams of the second wave, the days I spent running a 100-bed makeshift COVID ICU, fighting a tide that seemed unstoppable.

But the bitterest pill is the timing.

In the later part of the second phase, a magical drug entered the market: Monoclonal Antibodies. With this drug, I was personally able to save more than 200 elderly, severely compromised, and co-morbid patients from death.

It is a thought that haunts me: If only this drug had been available a few months earlier.

I strongly believe that if Dr. Rahman and Dr. Ummer had access to Monoclonal antibodies, they would have benefited. They would likely still be here today—guiding us, scolding us, and leading us.

We lost two pillars of Kerala’s medical history to the timing of fate. But while they are gone, the systems they built—the critical care units, the ambulance networks, the resuscitation schools—remain. They live on in every life saved by the infrastructure they helped create.

Rest in peace, my mentors. You are missed, but never forgotten.