Lessons Learned

The ED EVS team was working quite collaboratively that night. However, one of our EVS managers reacted to the stress by focusing the team’s efforts in unexpected places — such as dusting common walkways — instead of toward the emergent event. Reflecting on that now, we should have recognized that some team members, even leadership, can minimize the situation and use this as a defense mechanism when under intense stress. Had we realized this earlier, we would have removed this manager from the leadership role for that day and had other leaders step in earlier to direct the team.


There were assignments that should have been put on hold that morning, for example:  cleaning the MD call rooms, floor care in the other parts of the hospital and dusting the back corridor and ancillary spaces. We learned that we could have gotten tasks done faster if we had doubled up and assigned two EVS team members in the trauma room instead of one.


We took for granted that the Emergency Department EVS team members were accustomed to working five or six traumas at a time. However in hindsight, we could have brought down a team from the units to focus on the ED common areas and not relied solely on the Emergency Department EVS team members. We now refer to this as our MCI Staffing Response and Support plan.