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ERcast Lite

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Nov 30, 2019

What does emergency medicine have in common with astronautics? A lot, it turns out. Dan Mccollum and Rob break down the skills learned by International Space Station commander Chris Hadfield as explained in his autobiography An Astronaut's Guide to Life on Earth.


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  • You can be a “plus one” -- someone who actively adds value -- without behaving like an arrogant person craving significance.

  • Avoid trying to impress others by showing off.

  • We learn much through adversity, when things don’t go well.

  • What we say matters. Critique a behavior, not a person.


  • The pitfalls of thinking too highly of yourself.  [1:48]

  • On the importance of being a “plus one” and the wisdom of not proclaiming your plus-oneness.  “If you’re really a plus one, people will notice”. [2:25]

  • Aim to be a zero -- having neutral impact.  Observe and learn. Pitch in with the grunt work. Being a zero is a good way to get to plus one.[5:10]

  • What Mccollum looks for in EM residency applicants:  people who treat the receptionist or program administrator well. [8:02]

  • Focus on the simple core things which are most likely to save lives, as opposed to shooting for the stars with cutting edge treatment.  [8:50]

  • On why the weight and power of ego impairs our ability to learn and harms patients. [11:04]

  • Sweat the small stuff. [13:03]

  • The quintessential nature of EM and how they’re similar to flight rules:  solving complex problems rapidly with incomplete information.  [13:51]

  • Why we should be using checklists, particularly when we think we don’t have time for them. [14:49]

  • Even when you follow all the rules, sometimes bad things happen. Perfectionism is not part of the flight rules. [15:51]

  • Why early success is a terrible teacher.  If you’ve always been the star and never experienced failure, this can be a barrier to learning. [18:29]

  • Jocko Willink video, Good. When bad things happen and you get knocked down, “get up, dust off, reload, recalibrate, re-engage, and go out on the attack”. [20:15]

  • When in a position of leadership, be careful with your words.  Don’t ridicule. The small things we do or say can have a big impact. [22:02]

  • Expeditionary behavior is the willingness to endure hardships for the sake of the mission. And why whining poisons the pool.  [24:15]



An Astronaut's Guide to Life on Earth by Chris Hadfield