Earlier in my life, I was a flight surgeon for the Air National Guard in West Virginia (130th TAG) and in Indiana (with the 181st TFG). After I moved to South Carolina, I was with the Air Force Reserve at Charleston, AFB, with the 315th Medical Squadron. It was great fun, and I learned a lot as a flight surgeon. I learned about the amazing men and women of the Air Force. I learned that we have the finest air force and aircraft in the world. I learned how to be an officer, and what my place in the organization was, and that I was a small part of a very large machine. And I learned that even if you survive the centrifuge with your honor intact, you’ll still vomit later.
One of the most fascinating things I learned came from my time in the Aerospace Medicine Primary Course, at Brooks, AFB, in San Antonio. There we talked about, among other things, high performance aircraft, pilot fatigue and a little thing called ‘task saturation.’

In a nutshell, task saturation means that you’re trying to do too many things at the same time, and most the them have to do with staying alive and accomplishing your mission.

If you think about an F-16 pilot, he or she is flying at 400+ mph, often faster . That pilot has to be constantly aware of air-speed, altitude, attitude, somato-sensory illusions that can cause crashes, fuel levels, and untold engine gauges and lights regarding everything from on-board computers and navigation to munitions.

All the while, that pilot has to stay in touch with his base and other members of his flight. Of course, he or she also has to focus on accomplishing a stated mission by providing air cover to ground troops (accurately delivering high explosives on enemy targets), by providing air-to-air combat capability and denying the air to the enemy, by acquiring intelligence through observation and photos, and all the while staying alert not only to enemy aircraft but to surface-to-air missiles made for one purpose…to kill that pilot and his or her aircraft.

Does it sound familiar? It should, whether you’re a former fighter pilot or not. Because it describes modern emergency care and the role we have as physicians in delivering it. I’m not trying to aggrandize what we do, but I want to point out how we have, in many instances, reached a real breaking point in terms of”task saturation.’
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I worked today and saw about 24 patients in eight hours. Not a lot compared to some of you heroes out there. But some of them were quite sick. I work in a community setting, and our 20 beds are often full. Our day-shifts are covered by one MD from 7 AM to 3 PM. At 10 AM a physician’s assistant comes in and works 12 hours. That’s great, except they really don’t see the sickest of the patients.

For eight hours, the day doc sees every significant chest pain, shortness of breath, elderly altered mental status, febrile infant, trauma, stroke and anything else that has the potential to be life or limb threatening.

Fine, that’s what we do. But as I approach 3 patients per hour, I start to feel a little stretched. I’m in a community hospital. I can’t call for back-up unless I’m consulting someone who doesn’t really want to be consulted. I don’t have herds of residents or students running around to help. It’s me and the PA.

So, it’s tachycardia in room 9, hypotension in room 11, shortness of breath in room 5, chest pain in room 7, confusion in room 6, fracture in room 13, unable to walk in room 17, doesn’t want to take family member home in room 8, overdose in room 20, which needs a stretcher but doesn’t have one. It’s screaming finger laceration in child in room 18 that needs repair and probably sedation, it’s still tachycardia in room 9, but now more short of breath. It’s still chest pain in room 7 with EKG changes, but whose cardiologist says ‘don’t worry about it, it’s nothing.’

It’s phone calls from the urgent care, sending a patient, the ENT sending a patient, the nursing home sending a patient, the nurse practitioner clinic sending a patient. I want somewhere to send my patients!

It’s charting everything to convey important information, to protect myself legally, to bill appropriately, even as 5 nurses as 20 questions and the radiologist says, ‘well, it’s probably nothing, but you might want to do a follow-up CT on this nodule in the lung…’

It’s not much for lunch, no time to sit. It’s ‘did I actually give him nitroglycerin and start her antibiotics? Did I call her doctor for follow-up and can he get that prescription filled?’

It’s task saturation. We want to do it all well. We don’t want to miss anything, or mess anything up. We want all our patients alive, healthy and happy. And society wants it all done quickly and neatly, with no complaints, no inefficiency, and no extra cost.

It’s flying the F-16 while writing a letter home to family, making a quilt, writing a novel and cooking a nice Italian meal. (And worrying if the guys on the ground will give you good pilot satisfaction scores).

It’s a little crazy. I’m proud of how well we do it, but sometimes I wonder how we do it at all.

‘We live in fame or go down in flame. Hey!

Nothing can stop the US Air Force.’
Edwin

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