Sean McKay - Academia.edu (original) (raw)
Papers by Sean McKay
High Reliability Organizing for (HRO) Disasters – Disaster Ecology and the Color of Noise
Neonatology today, Dec 20, 2021
The frequencies of stochastic noise inherent to the environment can be described as colors. The v... more The frequencies of stochastic noise inherent to the environment can be described as colors. The various colors of noise refer to the disruptive potential of stochastic energy within the environment and its characteristics. The meaning of the type of noise lies in the unpredictability of events and the 'forcing functions' of energy. That is the strength of the environment to force a system or population to respond. For human activity, the color types correlate to problem characteristics such as leadership-line authority coupling, well-structured, ill-structured, and embedded problems. When the noise color changes, forcing functions and the types of problems also change, increasing characteristics necessary for adaptation or altering characteristics in unexpected ways through relaxed selection. The noise process applies equally to nursing homes, NICUs, and public safety and is independent of timescale or magnitude. We need not characterize normal environmental variation differently from catastrophes.
Neonatology today, Jul 20, 2020
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2011
Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan
Neonatology today, Dec 20, 2021
An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuat... more An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.
Neonatology today, Nov 20, 2021
Wildland fire threatens the hospital, evacuation routes, and even vehicles, whether air or ground... more Wildland fire threatens the hospital, evacuation routes, and even vehicles, whether air or ground. Smoke-filled air endangers the neonate inside the NICU or riding in an ambulance. Rural hospitals several hours from a receiving hospital have but a few local ambulances available for evacuation." "These are the situations when preparations to evacuate inform the decision to shelter, and preparations to shelter inform the decision to evacuate. In the episodes described below, Neonatologists and administrators consistently prepared to evacuate and shelter at the same time. "
Operational Rescue
Elsevier eBooks, 2024
Journal of Special Operations Medicine
Journal of Special Operations Medicine
Redefining Technical Rescue and Casualty Care for SOF: Part 1
Journal of Special Operations Medicine
Trauma care in the tactical environment is complex; it requires a unique blend of situational awa... more Trauma care in the tactical environment is complex; it requires a unique blend of situational awareness, foresight, medical skill, multitasking, and physical strength. Rescue is a critical, but often over-looked, component of nearly all tactical trauma casualty management. Successful full spectrum casualty management requires proficiency in four areas: casualty access, assessment, stabilization, and extraction. When complex rescue situations arise (casualty removal from roof tops, mountain terrain, collapsed structures, wells, or a karez), casualty care often becomes further complicated. Special Operations units have historically looked to civilian technical rescue techniques and equipment to fill this ?rescue gap.? Similar to the evolution of pre-hospital military medicine from civilian guidelines (e.g. Advanced Trauma Life Support) (ATLS)) to an evidence-based, tactical-specific guideline (Tactical Combat Casualty Care (TCCC)), an evolution is required within the rescue paradigm. This shift from civilian-based technical rescue guidelines towards an Operational Rescue? capability allows tactical variables such as minimal equipment, low light/night vision goggles (NVG) considerations, enemy threats, and variable evacuation times to permeate through the individual rescue skill set. Just as with TCCC, in which the principles of casualty care remain consistent, the practices must be adapted to end-users environment, so it is with rescue.
Disaster Series: Prolonged Improvisation during Hurricanes – High Reliability Organizing in the NICU
Neonatology Today, 2022
NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transf... more NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transfer neonates, communication, and emergency transport systems to move neonates to safer ground. Under-represented are identifying the skills and capabilities to support a neonate for hours, if not days, in an austere and adverse environment. The successful operations that sheltered and evacuated 235 neonates with only two deaths and no adverse events recorded are under-recognized. Such accomplishments came about from the actions and improvisations of local Neonatologists and NICU staff who extended an ordinary workday into the consequences of major hurricanes.
Neonatology Today, 2021
A disaster is an environmental disruption of medical care, a victim generator that disrupts the a... more A disaster is an environmental disruption of medical care, a victim generator that disrupts the ability to treat multiple patients. Death can come from physiological, physical, social, or behavioral threats within the disaster environment. Legal or administrative definitions of disasters are necessary for out-of-area resource allocation. Topological dynamical systems describe the continuous transformations within the topological space of a disaster. A functional description of disasters focuses on the damage produced by the disaster rather than how the damage was caused. An ecological description underscores how damage creates a new environment within our familiar, formerly safe work environment. The disaster environment can have a latent effect on physiology in several ways. The disaster forms an embedded problem, an ill-structured problem embedded in the environment. We extend operations into disasters by developing capabilities rather than assessing risk.
Western Journal of Emergency Medicine, 1996
Journal of High Threat & Austere Medicine, 2021
Environmental hazards have an unrecognized and unmet influence on operations. The mistranslati... more Environmental hazards have an unrecognized and unmet influence on operations. The mistranslation of vertical access and rescue customs and practices, to an environment with uncertain and unrecognizable hazards, can lead to catastrophic failure. Application of these customs and practices to meet the complex operational constraints and environmental hazards central to high-hazard mission sets, has persisted and confused operational vertical rescue teams. Improvised approaches, using minimal but readily available equipment, can close gaps between theory and practice and between discrete concepts in a continuously evolving environment. This paper addresses existing gaps in operational vertical response utilizing a context-specific approach similar to the authors of the original Tactical Combat Casualty Care (TCCC) project published in the 1996 supplement of Military Medicine (Butler FK, 1996). A pragmatic framework is introduced, which has been evolving for the past 10 years wit...
Neonatology Today, 2020
The threat of COVID-19 to professionals has become personal. Professionals in neonatal healthcare... more The threat of COVID-19 to professionals has become personal. Professionals in neonatal healthcare can acquire infection and unknowingly become a vector, infecting babies, and their colleagues. A pragmatic stance of leadership, derived from leadership in extremis, communicates to subordinates that leaders have their immediate well-being in mind while engaging in demanding situations. Effective leadership for ill-structured problems embedded in the environment has distinct characteristics such as modeling cognitive and affective skills (attitudes and the contingent value of information) and the ability to modulate emotional states. Pragmatic leaders effectively increase subordinates' collective stress capacity for, and leverage individual capabilities during, in extremis circumstances. This paper describes pragmatic leadership characteristics and practices derived from experience, primary sciences, and High Reliability Organizations (HRO).
Prehospital Emergency Care, 2017
Prehospital and Disaster Medicine, 2010
A terrorist attack on US schools no longer can be considered a Black Swan event. Mounting evidenc... more A terrorist attack on US schools no longer can be considered a Black Swan event. Mounting evidence suggests that extremist organizations actively are targeting US schools. Equally disturbing are data suggesting that schools, universities, and communities are unprepared for large-scale violence. The Operational Medicine Institute Conference on an Integrated Response to the Modern Urban Terrorist Threat revealed significant variations in the perceived threats and critical response gaps among emergency medical providers, law enforcement personnel, politicians, and security specialists. The participants recommended several steps to address these gaps in preparedness, training, responses, and recovery.
Hands free extraction drag strap
The journal of trauma and acute care surgery, Jan 21, 2016
Dual handle adjustable drag strap
Rapid extraction body harness with extendable drag straps
High Reliability Organizing for (HRO) Disasters – Disaster Ecology and the Color of Noise
Neonatology today, Dec 20, 2021
The frequencies of stochastic noise inherent to the environment can be described as colors. The v... more The frequencies of stochastic noise inherent to the environment can be described as colors. The various colors of noise refer to the disruptive potential of stochastic energy within the environment and its characteristics. The meaning of the type of noise lies in the unpredictability of events and the 'forcing functions' of energy. That is the strength of the environment to force a system or population to respond. For human activity, the color types correlate to problem characteristics such as leadership-line authority coupling, well-structured, ill-structured, and embedded problems. When the noise color changes, forcing functions and the types of problems also change, increasing characteristics necessary for adaptation or altering characteristics in unexpected ways through relaxed selection. The noise process applies equally to nursing homes, NICUs, and public safety and is independent of timescale or magnitude. We need not characterize normal environmental variation differently from catastrophes.
Neonatology today, Jul 20, 2020
Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 2011
Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan
Neonatology today, Dec 20, 2021
An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuat... more An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.
Neonatology today, Nov 20, 2021
Wildland fire threatens the hospital, evacuation routes, and even vehicles, whether air or ground... more Wildland fire threatens the hospital, evacuation routes, and even vehicles, whether air or ground. Smoke-filled air endangers the neonate inside the NICU or riding in an ambulance. Rural hospitals several hours from a receiving hospital have but a few local ambulances available for evacuation." "These are the situations when preparations to evacuate inform the decision to shelter, and preparations to shelter inform the decision to evacuate. In the episodes described below, Neonatologists and administrators consistently prepared to evacuate and shelter at the same time. "
Operational Rescue
Elsevier eBooks, 2024
Journal of Special Operations Medicine
Journal of Special Operations Medicine
Redefining Technical Rescue and Casualty Care for SOF: Part 1
Journal of Special Operations Medicine
Trauma care in the tactical environment is complex; it requires a unique blend of situational awa... more Trauma care in the tactical environment is complex; it requires a unique blend of situational awareness, foresight, medical skill, multitasking, and physical strength. Rescue is a critical, but often over-looked, component of nearly all tactical trauma casualty management. Successful full spectrum casualty management requires proficiency in four areas: casualty access, assessment, stabilization, and extraction. When complex rescue situations arise (casualty removal from roof tops, mountain terrain, collapsed structures, wells, or a karez), casualty care often becomes further complicated. Special Operations units have historically looked to civilian technical rescue techniques and equipment to fill this ?rescue gap.? Similar to the evolution of pre-hospital military medicine from civilian guidelines (e.g. Advanced Trauma Life Support) (ATLS)) to an evidence-based, tactical-specific guideline (Tactical Combat Casualty Care (TCCC)), an evolution is required within the rescue paradigm. This shift from civilian-based technical rescue guidelines towards an Operational Rescue? capability allows tactical variables such as minimal equipment, low light/night vision goggles (NVG) considerations, enemy threats, and variable evacuation times to permeate through the individual rescue skill set. Just as with TCCC, in which the principles of casualty care remain consistent, the practices must be adapted to end-users environment, so it is with rescue.
Disaster Series: Prolonged Improvisation during Hurricanes – High Reliability Organizing in the NICU
Neonatology Today, 2022
NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transf... more NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transfer neonates, communication, and emergency transport systems to move neonates to safer ground. Under-represented are identifying the skills and capabilities to support a neonate for hours, if not days, in an austere and adverse environment. The successful operations that sheltered and evacuated 235 neonates with only two deaths and no adverse events recorded are under-recognized. Such accomplishments came about from the actions and improvisations of local Neonatologists and NICU staff who extended an ordinary workday into the consequences of major hurricanes.
Neonatology Today, 2021
A disaster is an environmental disruption of medical care, a victim generator that disrupts the a... more A disaster is an environmental disruption of medical care, a victim generator that disrupts the ability to treat multiple patients. Death can come from physiological, physical, social, or behavioral threats within the disaster environment. Legal or administrative definitions of disasters are necessary for out-of-area resource allocation. Topological dynamical systems describe the continuous transformations within the topological space of a disaster. A functional description of disasters focuses on the damage produced by the disaster rather than how the damage was caused. An ecological description underscores how damage creates a new environment within our familiar, formerly safe work environment. The disaster environment can have a latent effect on physiology in several ways. The disaster forms an embedded problem, an ill-structured problem embedded in the environment. We extend operations into disasters by developing capabilities rather than assessing risk.
Western Journal of Emergency Medicine, 1996
Journal of High Threat & Austere Medicine, 2021
Environmental hazards have an unrecognized and unmet influence on operations. The mistranslati... more Environmental hazards have an unrecognized and unmet influence on operations. The mistranslation of vertical access and rescue customs and practices, to an environment with uncertain and unrecognizable hazards, can lead to catastrophic failure. Application of these customs and practices to meet the complex operational constraints and environmental hazards central to high-hazard mission sets, has persisted and confused operational vertical rescue teams. Improvised approaches, using minimal but readily available equipment, can close gaps between theory and practice and between discrete concepts in a continuously evolving environment. This paper addresses existing gaps in operational vertical response utilizing a context-specific approach similar to the authors of the original Tactical Combat Casualty Care (TCCC) project published in the 1996 supplement of Military Medicine (Butler FK, 1996). A pragmatic framework is introduced, which has been evolving for the past 10 years wit...
Neonatology Today, 2020
The threat of COVID-19 to professionals has become personal. Professionals in neonatal healthcare... more The threat of COVID-19 to professionals has become personal. Professionals in neonatal healthcare can acquire infection and unknowingly become a vector, infecting babies, and their colleagues. A pragmatic stance of leadership, derived from leadership in extremis, communicates to subordinates that leaders have their immediate well-being in mind while engaging in demanding situations. Effective leadership for ill-structured problems embedded in the environment has distinct characteristics such as modeling cognitive and affective skills (attitudes and the contingent value of information) and the ability to modulate emotional states. Pragmatic leaders effectively increase subordinates' collective stress capacity for, and leverage individual capabilities during, in extremis circumstances. This paper describes pragmatic leadership characteristics and practices derived from experience, primary sciences, and High Reliability Organizations (HRO).
Prehospital Emergency Care, 2017
Prehospital and Disaster Medicine, 2010
A terrorist attack on US schools no longer can be considered a Black Swan event. Mounting evidenc... more A terrorist attack on US schools no longer can be considered a Black Swan event. Mounting evidence suggests that extremist organizations actively are targeting US schools. Equally disturbing are data suggesting that schools, universities, and communities are unprepared for large-scale violence. The Operational Medicine Institute Conference on an Integrated Response to the Modern Urban Terrorist Threat revealed significant variations in the perceived threats and critical response gaps among emergency medical providers, law enforcement personnel, politicians, and security specialists. The participants recommended several steps to address these gaps in preparedness, training, responses, and recovery.
Hands free extraction drag strap
The journal of trauma and acute care surgery, Jan 21, 2016
Dual handle adjustable drag strap
Rapid extraction body harness with extendable drag straps