“In a small Austrian town in the Alps, a mother and father had been out on a walk in the woods with their three-year-old daughter. The parents lost sight of the girl for a moment and that was all it took. She fell into an icy fishpond.
The parents frantically jumped in after her. But she was lost beneath the surface for thirty minutes before they finally found her on the pond bottom. They pulled her to the surface and got her to the shore. Following instructions from an emergency response team reached on their cell phone, they began cardiopulmonary resuscitation.
Rescue personnel arrived eight minutes later and took the first recordings of the girl’s condition. She was unresponsive. She had no blood pressure or pulse or sign of breathing. Her body temperature was just 66 degrees. Her pupils were dilated and unreactive to light, indicating cessation of brain function. She was gone.
But the emergency technicians continued CPR anyway. A helicopter took her to the nearest hospital, where she was wheeled directly into an operating room, a member of the emergency crew straddling her on the gurney, pumping her chest. A surgical team got her onto a heart-lung bypass machine as rapidly as it could.
The surgeon had to cut down through the skin of the child’s right groin and sew one of the desk-size machine’s silicone rubber tubes into her femoral artery to take the blood out of her, then another into her femoral vein to send the blood back. A perfusionist turned the pump on, and as he adjusted the oxygen and temperature and flow through the system, the clear tubing turned maroon with her blood. Only then did they stop the girl’s chest compressions.
Between the transport time and the time it took to plug the machine into her, she had been lifeless for an hour and a half. By the two-hour mark, however, her body temperature had risen almost ten degrees, and her heart began to beat. It was her first organ to come back.
After six hours, the girl’s core reached 98.6 degrees, normal body temperature. The team tried to shift her from the bypass machine to a mechanical ventilator, but the pond water and debris had damaged her lungs too severely for the oxygen pumped in through the breathing tube to reach her blood. So they switched her instead to an artificial-lung system known as ECMO–extracorporeal membrane oxygenation. To do this, the surgeons had to open her chest down the middle with a power saw and sew the lines to and from the portable ECMO unit directly into her aorta and her beating heart.
The ECMO machine now took over. The surgeons removed the heart-lung bypass machine tubing. They repaired the vessels and closed her groin incision. The surgical team moved the girl into intensive care, with her chest still open and covered with sterile plastic foil. Through the day and night, the intensive care unit team worked on suctioning the water and debris from her lungs with a fiberoptic bronchoscope. By the next day, her lungs had recovered sufficiently for the team to switch her from ECMO to a mechanical ventilator, which required taking her back to the operating room to unplug the tubing, repair the holes, and close her chest.
Over the next two days, all the girl’s organs recovered–her liver, her kidneys, her intestines, everything except her brain. A CT scan showed global brain swelling, which is a sign of diffuse damage, but no actual dead zones. So the team escalated the care one step further. It drilled a hole into the girl’s skull, threaded a probe into the brain to monitor the pressure, and kept that pressure tightly controlled through constant adjustments in her fluids and medications. For more than a week, she lay comatose. Then, slowly, she came back to life.
First, her pupils started to react to light. Next, she began to breathe on her own. And, one day, she simply awoke. Two weeks after her accident, she went home.”
As Atul Gawande goes on saying in his book The Checklist Manifesto (fascinating read by the way), what makes this recovery astounding “isn’t just the idea that someone could be brought back after two hours in a state that would once have been considered death. It’s also the idea that a group of people in a random hospital could manage to pull off something so enormously complicated.”
To save this one child, dozens and dozens of people had to carry out thousands of steps correctly: “placing the heart-pump tubing into her without letting in air bubbles; maintaining the sterility of her lines, her open chest, the exposed fluid in her brain; keeping a temperamental battery of machines up and running. The degree of difficulty in any one of these steps is substantial. Then you must add the difficulties of orchestrating them in the right sequence, with nothing dropped, leaving some room for improvisation, but not too much.”
What made this rescue possible?
It was made possible by a certain strategy for overcoming failure, which I’ve spoiled in the title of this article. Though it will seem almost ridiculous in its simplicity, maybe even crazy to those who have spent years carefully developing ever more advanced skills and technologies.
It is a checklist.
Checklists and standard operating procedures are today used by doctors, pilots, engineers, and other highly specialized professions to minimize failure and get better at what they do.
Checklists is the reason why central line infections in hospital patients dropped from affecting 11% of patients to zero at one hospital. In this hospital the checklist had prevented forty-three infections and eight deaths and saved two million dollars in costs. And that’s just from a single checklist targeting a single problem.
Checklists and more effective procedures is also the reason why buildings, now more complex and sophisticated than ever in history, with higher standards expected for everything from earthquake proofing to energy efficiency, take a third less time to build than they did a couple of decades ago.
Checklists work – and here’s how you can use them
Far from every endeavor takes advantage of checklists. What’s clear to me, is that when it comes to pursuing self-reliance and creating a life of freedom we’ve not even started exploring the potential of systems-thinking, checklists and standard operating procedures.
What if we could grow our own food with a third of the efford of previous generations? Or build our own home mortgage free? Or harvest all the fresh water we could ever use on our own properties?
What’s needed to take self-reliance, and the freedom of every individual, to the next level is simple…
- We need systems…
- We need checklists…
- We need “cheat sheets”…
- We need standard operating procedures…
And specifically, we need ones that show us the best ways for producing healthy food, abundant energy, clean water, affordable shelter, personal protection and education for our kids on a local level, right in our own communities.
Just imagine:
What if virtually every aspect of self-reliance; growing your own food, generating your own energy off-the-grid, heating your house for free with passive solar heat, planting a food forest, earning an income from home… was documented in step-by-step detail for anyone to follow.
What if you could hand these checklists over to less-experienced individuals or even complete beginners on the other side of the globe, and they could follow the steps in these plans and achieve similar results?
And what if we could improve these checklists constantly so that we can produce our food, water, energy and homes with a fraction of the effort, maintenance and resources that previous generations had to use?
I don’t know about you, but I sure get excited about that idea. I’m sure Atul Gawande would say the same. As he says…
“There is no other choice…we recognize the same balls being dropped over and over, even by those of great ability and determination. We know the patterns. We see the costs. It’s time to try something else. Try a checklist.”
Let’s stop dropping the same balls as previous generations have dropped. It’s time to try something else, and that “something else” is systems-thinking.
Now, checklists used to be reserved for big corporations with thousands of employees, e.g. McDonalds or international organizations such as the World Health Organization. But no more.
Personal power is rising around the world, and I started Walden Labs because I wanted to be at the forefront of this trend.
That’s why I’m excited to announce a new project that I’ve had in the works for the past couple of months.
It’s called Self-Reliance 365, and it’s all about going through the strategies and projects for self-reliance, step-by-step, and documenting them in detail. The end result is a checklist, or Execution Plan as we call them here at Walden Labs HQ.
We’ve already had our first members join, and right now they have access to the very first Execution Plans, with many more in the pipeline.
For example, you’ll find one Execution Plan that’s called How To Figure Out The Optimal Size For Your Off-Grid Solar PV System (in 5 Steps) and I’m excited to release The 6-Part Rural Property Purchase Checklist within the next two weeks.
Now, if you think this sounds the least bit interesting please take a minute to check out the details of Self-Reliance 365, right here.
To your self-reliance,
Dan West
