Put on your own oxygen mask first. But how?

By Una Harrington

I recently flew from Australia to Ireland and back again with my 4 month old baby in tow.

During the 27-hour journey each way, I listened to the in-flight safety briefing 6 times.

For the first time, I really thought about the advice to ‘Put on your own oxygen mask first, then attend to your child’.

I thought – That makes total sense. But… Is that what I would do, if the plane depressurised?

To be honest, my brain went ‘HELL, NO. I’m putting that mask on the baby first and then my own, thank you very much”. No engaging of highbrow System 2 thinking to temper my System 1 thinking, no thought of the logic of how much better off he would be if I could breathe. Just NO. Hell, NO!

Then, at 20,000 feet, I got to thinking about how many wellness related talks I have sat in, where the oxygen mask analogy was used, to highlight the importance of taking care of yourself first. I suspect I’ve even used the analogy myself in my own presentations.

20,000 feet above ground, I wondered: Have I had it all wrong the whole time? Is anyone really ever going to reach for their own oxygen mask first?

Imagine you are the doctor in charge of your ED on a busy Monday evening. Yup, that utter madness that is Monday: patients crammed in every available treatment space; an 8-hour wait for a hospital bed; hospital executive calling you on the half hour asking why so many patients are breaching the 4-hour target.

So much of our day-to-day work in hospitals is now spent in crisis mode – when the demand for our services radically outstrips our resources. This is exactly the time, when those oxygen masks would be deployed from the overhead compartment on the plane. If the ED was a plane, those oxygen masks would be down the whole way through the year-long ‘Winter Crisis’!

I wonder if sometimes our patients are like our children sitting beside us at that critical moment on that flight – we think, I’ll just sign one more ECG before I take my break (which becomes five ECGs and two CXRs to review); I’ll quickly RAT (Rapid Assessment at Triage) two ambulance patients before I fill my water bottle (which then becomes a review of five stretchered patients); I’ll go discharge one of those Short Stay patients before I pee (which then can become a 16-bed review with the nurse in charge of Short Stay).

We think – I’ll put on all my patients’ oxygen masks first. I’ll just quickly do these tasks and then I’ll breathe my own oxygen. We all know how that ends….

So, if it’s not instinctive for us to reach for our own masks first, what can we do to remind ourselves that this is necessary? And then actually do it? How can we recreate having a flight attendant at our shoulder to remind us? And then overcome the barriers to reaching for that mask?

We need to normalise and actively cultivate a workplace philosophy and action where basic self-care comes first – especially during times of chaos in the work environment; where reaching for our own oxygen mask is not just the norm, but is encouraged and enabled.

Yes of course – we will always deal with the critically unwell patients who need immediate care as a matter of urgency. But most patients don’t need our immediate care. They can wait 5 minutes while we drink a glass of water, or catch our breath after a difficult resuscitation. They will probably benefit from it!

But even looking beyond that, when on a busy shift, we are often so cognitively overloaded we can hardly think: when we need to pee so bad we can hardly walk. When we are bed blocked to our eyeballs, we as a group of ED workers, need to think, “Me first; my colleague first”. At that time, no more ‘one more ECG’, no more ‘one quick review in Short Stay’, no more ‘I’ll just RAT those ramped patients’. Rather, our inner dialogue needs to be: I will eat something; I will encourage my staff to do the same (even if it’s on the go); we will go to the toilet (though it’s bit awkward in the cubicle if everyone goes at once!).

Attention to self-care isn’t the solution to fix our over-stretched and under-resourced emergency departments. It is about us as individuals, as a team and as an ED community making it normal for both ourselves and our colleagues to make sure we put our own oxygen masks first – and actively enabling ourselves to do so.

And finally yes, in case you are wondering, it is possible to survive 27 hours on a plane, with a 4 month old as your only company!