Intro
The vibration of the pager has a sound all its own.
It’s a low, insistent buzz — felt before it’s heard — and in the fraction of a second before the speaker crackles to life, your body is already deciding what to do. Static. Modem tones. Then the dispatch, flat and efficient: Car versus motorcycle. Intersection of Route 299 and 44/55.
I am standing in my laundry room. It is a Saturday afternoon. Thirty seconds ago, I was thinking about where my wife and I might go for coffee.
Now I am a bundle of nerves pulling on my boots.
As a volunteer EMT, still newer to the work than most of the people I ride with, I’m not waiting at a station or posted in a parking lot. I am living my regular life until I’m not — until the tones drop and everything else becomes secondary. Given the location, I’ll head directly to the scene while other volunteers bring the ambulance and the rescue vehicles from the station. This means I will likely be the first responder to arrive. I will be responsible for evaluating the emergency, triaging, providing what care I can, and directing bystanders and other first responders as the situation develops.
The drive is three minutes. Stress-induced time dilation makes it feel much longer.
I keep reminding myself of the old adage: slow is smooth, smooth is fast.
I pull up to find people clustered around a motorcyclist lying on the ground. Not moving. It is daunting to be first on scene with no backup, no ambulance, no senior partner to defer to. I don’t know what I’m walking into, whether the bystanders will help or get in the way, or what the sixty seconds before I arrived looked like.
I grab trauma shears and a tourniquet from my car. I pull on my gloves. I check the scene. I take a breath.
Okay. Let’s get started.
What I find is this: the motorcyclist is on his back, moaning, with a bone visible through the broken skin of his left leg. Bystanders are yelling. Someone is filming. The summer air is like a wet blanket, thick and humid, making everything feel like it’s in slow motion.
My first instinct is to wish for a paramedic — a higher-level provider who could deliver Advanced Life Support, the kind of interventions I’m not certified to perform. Then something my instructor said during training cuts through the noise.
BLS before ALS.
Basic Life Support before Advanced Life Support. The principle is simple: despite everything a paramedic can do, it is the basic skills — airway, breathing, circulation — that most often make the difference in the field. The fundamentals are not a stepping stone to the real work. They are the real work.
I instruct a woman who identifies herself as a nurse to stabilize the patient’s head for spinal precaution. Then I run the XABCs, a rapid field assessment protocol. Is he exsanguinating — bleeding out? A quick sweep shows no critical external bleeding. Airway and breathing? I ask him his name and birthday. He answers both easily. Circulation? I find a radial pulse — weak, thready. His skin is cool and clammy. That points to the immediate life threat to address.
By the time the ambulance arrives, I have my assessment. I have my handoff. I know what we’re dealing with, and I know what we need to do next.
Treating that patient in the middle of the road, waiting for backup, I felt something I hadn’t expected to feel: calm. Not the absence of adrenaline — adrenaline was everywhere — but the specific calm that comes from having a framework. From knowing, even in chaos, where to look and what to do with what you find.
That calm is the subject of this book.
I had searched for it before. Just never on a highway.
Before I ever heard a pager go off, I had spent more than fifteen years inside large organizations as a design and product leader. I built and led teams at Google, Amazon, and Capital One — the kind of organizations where the org charts were wide, the stakeholders were many, and the definition of urgent changed depending on whose calendar you were on. I led teams building software used by millions of people, navigated reorgs and product failures and high-stakes presentations, and sat in rooms where someone said “we need to move faster” without any agreement on what we were supposed to be moving faster toward.
Midway through that career, I trained at the Hudson Institute of Coaching as a developmental and executive coach. Coaching became a second discipline alongside the design work, and eventually a practice of its own — sitting with directors, VPs, and founders who were operating at altitudes I knew well, trying to do the same hard thing I had been trying to do. It gave me a vocabulary for craft I had been practicing by instinct for years.
And in all of that — the leading, the building, the coaching — I was responding to emergencies every week. Just different ones.
A launch that surfaced a fundamental misalignment between what the team had built and what the customer actually needed — discovered forty-eight hours before go-live. A key designer disappearing two weeks before a critical deliverable, leaving a gap that no one wanted to admit out loud. A VP who had been supportive of a project for six months, announcing in an executive meeting that she wasn’t sure the direction was right. An offsite where the strategy got relitigated from scratch after two quarters of work.
These were my calls. My emergencies. And for a long time, without a framework, I handled them the way most managers do — by responding to the loudest voice, the most urgent Slack message, the person who had the most access to leadership. I led by feel. I triaged by instinct. I made decent decisions when I had time and worse ones when I didn’t.
What I was missing, though I wouldn’t have named it this way then, was a system. Not a management methodology or a productivity framework or a quarterly planning template. A system for thinking clearly when things are unclear. For staying calm when the situation is not. For knowing, before you reach the scene, what questions to ask and in what order.
I found that system — unexpectedly, much later in my career — in the back of an ambulance.
When I began my EMT training as a volunteer in a small fire department, I was not looking for a professional revelation. I was looking for a challenge — something that would push me outside the very specific walls of the corporate world I had lived in for nearly two decades. What I found instead was a mirror.
Call after call, I kept recognizing something. A protocol that sounded exactly like a leadership principle I had learned the hard way. A piece of field wisdom from my partner — who had years on me and the particular gift of making competence look effortless — that mapped directly onto a problem I had wrestled with in my last performance review cycle. A way of doing things, under conditions of genuine pressure, that I had been trying to approximate in meeting rooms for years.
The best of what I had learned as a corporate leader and the best of what I was learning as an EMT were, at their core, the same things.
Here is what I came to believe, and what this book is about: the principles emergency responders use — the frameworks they train on until they become instinct, the habits of thought they develop for operating in ambiguity, the cultural practices that allow small teams to perform at extraordinary levels under impossible conditions — are the most practical leadership tools I have ever encountered.
And almost no one in the corporate world is talking about them.
The reason these principles work is not that emergencies are like leadership. The reason they work is that emergency responders have figured out something most leaders never do: that competence under pressure is not a personality trait. It is a trained practice. It comes from disciplines developed in advance — frameworks, protocols, and shared language that are already in place before the situation requires them. The responders who perform best in chaos do so because they have done the cognitive work ahead of time. They are not calmer than everyone else. They are better prepared to be useful when calm is what the moment requires.
Most leaders face analogous pressure without analogous preparation. They improvise in the middle of a crisis because they never built a framework for one. They learn their lessons the way I learned mine in those first fifteen years — by feel, by instinct, by failing to meet the moment.
I want to be honest about my authority to make this argument. I am not a career first responder. I am a volunteer, still newer to the work than most of the people I ride with, still occasionally surprised by what I find on a scene. I often describe myself as a barely competent EMT. My Captain would probably be the first to tell you there are many, many things about this job I still have to learn. She would be right. The authority in this book does not come from decades in EMS. It comes from the particular vantage point of someone who arrived in EMS already formed as a leader — which meant I could see, with fresh eyes, exactly which principles transferred well, and why.
What I can speak to with confidence is the corporate side of this equation. I have led teams, managed people, coached leaders, survived reorgs, shipped products, and made the mistakes that make you better if you pay attention. That experience is the primary lens through which this book is written. The field anecdotes open the door. The leadership experience walks through it.
This is also, deliberately, a practical book. Each chapter takes a principle from emergency medicine — a saying, a protocol, a habit of mind — and translates it into something you can use with your team this week. There are frameworks. There are challenges. There are moments where I am going to ask you to stop and think before you keep reading, because the thinking is the point.
The book is organized in three parts, moving outward through the registers a leader actually operates in. Part One is about the self — the work of preparing your own readiness before you are useful to anyone else. Part Two is about the team — the small unit closest to the work, where trust and shared language are built or aren’t. Part Three is about the system — the wider organization that shapes what’s possible inside any team, and the moments when the system itself is the problem to be solved. Each chapter stands on its own, but the three parts build on one another. Self before team. Team before system. It is the same logic emergency responders use on every call: stabilize what’s in front of you before you reach for what’s farther out.
The motorcyclist on Route 299 was experiencing an emergency. My job — as a responder, as a leader, as a human being trying to be useful in someone else’s crisis — was to stay clear-headed enough to actually help. That is harder than it sounds. Urgency is contagious. Panic is contagious. Calm is also contagious, and it is rarer, and it is a choice.
The best leaders I have known — in the field and in the conference room — are the ones who have trained themselves to make that choice. Not because they feel less than anyone else. Because they have built the disciplines that let them stay functional when everyone around them can’t. They feel the weight of the situation without being flattened by it. They move fast without rushing. They know the difference between the call and their reaction to the call.
That is what this book is about.
The tones will drop again. They always do.
The question is what happens in the minutes between the pager going off and the moment you arrive on scene — what you tell yourself, what you reach for, how you prepare to be useful in a situation you didn’t choose and can’t fully control.
The EMTs, paramedics, and firefighters I have had the privilege of working alongside have answers to that question that took them years of hard-won experience to develop. Those answers, it turns out, work in boardrooms and conference rooms and executive offsites.
They work any time the stakes are real and someone needs you to show up clear-headed and ready to work.
Let’s get started.