Episode 12: When Every Second Counts: A Live Podcast Recording with John Kinsey

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Reliably Well brings you thoughtful conversations from those who are shaping the future of healthcare, focusing not just on the technical side of the industry, but on the human element, the stories, the struggles and triumphs of individuals who are driving change. Join us for candid discussions that highlight both the challenges and rewards of working in a field where humanity and healthcare intersect.

Welcome to Reliable Well, a podcast from Relias Healthcare. I’m Libbo Crosswhite, the producer of season two and the people person here at Relias. Today’s episode is a little bit different. It was recorded live at our annual leadership forum, a gathering that brings together our clinical and corporate leaders to connect, to learn from industry and clinical experts, and to lean into Relias’ passion for excellence, quality, innovation, value, and people. In this session, you’ll hear

from John Kinsey. John began his career as a volunteer firefighter and paramedic on the Mississippi Gulf Coast, where he quickly became known for his ability to stay calm and lead in the midst of crisis. Over the years, he has worn many hats, from reserve deputy sheriff and SWAT medic to chief deputy coroner to flight nurse in Alaska to emergency room nurse practitioner across the country.

He has deployed internationally with disaster medical teams, worked in remote villages from Nome, Alaska to Peru, and even served in Iraq as a paramedic during Operation Iraqi Freedom. He was on the front lines of Hurricane Katrina at Ground Zero, led teams during multiple natural disasters, and helped care for one of the first COVID-19 patients in Tokyo. John Holds multiple advanced certifications, has served as faculty in nursing education,

and continues to provide emergency care today with Relias Healthcare. Through it all, he has been united by a single mission, to step into chaos and bring order, care, and leadership when it matters most. At Reliably Well, we hold firmly to the belief that stories have healing power. That’s why you’ll never hear advertisements or outside promotion here. This podcast is for our people. It’s our way of honoring those who serve,

and reminding us that no matter our specialty, site or credentials, we share far more in common than we often realize. It was an honor to sit with John and meet his wife at our Leadership Forum. And I hope that this story encourages you, challenges you, and helps all of us to remember the humanity at the heart of healthcare. John, your story is one of service, starting as the volunteer firefighter and paramedic.

Later serving as a SWAT medic and reserve deputy sheriff, and now as a nurse practitioner. Walk us through your journey and what drew you to this life of public service and medicine. It actually started when I was really young. Most people, when they’re a kid, they don’t know what they want to do. I watched the mash in emergency 51. So I wanted to be Hawkeye and I wanted to be Johnny or Gage on the rescue truck. My mom owned a daycare at our home.

So had all the kids I wanted to play with. Well, they became patients on the battlefield. I had a red wagon for an ambulance and a Fisher Price medical kit. So they all became patients sometime throughout the day. What really sealed it, my senior year in high school, my mom was a realtor and a contractor. So she had about 40 yards for me and my brother to mow. So we never got in trouble. We were too busy. ⁓ We were cutting our grass.

and a bolt of lightning struck my brother. So at 17, I performed CPR on my 11-year-old brother. And that kind of sealed it, that medicine was where God wanted me to go. That’s quite a calling right there. You’ve worked on six different continents with the National Disaster Medical System and as part of disaster medical teams around the world. Looking back,

What do you feel shaped your ability to step into those situations of chaos and then be able to lead? I was raised by strong men. My family is very military oriented, so we were always taught to stand up and lead. But as a volunteer firefighter, sometimes you were the only one that showed up because everybody else was at work. So you had to step in. You had to be in charge. And when you step out of a fire truck, everybody’s looking at you.

So you had to take charge and do what you needed to do. And you learn how to take charge at an early age and it just becomes part of your persona. And that, I worked the best in chaos. I hate to say that, but you know, turn me loose in a storm and I’m good. Don’t make me go to an admin meeting. And all of that life of experience and those events that you…

dealt with, even though you don’t like the administrative side of it, you even wrote your master’s thesis on disaster response in 2013. So what was that about? Where did that intellectual side come from? I was working on my master’s in nursing and they told me I had to write a thesis. Why I went to a school that made you write thesis is I’ll never know.

But I’ve got one that’s 60 pages long. It will put you to sleep by page two, I promise. But I knew knew disaster medicine because at that time I’d already spent 20 years on an ambulance and five or six years as a nurse. The first thing when I wrote my first chapter, the lady said, you can’t quote yourself because you’re not a, you’re not, you know, you don’t know what you’re talking about. And I said, well, how do you become an expert? She goes, you have to have five years. I said, well, I’ve got 25.

So had to write a paper to prove myself to be an expert in the situation. I think we can assume you’re an expert and let’s fast forward then from your 25 years of experience to this spring in Tylertown, Mississippi. And a tornado hits the people of Walthall County and you find yourself as the only provider in the ED. And additionally, no one on shift had ever worked a disaster there before.

And suddenly the administrator hands you the keys literally and said, John’s in charge. Can you take us into that moment? What’s it like stepping in to that sort of responsibility? For those that don’t know, Tyler Town is a very small hospital. It’s about six to eight beds in the ER. There’s usually two nurses and one tech. And on the weekend, there’s a skeleton crew on the inpatient side. So there’s maybe 10 people total in the building.

counting the janitor and the lady that works in the kitchen. So that’s the picture of what I’ve got to work with. I had two nurses in the ER who were seasoned nurses, but had never worked in a disaster, had never done disaster triage, because we all do triage, but disaster triage is a whole nother game. Because that’s when you have to choose who are you really going to see first, who can wait, and who can we not save.

That’s the worst one is picking on who’s gray and who’s black because you can’t waste your resources. And when you’re the only provider with two nurses, you have to be able to choose. That day we had been watching the weather. We knew it was supposed to get bad, but we didn’t know it was going to become tornadic. Our ER was already full. I was waiting to transfer out a patient that was in DKA, but the amulet service was tied up with wrecks of stuff from the rain.

Then all of sudden we look up and we had the TV on and they’re calling for tornadoes to come through our area. All of our phones start going off of the weather alerts. Not only do we have one tornado come through and we start getting the admin came in to the building. goes, the tornado hit the, I forget which side of town. And I said, okay, no big deal. So we started setting up. I went first and had them set up a triage area outside the ER.

Well, actually, I first had them go lock the front doors. I said, we only need one entrance because I don’t need people coming into our ER from every entrance in the hospital. Let’s lock it down where we have one point of entry. Let’s set up a triage in the hallway and we’ll have green, yellow, and red. And they all looked at me crazy. What’s green, yellow, and red? What are you talking about? How do you do emergency triage? So I give them a quick class on emergency triage.

Had a brand new nurse that was orientating, so I stuck her out there because I knew I needed my seasoned nurses in the ER for when we got a red patient. Called for my tech to run downstairs and get me all the supplies. And I asked her, said, I need all the tourniquets you can find. We had one in the building. So I gave her the keys in my truck. I said, go look in my backseat. There’s a green bag and bring it back in. And she goes, why? said, because there’s four tourniquets in my personal trauma kit.

We’re going to need all of that we can find. That was just the beginning before the first patient showed up. During this time, our admin walked in and she said, I’ve never done a disaster. I said, well, I have. goes, you’re in charge. She goes, what do I need to do? said, answer the phone and keep people off my back. So you’re leading in this situation. You don’t have adequate supplies and you have a team that’s not trained for.

the disaster triage situation and you’re about to have patients coming through the doors. What’s that experience teach you about the importance of preparation? When we started getting prepped for it, somebody goes, ⁓ we do have a disaster kit. I said, great, go get it out. Let me see what’s in it. I want to see a hand raised. Who remembers carbon paper?

Everything in that box was made with carbon paper. So it was at least 30 years old. The disaster tags fell apart when I picked them up. So you’re going, okay, here we go. Our plan B is now plan D-E-F. know, let’s learn how to do triage. And I went and got markers. Here’s a green marker. If they’re a green, put that green X on their forehead. If they’re yellow, put a yellow. In a red.

We’ll take them. So we quickly learned triage, our plan, and I had the admin on the phone with Reliance and everybody else trying to get me more support in because we knew we would get inundated shortly with what we had coming. So one of the reasons we wanted you here and we wanted to discuss this is it’s not just a story. It’s a lesson ⁓ for all of us when we were.

talking yesterday, I’ve been through four, I think, of these ⁓ in my career and whether it’s a tornado ⁓ or it’s an exposure or ⁓ whatever the disaster is, we know we work in these sorts of environments where these things happen. So for those of us who will one day face these sorts of mass casualty events, what do we need to know? What do we need to take away?

People are gonna feed off of you. If you’re running around like a chicken with your head cut off, everybody else is going to go crazy. Keep your composure. You can look like a duck paddling underwater inside, but on the outside, make it look like you’ve got it calm and your staff will be calm around you. Give direct information to them. Tell them this is what they need to do. Because if you just say, somebody needs to, nobody’s going to.

because they think somebody else is going to do it. It’s just like CPR. You got to point to somebody and say, you do this. And by doing that, you can direct people you know who’s in charge of what, and they can report back to you. But you need to know what you have to work with. You’ve got to have the basic supplies.

So now we’ve gone after our disaster, we’ve gone through and we’ve ordered disaster flags where we can mark a yellow, green, red area, black area. And we’ve started training our people on what disaster triage is. Because it’s very important if you have 15 people show up, you need to be able to separate them and figure out who needs to be seen first, and who can wait. And it’s easy.

You can teach anybody disaster triage in just a few minutes. There’s several classes on it, or I’ll be glad to come teach you. It’s easy. You can learn it. And it makes things a whole lot easier if you know that you’re taking care of who’s the sickest first. Then you just go down the line because somebody with a broke finger does not need to be at the front of the line when you’re dealing with a sucking chest wound. So you had to do the training on the spot, obviously on the job training.

in a actual tornado is non-ideal. ⁓ tell us about your practical steps that we can take as leaders to kind of initiate this sort of ⁓ training for our institutions. What can we do to get our teams, our departments kind of up to speed in this sort of stuff besides have you come and do all of it for us?

first thing I would do is find out what your disaster box looks like for the hospital and what their plan is. Something else you can do is step away and look at what possible disasters you have in your area. Do you have a chemical factory around the corner? Are you next to a major highway? Do you have bad weather? I’m from the coast. I’m used to hurricanes where you knew about them three or four days ahead and you could plan. Tornadoes, you can’t really plan far.

But if you know what you’re planning for, you can prepare. And if you prepare, you’re a whole lot better off for when it hits the fan. Then you can teach your people how to do the disaster triage, how to apply a tourniquet. They’re not taught that in nursing school anymore, how to apply the new cat tourniquets, because they’re still new, or how to put on an Israeli dressing.

Nobody knows how to do those unless you’ve been into a combat zone or how to pack a wound with, I ⁓ got a fancy name for it, but it’s a dressing where you just stick it in the hole and make it stop bleeding if you don’t have surgery. It’s called a stop the bleed class. We taught them in Alaska to all the hospital staff just in case we ever had a shooting in the hospital. It’s something that I would say everybody needs to take.

because you learn your tourniquets as well as stop the bleeding. And it will save your life or your family’s life if you have a wreck on the road. Yeah, so I think it’s more than just having a plan in place. And I think as we all bemoan the fact that while you had some experienced nurses in your department, all too common, the nursing staff turns over at a rapid rate in most of our departments. And so…

while we have a disaster plan and the nursing staff trained on it three years ago, that nursing staff is not in the department today or the bulk of them. And so that training has atrophied. And so the fact that, one, we had a disaster plan and we did do some training ⁓ and we have some supplies, all of those things may be inadequate because the

supplies are from 30 years ago where they sat in a box outside and got ⁓ heat destroyed over the past three summers. The nursing staff has now lost that ⁓ knowledge base that they had before. ⁓ So it’s more than just having the plan, it’s making sure, testing the plan, seeing that it still ⁓ is up to date. So kind of opening it up.

to our audience here a little bit. What are some of the takeaways that our team has from ⁓ this experience that ⁓ John’s story ⁓ at Waltho ⁓ has for the team here? What can we ⁓ do in our departments? What can we ⁓ grab from the ⁓ executive summary that you have moving forward?

⁓ in preparation for our other departments. Anybody have questions for John? He’s got great ⁓ insight from that debrief. ⁓ What are some things that you want to know? What are some things that we need to ⁓ think about going forward? Luke’s got a question. Two questions. One, what was the outcome? Like how many patients did you have? But secondly, after that, Rolius frequently, you every facility has their disaster.

We’re not involved that often. usually an active call when the tornado hit in Amory. ⁓ A few of us responded down here in the hospitals like after we showed up. We need to talk to our ER doctors. were not. We’re thought through that. What could realize have done differently to support you? What do we need to be thinking about as a company to be able to something happens tomorrow to support the clinician there?

We had nine major trauma patients come through. Luckily, University had sent their flight team since they could not fly, so they came in and were able to drive in and augment our ER staff with nursing and paramedics, which helped turning over to very experienced people with emergency medicine so they could help us with our patients.

What we can take away as a company, I don’t know if we need to set up a response team for each area where someone has extra supplies that we need, where you can show up and you can go, hey, here’s a box of extra stuff. I’m here to help you or have somebody on call to report to come to an area. The problem we had was we had two tornadoes that day. The first tornado came through

About 30 minutes later, a second one came through. Well, nobody knew about the second tornado because it knocked out the power, the radio, the cell towers. Most of our patients came from the second one because they were outside and they were struck with it. I had a gentleman who was outside removing limbs when the generator he had in his backyard landed on top of him in his front yard.

and he was trapped under it till they could get the jaws and pick it up and he had a sucking chest wound coming into my ER. So sometimes you don’t know that you have more disaster than you planned for. We knew about one tornado, but we didn’t know about the second one till it spanked us. So sometimes you need more resources than you can have. Your reliance was great. I got texts from Luke and I think Dr. Johnsey texts me asking me what I needed. And at that time I needed people.

but there was no way to get them into us because every road into Tyler Town was covered with trees. It took them about two hours to get the roadway opened up to get us help in. So sometimes you’re going to be the lone ranger on a deserted island. You need to be able to step up and take care of it. I think again, it’s something, the experience there is something for us all to think about and to be aware of and to

take an inventory ⁓ to make sure that we’re ready ⁓ because ⁓ again, we know this can happen. John, your career’s taking you from Katrina to Tokyo, from Peru to Alaska, and you were right where you needed to be when the tornado came through Tyler Town ⁓ this spring. ⁓ Again, we all work in spaces and places where disaster can strike.

⁓ next. ⁓ And so thanks for your powerful story that helps to dramatically ⁓ emphasize the need for all of us as leaders to be there for our teams, for our departments, for our hospitals, for our communities, no matter what, no matter when. Thank you for ⁓ your unwavering commitment to serve your community in the most vulnerable moment and for sharing your story with us and for giving us practical lessons.

we can use to develop our own leadership in times of crisis.

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