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Everything presents as red
In a mass casualty incident, priorities are written on the body. Breathing too fast, no pulse at the wrist, can't squeeze my hand. You sort the whole scene fast, and nobody argues with the tag. Life doesn't come with vital signs, so right now everything in mine shows up looking red. This one is about borrowing triage for a life with too many priorities, and what the research says about why urgency wins and why saying no costs less than we fear.
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Nobody argues with the tag
Picture a pileup on the freeway at two in the morning. Nine patients. You and your partner are the only unit on scene, fire to arrive in a few minutes, and the next ambulance is ten minutes out. You can't treat anyone yet. Your only job is to sort.
You start by yelling. "If you can hear me and you can walk, go stand by that guardrail." Anyone who gets up is breathing, has a pulse, and has a brain working well enough to follow directions. They have to wait. You've immediately deprioritized and sorted part of the scene without touching anyone.
Then you walk to everyone who stayed down and check three things. Medics learn it as 30, 2, can do. Breathing more than 30 times a minute? Red. No pulse at the wrist, or color takes more than two seconds to return after you press a fingernail? Red. Can't follow a simple command like "squeeze my hand"? Red. Pass all three and you're yellow, hurt but stable enough to wait. You get under a minute per person, and the only things you're allowed to fix are a blocked airway and major bleeding. Then you tag and keep walking. You don't have time to get into the “weeds” as the first on the scene. You REALLY need to make sure you capture the landscape to relay information as help comes.
Then there's the patient who isn't breathing. You reposition the airway. If they still don't breathe, they get a black tag, and you move on. Stopping for CPR would cost the people you haven't reached yet.
The loudest patient on scene is almost never the sickest. The one screaming about a broken leg is telling you they have an airway, they're breathing, and their brain is getting enough oxygen to be upset. The quiet one is the one who scares you.
In my first newsletter, I wrote about doing CPR alone in the back seat of a car while nearly ten responders cut the roof off. One patient, and every hand on scene could have gone to them. Put that same patient in the middle of this pileup, and the protocol says tag them black and keep walking. Same patient, different math.
That's the beauty of triage. The priorities are physical, and the criteria were written in advance by people who weren't standing in the chaos, so the person in it only has to check. START was built in 1983 by Hoag Hospital and the Newport Beach Fire Department in California. And a tag is only good for right now. You reassess, yellows turn red, and you're expected to change the call.
Everything presents as red
Now look at my scene. I'm building a startup, SteadMark. This summer I started a new full-time job that moved me, my Jeep, and my dog from Southern California to the Chicago suburbs. I'm working on my MBA, and I serve as VP of Membership for the student organization for Gies grad students, which I want to grow. Every one of those is a good thing. Every one of them walks up yelling.
Not all of life comes with vital signs. Nothing in my inbox is lying on the pavement not breathing. Everything walks, talks, and sends a follow-up: the investor email, the project deadline, the board meeting, the apartment I'm still furnishing. It all presents as red, and when everything is red, you haven't triaged anything. Medics call that over-triage. It buries the patients who need you under the ones who are just loud.
The move was the easiest triage I did all year. Everything I kept had to fit in a Jeep, so the cargo space made the call, the same way a respiratory rate does. My week has a cargo limit too, 168 hours. It just doesn't feel that way when someone asks for something three weeks out. Across seven experiments, Gal Zauberman and John Lynch found that people generally expect more free time in the future than they have today. That makes a yes to next month feel cheap. It's known as the "Yes... Damn!" effect. Their paper sums up the pattern as a yes that eventually turns into a damn, because next month shows up just as full, if not more.
So I'm borrowing the protocol.
Green. Before I touch anything, I ask what can walk. What can wait, get handed off, or go without me for a few weeks? That goes to the guardrail. It's hurt, but it'll wait.
Red. Then I check vitals before volume. My version of 30, 2, can do is one question: what breaks, and stays broken, if I don't touch it this week? That list is short.
Yellow. A yellow tag tells someone they're stable and I'm coming back. I give every yellow a date, so it can stop yelling in the meantime.
Black. This is the one I'm still learning. Some things I care about can't be saved with the hands I have right now: a good opportunity, a side project, a yes I gave months ago. My version of the airway check: give it one quick fix, and if it still won't breathe without me doing CPR on it every week, it gets the black tag. The protocol says make the call and keep walking. For me, that means saying no early and kindly, before a half-hearted yes costs someone else.
A kind no is the same muscle as speaking up, which I wrote about in Power Tripping: say it early, and leave the heat out of it.
The Vitals
Why the loud stuff wins. In 2018, Meng Zhu, Yang Yang, and Christopher Hsee published five experiments in the Journal of Consumer Research on how people choose between urgent and important tasks. Participants picked between two identical tasks, one paying more than the other. The researchers gave the lower-paying task a fake deadline that everyone could easily beat, and it worked anyway. In the first experiment, the share of students choosing the worse-paying task rose from 13 percent to 31 percent. In another, it rose from 7 percent to 48 percent. The ticking clock pulled attention away from what each task was worth. People who saw themselves as busy were more prone to it, and in a repeated version they kept making the same mistake round after round. When the researchers simply reminded people of each task's payoff at the moment of choosing, the effect largely disappeared. That's what 30, 2, can do does for a medic. It forces a look at the vitals before the volume. The authors warn that this is how health and family lose out to whatever has the shortest deadline, especially for people who feel busy.
Why no is so hard. Julian Givi and Colleen Kirk ran five experiments with more than 2,000 participants. In a pilot survey, 77 percent of people admitted accepting an invitation they didn't want because they worried about the fallout of declining. The experiments showed the fear is overblown. People who imagined turning down a friend's dinner invitation predicted the friend would be angrier, more disappointed, and less likely to invite them again than people who imagined being turned down actually reported. The result held consistently for real couples, most of them together more than five years. The blind spot is that decliners assume the other person will fixate on the no itself, while inviters pay more attention to the thinking behind it. Givi's own advice is balanced. Turn things down here and there to avoid burnout, and keep saying yes often enough, because time together is how relationships grow.
The Handoff
Triage works because the hard calls get made before the chaos, so the person on scene only has to check. I'm trying to do the same: decide ahead of time what counts as a vital sign, check it before I check who's loudest, and tag the rest honestly. Green waits. Yellow gets a date. Black gets an early, kind no. None of my calls are life or death, and that's the point. If a medic can make them in under a minute with lives on the line, I can make them about a meeting.
Priority One: Find the one thing you're keeping alive with CPR. That's your black tag. Give it a kind no this week, no matter how much it hurts.
This is my third newsletter. Reply and tell me one thing you've said no to lately, or one thing you know you should. I'll read every response.
With love,
Jim Sullivan