What Trauma Teams Can Learn from College Football

In June 2025, we delivered the keynote at the Teamworks Human Performance Summit. It was a great opportunity to share the work we’re doing at Mission Critical Medicine with a room full of elite performance experts, but one of the most thought-provoking moments happened off-stage, over lunch.

We had just heard John Wagle, the Senior Director for Sports Performance at Notre Dame talk about the seriously impressive performance structures they’ve put in place for their athletes, and I found myself wondering about one critical advantage Notre Dame has over a typical Mission Critical Medicine Team: predictability of demand.

Athletes at Notre Dame can predict demand. They know when they’re going to need to perform and when they can rest, and they know the durations of the games and the schedule they will play them.

On most MCM teams, we don’t have that luxury. Patients decompensate without warning. The trauma pager goes off on its own schedule. There’s no game clock to work backward from.

If the demand for performance is unpredictable, unknowable, and unbounded, what do we do on the supply side to build better outcomes?

Here are a few ideas we’ve been working with:

1. High performance can look inefficient.

Since we have unpredictable demand and we work in must-not-fail situations, we need to staff for what might happen, not necessarily what does happen. When we get this right, we will (nearly) never fail to have teams and resources ready, but we might frequently have spare or unused capacity. To the outside observer, this could look like inefficiency or waste.

➡️ How are you helping leadership and partners see this difference?

2. Not all "unpredictable" is the same.

While we can't predict specific emergencies, we can often spot trends. We tend to see more traumatic injuries on weekend nights than on weekday mornings. Trauma increases during warmer summer months, and firework injuries tend to cluster around the 4th of July in the USA. Some patterns persist, even in noisy systems.

➡️ Where in your system are you seeing patterns in demand, and how are you adjusting to them?

3. High performance is always context-dependent

A rural emergency department. A military field hospital. A top-tier trauma center. Each faces different constraints, missions, and realities. The definition of "high performance" has to adapt accordingly.We’ve found that being clear about what you’re aiming at is essential. Otherwise, it’s easy to chase the wrong standard — or burn out trying to hit an impossible one.

➡️ How clearly have you defined what excellence looks like for your team?

So, if your team had the resources of a powerhouse Division I program behind it, what would change? And in the absence of that — when the demand is irregular and the stakes are high — what can still be improved?

These are questions we’re still working through, and we’d love to hear what you’re learning.

Good luck out there.

Dan