Dr. Derek Donegan is an orthopedic trauma surgeon and Associate Professor at the University of Pennsylvania, a healthcare entrepreneur, co-founder of ORtelligence, and a national leader with the Orthopedic Trauma Association, where his work centers on well-being, moral injury, and advocacy.

Dan and Derek start with the distinction that elective joint replacement is planned, optimized, and predictable weeks out, while orthopedic trauma is a patient you've never met and can't prepare for. The two paths have the same training pipeline, same residency spots, but somewhere along the way some surgeons catch the "trauma bug" and start looking for chaos to organize instead of variables to eliminate.

From there they dig into what Derek calls his "Spidey sense", the signal that a case is turning before he could point to why, and his reputation for going quiet in the OR exactly when things get hardest. They use cognitive load theory to get at why that instinct resists being taught even when everyone in the room wants it taught.

This conversation was released in partnership with The Emergency Mind Podcast.

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Recorded in 2020 during Melbourne's COVID lockdowns, this episode opens on what that stretch demanded of a tactical policing workforce that couldn't pause: fatigue management, disrupted home lives, and the added risk of infection in a workplace that had to keep running. From there, host Harry Moffitt and Superintendent Peter Ward move into a conversation that holds up well beyond lockdown.

At the time of recording, Peter Ward was Divisional Commander of the Security Services Division at Victoria Police, overseeing the Special Operations Group (SOG), the Critical Incident Response Team (CIRT), the Bomb Response Unit, and the Protective Services Unit — a 30-year career that includes operator and team leader roles in the SOG, the Port Arthur arrest team in 1996, and training alongside the FBI and LAPD SWAT.

Harry and Peter trace his path from SOG selection through the "privilege of suffering" bond among the final survivors, to the career-defining feedback that leadership means bringing your people with you, not just chasing the task. They close on his current work modernizing selection, opening tactical policing to women, and confronting the mental health toll of the job head-on.

Book mentioned: Legacy by James Kerr.

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Diane Malaspina is a psychologist, performance coach, and longtime yoga teacher who specializes in stress and burnout recovery, nervous system regulation, and optimal performance. She coaches frontline medical professionals, military human performance psychologists, executives, and athletes, and has worked extensively with medical students and residents through Arena Labs.

In this conversation with Dan Dworkis, Diane makes the case for a strengths-based approach to burnout: instead of asking what's broken in the 65% of people who report burnout, look at what the 35% who don't are doing right. They cover reframing stress as a challenge rather than a threat, plus two of the fastest levers for shifting your nervous system in real time—sleep and breath.

This conversation was released in partnership with The Emergency Mind Podcast and originally aired on April 27, 2026.

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This week we're recasting Preston's conversation with Dr. Anna Simons from May 2023. Anna retired as a Professor of Defense Analysis at the Naval Postgraduate School. She holds a PhD in Social Anthropology from Harvard University and an A.B. from Harvard College.

She is the author of Networks of Dissolution: Somalia Undone and The Company They Keep: Life Inside the U.S. Army Special Forces. She is also the co-author of The Sovereignty Solution: A Commonsense Approach to Global Security. Her fieldwork began in Somalia in the late 1980s, embedded with a Special Forces mobile training team, years before most Americans had heard of the country. This work marked the start of a career devoted to studying the ties that bind operators together and the forces that pull them apart.

Preston and Anna range widely: why assessment and selection should simulate the actual conditions operators will face rather than test for a generic standard; "warrior" branding and tribal emblems, and what it signals when a unit needs more mystique than its mission alone provides; the difference between interchangeability and neurodiversity, and why teams need both depending on whether the problem in front of them is technical or adaptive; and the concept of communitas.

Asked what advice she'd give the people responsible for assessing, selecting, and educating MCTs today, Anna recommends holding people to high standards and communicating your expectations. She also makes a book recommendation of her own: Chris Miller's Soldier Secretary, which she read cover to cover the day it was published in 2023.

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Sara (Mills) Kerr is a firefighter with Fire and Rescue New South Wales and a PhD candidate at the University of Newcastle, researching the trustworthiness of AI-generated information in disaster and emergency management decision-making. Before the fire service, she worked as an e-commerce data analyst, until Australia's 2019/2020 Black Summer bushfires redirected her path. Instead of returning to her normal work, she entered the Emergency Services Academy.

Harry and Sara talk about what fourteen weeks at the Academy built in her, and what it didn't. They get into why "overthinking" is often mislabeled: vigilance is a protective mechanism, not a weakness, and only becomes a problem when it overwhelms rather than informs.

That gap between training and readiness eventually pointed Sara toward research into AI and disaster management, and eventually the PhD. AI, in her framing, is a cognitive aid that should enhance operator judgment, never replace it. She's also recruiting participants for that research - anyone using AI operationally in Australian disaster and emergency management, frontline or otherwise is invited to reach out to Harry for a connection: [email protected].

Their conversation also covered how why diversity strengthens a team's shared operating picture, and Sara walks through her Inner Command framework she built out of her own early struggles and the framework's 5 C's: Calm, Control, Competence, Confidence, Courage.

Advice for Monday: weaponize your vigilance, and give yourself credit for what you do well.

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A few years ago, senior FBI SWAT team leader Matt Hoffman called Preston after a fatal operation. To assist the team in working through the loss, Preston and Matt used a process that went beyond the standard after-action review by incorporating narrative inquiry. The goal was to let a fractured team's story come back together before anyone examined what went wrong, rather than extracting lessons first.

Later, Preston worked with Matt and Dr. Angus Fletcher — Professor and Director of the Leadership Initiative at Ohio State's Fisher College of Business — to write up what they learned. Their paper, "A Better Approach to After-Action Reviews," was published in Harvard Business Review.

This summer Matt and Angus joined Preston to discuss Angus's research, why traditional AARs work when they're done right, and narrative competence over narrative allegiance.

The three of them dig into why a story lands in the brain differently than a data point does, why the breakfast that follows a hard AAR isn't a throwaway ritual but an active repair, and why naming the discomfort in the room, not necessarily fixing it, is often the whole job of a leader. Advice for Monday: stop chasing lessons learned first. Get the full story. The lessons will surface on their own.

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Christine Stead is the CEO of ELSO: the Extracorporeal Life Support Organization. ELSO is the premier global nonprofit for ECMO and ECLS, connecting providers, researchers, and regulatory agencies across 66 countries and nearly 800 contributing centers worldwide.

Earlier this year, Dan's conversation with Thomas Preston explored trust and communication at the bedside. They discussed what it takes for a single ECMO team to function in a single room under pressure. On this Teamcast, released in collaboration with The Emergency Mind Podcast, Christine joins Dan to talk about how ELSO held the field together during COVID: a live registry built in weeks, a global capacity map, real-time coordination running patient-by-patient across time zones. Getting information out mattered more than getting it perfect, because withholding it presented a different kind of risk.

They also get into ELSO's founding philosophy, the systems-of-systems challenge in out-of-hospital cardiac arrest, and an upcoming center certification program that has been two years in the making. If you find this episode useful, the best way to support the work is to subscribe and leave a quick rating or review.

This conversation originally aired December 6, 2022.

Dr. Michael Platt is a Professor of Neuroscience, Psychology, and Marketing at the University of Pennsylvania and holds joint appointments at the Perelman School of Medicine, the School of Arts and Sciences, and the Wharton School. He is the founder of the Wharton Neuroscience Initiative and the author of The Leader's Brain.

Preston and Michael work through the neuroscience underneath three questions: Why do emotional interventions sometimes produce learning, and sometimes just produce resentment? What does it actually mean to have a "social brain," and what happens to it when you cut people off from each other? And what are the neurological precursors to the thing teams call flow?

Listen to learn the marble metaphor for habit and development, the default mode network as a muscle that atrophies without boredom, the role of synchrony in what rowers call "swing," and a standing challenge to the introverts in the audience (go talk to your neighbors).

Michael's closing recommendations are three things most likely to keep your brain and your team's brains healthy under pressure.

We're continuing our conversation on human performance by asking why some performers keep improving under pressure while others hit a ceiling. One of the most powerful answers is curiosity. In this Teamcast, released in partnership with The Emergency Mind Podcast, Dan talks with Marius Aleksa, a performance advisor who has coached elite performers across professional baseball, special operations, medicine, and high-level athletics. Together, they explore how curiosity helps people recognize their strengths, uncover hidden leverage points, and build the kind of solid foundation that supports growth at the edge of their ability.

Andy Walshe has spent his career at the frontier of human performance, from Australia's post-Sydney Games high-performance system, through a decade at Red Bull, to his current work with Liminal Collective across elite sport, government programs, and executive development. His assessment of where the field actually stands: about a ten out of a hundred.

Harry and Andy dig into what that means. They cover the challenge of building operator-centered performance programs inside organizations still stuck on the basics; why character and creativity are the two most important elements most programs underweight; and how the rise of AI is forcing a reckoning with what makes humans irreplaceable. Andy's term for it is Imagineering: the capacity to generate the questions worth asking, not just consume the answers the machine provides.

They close on the cognitive warrior as the emerging frontier: why cyber and analyst communities, starting from scratch, may end up leading the DOD in human performance, and what Monday could look like for anyone building high performance programming.

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Six years ago this week, on May 7, 2020, we released our first Teamcast on Residue. In that episode, Preston shared a conversation with Coleman Ruiz on the psychological and emotional substance left behind after choosing the hard path. The episode, and the paper that grew out of it, traveled further than we expected. Eight operators have since told us that paper is the reason they are still here.

In 2018, at a Wounded Warriors event in Alexandria, Tom Hardy introduced the idea of Residue to Preston. Preston then turned to FDNY Chief David Morkal, who pointed him toward Denis Leary. Denis's response became an essential part of MCTI's paper.

Six years later, this is the first time Preston and Denis have actually talked in person. They get into what method actors and mission critical operators share, the difference between trauma and burden, dark humor as survival, the Clark Kent–at-the-barbecue experience, and why music does the work that nothing else quite does, as evidenced by Denis singing in the car on the way to the recording. Denis's response to our Monday morning question is in there, too.

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