So last week I wrote a post about a presentation by a guy named Mike Lauria (@ResusPadawan)on the topic of "Making the call" that I found on Scott Weingart's EM Crit site.

Mike's presentation covers all of the key areas relevant to current thinking on critical decision making in high stakes environments, drawing on his experience as a U.S. military pararescueman and a civilian paramedic. (He is also now studying to be doc.)

This is an area I've been following for a little while now, through the FOAMed community and it has become a hot topic where pre and in-hospital resuscitation is concerned.

So I sent Mike a message and he agreed to sit down for a discussion where we teased apart some of the core elements of his talk. If you haven't listened to Mike's original presentation, don't go any further down this page and go and listen to it here. Then come back and listen to our discussion.

Now on to the podcast:

Decision making in high stakes environments with Mike Lauria

After we finished recording, I had some time to think the material through and came up with this diagram which I think summarises the essence and structure of what Mike is getting at.

Here are Mike's 5 elements for successful effective decision making in high stakes environments

1) Cognitive off-loading
  • skills prep
  • checklist
  • pre-emptive planning

2) Cognitive rally or stop points
  • Being aware of when and how to use System 1 and 2 thinking (Read Daniel Kahneman's "Thinking fast and slow")

3) Cognitive building
  • Training to enhance cognitive capabilities through practice and simulation

4) Innoculating for stress
  • Building mental toughness (cognitive resilience) through context specific practice and simulation

5) Cognitive flexibility
  • Developing awareness of cognitive traps and biases (e.g. anchoring, post hoc ergo propter hoc, diagnostic momentum, premature closure) and strategies to avoid them

Mike's BTSF strategy for stress de-escalation

This is really practical stuff and I have no doubt it can be applied to your very next work shift or motorsport event.

As always, I'd love to know your thoughts.

Have fun