1. S

2. An 86 y/o male involved in a one-car motorvehicle accident. Patient has an obvious tib/fib fracture with severe bleeding and iscomplaining of back & neck pain, chest pain,dizziness & shortness of breath. She hasaltered mental status and is moaning abouther implanted defibrillator firing. What now?

3. Difficult AssessmentsSimple Tools

4. Cloudy Earwax Fell YesterdayBystander is Concerned!!!!!Daughter wants pt. transported!!!! ColdBleeding from Tib/Fib Fx Green Sputum BP 96/70 Enjoys Jello!Chest Pain Trouble Breathing Ate paste as a child Severe Leg PainIs worried that cat might have a fear of mice Back Surgery in 2009 .Is patient wet from soda, antifreeze or urine? Worried car is totaledNo DNR on File Was on the way to visit his granddaughter for dinnerCant eat hot dogs. Recent Antibiotic Prescription Ate Spanish OlivesUrine has been green-ish Pulse weak and thready ??? EtCO2 44%Sinus Rhythm Dog has been burping recently. Respirations 32/min.124 bpm Afraid of Spiders Anxiety Dizzy !!!!! Rales RhinorrheaWeak Coughing Pale $%& Headache SpO2 90% Allergic to Peanuts

5. BP 180/100 Enjoys Jello! Ate paste as a childIs worried that cat might have a fear of mice Ate Spanish Olives EtCO2 44%Sinus Rhythm Dog has been burping recently. Respirations 32/min.114 bpm DizzyWeak SpO2 92%

6. An 86 y/o male Motor vehicle accident. Obvious tib / fib fracture Severe bleeding Back & neck pain Chest pain, dizziness & shortness of breath Altered mental status Implanted defibrillator firing

7. Duties Size Up Scene Manage Hazards Direct Resources Assess Patient Address Life Threats Preserve Evidence Pre-Notify Hospital Collaborate with other Responders Treat Patient Best Practices

8. Defined as Knowing what is going on so you can figure out what to do."And "What you need to know to not be surprised."

9. You can perceive context & cues in theenvironment and still miss CRITICAL ones.You can perceive CRITICAL CUES and stillnot be able to make SENSE of them.

10. Situational Awareness / Attention Management is the prioritization of applying brain resources to:Visiting Nurse is Concerned Trouble Breathing Allergic to Peanuts!!! Distress, Dyspnea, Tachypnea, Identifying Cues PERCEPTION 1 stSister has medicalWheezing, Old Inhalers Power of Attorney Recent Antibiotic PrescriptionHad a lovely time at the flower show on Wednesday! Pulse 118 bpm Asthma Sensemaking PROCESSING 2ndECG = Sinus Rhythm w/ PVCs Respirations 32/min. BP 180 / 100SpO2 88% Weak !!!!!!! Leg Pain Diaphoretic Anxiety EtCO2 28% Nebulizer PREDICTING ProblemSurgery in 2004 for cysts. Numerous inhalers empty Pale!! Elderly Solving 3rd Now Petechiae

11. Naturalistic Decision Making How people ACTUALLY make decisions.Good News We can make rapid decisions with poor info.Bad News We tend to this even if good info is available.

12. Signal Detection Theory A means to discern SIGNAL from NOISEIf we can raise SIGNAL with good attentionAnd reduce NOISE by ignoring distractionsThen we can make better decisions.

13. Thin Slicing A method to identify patterns in very thin slices or blinks of time.May maximize SIGNALMinimize NOISEMore time/info only adds more NOISE.

14. Recognition Primed Decision Making Identify Patterns in the Signal. Select Action to achieve outcome. Compare with previous similar experiences. Implement Action or Alter Action. Relies upon Attention and Perception.

15. Collect IntuitivelyCollect CollectivelyCollect SystematicallyExternalize Them

16. What we hear.What we see around us.

17. Who we ask. Patient Caregiver Family Bystander

18. What we ask. CC Why are we here? OPQRST Patients acute condition. SAMPLE Patients chronic condition.

19. What we Feel. Physical ExamWhat we Read. Patient Hx W-10 Med List Med Labels

20. Data Stethoscope BP Cuff SpO2 ABGTSmell & Taste

21. When To Accumulate Critical Cues 1) Enroute Phase - Size up 2) Approach Phase - Initial Assessment 3) Patient Phase Rapid / Focused 4) Transport Phase Detailed / Ongoing

22. Size Up Shift Dispatch Enroute Arrival

23. Initial Assessment Patients Side Load-n-Go / Stay-n-Play ABCs Airway Breathing Circulation

24. Rapid Trauma HtT Medical ! Hx ! VSFocused

25. P in CUPS Prioritize Critical Unstable Potentially Unstable Stable

26. DetailedOngoingInterventions

27. The OODA Loop Col. Boyd F-86 Sabre Observe Orient Decide MiG 15 Act Perception > Equipment

28. Immediate Life ThreatsUnderlying CausesLimb ThreatsTertiary Injuries

29. Obvious, open tib / fib fracture Severe bleeding & hypotension Back & neck pain Atraumatic chest pain & SOB Altered mental status Implanted defib firing, V-Tach

30. TimeInformation OverloadInformation UnderloadMultitaskingDirective to DiagnoseCompartmentalization

31. IntuitivelyCollectivelySystematicallyExternally

32. HearSeeWho / What we askFeelData