Call it size-up, assessment or situational awareness; the ability to perceive and interpret information is critical for managing any emergency incident. But when does focused concentration turn into tunnel vision? Sometimes the training and experience that we rely on to do our job can make us perceive and even recall events very differently than they actually are, sometimes with disastrous results. Using a step-by-step approach, this program discusses how to develop the ability to better direct attention to critical cues without losing sight of additional information vital to the emergency. Teaching Formats: -Lecture -Interactive Role Play -Question and Answer Learning Objectives: Students will learn: -Both the importance and the danger of focus and attention to detail in emergency services. -How to manage distracters and minimize the impact that they have on our attention. -How we overestimate our ability to perceive, process and recall information, especially during emergency operations. -How preparation and training can impact what we think we see and hear on calls, both positively and negatively. Find more at www.romduckworth.com

1. The Illusion of Attention
How Did I Miss That?
Lt. Rommie L. Duckworth, LP
New England Center for Rescue and Emergency Medicine, llc.

2. Assessment
Assessment
Size Up
Situational Awareness

3. Situational Awareness
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."

4. Situational Awareness
• Intuition • Expertise
• Gut Feeling • Sixth Sense
• Hunch • Feeling
• Instinct • Insight

5. Situational Awareness?
You can perceive many cues in the
environment and still miss CRITICAL ones.
You can perceive CRITICAL CUES and still
not be able to make SENSE of them.

6. Situational Awareness
Situational Awareness / Attention Management is the
prioritization of applying brain resources to:
Visiting Nurse is Concerned Trouble Breathing Allergic to Peanuts!!!
Distress, Dyspnea,Recent Antibiotic Prescription
Tachypnea,
Identifying Inhalers
PERCEPTION – 1Cues
Sister has medical Power of Attorney
Wheezing, Old
st
Had a lovely time at the flower show on Wednesday! Pulse 118 bpm
Sensemaking 32/min. BP 180 / 100
Respirations
PROCESSING – 2nd
ECG = Sinus Rhythm w/ PVCs
Asthma
SpO2 88% Weak !!!!!!! Leg Pain Diaphoretic Anxiety EtCO2 28%
PREDICTING
Surgery in 2004 for cysts. Urine has been “green-ish” Pale!! Elderly
Problem
Nebulizer
Solving
3rd
Petechiae
Now

7. Situational Awareness
• Self - Assessment

8. It’s Right There!
Tunnel Vision

9. Situational Awareness
• Self - Assessment
1 2 3 4 5 6 7 8 9 10
11 12 13 14 15 16 17 18 19
• Raise your hand when you see the mitsake

10. Illusion of Attention
Understand that we overestimate our ability to identify CRITICAL
CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE
and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS
integrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS

11. Illusion of Attention
Understand that we overestimate our ability to identify CRITICAL
CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS inteiygrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS

12. The Books

13. Neuroscience!

14. Who is Blind?
You aren’t born to it.
• No NOTICERS and MISSERS
You can’t train to it.
• This program won’t “fix” you.
There are controls that you can put in place.
• Recognition is the first Assessment technique.

15. Illusion of Attention
Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE
and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS

16. How it works
• Sensorimotor Theory
• The BRAIN perceivesthe BRAIN notices.
EYE perceives and and the EYE notices
• Forget the Retina!

17. How it works

18. On the Road & In the Classroom

20. Expectations

22. How are we blind?
What we look FOR isn’t what we’re looking AT.
• We don’t need more eyes, we need more brains.
What we look AT isn’t what we’re looking FOR.
• We need a systematic method and practice.
What we see is what we expect.
• We need EXPERTISE, not EXPECTATIONS.
What doesn’t move, doesn’t groove.
• We need outside stimulus.

23. Homework
• Memory. Can you draw a penny?

24. Illusion of Attention
Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS
integrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS

25. The Next Step
• 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.

26. The Next Step
• Signal Detection Theory
• A means to discern SIGNAL from NOISE
• If we can raise SIGNAL with good attention
• And reduce NOISE by ignoring distractions
• Then we can make better decisions.

27. The Next Step
• Thin Slicing
• A method to identify patterns in very “thin
slices” or “blinks” of time.
• May maximize SIGNAL
• Minimize NOISE
• More time/info only adds more NOISE.

28. The Next Step
• 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.

29. The Next Step
• The OODA Loop
F-86 Sabre
• Col. Boyd
• Observe
• Orient
• Decide MiG 15
• Act
• Perception > Equipment

30. Illusion of Attention
Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS.

31. Beat the Blindness
CODE - Easy

32. CODE - Easy
• Cognition: We need brains!
• Good Partner
• Teamwork
• Dispatcher Monitoring
• Crew Resource Management
Tip

33. CODE - Easy
• Observation: Sense and Perception
• Increase the Signal
• Systematic (not robotic) Assessment
• Good Protocols
• Guiding Policies and Procedures
• Concise, systematic Hand-Off Reports

34. CODE - Easy
• Distractors: The Medic needs quiet time!
• Decrease Noise
• Assessment Prioritization
• Checklists
• Good Scene Management

35. CODE - Easy
• Experience: Knowing is half the battle!
• More slides in the slide tray.
• Education
• Simulation
• Visualization
• Practice
• Mentorship

36. CODE - Easy
• Easy: Off load from Working Memory
• A Lazy Medic is a good Medic
• Field Guides / Apps
• Checklists / Tactical Boards
• Automated Assessment
• Streamlined Protocols and Algorithms

38. Don’t Be Fooled!
Understand that we overestimate our ability to identify CRITICAL
CUES when paying attention.
Recognize the function and limits of the human mind to PERCEIVE
and PROCESS its surroundings.
Understand how ATTENTION and SITUATIONAL AWARENESS
integrates with DECISION MAKING.
Identify methods to OVERCOME INATTENTIONAL BLINDNESS.

39. CODE - Easy
Cognition: We need brains!
Observation: Perception & Information!
Distractors: The Medic needs quiet time!
Experience: Knowing is half the battle!
Easy: A Lazy Medic is a Good Medic!

41. • What this was not…
• What this was…
• Who I am…
• Who you are…
• Because we are EMS,
and we’re here to help.