Situational Awareness PDF

Situational Awareness Chapter 2 - In the early days of decision-making research, most of the studies were conducted in college classrooms and laboratories that provided convenient venues and ready access to participants. However, these settings were nothing like the high-risk, high-consequence envi...

Situational Awareness Chapter 2 - In the early days of decision-making research, most of the studies were conducted in college classrooms and laboratories that provided convenient venues and ready access to participants. However, these settings were nothing like the high-risk, high-consequence environments faced by public safety providers. Early Decision Research This section presents an example of how an early decision research study might have been conducted. A college professor/researcher received a grant to study decision making and created an experiment that involved stock trading. The researcher used students from his economics class because they were easily accessible and would work for little money, sometimes participating for the opportunity to earn extra credit (figure 2--1). Fig. 2--1. Most early decision-making research involved college students who lacked expertise about the subject matter they were being asked to make decisions about. The researchers distributed packets of information on 6 to 10 companies, including historical data, biographies of key executives, product/service information, financial statements, and stock price trends. Each student then received a hypothetical amount of money to invest---say \$10,000---and were instructed to evaluate each company, and then decide in which companies they wanted to invest their money. The students were allowed to buy and sell throughout the semester, keeping track of the transactions and the processes they used to make their decisions. At the end of the term the researcher asked the students questions about which companies they invested in, how much they invested, how often they traded, how much money they earned, and how they made their decisions. Whereas the student may have thought the goal of the study was to have the most money at the end of the term, the researchers' goals were to understand how the students made their purchasing and trading decisions. I can't say for sure that I was actually a victim of such experimentation, but I can vividly remember participating in an exercise similar to this in one of my college economics classes. Maybe the reason I remember this so well is the professor rewarded the winner with a pizza party. I figured what the hell... I am a financially struggling 21-year-old student. I'd have done just about anything for free food. The researcher got what he wanted, and the winning student got what he or she wanted. I know inquiring minds will want to know... No, I didn't win. But it was research similar to this, repeated over and over again in college classrooms and laboratories, that yielded the traditional decision-making model. The Traditional Decision-Making Process The traditional decision-making process is sometimes referred to as the rational decision-making process because the process follows a rather regimented series of steps. The process is also sometimes referred to as the analytical decision-making process because of its heavy reliance on the use of metrics to weigh and evaluate options. For simplicity, I call it the traditional decision-making process. The steps of the traditional decision-making process include:      1. Define the problem.      2. Identify the decision-making criteria.      3. Allocate weights to each of the criteria based on importance.      4. Develop alternatives for solving the problem.      5. Evaluate each alternative based on the weighted criteria.      6. Select the best alternative that maximizes the desired outcome.      7. Evaluate the effectiveness of the action that was taken. Step 1: Define the problem The first step in the traditional decision-making process is to define the problem. This makes sense because if you don't have a problem to solve, you don't really have to make a decision. Defining the problem is an important step. If you define the problem incorrectly, you vastly increase your chances of making a poor decision, so this is a step you want to think about. It's easy to get lulled into focusing on the symptoms of the problem versus defining the root problem. Take, for example, a person having chest pains and shortness of breath. The pain and difficulty breathing are not the problem; they are symptoms of the problem. What, exactly, is causing the problem cannot be uncovered without additional investigation and analysis. Emergency medical services (EMS) personnel are taught that if a patient displays certain combinations of symptoms (e.g., chest pain, shortness of breath, pale and clammy skin, ST-segment elevation on the EKG), the patient receives a certain treatment modality congruent with heart attack as the root cause. It's the safest default treatment option for field personnel with limited diagnostic tools. However, a heart attack cannot be diagnosed in the field. We often treat symptoms, not root causes. Step 2: Identify decision criteria The second step in the traditional decision-making process is to identify the decision criteria. In this step you set up all the criteria you need to help you make the decision. Using the stock picking scenario I discussed earlier in this chapter, the various criteria you consider might include how long each company has been in business, how profitable each company has been over the past ten years, how qualified each company's management team is, and how well each company's stock has performed over the past five years. In the public safety arena, let's say you are a police officer on patrol and you observe a driver weaving on the roadway. As you stop the vehicle you observe that the driver's behavior seems a bit out of the ordinary. The driver's breath smells fruity; his speech is slurred and he stumbles when getting out of the vehicle. Everything I've described up to this point are symptoms, not the root problem. And although you might conclude the operator is driving while intoxicated (the root problem), it very well could be that the driver is diabetic and is having an issue with blood sugar regulation. Further investigation can help you analyze the root problem. And, regardless of the root cause, you can surmise, with certainty, that the driver's ability to make good judgment is impaired and he cannot drive in that condition. But the additional assessment helps you determine whether to arrest the driver or call an ambulance. Step 3: Weight the criteria The third step in the traditional decision-making process is to assign weights to the various criteria. In other words, how important is each of the decision criteria you set in the previous step? Using the stock purchase example, is the profitability of the company more important than the quality of the management team? Is the length of time the company's been in business more important than how well the stock has performed over the past five years? Are all the criteria equally important? Step 4: Develop alternatives The fourth step in the traditional decision-making process is to develop some alternatives (choices). If you are a stockbroker, the list of alternatives includes all of the companies traded on the stock exchange. However, as you can imagine, there are thousands of publicly traded companies, and it would be impossible to consider and apply the criteria and weighting method to every company. So the trader might limit the alternatives by applying some additional criteria. For example, the trader might want to only choose companies traded on the New York Stock Exchange; or the trader might want to choose companies who are considered blue chip; or the trader may want to consider companies that are considered mid-level capitalized. Don't get knotted up about knowing what all these terms mean. You're not going to be asked to pick stocks. Just know you may want to apply additional filters to get your choices down to a manageable number. How many choices are manageable? Great question. We address that in chapter 4. Step 5: Evaluate alternatives The fifth step in the traditional decision-making process is to evaluate each alternative. After you have all the alternatives you want to consider, apply the weights for the decision criteria you set up in steps 2 and 3. This results in a numerical score for each alternative. The choices are then ranked from the highest scoring (best choice) to the lowest scoring (worst choice). Step 6: Make the decision The sixth step in the traditional decision-making process is to make the decision---to pick the highest-ranked alternative. Of all the steps, this one should be the easiest. You've applied a logical, arguably scientific, way of evaluating your choices, and the best decision has risen to the top of the list. So decide and move on. Easy enough, right? Enter emotions The traditional decision model is a solid process... until your emotions start to get involved in the process. Every step in the process up to this point has been very rational, scientific, numerical, and logical. It all makes sense. Then you find out that the company you really liked (maybe because they make a product you use all the time) didn't fare so well. Maybe that company isn't even in the top 10 based on the criteria you had set. But you've heard some great things about this company, and you have a really good feeling about its future performance. Now what do you do? You're torn between your logical, rational side and your intuitive, emotional side. It can be an interesting dilemma, and what you should do about it isn't always obvious. In other words, you can't say that always making the logical, rational decision is best. Nor can you say that always making the intuitive, emotional decision is best. And finally, you can't always say that blending the two will result in the best decision. Nonetheless, you make your decision and put your plan into action. Step 7: Reflection This leads to the seventh and final step in the traditional decision-making process---reflection. In this step you evaluate the effectiveness of your decision. In other words, how did you do? Did you make a good decision or a bad decision? Did things turn out as you expected, or were there some surprises? Maybe there were consequences as well. The clock is ticking. A critical consideration in the public safety arena is how long you should wait before you evaluate the effectiveness of your decision. The greater the risk and consequence and the more compressed the time line (i.e., the speed in which the incident is moving), the quicker you have to assess if your decision was a good one. Change the course of action too soon and you may not have given the decision an opportunity for success. Delay changing the course of action too long, and you may find yourself drifting into a catastrophe. Experience Is the Secret Sauce I've learned more in my life from the mistakes I've made than from the things I've done right. Reflection is the seventh and final step mentioned in the previous section. This reflection on your decisions is the kind of stuff that experience is made from. Stated simply, the collective outcomes of your decisions and the lessons you've learned from them are what help you make better decisions. Children (and teenagers) tend to make poor decisions because they don't have the collection of experiences that you have---the lessons from all the mistakes you made while growing up. And this is where parents (and in emergency services, mentors) can be so darn valuable. You may not want to admit it, but those old people may actually know a thing or two about the problems you're facing. Why? Not because they're old, but because they are wise (figure 2--2). That wisdom is the collection of their experiences, success, failures, and the evaluation of their lessons learned along the way. Fig. 2--2. Young firefighters benefit from the shared knowledge of seasoned veterans. The passing of knowledge through mentoring helps newer firefighters become better decision makers. Having spent 30-plus years in emergency services, my mission now, as an old firefighter, is to ensure young firefighters become old firefighters. I Need a Vacation Here's an example of how to make a decision using a traditional process. The scenario revolves around a person contemplating a vacation. An application of the traditional (rational) decision-making process might help make a good decision. Step 1: Define the problem.      -- I've been working too hard. I'm burned out and I need a vacation! Step 2: Define the decision-making criteria.      -- Cost, amenities, activities, solitude, weather Step 3: Allocate weights to each criteria based on how important they are to you.      -- Cost = 50%      -- Amenities = 20%      -- Activities = 15%      -- Solitude = 10%      -- Weather = 5% Step 4: Develop alternatives for solving the problem.      -- Beach      -- Mountains      -- Cruise      -- Theme park      -- Visit relatives Step 5: Evaluate each alternative based on the weighted criteria. (Ranked order for first decision criteria---most expensive to least expensive)      1. Theme park \$4,000      2. Cruise \$3,500      3. Beach \$3,000      4. Mountains \$2,500      5. Visit relatives \$1,000 Multiply the criteria weight by the ranking weight. For example, the weighting for expense (because that is a big concern) is 50%. So multiply the option ranking by the criteria weighting.      -- Theme park: (50 × 1) = 50      -- Cruise: (50 × 2) = 100      -- Beach: (50 × 3) = 150      -- Mountains: (50 × 4) = 200      -- Visit relatives: (50 × 5) = 250 Visiting relatives gets the highest score, reflecting it's the lowest-cost alternative. Conversely, the theme park option received the lowest score because it is the highest-cost alternative. Repeat Step 5 for each of the decision criteria. The collective scoring for all the criteria and alternatives is charted in figure 2--3. Fig. 2--3. The traditional decision-making process uses analytical decision making to evaluate alternatives. It is a very logical process. There's Just One Problem This is an effective process for making decisions. It's rational, and it reflects careful consideration to all the essential criteria and priorities. However, you must ask:        Does the rational decision-making process accurately reflect the realities of how decisions are made at emergency scenes?        Is there enough time to do something like this?        Is there enough good data?        Is the data stable enough for us to assess it this way? In many instances the answer to these questions is no. Perhaps if you were able to hold the incident in abeyance for 20 or 30 minutes, you might be able to effectively apply the traditional decision-making process. A hazardous materials spill that is confined, presenting little immediate danger to life, property, or the environment, might serve as one example where time is on the side of the decision maker and the traditional decision-making process could (and some may argue should) be used. However, more often, the decision maker is under an extreme time pressure to do something immediately in an effort to prevent an emergency from becoming exponentially worse. Experienced public safety personnel, under the compression of time, are not likely to use such a rational decision-making process (fig. 2--4). But, if first responders don't have time to use a rational decision-making process, does this imply, perhaps, that they are using an irrational decision-making process? No, not at all---although at times their behavior may lead you to believe they are acting irrational. chapter 3 introduces you to the alternative decision-making model that is far more realistic for making high-stress, high-consequence decisions in dynamically changing environments. Fig. 2--4. An incident commander operating in a dynamically changing environment will struggle to make effective decisions if relying entirely on analytical decision-making processes. CHAPTER 3 RECOGNITION-PRIMED DECISION-MAKING PROCESS Experienced public safety commanders, making decisions in high-stress, high-consequence, time-compressed situations, often don't have time to employ the rigors of rational, analytical decision making. I'm not making excuses for public safety providers or providing an excuse for fly-by-the-seat-of-your pants decision making. There is a process used in domains of considerable risk, consequence, and time compression. Recognition-Primed Decision Making The process of recognition-primed decision making (sometimes referred to as RPD or RPDM) is an effective method for making high-risk, high-consequence decisions. This model was first discovered by Gary Klein, a cognitive decision researcher, while conducting a study with firefighters in the 1980s. Klein and several of his associates were hired by the United States Army to help improve battleground decision making (certainly a high-risk, high-stress, high-consequence, and time-compressed domain). The army had been training battleground commanders to use the traditional decision-making process (figure 3--1). Why? Because it was the only process that existed. That is, until Gary Klein rocked the decision sciences world with his RPD discovery. Fig. 3--1. Soldiers operating in battleground conditions. (Photo by Sgt. Christopher O'Quin.) The Birth of RPD The researchers in Klein's group knew that the best way to understand the complexities and challenges of making decisions under stress on the battlefield would be to observe the decision makers in their natural environments (sometimes referred to in the research community as going native). This would entail watching battleground commanders in their natural working environment while making decisions under stress. However, it was impractical (not to mention dangerous) for the researchers to go into battle with commanders to observe their decision making first-hand. So they went on a quest to find decision makers whose command environment closely resembled the conditions found on a battleground. That led Klein and his associates to the fire service and a study of the decision making of fireground commanders. Fireground commanders were an ideal fit.They work in time-compressed, high-stakes, rapidly changing, and unpredictable hazardous environments, and the researchers could observe them during actual emergency incidents without putting themselves in harm's way (figure 3--2). Fig. 3--2. Fireground commanders operate in a time-compressed, high-stakes, rapidly changing, and unpredictable environment. The goal of Klein's associates was to observe and understand how fireground commanders use the traditional decision-making model. They theorized that understanding how fireground commanders make decisions would help them help the Army solve their battleground command challenges. It was through a series of observations and interviews that Klein realized fireground commanders did not use the traditional decision-making process. It shocked him to learn that the way fireground commanders made decisions didn't even fit the standard definition of a decision (a choice between two or more alternatives). Fireground commanders didn't identify decision criteria. They didn't apply weights. They didn't compare alternatives. And they didn't select the best alternative from among a collection of choices. Rather, experienced fireground commanders gathered a small amount of information quickly, processed what it meant, came up with a solution, and visualized an action plan to see if it would work out (termed mental modeling). If the outcome of the mental model was acceptable, the commander put that plan into action and never gave thought to an alternative plan as a comparison to the first plan that worked (at least initially). If the mental model of the plan the commander contrived did not work (i.e., there is a bad outcome), the commander scrapped the plan and modeled out an entirely new plan. Commanders never compared alternatives (comparing the plan that did not work with the plan that did work to see which one was better). Commanders completely disregarded the plans that did not work and considered it unproductive to compare a new plan with a plan that had already been determined to be unfeasible. When the commanders found a plan that worked, that prompted the decision and the plan was put into action. It was a significant finding in Klein's research and a departure from what they had expected to learn---which was how fireground commanders used the traditional decision-making process. The commanders in Klein's study never considered comparing two choices side by side and selecting the best one. So, in essence, commanders were not making decisions, at least not by the traditional definition (a choice between two or more alternatives). A decision was always thought to be a choice between two or more alternatives, but Klein discovered that was not how fireground commanders were making decisions. Experience---A Key Ingredient As you might imagine, to use a decision-making system that depends on a good solution popping into the commander's head can, at most, be very risky and, at the very least, be scary to the commander and those who must follow those orders. For commanders to successfully use recognition-primed decision making, they must have a level of expertise to draw upon. Having a collection of experiences and training allows commanders to recognize how to deal with problems because they have seen the same thing (or something similar) in the past and have learned valuable lessons about what has worked well (and not so well) previously. Time compression and dynamically changing environments One facet that separates many first responder decision environments from others is how dynamically changing the environment is, coupled with the compression of time and the need to make rapid decisions---an essential element for successful outcomes at many emergency scenes. Commanders must size up situations quickly, often in less than a minute. If a commander is going to make decisions where the consequences could cost the lives of responders and/or civilians, some might argue that only a fool would rush such an important decision. It would make much more sense for the commander to take some time, perhaps 5 to 10 minutes, to make such a critical life and death decision. But experienced fireground commanders know this is extremely difficult, if not impossible, to do. The incident conditions change so rapidly that information gathered 5 minutes ago would have degraded and assumptions made on the information gathered 5 minutes ago may no longer be valid. Too much will change in a 5-minute period. So the size-up and the processing of what is going on must be done quickly for the commander to have a comprehension of what is happening. The amount of time a commander spends on the size-up will vary depending on the complexity of the incident and the size of the incident scene. I have posed this question to hundreds of incident commanders: "After you arrive on the scene of a single-family, 1,200 square-foot, residential dwelling fire with no exposures, how long does it take for you to do your scene size-up?" The answer is nearly universal: "Seconds." When I press them for a number, the range is typically "5 to 15 seconds," with some commanders saying, "However long it takes me to do a 360-degree size-up." I want to hug the people who say that because they understand the process of completing a size-up includes seeing as many clues and cues as possible. Suffice it to say, most commanders don't take 5 to 10 minutes. They only take a few seconds to gather the essential information needed to make an action plan after arriving at the emergency scene. Expertise is important To be able to conduct a size-up and quickly make sense of what is going on and how to handle the situation requires expertise (figure 3--3). A novice decision maker, lacking experience, cannot do this very well. There's too much information to gather, process, and comprehend. The person who lacks experience has to pause and think about what each piece of information means. Experts, on the other hand, are able to comprehend the meaning of clues and cues much quicker. In fact, experts can quickly assemble groupings of clues and cues, mentally package them together, and determine the meaning of the packaged information. For example, an experienced paramedic can take a quick glance at a trauma patient and determine relatively quickly how severe the trauma is simply by packaging together audible and visual clues and cues (figure 3--4). Fig. 3--3. Expertise allows fireground commanders to conduct rapid size-ups of situations. Fig. 3--4. Experienced medical responders can conduct rapid triage of trauma victims by assessing a relatively small number of visual and audible clues and cues. Novices also struggle with the task of the fitting pieces of information together to form a big picture perspective of what's going on. Their attention can be drawn to what appears to be important things, and they can completely miss a lot of smaller clues and cues that, alone, may not mean much individually, but collectively can mean a lot. Negative clues and cues Another advantage that experts have over novices is their ability to process and comprehend negative clues and cues. Negative, in this context, does not mean bad clues or cues. Negative means absent clues or cues. Novice decision makers can size up a situation and readily identify the clues and cues they see and hear that help them make their decision. Experts do the same thing; however, experts possess the additional ability (based on their experience level) to be able to size up a situation and comprehend the meaning of clues and cues that are absent (but should be there). In these situations, the absence of certain clues and cues are as critically important as the presence of others. However, because novices lack expertise, they are not able to comprehend the meaning of what is missing. Here's an example I recall from paramedic school. One time in class the instructor asked the students if sick babies cry. Even though I was the youngest sibling in my family, I had seen enough sick kids as an EMT to answer in the affirmative. Then she asked the class if kids cry louder the sicker they are. Again I answered in the affirmative. To my surprise, the instructor informed the class that really sick kids---the ones who may be ill enough to die---oftentimes don't cry. They are too scared to cry, so they remain quiet. Little did I know this line of inquiry was a setup for a lesson that would later pay off many times for me. If that lesson had not been taught to me in medic school, I could have easily been fooled by this negative clue. The absence of crying can be a significant indicator of critical illness or injury. The Debate Some could argue that it's not necessary to conduct a rapid size-up and engage first responders so quickly into action. I agree there is some logic to this argument. Nothing says you have to conduct aggressive interior structural fire attack, launch an aggressive search for victims, or barge into a house where an assailant is holed up with hostages without taking time to consider and compare your alternatives. Others would argue that to make a difference in the outcome (to save lives and property), the action required is rapid and necessary. I recall attending a program where the lessons for public safety personnel who responded to the Columbine High School massacre incident were being assessed. One of the take-away lessons was the presenter thought the responders took too long to assess the situation, and this contributed to additional casualties. I'm not taking this position. I can't. I wasn't there to know what was the appropriate thing to do. But the presenter was critical of the decision makers who were reportedly gripped by the need for more and more and more information and, because it was constantly changing information, it took a very long time to gain a good understanding of what was really happening. It's easy to analyze and dissect decisions after the fact and be critical. I discourage the practice of Monday-morning quarterbacking. It's not productive, and it's disrespectful. It's always helpful to frame an analysis of decision making by asking: "Why did it make sense to them at that time?" The novice disadvantage Experienced commanders who possess the ability to quickly capture and comprehend information under stress are the best at completing rapid size-ups and implementing quick action plans. It can be problematic when novice commanders observe their experienced counterparts conducting rapid size-ups followed by rapid actions and think they can do the same thing. This happens because a novice is not likely to understand what the expert is doing, mentally, in those first few seconds. When novices try to conduct rapid size-ups and take quick actions, the risk associated with their decision making increases dramatically (figure 3--5). What's worse, novices may not even know what they don't know (or realize what they missed and failed to comprehend). They are confident, but essentially incompetent. The progression of first responder competency will be discussed in greater detail later in the book. Fig. 3--5. Inexperienced firefighters are able to see and process positive clues and cues. However, their lack of expertise can inhibit their ability to capture and process negative clues and cues. Physical Reactions to Stress The stress of operating at an emergency scene where the lives of responders and civilians rely on quality decisions can cause a significant amount of stress. As a first responder, you already know that. But what many responders don't fully understand is the impact of stress on the process of making good decisions. Stress contributes distinct, identifiable, and measurable physical, mental, and emotional changes including increases in blood pressure, pulse and respirations, heart palpitations, profuse sweating, dry mouth, trembling, narrowing of attention, and hyper awareness to name a few. These reactions to stress are natural and, for many, difficult to control. Stress is a game changer Stress triggers a reaction in the hypothalamus, a small pea-sized organ sitting approximately in the middle of your brain. This organ, in turn, sends out messages to other parts of your brain and other organs in your body that you are having a stressful event. These electronic messages trigger the release of hormones and chemicals that are designed to help you deal with the stress. Adrenalin is released to prepare you for action. Glucose is released to give you energy. Endorphins---your body's naturally produced morphine---are released to mask pain in the event you are injured. Cortisol is released to help counter the effects of the adrenaline. Suffice it to say that under stress you have a lot of thought-and performance-altering drugs coursing through your veins. These chemicals change the way you perform under stress. Avoiding the chemical dump The only hope you have in reducing the impact of stress is to reduce the number of chemicals being released into your body in the first place. This can be accomplished using stress-calming techniques like controlled breathing. This helps calm the hypothalamus and prevent a reaction that can have undesirable consequences. Learning how to remain calm under stress and then practicing the techniques that work for you can also reduce the release of chemicals and help you maintain some control over your reactions. Finally, the more often you are exposed to stressful events, the more likely you are to develop immunity to stress. You only need to observe the demeanor of a veteran responder to that of a new recruit at an emergency scene to witness the difference in their reaction to the stressful event (figure 3--6). Fig. 3--6. A recruit firefighter going through basic training is likely to experience more stress and anxiety than an experienced firefighter whose been under stress many times. When I was a new firefighter I remember my instructor telling me during self-contained breathing apparatus training to take deep breaths, hold it, and then breathe out slowly. He told me this would help slow down my breathing. He was right; it worked. What he didn't know (or at least never admitted to knowing) is the breathing technique I was being taught slowed my breathing because it calmed me down. It also helped prevent my brain and body from being overrun by stress-released hormones and chemicals. As a side note, in addition to calming my stress, slower respirations improved my air management. Hormones and chemicals Stress hormones and chemicals trigger primal reactions dating all the way back to your cave-dwelling ancestors. Granted, what triggered stress in a cave dweller was very different from what triggers stress in you. You stress about your kids getting into a certain college; cave dwellers stressed about their kids being eaten by a saber-toothed tiger. Nonetheless, stress is stress and the reaction is the same. Stress increases your heart rate. Consequently, to ensure the proper oxygenation of blood, your respirations increase. Your pupils also dilate to let in more light. This improves your visual acuity, making it easier to see the saber-toothed tiger if the attack occurs at night. The glucose release I mentioned earlier gives you the energy to react. The endorphins (or more accurately endogenous morphine), while fulfilling the valuable task of masking pain, also act as stimulants; thus, they make you more excitable. You've probably seen the effect of endorphins in action before. You respond to the scene of an automobile accident, and you see the horrific damage done to a vehicle and you know, almost instantly, anyone who was in that vehicle is either dead or at the very least seriously injured. You approach the vehicle, and you see there's no one in it. Then you notice someone standing on the side of the road who tells you they were the driver of the vehicle and they deny having injuries. How could this be? The vehicle is nothing short of a twisted mass of metal. And the driver is saying to you, "I'm OK. I'm not really hurt." Then a short time later the driver starts to complain about pain in their back or neck. Set aside the fact for the moment that this could be insurance-related pain. Alternatively, the explanation may be when the accident happened endorphins were released into the person's bloodstream. As they are designed to do, the endorphins masked the pain of the injuries. As the endorphins worked their way through the system, the victim started to feel the pain of their injuries. I have witnessed the phenomenon of endorphins masking pain on numerous occasions at emergency scenes, and if you haven't yet, you will. As a decision maker under stress, you will get this rush of endorphins that will make you excited and may even give you a euphoric high. Physiological changes from stress The chemicals released under stress cause your heart, lungs, brain, and muscles to kick into high gear. That's good because you need extra blood to provide oxygenation and nutrients to handle the stress event. Your body also restricts the blood supply to your kidneys and your digestive tract. That blood is redirected to the organs and muscle groups that are working extra hard under stress. If this did not occur, you might not be nearly as physically strong or mentally sharp in a stressful situation. Another interesting physiological reaction that can occur under stress is the inability to control the release of contents from your bowel and bladder. Yes, it's true. If your department responds to medical calls, I can say with confidence that you have probably responded to emergency calls where someone was injured or having a significant medical crisis and lost bowel or bladder control because of stress. It's all part of the naturally occurring stress reaction. The impact of stress on decision making The process by which decisions are made under stress is different from how decisions are made in the normal course of daily life. This should not come as a surprise. If you're driving down the road and come upon a four-way intersection, you have to make a decision whether to go left, right, or straight ahead. Typically you've had some time to think about it. The need to make the decision was anticipated, and there was plenty of time to process information to help you make a quality decision. Conversely, if you're driving down the road and a deer bolts out in front of your car, your decision-making environment is very different. This event is high-stress, high-consequence, and time-compressed. You didn't know it was coming and had just a nanosecond to process information before making a decision that could result in a near miss or a big messy problem. In both scenarios you are processing information and making decisions. Just one happens slowly with low stress and low consequence, while the other is at warp speed and fraught with stress and consequence. In both cases it's just a matter of seconds to know if the decision was a good one. The speed of a decision Is it possible to process information and make fast decisions? You bet it is. Think about a major league baseball player up to bat and facing a 90 mile-per-hour fastball. The batter has just under a half-second from the time the ball leaves the pitcher's hands until it hits the catcher's mitt. That decision to swing (or not to) takes just slightly longer than a blink of an eye. Incidentally, the clues and cues that help the batter decide whether to swing starts well ahead of the ball ever leaving the pitcher's hand. Making rapid decisions under stress is one of the hallmark qualities of good public safety responders, whether it's on a fireground, during a shootout, or while triaging accident scene victims. Most responders do it without really understanding the mystery behind how they make such good decisions in time-compressed environments. I'm going to take the mystery out of the process of how you do this and why you are so darn good at it. Decisions under stress The findings in neuroscience support the notion that stress can change behavior and the way you make decisions. Your natural, rational, analytic judgment system does not function the same under stress. For a variety of reasons, some relating to hormones, some relating purely to time constraints, your rational judgment system is not terribly effective at making split-second decisions. But wait! If you're not thinking rationally, are you thinking irrationally? You might think so sometimes as you observe the seemingly irrational behavior that some responders display under stress. But, rest assured, the behavior is not irrational. In fact, it's quite predictable. As your stress level increases and your level of personal risk goes up (perceived or real), primitive instincts kick in and you start thinking (and sometimes acting) like your cave-dwelling ancestors. I'll speak to that in a little more detail shortly. Most people residing in civilized nations dwell in a rational decision-making environments---where in the normal course of day-to-day living one is far more likely to make rational, analytical decisions based on easily accessible facts and data. Decision makers can easily identify an array of options and logically deduce which one is best for the situation. Under normal (i.e., low stress) conditions, you are able to gather and comprehend complex information and apply analytical techniques that help you make decisions. As your stress level increases and your body triggers the physiological reactions discussed earlier, it becomes more difficult to comprehend complex and detailed information. You may even struggle to understand things that, under normal stress levels, you would find easy to comprehend. For example, here is a word problem I borrowed from one of my son's third-grade homework assignments. There are three playing cards lying face up, side by side on a table in the following configuration: A five is just to the right of a two. A five is just to the left of a two. A spade is just to the left of a club, and a spade is just to the right of a spade. What are the order and suite of the cards on the table? Figure 3--7 contains the solution to this word problem. Under normal stress levels (which I hope you are under as you read this book), and with the aid of a deck of cards to assist you with the visualization, you may be able to solve this problem relatively easily. However, if you were under stress of risk and consequence and some of the information was changing as you were trying to solve the problem, you may struggle to make sense of what is happening and how to solve the problem. Fig. 3--7. Solution to the third-grade card riddle Imagine this scenario: You are part way through solving the previous word problem and you're told that there was a mistake in the original data---the five is actually a seven, and the spade is actually a heart. You might find this scenario confusing and frustrating (which can create stress), and you might find yourself struggling to understand, "Why are these cards changing? Why can't I just solve the original problem?" And saying to yourself (out of frustration), "I'm not going to try to solve this until I know the cards aren't going to be changed on me any more." If you were given this word problem to solve in a calm and controlled setting (and didn't have the information changed while you're trying to solve the problem) I am confident you'd be able to figure it out; however, if you were put under stress with added risk and consequence, experienced a change in information---and for good measure, added external environmental stressors such as bright lights and obnoxious noises---you might find yourself struggling to solve this problem. Why? All the distractions and changing conditions add stress. Stress drives a person to use a primitive, instinct-driven form of decision making, one that draws upon mechanisms that have been genetically engineered into the human brain over millions of years of evolution. Intuition, triggered by stress, can lead to the often-referenced intuitive gut feelings, a primal decision process that uses subconsciously stored training and experiences supported by prewired evolutionary programming in your brain. The physical reactions to stress have been well studied and documented by researchers and scientists. The term often used to describe the physical reaction to stress is fight or flight syndrome or fight or flight response. Earlier I stated that when you are under stress, your rational decision-making process is impacted and you revert to using an intuitive process that can result in a gut feeling about what is going on and what you should do. Without understanding the science behind how this works, it could be a little unnerving to think an emergency scene decision maker might simply rely on gut feelings to make critical life-and-death decisions. Some might argue it defies logic and it's irresponsible to rely on intuition. It's a common argument in decision research circles, especially among those with strong convictions for rational or intuitive decision processes. There is a number of research studies that have shown decisions made using a rational decision process yielded no better outcomes than decisions based on intuition. Intuitive decisions draw on your collective life's experiences stored in the subconscious mind; therefore, it's important to spend a little time to ensure you understand the role of intuition in decision making. This will allow you to be comfortable and confident with your intuitive decision-making abilities. Memory To help demystify the intuitive decision-making process, I use a few analogies and metaphors. The first analogy is your brain is like a computer (figure 3--8). Those versed in neuroscience, admittedly, do not favor this comparison because your brain is really nothing like a computer. Notwithstanding the criticism I may suffer from the scientific community, it really does make explaining some components of brain function easier so I'm willing to take the risk. Fig. 3--8. The brain is often compared to a computer, which can be a dangerous analogy because the two operate very differently. However, the metaphor can be useful in explaining some functions. Your computer has memory, both short-term (random access memory or RAM) and long-term memory (the hard drive). Your computer's short-term memory is only a fraction of its long-term memory capacity. Short-term computer memory allows the user to draw up programs and information from the long-term memory and put them in a space where they can be readily accessed and used. When the need for that short-term memory data is complete, it goes back into the long-term memory until it is needed again. (My apologies to the tech-savvy readers who can readily tell I am simplifying how computers work.) The user of a computer determines what programs and information are stored on the hard drive, where it is stored, and assigns a name to each file. The user can even search for the files and data using keywords. Files and programs can also be deleted from the computer's hard drive. In some respects your brain resembles a computer. It has the ability to store and retrieve information. It stores different types of information in various places. It has a short-term memory (the neuroscience term is working memory) and it has a hard drive (the neuroscience term is long-term memory). Working memory holds the things you are thinking about or working on in the current moment in time. It's horribly vulnerable to degradation if the data is not quickly passed along to long-term memory stores. The short-term memory can be populated with information extracted from long-term memory stores, or it may be new (novel) information being received and processed (think of this as learning). Like a computer, your short-term memory is a fraction of the size of your long-term memory, and like a computer there is a limit to the capacity of your short-term memory. When the capacity of the short-term memory is exceeded, bad things can happen. This is catastrophically important to understand because your short-term memory is relatively small, and the consequences of short-term memory overload in public safety domains can be horrific. If you've ever had the pleasure (a term I use loosely) of overloading the limited random access memory (RAM) on an older computer by trying to run a newer, RAM-intensive program, then you know what can happen when your brain gets overloaded. The program may run very slow, stutter (appear to skip and hop), or completely freeze up. When the information being processed exceeds the capacity of the computer's RAM, performance suffers. The same thing can happen when your brain's working memory capacity is exceeded. Indisputably, your brain has a limited amount of short-term memory available to capture and process information. When the information coming in exceeds your brain's capacity to process it, your ability to make decisions may slow down, stutter (skip and hop around), or your brain may just freeze up, just like a computer does. Scary, huh? First responders have shared many first-hand examples with me of this very thing happening to them under stress. They were overwhelmed with information coming into their short-term memory at an incident scene, and it became impossible for them to process and comprehend everything that was happening. I discuss this challenge in greater detail later on. There are a few differences that separate how your brain works from how your computer works. With your computer, you get to decide the names of your files and assign the storage location for those files. If your computer starts to run slow, you can selectively close programs and shed information from the RAM cache. This can be done in whatever fashion or priority that makes sense for you. Unfortunately, your brain doesn't work the same way. Imagine how much easier life would be if it did. Imagine if someone inquired about what you ate for lunch on December 1, 1998. Chances are, unless that date holds some special significance for you (e.g., it might have been a milestone birthday and you ate something special that day), you are not likely to remember. But it's very likely the details of what you ate for lunch that day are stored on your hard drive (or more accurately, in your long-term memory). Research has proven that much of what you see, hear, smell, taste, touch, and experience is captured and stored in memory. But you don't get to decide what is kept and what is thrown out. Nor do you get to decide where it's stored or how easily it's recalled if you need it. Storage For the sake of simplicity, you can think of those experiences stored in your memory as similar to photographs, cataloged into albums, representing your collective life's experiences. In reality, it's a little more intricate than I've portrayed here. Your brain actually stores various component parts of lived experiences in different places in your brain and stores the information for recall in some very complex ways. Again, thinking about it simplistically, your brain stores smells in one area, tastes in another, visual images in another, and sounds in another. It even stores vertical lines in an image in different places than it stores the image's horizontal lines. Stimuli can then trigger vivid and instant recalls of experiences. For example, a particular smell (say, the smell of chocolate chip cookies baking) might instantly trigger memories of your childhood visits to your grandma's house at Christmas time. This is not one memory stored in one place. Rather it is a complex recall of many memories stored in many places across your cortex. Researchers haven't been able to completely crack the code on how your brain pulls it all off so quickly and accurately, but it does. In one study, a psychologist was able to hypnotize an adult patient and the patient was able to recall memories dating to back to very early childhood, including his first birthday party. The patient vividly recalled the guests present, the gifts received, and the flavor of the cake and ice cream (figure 3--9). Imagine how large the hard drive capacity of your brain would need to be to store so much detail about so many experiences. I recall reading where a neuroscientist once predicted the capacity of the human brain as being greater than all the information currently residing on the Internet. It amazes me to imagine it. Fig. 3--9. Under hypnosis, psychologists have been able to get adults to recall as far back as their first birthday party. Memory loss Some neuroscientists have suggested the only way to lose information stored in your brain is to damage your hard drive---to suffer brain damage, either from an injury that physically damages the anatomical structure or from diseases that alter or destroy brain function. However, researchers also acknowledge that brain cells are continually destroyed and regenerated throughout the normal course of life. Your brain also deploys some coping mechanisms that can suppress traumatic and stressful memories. We can all be thankful for that; otherwise, there might be many more neurotic people among us. Recall It may be a little unsettling to learn you have so little control over where and how your experiences are stored. And, as if that was not disconcerting enough, for the most part you have little conscious control over how your brain recalls much of the information you may need. There are many factors that contribute to your ability to readily recall information, such as how recent your experience was (e.g., what you had for lunch yesterday is easier to recall than what you had for lunch last week, last month, or last year). Also contributing to your ability to recall is the significance you give to certain events in your life. For example, you're more likely to remember your 16th birthday more than your 15th because it may have been perceived to be more important. Or you may recall with greater detail the birth of a child versus the day you got your first pet. For some, the day you got your pet may be a highly significant event. In simplistic terms, the regular and routine (nonspecial) events of daily life are stored in files that are not given the same prominence; thus they are not as readily recallable. It's those collectives of regular and routine events that I want to focus on for a moment. Memories of routine experiences Recall that many of your life's experiences are stored in various parts of your brain in a way you do not control. Under low stress conditions you are able to think things through in rational and logical ways. You can take the time to apply the traditional decision-making process discussed earlier; however, under stress (especially when time is compressed) it can be very difficult to process information and evaluate your options the same way. There simply may not be enough time. Fortunately, the intuitive process works well under stress. It should. Your brain has millions of years of practice in refining its intuitive skill set. When you are under stress your brain searches through collections of experiences, looking for the solution to the problem. Fortunately it conducts these searches very fast, which is helpful in time-compressed emergency scene decision-making environments. By comparison, think about the work environment of a commercial airline pilot. As long as the plane is flying properly, there is only a moderate amount of stress present. However, when something catastrophic goes wrong with the jet and the plane is rapidly losing altitude (while traveling at 500 mph) it's an understatement to say the stress level on the flight deck is high. The pilot may have only a few seconds or minutes to assess the problem and devise a course of action to prevent an otherwise inevitable bad outcome. Think of the quick actions needed by Captain Sullenburger when he ditched an Airbus A320 in the Hudson River on January 15, 2009, sparing the lives of 155 passengers and crew members. When your brain is searching your stored images, it's looking for previous experiences that may help you solve your problem. If your brain is able to locate a similar experience (keeping in mind it doesn't have to be an exact match) it results in an intuitive gut feeling that indicates your brain has made a pattern match. Because these searches and matches happen at the subconscious level of the brain, the decision makers may not understand how they know what to do, they just know, intuitively, it's the right thing to do. When Gary Klein's research group rode along with the expert fireground commanders in Cleveland, Ohio, they asked the commanders how they knew what to do. The common answer was, "I don't know how I knew... I just knew." This unconscious knowledge possessed by those commanders---and by you---is known as tacit knowledge. As tacit knowledge resides in the subconscious, it's very likely you can't explain how or where you acquired it. One of the reasons you may not be able to explain how you acquired it is that experiences (often in the form of stored images in the subconscious brain) may have been placed there without your awareness. In other words, your brain stores images of experiences you want to remember as well as images of experiences you don't even think about remembering. Recall, your brain stores nearly everything. Unfortunately, it also stores some things you might rather forget (like the image of that snazzy mullet you sported in high school). On the flip side, if the decision maker has no previous experience or training related to the situation being faced, the brain may search the image files for the solution and come up empty. No match! When this happens, you're not going to get an intuitive gut feeling that tells you what to do. Some think the absence of a gut feeling is a good thing, but it can be foretelling that the decision maker may be essentially clueless about what to do because there are no stored experiences to draw upon. This is why kids make so many mistakes; they lack experience. It's also why you, a parent, spend so much time trying to impart your wisdom to them, sharing your experiences with them, helping them to learn from your mistakes. This can be very helpful, even if you think they're not listening or heeding your advice. This is also why novice responders are prone to making mistakes under stress. They don't have enough stored experiences to be able to effectively use an intuitive decision-making process under stress. Under stress, the novice is likely to have no pattern match; therefore, whether it's your kids or a novice first responder, you see their deer-in-the-headlights look. If you've ever observed it, you know what I'm talking about. I stated earlier that when your brain is searching for a solution, the images (i.e., experiences) your brain identifies as containing a solution to your current problem do not have to exactly match your previous experiences. Think about it---an exact match would be incredibly rare. (Personally, I can't think of two identical emergency calls I've responded to in my 30 years on the job.) Fortunately, your brain is pretty good about searching and combining together pieces of various experiences to help solve the problem. Whether it's from one experience or a variety of experiences combined, when your brain identifies the solution, it creates a pattern match. The pattern match is what causes the intuitive gut feeling. While an intuitive gut feeling can guide decision making, the brain is not infallible; therefore, it is important to verify your gut feelings with facts that validate your intuition. A decision maker can get a pattern match that is incorrect, and the solution that feels intuitively correct may actually be wrong. It's important to seek out facts that validate the decision as a good one. It's important to pause and issue a warning here. When decision makers assess a situation, capture clues and cues, form a pattern match, and get an intuitive gut feeling, it builds confidence. As the decision makers search for additional facts to validate intuition, it can cause them to look for the clues and cues that only affirm their intuition. In the process, clues and cues that refute their intuition may be dismissed or excused away. This phenomenon is known as confirmation bias. Here's an experiment that demonstrates how your brain searches through your life's experiences in search of a pattern match, resulting in an intuitive gut feeling and the search for facts to validate the feeling: You receive a 1,000-piece jigsaw puzzle in its box. The box is opened and the pieces are spilled out on a table. The researcher takes great care to ensure you don't get to see the picture on the lid of the box because it would make it too easy for you to figure out what the end result of the puzzle is supposed to look like. Relating this to emergency responses, it makes sense to do this because you never have a complete picture of the outcome when you arrive at an emergency situation, so you don't get to see the end result here either. The likely first step for most participants is to turn all of the puzzle pieces upright and spread the pieces out on the table. This strategy serves two purposes. It allows the participants to see the colors, textures, and shapes of all the pieces. Think of each piece of the puzzle as a needed clue to solve the problem. Spreading the pieces out provides a way to scan all the clues and cues. This is critically important because some of the most important clues may be on the bottom of the pile, and if the participants don't spread the pieces out, they'll never know what they're missing. The same principle can be applied to an emergency scene size-up. Conducting a complete size-up (i.e., looking at all sides of the incident) allows you to capture all the critical clues and cues. If the size-up is incomplete, you miss something that might be critical information. The next likely step the puzzle assemblers take is to conduct a rapid scan of all the puzzle pieces. This allows them to capture small snippets of clues contained on each puzzle piece and make some assumptions about the picture's general characteristics and theme. Captured clues and cues might be parts of trees, water, sky, cars, buildings, people, words, animals, and so on. It would be nearly impossible to assemble all 1,000 pieces mentally (unless you possessed the prodigious memory abilities of Kim Peak, the man who inspired the movie Rain Man). The next likely step is to locate the four corners. Why? Because the participant knows, with confidence, the corners are clues that contain a piece of certain information. The corners are great starting points from which the puzzle can be assembled because it can be deducted they go in one of four distinct places. Until some additional puzzle pieces are assembled, however, it's nearly impossible to know where any of the other 996 pieces go. Assume one of the four corners is blue. The participant doesn't have much to go on with that clue---it's blue and it's a corner piece. Further, assume the initial rapid scan of the pieces indicated the assembled picture would be an outdoor scene. So, with that assumption, what could a blue puzzle piece represent? Logic coupled with life experience (and perhaps some experience with jigsaw puzzles) might lead to the assumption a blue piece would be sky or water. Again, drawing on experience, it could be further assumed that if the blue piece is sky, it will be one of the top corners of the puzzle; if it's water, it will be one of the of bottom corners. The next logical step would be to look for other pieces that fit together with the blue piece. Fortunately, experience with puzzles enables the participant to quickly sift through and eliminate (at least for now) all the pieces that do not have flat edges and are not blue. So, in essence, they are searching for the clues that fit with the blue corner piece. As multiple pieces are fit together, the participant is, essentially, forming a pattern match. The pieces that fit together provide additional information about the problem. Now, in addition to seeing just a single plain blue puzzle piece (which is assumed to be sky), the participant is able to identify pieces that have clouds and birds. The clouds and birds are facts that validate assumptions, and the participant can confidently deduct those pieces represent sky (see figure 3--10). This is a very simplified example of tacit knowledge---how your brain searches through stored images of life experiences (the puzzle pieces) and fits the experiences together to form a pattern match that yields an intuitive gut feeling about what to do (or not to do). What makes the knowledge tacit is where the knowledge is stored and how it is used---subconsciously. Tacit knowledge allows you to form subconscious pattern matches without awareness. Fig. 3--10. Assembling the pieces of a jigsaw puzzle is a lot like how the brain gathers and processes information in the decision-making process. Clues and cues (puzzle pieces) are captured and processed (put together). There are multiple documented cases where people who have had near-death experiences reported seeing their lives flash before their eyes. Maybe you've heard of this happening, or perhaps you've been unfortunate enough to have a personal near-death experience and had it happen to you. The reports typically involve people who suddenly find themselves in a sudden and unexpectedly grave situation (e.g., in a vehicle running off the roadway and careening down a steep embankment at a high rate of speed). In the few seconds it takes for this event to occur, they report having visual images of their lives flashing before their eyes. While having a discussion on the topic of decision making under stress with a group of firefighters, I asked how many had experienced near-death events and had their lives flash before their eyes. It was a fairly large group, and at least six hands went up. I asked one gentleman to share his experience with the group, and he shared an amazing story. "I was a gunner on a helicopter in Vietnam in 1967. We were flying just above the trees when our helicopter was struck with a rocket-propelled grenade. The rotor seized up, and we were on a free-fall to the ground. We were about 1,500 feet in the air when we got hit. As we were falling, I saw images of things from my life." At this point, I prompted him to share the details about the images he saw. "I saw an image of me at my high school graduation. I saw an image of me driving the first car I owned when I was 17. I saw an image of me riding a bicycle down a street in Germany when I was a kid. I saw an image of my first child being born. I saw an image from my wedding day. I saw an image of my grandmother in her casket at her funeral." I asked how long he thought it took for the helicopter to fall to the ground. "It was only a few seconds." I was intrigued by the image of his grandmother's funeral, so I asked him where in the sequence that image occurred. "That was the last image I saw before we hit the tree tops." The gentleman further explained that these images weren't just in his head---they were what he was actually seeing... and doing! Everything in his peripheral vision went black, everything went silent, and these images were what his eyes saw as if he were actually in these locations and actually doing these activities. He said that they weren't images (still shots); they were movies playing out in real time, and he was the lead actor in each scene. I asked him if he'd ever given much thought to what was happening to him that day and what it all meant. What he said next, if it were not a near tragedy, might have been quite funny. He said he did not tell anyone what happened because he was afraid they'd think he was nuts. Indeed it does seem odd that in the few seconds it took for his helicopter to crash he would see (and be part of) all those scenes---scenes that didn't really seem to have any connection to what was happening to him. When I shared with him an explanation of what was happening, I could see the relief on his face, as if to say, "Thank you for helping me to understand I'm not crazy." What was happening is he was under stress. His brain was searching through his stored life experiences, trying desperately to find a pattern match that would give him the intuitive gut feeling about how to survive his crashing helicopter. Unfortunately, he hadn't experienced anything even close to a helicopter crash; thus, there was no pattern to match. No tacit knowledge. No gut feeling to tell him what to do. But what did happen was while his brain was searching through its stored visual images of his collective life's experiences, several of his life experiences rose from the subconscious level of his brain to the conscious level. And before him were actual relived experiences in real-time replay. Science hasn't been able to offer any plausible explanations as to why this happens for some people and not others, or which images are elevated to consciousness. Some images hold great importance (e.g., a wedding day or a child's birth) whereas others appear to be completely innocuous (riding a bicycle or riding a thrill ride at an amusement park). Nonetheless, it's a fascinating phenomenon that has been documented extensively. I think it was quite ominous that the last scene this soldier lived out before his helicopter hit the ground was his grandmother's funeral. It's purely conjecture on my part, but this may have been his brain's way of saying it searched all the experiences on file and the only solution---the only way out of this stressful predicament he was in---was death. The Role of Emotions in Decision Making I want to go back to something I stated earlier in the chapter about the role of emotions in decision making. Rational, thinking people, supported by the findings of some research, believe there's no place for emotions in decision making---emotions should be set aside, and the decision should be made purely on rational, analytical facts. As many of us know, it's not that easy to control our emotions. Chances are some of the most important decisions a person will make in their life are heavily influenced by their emotions. Take, for example, choosing a life mate. Setting aside emotions in the decision would yield a purely rational, analytic evaluation of the lucky candidate. What are the person's personal hygiene habits? How compatible are you? Again, not based on how the person makes you feel---emotions are out. Base it on an analytical (1--10 scale) of measureable criteria. Remember to set minimum thresholds for what is acceptable and try your best not to let irrational, emotional things, like love, get in the way of making your good decision. In fact, ask someone what they love about the most important people in their lives and among the responses you're likely to get will be: The way they make me feel when I'm around them. But an advocate of purely rational, analytical decision making, would say there's no place for feelings. One of the best books I've read on this subject is Descartes' Error: Emotion, Reason, and the Human Brain by Antonio R. Damasio. In the book, Damasio chronicles the studies of a man named Phineas Gage who suffered damage (from an injury) to the prefrontal cortex of his brain, which is the portion of the brain that controls his emotions. Gage was able to live a reasonably normal life, meaning he had no physiological deficit that affected his speech, hearing, vision, or motor skills. However, he lost several critical functions, including problem solving, maintaining attention, and the ability to control emotional impulses. This damage to the emotional control center of his brain also left him with an inability to make good choices and, to some respect, crippled his ability to make cogent, timely decisions among alternatives. For example, a discussion between Gage and his doctor about setting an appointment might take more than an hour because Gage could not decide on a good date or time. When he did make decisions they were often impulsive and inconsistent with his pre-accident demeanor. In another study, a subject was engaged in a rigged card game where the cards being dealt followed a set pattern (see figure 3--11). The participants with normal prefrontal cortexes were able to pick up on the patterns, use intuition to help them anticipate the future cards, and avoid placing bets when they sensed the next card dealt was going to be bad (remember, the cards followed a pattern). The participants with damaged prefrontal cortexes were also able to identify a pattern within the cards, but they were unable to use intuition to anticipate when the bad cards were coming. Thus, they would continue to bet money even when the bad cards were inevitably going to be dealt. The lack of emotion essentially left a blind spot in their decision making. Fig. 3--11. When the brain picks up on patterns of information it can predict future outcomes based on those established patterns. The next card dealt would be...? Sliced and diced Throughout this chapter I have been referring to how the brain stores lived experiences as images or scenes and stated, briefly, that it's a little more complex than that. Some research has shown that the brain does not store complete experiences as packaged images or scenes. Rather, the brain stores the various stimuli in separate regions of the brain. The things you see are stored one place. The things you hear are stored somewhere else. I recall hearing it described as like your experience being put into a blender with the lid off and pieces of the experiences are splattered all over your brain. Then, in a most mysterious way, your brain reassembles the experiences into coherent memories. Under stress, as you gather the clues and cues in your current situation, you cannot consciously know whether it will be written words, spoken words, other sounds, images, colors, textures, aromas, odors, or what combination stimuli that will trigger a pattern match for you because, as you recall, it's all happening subconsciously. On a number of occasions I have encountered someone I know in a store or a restaurant. The chance meeting came unexpectedly and although I recognized the person as someone familiar to me, I could not immediately place a name with the face or even recall how I knew the person. After I walk away and give it some thought, I remember who the person is. Because so many of my professional associates wear uniforms, I am used to seeing them in uniform. In fact, part of the pattern that my brain matches (subconsciously) when I see them is their uniform and their faces---together. When one of those clues is missing (in this case, the uniform because the person is wearing civilian clothes), I struggle to make sense of who that person is. Eventually it comes to me, but not right away. A similar thing can happen at an emergency scene. If you are used to regularly seeing a grouping of cues and clues that, together, hold some meaning for you and then one or more of those cues or clues are missing, you may struggle to make sense of what's happening.Your brain is efficient at taking pieces of a puzzle and putting them together correctly, resulting in something meaningful. In other words, an individual puzzle piece may not mean much until it is coupled with five or six other pieces. Then, and only then, is the meaning significant. But individually, that one clue or cue held little meaning for you. Much like you seek jigsaw puzzle pieces that fit together and connect them, your brain does the same thing. This process is called chunking. To demonstrate how effective your brain is at chunking information, take a moment to read the following paragraph out loud. Aoccdrnig to rscheearch cnoedtcud at Cmabrigde Uinervtisy, it deosn't mttaer in waht oredr the ltteers are in a word. The olny iprmoetnt tihng is taht the frist and lsat ltteer are in the rghit pclae. The rset can be a toatl mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae yuor biarn deos not raed ervey lteter by istlef, but it chknus the ltters together and fmors the wrod as a wlohe. Could you read the paragraph without a problem? Much to the chagrin of elementary school teachers who harp on the need for perfect spelling, most people can read it with ease, yet they don't really know how they can do it. The explanation lies in understanding that the letters of the words are chunked together in the brain and don't have to be in the proper order. The brain does need some facts to prime the recognition. In the case of the example above, the facts are the correct location of the first and last letters. I once conducted an impromptu experiment where I put the paragraph with misspelled words up on a screen and asked someone to read it. A participant expeditiously read the entire first line without realizing any of the words were misspelled. Then she abruptly stopped reading, paused, and said in a surprising voice: "You know you misspelled the word 'university'?" The entire audience erupted in laughter, realizing something the participant had not---she read four misspelled words correctly without even realizing they were misspelled. After acknowledging my spelling error, I encouraged her to read on, and she did, reading the rest of the paragraph flawlessly. I have seen, heard, and personally experienced the power of tacit knowledge driving decision making on numerous occasions. One call that comes to mind as a salient example was an incident I responded to where a fire was reported in a manufacturing facility. On my arrival there was smoke showing from the rear of this single-story 100-foot-by-400-foot warehouse-style building. I noted the location of the municipal fire hydrant on the boulevard, roughly 1,100 feet from the rear of the building. The access to the back of the building was a roadway that ran along the right side of the building. On my way in I noticed a private yard hydrant about half the distance to the back of the building. As I pulled around to the rear of the building I could see smoke was coming from an open garage door. I instructed the first-arriving engine to connect to the municipal hydrant at the street (even though I had noted the yard hydrant that was less than half the distance away). As the engine stopped to connect to the municipal hydrant, employees from the company were screaming at the company officer that there was a closer hydrant down the driveway. The company officer called me on the radio and relayed what the employees were saying. I instructed the company officer, again, to connect to the street hydrant and lay in. The engine laid out its entire bed of hose and came up short of reaching the rear of the building. This left the engine crew both confused and angry with me. I didn't make the employees of the company very happy with me, either, and several came up to me immediately to express their displeasure. Thankfully our police department was able to quickly usher them away from the command vehicle so I could concentrate on the more important task of putting the fire out safely. But it did raise a valid question about that decision. Why would I do that? I had to order the second-in engine to complete the hose lay while the first engine attacked the fire with tank water. On their way in, the third-in engine officer decided it would be a good idea to secure a second water supply, and they stopped to connect to the yard hydrant I'd ordered the first engine to pass by. From where I had established command, I could not see this hydrant so I was unaware the third-in engine had stopped to connect to it. Then I received a radio transmission from the third-in engine officer informing me that they had stopped to connect to the yard hydrant, but the hydrant was non-functioning. At that moment, I went from being viewed as the dope that made the companies lay more than twice the hose needed and delaying the establishment of a patent water supply for the attack engine to being Nostradamus-like in my prediction that the yard hydrant would not work. When the incident was over, the officer on the first-in engine came up to me and asked, "How did you know? How did you know that yard hydrant wasn't going to work?" I wish I could have given him an answer that made me look smarter than I really am. The fact was, I didn't really know why I made that decision. Something inside me told me the yard hydrant was a bad bet. At the time I gave the order I had no idea the first-in engine was going to run out of hose in the process of laying in to the scene. When that happened, I started to doubt myself and my order to abstain from connecting to the closer hydrant. Part of my doubt came because I didn't have a real good reason for the decision I made. I relied on intuition---I trusted my gut feeling---and made a decision that I would have struggled to defend. When I told the officer the reason I made that decision was I had a gut feeling the yard hydrant wasn't going to work, I don't think he believed me. As I left the scene, I stopped to look at the yard hydrant. I noted on this slower, more methodical inspection, that the hydrant top was rusted and the presence of weeds around the hydrant gave me the indication it had not been maintained. Was that enough to prime my intuition---a little rust and a few weeds (see figure 3--12)? Apparently so. Fig. 3--12. Clues and cues---such as tall grass and the presence of rust---may be enough to trigger intuition and cause you to avoid connecting to a hydrant that appears to have not been maintained. As I have spoken with hundreds of firefighters about decision making, they have shared with me countless examples of situations they have found themselves in where they describe a gut feeling that saved their lives. They couldn't explain how they knew; they just knew. I've had occasions where responders have shared with me that they experienced gut feelings that bad things were going to happen and they ignored those feelings... dismissing them because they could not readily find a conscious, rational explanation for feeling that way. Unfortunately, a number of those stories ended with bad things happening, including first responder casualties. I am spending a lot of time on this topic because I want you to understand how important it is to understand intuition and the role it can play in your decision making. Those gut feelings are telling you something. You have to believe that when you get that gut feeling, it means something. Don't dismiss it. However, I am also going to caution you. You can get gut feelings that are wrong! Good, But Not Perfect Although your brain does a wonderful job of searching your collective life experiences for the solution to problems when you're under stress, you can have a pattern match that is wrong. To help you overcome this, when you get that intuitive gut feeling, remember to look for some facts to validate your feelings. Equally, look for facts that refute your gut feelings. This is an important point that you should not take lightly. When you think you have something figured out in your mind, it's natural to look for data and information that validates you are right. You do this all the time when you deal with people. If you have a good idea, you seek out the people who you believe will be supportive and encouraging of your good idea. Likewise, you may avoid talking to those who you suspect are going to be negative. This can be problematic because the negative feedback may actually be more valuable in the development of your idea than the supportive and encouraging feedback. When you are trying to validate your gut feelings, seek information that both validates your feelings as well as refutes them. Both provide valuable clues and cues. Another word of caution is in order. Some commanders may struggle with knowing how much factual information to gather to confirm they are making a good decision and consequently delay their decision or make no decision at all. This analysis paralysis can be dangerous. If you wait until you have 100 percent of the information needed to make an emergency scene decision, you're probably going to have a bad outcome because as soon as you think you have 100 percent quality and reliable information, a large portion of that information has changed. First responders are action oriented. If a commander is unable or unwilling to make a decision because of incomplete information, there's a risk the responders may grow impatient and engage in independent goal setting---freelancing. I'm not condoning independent action; rather, I'm simply making an observation about what can happen when timely decisions are not communicated. A good rule of thumb, depending on the emergency, might be to gather 30 to 70 percent good, solid information to validate your intuition, and then make a decision and go with it. Four Essential Requirements for Recognition-Primed Decisions (RPD) To be able to make good recognition-primed decisions, a decision maker needs the following four essential skills. RPD requirement \#1: Situational awareness The decision maker must develop and maintain strong situational awareness. A simple and often-used definition of situational awareness is paying attention. However, as is discussed throughout this book, paying attention can be much harder than it appears. A review of near-miss and line-of-duty death reports may lead to the assumption that those events could have been avoided if the decision makers were simply paying attention to what was going on around them. This is not to say the decision makers were purposefully not paying attention. Gasaway, Richard. Situational Awareness for Emergency Response (pp. 39-100). Fire Engineering Books. Kindle Edition.