CLINICAL DECISION CLINICAL DECISION MAKINGMAKING

Critical Decision MakingCritical Decision MakingYou will confront a situation that You will confront a situation that

requires you to make a critical decisionrequires you to make a critical decision

EMT-A as prehospital practitioners of EMT-A as prehospital practitioners of emergency medicineemergency medicine

Need for critical decision makingNeed for critical decision makingSituations will appear totally unfamiliarSituations will appear totally unfamiliar““patients do not read the textbook”patients do not read the textbook”

Clinical JudgmentClinical JudgmentThe use of knowledge and The use of knowledge and

experience to diagnose patients and experience to diagnose patients and plan their treatmentplan their treatment

EMT-A PracticeEMT-A PracticeYou must gather, evaluate and You must gather, evaluate and

synthesize informationsynthesize information

SynthesizeSynthesize

To form by combining parts or To form by combining parts or elementselements

http://dictionary.reference.com/http://dictionary.reference.com/browse/synthesizebrowse/synthesize

EMT-A PracticeEMT-A PracticeField diagnosisField diagnosisDeveloping and implementing Developing and implementing

management planmanagement plan

Classes of patient acuityClasses of patient acuity

{the severity or acuteness of {the severity or acuteness of your your patients’ condition} patients’ condition}

Critically life-threateningCritically life-threateningPotentially life-threateningPotentially life-threateningNon-life-threateningNon-life-threatening

Protocols and algorithmsProtocols and algorithmsProtocolsProtocolsStanding ordersStanding ordersalgorithmsalgorithms

Critical Thinking SkillsCritical Thinking SkillsThe ability to think under pressure The ability to think under pressure

and make decisions that cannot be and make decisions that cannot be taught; it must be developedtaught; it must be developed

Fundamental knowledge and abilitiesFundamental knowledge and abilitiesKnowing anatomy, physiology and Knowing anatomy, physiology and

pathophysiology pathophysiology

{disturbance of body functions}{disturbance of body functions}

Focusing on large amounts of dataFocusing on large amounts of dataOrganizing informationOrganizing information Identifying and dealing with medical Identifying and dealing with medical

ambiguityambiguityDifferentiating between relevant and Differentiating between relevant and

irrelevant datairrelevant dataAnalyzing and comparing similar Analyzing and comparing similar

situationssituationsExplaining decisions and constructing Explaining decisions and constructing

logical argumentslogical arguments

Differential field diagnosisDifferential field diagnosis

Facilitating behaviorsFacilitating behaviorsStay calmStay calmPlan for the worstPlan for the worstWork systematicallyWork systematicallyRemain adaptableRemain adaptable

Useful thinking stylesUseful thinking stylesReflective vs. impulsiveReflective vs. impulsive

ReflectiveReflective

Acting thoughtfully, deliberately and Acting thoughtfully, deliberately and analyticallyanalytically

ImpulsiveImpulsive

Acting instinctively, without stopping Acting instinctively, without stopping to thinkto think

Divergent vs. convergentDivergent vs. convergent

DivergentDivergent

Taking into account all aspects of a Taking into account all aspects of a complex situationcomplex situation

ConvergentConvergent

Focusing on only the most important Focusing on only the most important aspect of a critical situationaspect of a critical situation

Anticipatory vs. reactiveAnticipatory vs. reactive

AnticipatoryAnticipatory

Looking ahead proactively to potential Looking ahead proactively to potential ramifications of actionsramifications of actions

ReactiveReactive

Responding to events after they Responding to events after they happenhappen

Thinking Under PressureThinking Under PressureWhen you must make a critical When you must make a critical

decision, physical influences may help decision, physical influences may help or hinder your ability to think clearlyor hinder your ability to think clearly

Autonomic Nervous SystemAutonomic Nervous SystemPseudo-instinctivePseudo-instinctive

Learned actions that are practiced until Learned actions that are practiced until they can be done without thinkingthey can be done without thinking

Mental Check ListMental Check ListScan the situationScan the situationStop and thinkStop and thinkDecide and actDecide and actMaintain controlMaintain controlReevaluateReevaluate

Critical Decision ProcessCritical Decision Process

Your ability to analyze data effectively Your ability to analyze data effectively and devise a practical management and devise a practical management plan optimizes patient careplan optimizes patient care

Form a conceptForm a conceptScene size-up and initial assessmentScene size-up and initial assessmentFocused history and physical examFocused history and physical exam

Interpret the DataInterpret the DataConsider the most serious condition Consider the most serious condition

that fits your patients’ situationthat fits your patients’ situationWhen clear diagnosis is unclear, base When clear diagnosis is unclear, base

treatment on presenting signs and treatment on presenting signs and symptomssymptoms

Apply the principlesApply the principlesDevise management plan that covers Devise management plan that covers

all contingenciesall contingencies

Contingency: An event (as an Contingency: An event (as an emergency) that may but is not certain emergency) that may but is not certain to occur <trying to provide for every to occur <trying to provide for every contingencycontingency> >

EvaluateEvaluate

Perform on-going assessmentPerform on-going assessmentReflectReflect

Consult Emergency PhysicianConsult Emergency Physician

Consult crew Consult crew

THE 6 RsTHE 6 RsRead the sceneRead the sceneRead the patientRead the patientReactReactReevaluateReevaluateReviseRevisereviewreview