I Am Completely Lost

Introducing Chaos Thinking

What is “chaos thinking?” Originally when I began writing this article the subject was simply “critical thinking”. There were plenty of resources to draw from: business and academic sources as well as a multitude of various definitions. Yet each definition I found still felt like it was missing something, some important element. They didn’t seem to fit what public safety professionals would consider the real definition of critical thinking as it pertains to emergency services.

During my research over business and academic sources, I noticed a pattern, or lack thereof. There wasn’t anything that I could find that was tailor-made for emergency services. Note : I am still looking. Specifically there were critical thinking models for business or for the military. Tools like “Plan Do Check Act” or OODA Loops were effective in the fields they were applied to; however, they were never tailor-made for incident command or patient assessment. On the business discipline, the element of time as a limiting factor was not stressed nearly enough. For the military, OODA loops work well because it deals with strategies against a human opponent and psychological effects like morale on the enemy.

While a combative or difficult patient may seem like an opponent, we know that our true enemy is the collective ignorance of the patient’s underlying condition or the chaos of an unmanaged emergency environment. Again and again the element of chaos kept popping up as I tried to apply critical thinking to fire and ems. We need our own word; one that reflects the nature of our challenges: the lack of time and resources. Chaos Thinking comes to mind. Simply put, “chaos thinking” is critical thinking with a time limit. It is accurately assessing and interpreting a patient or scene and rapidly responding.

Chaos thinking is critical thinking that is comfortable with confusion. Unlike a fortune 500 company, we can’t hold meetings to plan out our next call or incident. Unlike the military, we can’t get ahead of the enemies’ decision cycle because our “enemies” don’t have a decision cycle.

The challenge for us, as it has always been, is to manage chaos. But how exactly do we become more comfortable with chaos? First we must be honest with ourselves and admit there are times we have felt overwhelmed. There isn’t a single firefighter, emt, paramedic, nurse, even physician, who hasn’t at one time in their career, felt completely lost in a situation. We’ve all experienced that overwhelming chaos, when our brain seems to simply stop while time seems to fast forward. It’s a terrible feeling to experience and we wish there was some magic reset button.

Process is the best antidote to chaos. It’s why Chief Officers will sit in an office and argue back and forth for the best operating guideline. It’s why the medical director will not let you practice unless you can show some competency with their protocols. It’s not just about planning, on some level we all know that having a process will help keep our minds free from the effects of chaos. Anyone remember this? : No matter how clueless you are about the patient you can always go back and start at the ABC’s.

It’s one thing to make sure you train on your proper technique for a skill or that you nail all your dosages. (pro tip, any difficult information you have trouble remembering, print it out and put it right in front of the toilet at work/home.) But, when was the last time you really thought about process? Was it when you were being precepted, or precepting someone else? Worse, was it back when you were in school?

I challenge you to ask yourself, “What is my process?” Even if you are going line by line on a classic NREMT Assessment sheet, you are still going to have your own way of applying the process. You’ll have your own way of determining what type of call it is and how you select the appropriate protocol. Have you ever written down your process? Just seeing it on paper will help encourage new thinking; try to wonder (and find) a situation where this process can’t be applied. Then you can adjust accordingly.

For example, one of my processes was, for medical calls with a conscious patient, is to very early on ask “has this happened before?” I had been asking that question in that way for years and it was a good question to rapidly identify what is a likely cause of the illness. My next question is usually, “What did they diagnose this as? But after I had written these both down I realized that I didn’t really need the first part of this question but the second. For years I had asking this question not realized there was a more direct way to phrase it. My new question I incorporated into my process was: “Were you ever treated for this illness before and did they tell you what was wrong?”

We don’t need to break down these questions to understand the importance of process. The new challenge is to find a way to sufficiently imagine all the things that could happen. Scenarios are a great way to refine your process. The “What If” game is a great way to break up what can be a mundane task of studying the DOG’s.

The last thing I would mention is, if you are trying to make a change, don’t do it alone. Life coaches and business experts call this an “accountability partner.” Reach out to your brothers and sisters and tell them, “Hey, I’m trying to refine my process for assessment…here are the changes I am trying to make, can you help keep an eye on them on the next call? People respect someone who is genuinely trying to improve and the more specific you can be, the easier it will be for them to help you.

No matter what we do, unfortunately, chaos will always be there on our calls, threatening to rise up and overwhelm us. Ultimately the best way to master Chaos Thinking is to learn by doing and facing this “feeling” for yourself. Incorporating new process can help mitigate chaos and running scenarios can aid in this as well. In the end, experience is the best teacher; all our training should be to replicate the chaos of the real patient or scene as close as possible.

Blake McCorkle

August 2015

Below are some links that can give some insight into the raw science behind the theory that goes into Chaos Thinking - https://www.ncbi.nlm.nih.gov/pubmed/15183394abstract fmri different areas of brain for visualization http://www.sciencedirect.com/science/article/pii/S0306452202001100

http://www.livescience.com/49244-imagination-reality-brain-flow-direction.html