Emergency Medicine Book

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Emergency Decision Cycle

Aka: Emergency Decision Cycle, OODA Loop, AAADA Model
  1. Pearls: Levitan and Braude
    1. Use self-talk with positive language
      1. Based on STEP-UP (Self Talk for Enhanced Performance Under Pressure)
        1. Sports psychology approach
      2. I have the skills and knowledge to do this
      3. I can imagine success on obtaining a definitive airway
    2. Break complex tasks into small steps
      1. Establish checklists (written or in rote memory) to fall back on in stressful situations
      2. Focus on one small step at a time (e.g. I need to see the epiglottis) in a steady progression
    3. Take ownership and responsibility of the situation
      1. Trust you own decisions
      2. Commit to decisions without hesitancy or second guessing
      3. Verbalize to the team, the plan as well as contingencies
    4. Control yourself physically
      1. Avoid hastily performing actions (Exercise control)
      2. Slow down your own breathing
  2. Protocol: AAADA Model
    1. Background
      1. Developed by a state police psychologist, Dr. Michael Asken, based on OODA Loop (see below)
        1. Asken also authored several books on "mindsighting" and "mental toughness"
        2. AAADA was expanded from OODA to take into account the complexity of life or death decisions
      2. May be applied to emergency medicine and critical care tenuous situations (e.g. difficult airway)
    2. Phases (applied to Advanced Airway)
      1. Alert
        1. Alert to potential airway problems (e.g. be prepared for failed airway)
      2. Assessment
        1. Assess oxygenation status, Lemon Mnemonic
      3. Anticipation
        1. Mark the Cricothyrotomy site and have surgical airway kit at bedside
      4. Decision
        1. Failed airway, can't oxygenate, can't ventilate, can't intubate
        2. Decision to perform Cricothyrotomy
      5. Action
        1. Perform Cricothyrotomy
    3. Resources
      1. AAADA
        1. http://www.lesc.net/blog/ooda-aaada-%E2%80%95-cycle-surviving-violent-police-encounters
  3. Protocol: OODA Loop
    1. Background
      1. Developed as a military strategy by US Air Force Colonel John Boyd
      2. Allows a combatant (e.g. pilot) to rapidly process developing events through a cycle of observation and reaction
        1. Goal is to cycle at a faster tempo than your opponent
      3. Extrapolated to law enforcement, business and other rapidly changing adversarial situations
    2. Phases
      1. Observe
        1. What is my adversary doing? Response to my last action?
      2. Orient
        1. Filtering, analysis and synthesis based on knowledge, culture, Genetics, prior experience
      3. Decide
        1. Decide on the very next action
      4. Act
        1. Follow through with the plan
    3. Resources
      1. OODA Loop (Wikipedia)
        1. http://en.wikipedia.org/wiki/OODA_loop
  4. References
    1. Braude and Levitan in Herbert (2015) EM:RAP 15(3): 8-9

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