Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

TMI and Making Decisions – Part I

At FireGeezer, there is a 5 part series on TMI (Too Much Information) and making decisions. It begins with Department of Near Miss: Too Much Info? – Part One.

Eric Lamar is pointing out that information management is important for fire fighters. The same is true for EMS and all of the rest of medicine.

Rather than preventing technology from producing a landslide of information at the least appropriate time, we abuse that technology. We are addicted to information – information that interferes with our ability to make decisions.

We think that more information produces better decisions. The information should not make our decisions, we should. Gathering more information can be just another way to delay making a decision. Sometimes delaying a decision for more information results in the further information being useless because it is too late to make a difference.

We need to discriminate among the information we do have, the information we might have, and the information we need. This is difficult to learn and some people never learn this.

The obvious and most basic example is the brand new person who focuses on the mangled leg of the apneic patient. By not prioritizing, we will kill the patient – the distinction between killing and not preventing a death that any competent person would prevent may be important in a courtroom, but it is irrelevant to the patient. We do not encourage people to practice making decisions. With children, we prevent them from making decisions for themselves until they reach a certain age, even with adults we use this same tactic. We act as if osmosis will be the method of instruction. It does not work.

Being next to someone making a decision is not the same thing as making a decision. In my opinion, the biggest difference between basic EMTs and paramedics is not the ability to intubate, or to start IVs, or to give drugs, or any of the things that most people seem to associate with being a paramedic.

The difference is the ability to make a decision about what to do with a patient.


Image source.

Stay and gather more information vs. transport immediately and worry about being yelled at by the doctors and nurses, but get the truly unstable patient to the right place right away.

Transport to the closest hospital vs. transport to the specialty hospital (pediatrics, burns, trauma, labor and delivery, . . .).

Pronounce on scene vs. wait until at the hospital to let the doctor make the decisions.

Give a treatment that is in the protocol because it is in the protocol vs. watchful waiting for an assessment to show that the treatment really is indicated, not just the next step in a mindless protocol.

Avoid making waves by calling for orders vs. call medical command and keep asking for orders if the doctor cannot come up with a good reason not to give a treatment.

And should I give Lasix to this SOB with crackles, tachycardia, and a fever?

Some people never learn to make decisions for themselves and should have their jobs outsourced. Some people do not have their medic card, but make much better decisions that many of the medics they work with.

It isn’t important that all of the decisions be right. It is improbable that all of the decisions of any person will be right. It is important that the decisions be made for good reasons.

It is important that we learn from the decisions we make.

Added 8-28-2011 at 12:22 – One of the things about the plane described in the articles at FireGeezer is the reliance on electrical controls without any mention of non-electric back up. An article about the FAA approval of the new 787 included the following –

Because of the heavy reliance on electric power, Boeing was also required to show “that the airplane is capable of continued safe flight and landing with all normal sources of … electrical power inoperative.”

Long-delayed 787 wins FAA approval to enter service
By Dominic Gates
Seattle Times aerospace reporter
Article

To be continued in TMI and Making Decisions – Part II.

The links to the series of posts at FireGeezer are below. There is a presentation of one situation where the decision making was critical for a lot of lives.

Department of Near Miss: Too Much Info? – Part One

Department of Near Miss: Too Much Info? – Part Two

Department of Near Miss: Too Much Info? – Part Three

Department of Near Miss: Too Much Info? – Part Four

Department of Near Miss: Too Much Info? – Conclusion

.