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

- Rogue Medic

Too Much Information and Risk Management

Steve Whitehead discusses the problem of Too Much Information the problem of people avoiding learning by claiming that they are being presented with Too Much Information.

He gives 3 examples:

1) We like to keep the bar low.

2) We fear the limitless and undefined.

3) We are inherently insecure.

These are all genuine problems.

I do not want to be treated by someone who embodies these three problems.

I know too many people who do make these mistakes and they are scary.

The people, who complain about Too Much Information, let’s call them TMIs, for the purposes of this post.

If the topic were TMI‘s favorite team, he would hardly be complaining that there is Too Much Information.

If the topic were TMI‘s favorite centerfold, he would hardly be complaining that there is Too Much Information.

The problem seems to be that TMI doesn’t care enough to obtain more information. Why have such a person in a job that involves caring.

A different problem with Too Much Information is in the ability to prioritize that information. This is not deciding that there is Too Much Information, rather determining how much information is important right now.

When we are on scene with a stable patient, how much information do we obtain before transport? What if the only source of the information is a family member – someone who cannot accompany the patient?

How much is too little information?

How much is enough information?

How much is too much information?

Are there other ways of obtaining the information? Can a nurse call from the hospital to gather more information after the patient is in the ED (Emergency Department)? How long do we delay transport to obtain more information?

Part of this can be dealt with by asking questions in a way to best obtain the most relevant information. However, we don’t always know what that way is. Which of the patient’s chronic illnesses – each with repeated complications that end with ED admissions – which of these do we not obtain a thorough history about with this stable patient?

We can come up with all sorts of BS excuses for not obtaining information, such as the need to get back in service quickly, but should we do an incompetent job just to keep to some imaginary schedule?

What about when we are on scene with an unstable patient? A lot of the information we would like is only available on scene. What do we do?

How much is too little information?

How much is enough information?

How much is too much information?

Since the patient is unstable, the option of camping out until we have all of the information we would like, is not one that will lead to the survival of the patient. We need to make certain decisions about how much is enough information right now.

What will a TMI do in that situation?

How would a TMI possibly understand?

TMIs are not understanding people.

TMIs are the people who should be working at jobs that do not require any decision making skill or any understanding of risk management, because TMIs are dangerous when permitted these responsibilities.

On what do TMIs base their decisions, if they have intentionally limited their preparation for the job?

Risk management has a lot to do with making decisions based on limited information.

Risk management requires an understanding of what is enough information given the limitations of the job.

Risk management for EMS involves working with limited equipment. limited personnel, and limited information.

Risk management for EMS cannot work with arbitrary traditional restrictions on the ability to exercise critical judgment, not if we are interested in doing what is best for the patient.

Some of us believe in luck.

Some of us pray to luck.

I prefer to make my own luck.

How do we make our own luck?

We don’t just prepare, we over-prepare.

That is luck?

No. That is preparation. That is having more than the lowest common denominator amount of information.

We do not know what we will be presented with on each call, so how do we know which information we will not need? How would we know, ahead of time, what is not necessary – what is too much?

Some people like using the 5 Ps to describe how to approach this.

Proper Planning Prevents Poor Performance.

Some extend it to 6 Ps.

Proper Planning Prevents Piss Poor Performance.

Either way, you get the idea. This is completely incompatible with claiming, Oh no. That is Too Much Information.

How do we know which information we will not need?

We don’t.

Only a fool would believe that he is smart enough to know what information he does not need, when he is still learning. Because of this prejudice, some never learn.

The problem seems to be that TMI doesn’t care enough to obtain more information. Why have such a person in a job that involves caring.

How do we know what we need to know?

Can someone, especially someone who intentionally limits the information he has, ever know?

From the quotes I have in the sidebar –

In the fields of observation chance favors only the prepared mind. – Louis Pasteur.

What these TMIs are saying is that they are too good to prepare to take care of patients, because the patients are not important to the TMIs.

EMS is not about the First Responder.

EMS is not about the EMT.

EMS is not about the Medic.

EMS is not about the Nurse.

EMS is not about the Doctor.

EMS is about the patient.

Competent EMS personnel insist on being prepared with more than enough information, in order to be best prepared for as much as is practical.

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Comments

  1. Gathering patient information is always a difficult thing. Some patients may have not much of a history which does make it easy, but some patients have multiple problems that we may never have heard of before. A trick I always use when I cannot get a person onscene who knows more about the patient is to get a phone number where they can be reached if the hospital has more questions then what I could get answers for.

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