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