The Illusion of Attention                          How Did I Miss That?  Lt. Rommie L. Duckworth, LP  New England Center f...
Assessment    Assessment      Size UpSituational Awareness
Situational Awareness                 Defined as                 • “Knowing what is going on                   so you can ...
Situational Awareness• Intuition     • Expertise• Gut Feeling   • Sixth Sense• Hunch         • Feeling• Instinct      • In...
Situational Awareness?You can perceive many cues in theenvironment and still miss CRITICAL ones.You can perceive CRITICAL ...
Situational Awareness Situational Awareness / Attention Management is the prioritization of applying brain resources to:Vi...
Situational Awareness• Self - Assessment
It’s Right There!  Tunnel Vision
Situational Awareness• Self - Assessment1    2    3    4  5   6    7    8    9    10     11 12 13 14      15   16   17   1...
Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL                 CUES when paying att...
Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL                 CUES when paying att...
The Books
Neuroscience!
Who is Blind?You aren’t born to it.• No NOTICERS and MISSERSYou can’t train to it.• This program won’t “fix” you.There are...
Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL CUES when paying attention. Recogniz...
How it works• Sensorimotor Theory• The BRAIN perceivesthe BRAIN notices.      EYE perceives and and the EYE notices• Forge...
How it works
On the Road & In the Classroom
Expectations
How are we blind?What we look FOR isn’t what we’re looking AT.• We don’t need more eyes, we need more brains.What we look ...
Homework• Memory. Can you draw a penny?
Illusion of Attention Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recogniz...
The Next Step• Naturalistic Decision Making   • How people ACTUALLY make decisions.• Good News   • We can make rapid decis...
The Next Step• Signal Detection Theory   • A means to discern SIGNAL from NOISE• If we can raise SIGNAL with good attentio...
The Next Step• Thin Slicing  • A method to identify patterns in very “thin    slices” or “blinks” of time.• May maximize S...
The Next Step• Recognition Primed Decision Making  • Identify Patterns in the Signal.  • Select Action to achieve outcome....
The Next Step• The OODA Loop                             F-86 Sabre  • Col. Boyd     • Observe     • Orient     • Decide  ...
Illusion of Attention Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recogniz...
Beat the BlindnessCODE - Easy
CODE - Easy• Cognition: We need brains!  • Good Partner  • Teamwork  • Dispatcher Monitoring  • Crew Resource Management  ...
CODE - Easy• Observation: Sense and Perception  • Increase the Signal     • Systematic (not robotic) Assessment     • Good...
CODE - Easy• Distractors: The Medic needs quiet time!  • Decrease Noise     • Assessment Prioritization     • Checklists  ...
CODE - Easy• Experience: Knowing is half the battle!  • More slides in the slide tray.    • Education    • Simulation    •...
CODE - Easy• Easy: Off load from Working Memory  • A Lazy Medic is a good Medic    • Field Guides / Apps    • Checklists /...
Don’t Be Fooled!Understand that we overestimate our ability to identify CRITICAL                 CUES when paying attentio...
CODE - EasyCognition: We need brains!Observation: Perception & Information!Distractors: The Medic needs quiet time!Experie...
•   What this was not…•   What this was…•   Who I am…•   Who you are…• Because we are EMS,   and we’re here to help.
Cognitive Blindness in Emergency Services
Cognitive Blindness in Emergency Services
Cognitive Blindness in Emergency Services
Cognitive Blindness in Emergency Services
Cognitive Blindness in Emergency Services
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Cognitive Blindness in Emergency Services

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Call it size-up, assessment or situational awareness; the ability to perceive and interpret information is critical for managing any emergency incident. But when does focused concentration turn into tunnel vision? Sometimes the training and experience that we rely on to do our job can make us perceive and even recall events very differently than they actually are, sometimes with disastrous results. Using a step-by-step approach, this program discusses how to develop the ability to better direct attention to critical cues without losing sight of additional information vital to the emergency.

Teaching Formats:
-Lecture
-Interactive Role Play
-Question and Answer

Learning Objectives: Students will learn:
-Both the importance and the danger of focus and attention to detail in emergency services.
-How to manage distracters and minimize the impact that they have on our attention.
-How we overestimate our ability to perceive, process and recall information, especially during emergency operations.
-How preparation and training can impact what we think we see and hear on calls, both positively and negatively.
Find more at www.romduckworth.com

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  • LIFE SAFETY!
  • OPPORTUNITY for LIFE SAFETYHERE TO HELP
  • DEFINITION
  • We “FEEL” that our guts will always lead us to always notice and act on critical cues.
  • Are we looking INTO these items (implications) or simply AT them (past them).
  • Baloon frame example.
  • We aren’t all “above average”
  • implies that they were IGNORING something important.Not what they were looking AT, Not what they were looking FOR.
  • We aren’t all “above average”
  • OBJECTIVES
  • Starting with
  • This is the book that inspired this program.SAY NOTHING!Thank you.
  • CHIEF’S HELMETS
  • Mud SplashRaise Your Hand When You See It
  • Mud SplashRaise Your Hand When You See It
  • Monitoring the Progress of a Fire
  • Where to look!What to look for!
  • WHY? Memorywill be both incomplete and flawed.
  • Col. John Boyd in VietnamF-86 Sabre vs MiG 15
  • “Solutions” - Because we’re the fire service and I’m here to help.
  • Automatic Mutual Aid, Etc.
  • The purpose of this presentation was to help make you confident that you were not falling prey to common cognitive illusions so that you could make better, faster decisions with more confidence.
  • Cognitive Blindness in Emergency Services

    1. 1. The Illusion of Attention How Did I Miss That? Lt. Rommie L. Duckworth, LP New England Center for Rescue and Emergency Medicine, llc.
    2. 2. Assessment Assessment Size UpSituational Awareness
    3. 3. Situational Awareness Defined as • “Knowing what is going on so you can figure out what to do." And • "What you need to know to not be surprised."
    4. 4. Situational Awareness• Intuition • Expertise• Gut Feeling • Sixth Sense• Hunch • Feeling• Instinct • Insight
    5. 5. Situational Awareness?You can perceive many cues in theenvironment and still miss CRITICAL ones.You can perceive CRITICAL CUES and stillnot be able to make SENSE of them.
    6. 6. Situational Awareness Situational Awareness / Attention Management is the prioritization of applying brain resources to:Visiting Nurse is Concerned Trouble Breathing Allergic to Peanuts!!! Distress, Dyspnea,Recent Antibiotic Prescription Tachypnea, Identifying Inhalers PERCEPTION – 1CuesSister has medical Power of Attorney Wheezing, Old stHad a lovely time at the flower show on Wednesday! Pulse 118 bpm Sensemaking 32/min. BP 180 / 100 Respirations PROCESSING – 2ndECG = Sinus Rhythm w/ PVCs AsthmaSpO2 88% Weak !!!!!!! Leg Pain Diaphoretic Anxiety EtCO2 28% PREDICTINGSurgery in 2004 for cysts. Urine has been “green-ish” Pale!! Elderly Problem Nebulizer Solving 3rd Petechiae Now
    7. 7. Situational Awareness• Self - Assessment
    8. 8. It’s Right There! Tunnel Vision
    9. 9. Situational Awareness• Self - Assessment1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19• Raise your hand when you see the mitsake
    10. 10. Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings. Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS
    11. 11. Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.Understand how ATTENTION and SITUATIONAL AWARENESS inteiygrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS
    12. 12. The Books
    13. 13. Neuroscience!
    14. 14. Who is Blind?You aren’t born to it.• No NOTICERS and MISSERSYou can’t train to it.• This program won’t “fix” you.There are controls that you can put in place.• Recognition is the first Assessment technique.
    15. 15. Illusion of AttentionUnderstand that we overestimate our ability to identify CRITICAL CUES when paying attention. Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS
    16. 16. How it works• Sensorimotor Theory• The BRAIN perceivesthe BRAIN notices. EYE perceives and and the EYE notices• Forget the Retina!
    17. 17. How it works
    18. 18. On the Road & In the Classroom
    19. 19. Expectations
    20. 20. How are we blind?What we look FOR isn’t what we’re looking AT.• We don’t need more eyes, we need more brains.What we look AT isn’t what we’re looking FOR.• We need a systematic method and practice.What we see is what we expect.• We need EXPERTISE, not EXPECTATIONS.What doesn’t move, doesn’t groove.• We need outside stimulus.
    21. 21. Homework• Memory. Can you draw a penny?
    22. 22. Illusion of Attention Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings. Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS
    23. 23. The Next Step• Naturalistic Decision Making • How people ACTUALLY make decisions.• Good News • We can make rapid decisions with poor info.• Bad News • We tend to this even if good info is available.
    24. 24. The Next Step• Signal Detection Theory • A means to discern SIGNAL from NOISE• If we can raise SIGNAL with good attention• And reduce NOISE by ignoring distractions• Then we can make better decisions.
    25. 25. The Next Step• Thin Slicing • A method to identify patterns in very “thin slices” or “blinks” of time.• May maximize SIGNAL• Minimize NOISE• More time/info only adds more NOISE.
    26. 26. The Next Step• Recognition Primed Decision Making • Identify Patterns in the Signal. • Select Action to achieve outcome. • Compare with previous similar experiences. • Implement Action or Alter Action. • Relies upon Attention and Perception.
    27. 27. The Next Step• The OODA Loop F-86 Sabre • Col. Boyd • Observe • Orient • Decide MiG 15 • Act • Perception > Equipment
    28. 28. Illusion of Attention Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings.Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS.
    29. 29. Beat the BlindnessCODE - Easy
    30. 30. CODE - Easy• Cognition: We need brains! • Good Partner • Teamwork • Dispatcher Monitoring • Crew Resource Management Tip
    31. 31. CODE - Easy• Observation: Sense and Perception • Increase the Signal • Systematic (not robotic) Assessment • Good Protocols • Guiding Policies and Procedures • Concise, systematic Hand-Off Reports
    32. 32. CODE - Easy• Distractors: The Medic needs quiet time! • Decrease Noise • Assessment Prioritization • Checklists • Good Scene Management
    33. 33. CODE - Easy• Experience: Knowing is half the battle! • More slides in the slide tray. • Education • Simulation • Visualization • Practice • Mentorship
    34. 34. CODE - Easy• Easy: Off load from Working Memory • A Lazy Medic is a good Medic • Field Guides / Apps • Checklists / Tactical Boards • Automated Assessment • Streamlined Protocols and Algorithms
    35. 35. Don’t Be Fooled!Understand that we overestimate our ability to identify CRITICAL CUES when paying attention.Recognize the function and limits of the human mind to PERCEIVE and PROCESS its surroundings. Understand how ATTENTION and SITUATIONAL AWARENESS integrates with DECISION MAKING. Identify methods to OVERCOME INATTENTIONAL BLINDNESS.
    36. 36. CODE - EasyCognition: We need brains!Observation: Perception & Information!Distractors: The Medic needs quiet time!Experience: Knowing is half the battle!Easy: A Lazy Medic is a Good Medic!
    37. 37. • What this was not…• What this was…• Who I am…• Who you are…• Because we are EMS, and we’re here to help.

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