911, What’s Your Emergency? The Cognitive Framework of Decision-Making in Prehospital Providers

In Emergency Medical Services (EMS), not only is the human body considered a complex "machine" but the variety of situations presented to EMS personnel are virtually limitless (Appel, 2019). EMS providers work in complex environments requiring time-sensitive interventions, under pressure, while performing high-stakes patient care. These environments require effective and accurate decision-making in order to achieve the desired patient outcome (Keebler, et al., 2017). This qualitative research study aimed to explore the cognitive framework, theories and concepts of decision-making in EMS providers-adopting both emic and etic research approaches as the primary method of data collection and review of scholarly journals. The research question answered is, “What medical scenarios and cognitive processes may influence prehospital providers (EMS personnel) decision-making in emergency situations and complex environments?” The conclusion is that EMS providers make decisions using a combination of System 1 and System 2 Dual-Process thinking. Intuition can be derived from the recognition of patterns and cues that are stored and recalled from the provider’s memory of former patients in similar emergency medical situations (Pelaccia et al., 2011). The availability heuristic may joggle reflections of former patients that presented with similar cues and patterns that can easily be recalled from the provider’s memory and aid in clinical decision-making. Medical scenarios where an EMS provider may exercise cognitive biases can be applied when the provider’s intuition or availability heuristic has a specific image of patient cues or pattern recognition from previous medical scenarios stored in their long-term or short-term memory.