Clinical Decision Making in a Team Context

Have you ever had one of those partners? The one you didn’t even need to speak to during the arrests, the profoundly collapsed CHF call, the multisystem trauma call? The one who had everything you needed in their hands as you felt your sphincter tighten and your heart rate increase? You turn and ask for an 16g in a big vein and they’re already doing it?  You mumble “maybe a NRFM?” and they’re already inflating the reservoir?  There’s a beauty to EMS when it runs like that, a precision and finesse that makes it look effortless.

For that call, and hopefully for many more, you were working with a shared mental model of what was wrong with the patient, what courses of action you had open to you, and how best to move the call forward to a good outcome.

You may have worked with that person a dozen years, or it could be your first call together.  You don’t need to be experienced to have that shared mental model.  Two brand new medics just out of school working on a classic EMS call are working from the same place of (over) confidence and unrecognized pitfalls, but from the same playbook of classic presentation and conservative treatment.

There are things you can do to enhance this, and improve your individual performance as well as that of your team, especially for uncommon procedures.  For those who don’t do thoracotomy or surgical airways, replace that with triage or childbirth. And it really works.

Classic cases are classic cases because they’re classic….