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What are the factors that couls effect decision making?

- Intrinsic Factors

- Extrinsic factors

- Bias

- Anchoring


What is involved in Intrinsic factors

- Knowledge, experience, mood/psycology - fear, stress, fatigue


What is involved in extrinsic factors

- Environment, information, protocols/rules, lone-working


What is involved in Biases

- Confirmation bias, information bias, optimism bias


What is involved in Anchoring

- Relying heavily on a single piece of information


Why do we need decision making tools

- Reduce variability in triage or decision making

- Provide logical cues and memory aids in times of stress

- Rational vs Emotional

- Pre-frontal cortex vs Amygdala

- A link between intuitive and analytical decision making
(Sandhu 2006)

- Standardise care for patients, reduce mistakes

- As a compliment not a substitute for clinical judgement


Name the Tool Types


- Clinical Guidelines

- Algorithms

- Decision matrix

- NEWS, APGAR, GCS. Evidence based


Define Protocols

- Rigid directions or set of predetermined criteria that determine the providers actions to manage specific presentations – evidence based


Define Clinical Guidelines

- Recommends the care people should give for patients with specific conditions. UK Ambulance Service Clinical Practice Guidelines (AACE 2016), NICE, Resuscitation Council UK – best practice, evidence based. May include advice, prevention and long term management


Define Algorithms

- a process or set of rules to be followed. Evidence based and can include patient data


Define the Decision Matrix

- quantitative tool to rank/score options using set criteria to gain a total score


Examples of Tools

- NICE Paediatric Traffic Light

- Trauma triage tool

- ALS protocol

- Sepsis 6 / care bundle

- FAST Acute stroke

- Ottawa ankle rules

- NEXUS / Canadian C-spine rules



- Manchester Triage Score

-Wells score

- Paramedic Pathfinder


Some disadvantages to the using Tools

- Over-reliance – clouds clinical judgement

- Oversensitivity

- Not all tools suited to pre-hospital practice
Lengthy, time consuming
Evidence is for in-hospital patients

- Not all tools suited to all patients