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Trauma, OODA Loops, & Bread Baking

Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

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Page 1: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Trauma,OODA Loops,

& Bread Baking

Page 2: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 3: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

System I

fast, automatic, impulsive, emotional,

and unconscious

System II

slow, reflective, deliberative, rational,

and conscious

Page 4: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 5: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

System I condemned as

heuristics, satisficing, non-

optimal or barely good enough

Page 6: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Expertise?

Page 7: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

BakingBread

Page 8: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

No System II Here

Page 9: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
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What aboutan expert-levelresuscitation?

Page 11: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Optimal Resuscitation

is a System I Game

Page 12: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

STC

Page 13: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Organic

Page 14: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Calm/joking

Page 15: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Not theregimented

ABCD

Page 16: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 17: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Why I Hate

ATLS

Page 18: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

If you don’t treat trauma patients frequently, an

ATLS course provides an easy method to

remember for evaluation and treatment of a

trauma victim.

--ATLS Website

Page 19: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

But what if you do treat traumafrequently…

Page 20: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 21: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Cognitive Fail

Page 22: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

IgnoresExpertise

Page 23: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

ATLS is anattempt at

Task Decomposition

Page 24: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Protocols &Guidelines

Page 25: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

A simulacrum of a System I Game for

System II levelPlayers

Page 26: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Best for controlled, simple

domains

Page 27: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

ATLS(and any procedural decomposition)

eliminatesany expertise

benefits

Page 28: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Novicesestablishesa baseline

(albeit an ok, but not great one)

Page 29: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Experts

Slow,Painful, &

Wrong(even when designed by that expert)

Page 30: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 31: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 32: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
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How Should We Approach Resus?

Page 34: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 35: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

John Boyd

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ArtofMan

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What the OODA Loop is and isn’t

Page 38: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Who We

Are

Page 39: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Observe

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If weObserve the

Wrong Things

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PulseRate

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Classes ofShock

Page 43: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

See Response to Crystalloids

Prior to Blood

Page 44: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Log RollSpine Exam

Page 45: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Observe the Right Things at the Wrong Time

Page 46: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

RSI beforeNeuro Exam

Page 47: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Observe the Right Things at the Right Time

Page 48: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient

Who We

Are

Page 49: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

MostImportant Part

of the Loop

Page 50: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Processingconscious orsubconscious

Page 51: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

How do we Observe the

Right Things at the Right Time?

Page 52: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 53: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

We need to lookin order to see

Page 54: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

We need to knowin order to look

Page 55: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient

Who We

Are

Page 56: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

ATLSis Empiric

Observation without

Orientation

Page 57: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

We can not see what we do not

know

Page 58: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Ideal Orientation leads to instant

grasp of the situation

Page 59: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient

Page 60: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Who we Areis

How we Orient

Page 61: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Boyd’s Mental Models for Military Orientation

Mathematical LogicPhysics

ThermodynamicsBiology

PsychologyAnthropology

Conflict (Game Theory)

Page 62: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient

Who We

Are

Page 63: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

*Knowledge*Experience

*Mindset/Stress*Affective

Dispositions to Respond (ADRs)

Page 64: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

MentalPreparation

Page 65: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Lateralization&

Cross-Training

Page 66: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

OptimalOrientation=SpeedOrientation=Tempo

Page 67: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Optimal Orientation

in the Resus Bayis a

System I Game

Page 68: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need
Page 69: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

PatternRecognition

Page 70: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

IllnessScripts

Page 71: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Decide(Hypothesize)

Who We

Are

Page 72: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Decide(Hypothesize)

Who We

Are

Page 73: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient toAct

Page 74: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Orient to Act

Page 75: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Fingerspitzengefühl

Page 76: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Fingertip Feel

Page 77: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

BakingBread

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Illness Scriptlinked to

Action Scripts

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Pattern Matching Based on Prior Experience/ Knowledge

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Will it work?

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Act(Test)

Page 85: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Execution GapDecision to

Completed Action

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Speed ofAction

Page 87: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Do Something:GET OFF THE X

Page 88: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Perturbate theSystem

Page 89: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Small movesto be able to re-observe

Page 90: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

OODA Loop

Page 91: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

A Bat and a Ball Cost $1.10

The Bat costs $1 more than the Ball.

How much does the Ball Cost?

Page 92: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Act toTest

Page 93: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Mess Up Your Opponents

Loop

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You

That Other Guy

Page 95: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

“…Every combatant observes the situation, orients himself…decides what to do and then

does it.

If his opponent can do this faster, however, his own actions become outdated and

disconnected to the true situation, and his opponent’s advantage increases geometrically.”

-John Boyd

Page 96: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

“Death is not the enemy, but

occasionally needs help with timing”

Rule #20Peter Safar

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You

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Plan forDecompensation

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OODA forError

OODA forImprovement

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AofMan

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Can ATLSTeach Trauma?

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ProceduralTask Lists

ErodeExpertise

Page 106: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

A simulacrum of a System I Game for

System II levelPlayers

Page 107: Trauma, OODA Loops, & Bread Baking...of the Loop Processing conscious or subconscious How do we Observe the Right Things at the Right Time? We need to look in order to see We need

Becomes the System I ofBad Players

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Mental ModelsIllness ScriptsAction Scripts

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Patterns/Scripts

Pulseless BluntPulseless Penetrating

Precordial Stab c HemoPelvic Trauma/Fast NegPelvic Trauma/Fast Pos

Head Inj/Abd InjLUQ Stab

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Experts’take on Cases

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Emergency Medicine Australasia 2015;27:152

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What the F*#&is going on?

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To Review

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All aboutSystem I

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ATLS/ACLSignore expertise

by Decomposing a System I Process

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These courses are a boon to novices

and a drag on experts

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OODA Loop Can Act as a

Framework for Analyzing

Resuscitative Thinking

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ABCDto

OODA

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Resuscitation is a game that should

be played by

EXPERTS

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Expert Resuscitation should be a

SYSTEM I Game

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Orient to Observe

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Orient to Act

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