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Threat assessment, sense making, and critical decision-making in police, military, ambulance, and fire services

Threat assessment, sense making, and critical decision-making in police, military, ambulance, and... Military and emergency response remain inherently dangerous occupations that require the ability to accurately assess threats and make critical decisions under significant time pressures. The cognitive processes associated with these abilities are complex and have been the subject of several significant, albeit service specific studies. Here, we present an attempt at finding the commonalities in threat assessment, sense making, and critical decision-making for emergency response across police, military, ambulance, and fire services. Relevant research is identified and critically appraised through a systematic literature review of English-language studies published from January 2000 through July 2020 on threat assessment and criti- cal decision-making theory in dynamic emergency service and military environments. A total of 10,084 titles and abstracts were reviewed, with 94 identified as suitable for inclusion in the study. We then present our findings focused on six lines of enquiry: Bibliometrics, Language, Situation Awareness, Critical Decision Making, Actions, and Evaluation. We then thematically analyse these findings to reveal the commonalities between the four services. Despite existing single or dual service studies in the field, this research is significant in that it is the first examine decision making and threat assessment theory across all four contexts of military, police, fire and ambulance services, but it is also the first to assess the state of knowledge and explore the extent that commonality exists and models or practices can be applied across each discipline. The results demonstrate all military and emergency services personnel apply both intuitive and formal decision-making processes, depending on multiple situational and individual factors. Institutional restriction of decision-making to a single process at the expense of the consideration of others, or the inappropriate training and application of otherwise appropriate decision-making processes in certain circumstances is likely to increase the potential for adverse outcomes, or at the very least restrict peak performance being achieved. The applications of the findings of the study not only extend to facilitating improved practice in each of the individual services examined, but provide a basis to assist future research, and contribute to the literature exploring threat assessment and decision making in dynamic contexts. Keywords Situational awareness · Decision making · Firefighter · Police · Ambulance · Military · Recognition primed · Heuristics · Bias · Threat assessment 1 Introduction * Greg Penney Effective emergency response to natural events, such as greg.penney@dfes.wa.gov.au earthquakes, and deliberate events, such as terrorist attacks, involves the anticipation of emergency events and the actions Department of Fire and Emergency Services, Perth, Australia taken during and immediately after to ensure that its affects are minimized (AIDR 2013). Within police, military, ambu- South Australian Metropolitan Fire Service, Adelaide, Australia lance and fire service contexts this requires that responding personnel can (1) accurately make sense of dynamic and St John Ambulance Western Australia, Perth, Australia unfamiliar environments, (2) assess potential opportunities School of Psychology, Murdoch University, Perth, Australia and threats to develop response plans, and (3) make critical Biosecurity and One Health Research Centre, Harry Butler decisions under significant time pressures (Cohen-Hatton Institute, Murdoch University, Perth, Australia et  al. 2015; Perona et al. 2019; Penney 2019; Reay et al. Edith Cowan University , Perth, Australia Vol.:(0123456789) 1 3 424 Cognition, Technology & Work (2022) 24:423–439 2018). When confronted with a structure fire emergency, for and leveraged. A common understanding between services example, a fire officer must process large amounts of visual could then be developed, and existing research could be and auditory information within short timeframes, including translated from service area to another. In turn this could fire behavior, the location of casualties, available resources, promote research and resulting theories around emergency and the construction of the structure involved. Simultane- management that are service general rather than service ously, they must be formalizing plans and contingencies to specific. maximize the opportunity to rescue casualties, and to con- Here, we present an attempt at finding the commonalities tain and extinguish the fire whilst also managing operations in threat assessment, sense making, and critical decision- within the incident area and minimizing risk to responding making for emergency response across police, military, firefighters. The cognitive processes associated with these ambulance, and fire services. We present a review of rel- abilities are complex (Reay et al. 2018; Stanton et al. 2009), evant research across these areas of research and across these susceptible to bias (Kahneman 2011; Seiler et al. 2010) and emergency services. First, we describe our aims and objec- difficult to master (Perona et al. 2019). tives, follow by our method. We then present our findings Where incidents increase in scale and complexity, impact- focused on five lines of enquiry that are relevant to emer - ing large populations and geographic areas, response can gency management: Language, Situation Awareness, Critical last weeks or even months. Incidents now regularly cross Decision Making, Actions, and Evaluation (terms defined regional, state, and national borders, resulting in a greater in “ Sect.1.1” below). We then consolidate these findings to need to share information across agencies and for coordi- reveal the commonalities between the four services. nated inter-agency response (Wilkinson et al. 2021). This This study is significant in that not only is it is the first subsequently poses additional challenges for decision- to bridge this gap and examine decision making and threat makers (Alison and Crego 2008; Comfort 2007; Flin 1996; assessment theory across the multiple contexts of military, House et  al. 2013; Pollock 2013; Coskun and Ozceylan police, fire and ambulance services, but it is also the first 2011). Front line responders and incident managers alike to assess the state of knowledge and explore the extent that must cooperate with different people in different organiza- commonality exists and models or practices can be applied tions. In the UK, representatives from several organizations across disciplines. The applications of the findings of the form Strategic Coordinating Groups that include fire, police, study not only extend to facilitating improved practice in ambulance, civil resource organizations, health agencies, each of the individual services examined, but provide a and government (Wilkinson et  al. 2021). In the US and basis to assist future research, and contribute to the literature Australia equivalent personnel and agencies form Incident exploring threat assessment and decision making in dynamic Management Teams (AIDR 2013; NIFC 2021). However, contexts. the challenge of multiple agencies in working together effec- tively during large scale disasters is ongoing (Alison and 1.1 Aims Crego 2008; Wilkinson et al. 2021; Pollock 2013). It is tempting to think that the cause of the problem is The scope of this study is multi-disciplinary, covering one of communication breakdown between different person- nel from differing agencies, and so collective understanding dynamic environments within civilian emergency services of policing, prehospital ambulance care, firefighting, and of the situation and operational requirements being lost in translation. Rather, we suggest the cause is that each service military operations. We aim to distill research in threat assessment, sense making, and critical decision making in member is viewing the situation quite differently, through the lens of their training and standard operating proce- dynamic emergency service and military environments. We also aim to discern the commonalities between services. In a dure. In part this arises from variance in theories of deci- sion making and threat assessment (Coskun and Ozceylan similar approach to House et al. (2013), the aim was decon- structed into six distinct lines of enquiry: 2011), which ultimately guides operational response. And, traditionally, these theories have been segregated by ser- 1. Bibliometrics, allowing the ‘spread’ of research to be vice stream. The human factors of firefighters, paramedics, police, and military personnel are considered in isolation categorized by research design, service type, country of origin, year of publication, and, publication area; despite the similar circumstances of their dynamic and high consequence environments. 2. Language, the terminology, definitions and descriptions within the research; We posit that these services share greater similarities in operation and theory than previously identified. We suggest 3. Situational Awareness (SA), threat assessment and sense making; that progress can be made to improve inter-agency coor- dination as well as performance within individual service 4. Critical Decision Making (CDM), the process used to decide on a course of action; contexts if commonalities between services can be discerned 1 3 Cognition, Technology & Work (2022) 24:423–439 425 5. Actions, the tasks both attempted and completed to exe- cute the decision; and 6. Evaluation, the reflection of the decision and subsequent actions to determine whether or not a “good decision” has been made. Whilst the justification for bibliometrics is self-explana- tory, an iterative approach (Morgan and Nica 2020) to select- ing lines of enquiry 2 to 5 was applied. In this way, initial lines of inquiry were revised by the research team during the conceptual phase of the study and refined, with the final lines of inquiry designed to bring meaning and identity a recurrent trends and variant manifestations as described by DeSantis and Ugarriza (2000). As such, the lines of enquiry were designed to capture and unify the nature or basis of the various context specific studies into a meaningful whole (DeSantis and Ugarriza 2000). 2 Method Adapting the approach applied by House et al. (2013), this systematic review adhered to the set of scientific methods described by Petticrew and Roberts (2006) to limit bias. The resulting review presents a narrative approach adapted from Perona et al. (2019), and Launder and Perry (2014). The pro- cess comprised of four distinct phases (Fig. 1): (1) system- atic identification of relevant studies; (2) critical appraisal of studies; (3) bibliometrics and narrative synthesis of data; and, (4) thematic analysis of findings. To achieve this a sys- tematic literature review was completed. 2.1 Phase 1: systematic identification of relevant studies To retrieve a large proportion of varied studies the search strategy was designed to be ‘highly sensitive’, as opposed to a ‘highly specific’ study which identifies a smaller num- ber of more specific studies (Petticrew and Roberts 2006). Literature meeting the following criteria was included in the Fig. 1 Phases of the study analysis: published peer-reviewed studies; reports; consen- sus guidelines; academic center, or professional association protocols detailing SA & CDM in civilian emergency ser- in the last twenty years (2001–2020) to ensure currency of evidence. Seminal papers from outside the date range vice or military environments; statistical analysis; and post- incident reviews, inquiries, and inquests after incidents, pub- were considered for inclusion where appropriate. Data- bases included Australian Federal Police Digest (Informit lished by government and non-government organizations. The search strategy included only terms relating to, or SA AFPD); ProQuest; Sage Journals Online; Science Direct; PubMed; and Cochrane Library. Non-English speaking & CDM in dynamic emergency service and military envi- ronments (Table 1) that were identified during the prelimi- literature, abstracts, citations, thesis, unverified or unsub- stantiated opinion pieces, press or news media reports, non- nary literature review when determining the feasibility of the full study. A secondary search of bibliographies identified peer reviewed conference proceedings, articles that are not related to threat assessment and decision making in these further literature for inclusion. Completed in October 2020, the review included English-language papers published environments were excluded. 1 3 426 Cognition, Technology & Work (2022) 24:423–439 Table 1 Search terms used in the systematic literature review Sources Informit AFPD, ProQuest, Sage Journals Online, Science Direct, PubMed and Cochrane Library Search terms (Military OR Soldier OR Paramedic OR Ambulance OR Fire* OR Wildfire OR Bushfire OR Polic* OR Law Enforcement OR Command*) AND (Decision OR Risk OR Threat Assess- ment OR Dynamic) Limits English Language AND Published Between 2001 and 2020 Two review authors (GP & JC) independently tested the guide new findings and conclusions (Fielding and Thomas search criteria and completed the initial search. 2001). Data were initially quantitatively analysed, allowing the 2.2 Phase 2: critical appraisal of studies ‘spread’ of research to be categorized by research design, service type, country of origin, year of publication, and pub- The initial search strategy yielded 10,084 studies for poten- lication area. Research design was categorized as qualitative tial inclusion. Three authors (GP, JC & DL) completed this (did not yield numerical data/analysis), quantitative (yielded process, with each stage initially completed independently numerical data/analysis) or mixed method. Publication area by each author before group evaluation occurred. At each was categorized as detailed in Table 2. stage, a minimum of two of the three authors in the process Three authors (GP, DL, JC) completed the initial narrative had to agree for a study to progress to the next stage of synthesis in line with the five remaining lines of enquiry: review. Using this process, of the 10,084 records identified Language, Situational Awareness (SA), Critical Decision through the initial search strategy, 377 (excluding dupli- Making (CDM), Actions, and Review. In an attempt to mini- cates) had titles that were broadly identified as potentially mize bias that may develop by the authors working closely relevant to the current study and progressed to a review of together on the study over a period of time, the fourth author the abstract. The process was repeated with the abstracts (MT) was deliberately excluded from the initial synthesis reviewed against the eligibility criteria of the study, with and subsequently provided detailed critique and deliberate 135 progressing to full manuscript review. Ninety-four (94) challenge once the initial review was complete. Any disa- studies were ultimately included in the study. Results are greements were resolved through discussion. presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist 2.4 Phase 4: thematic analysis (Fig. 1). Applying the approach described by House et al (2013, Thematic analysis is a method for identifying, analysing p. 3), a framework of assessment quality was established to and reporting patterns or themes within the data (Braun and critically appraise the 94 included studies. The framework Clarke 2006). An inductive thematic analysis, which seeks appraised studies for their internal validity (the degree to to identify broad trends arising from the literature itself which the research design, analysis and presentation have (Braun and Clarke 2006), was applied to the results of lines avoided biased comparisons), their external validity (the of enquiry two to six, being: Language, Situational Aware- extent to which one can generalize findings to other set - ness (SA), Critical Decision Making (CDM), Actions, and tings) and the appropriateness of the data analysis and pres- Review. In the context of the study, a centralized theme of entation. The findings of this analysis assisted prepare the commonality, or sharing of language, theories and processes reviews of each included study, which are provided as a sup- was realized and explored. Applying the same approach as plementary file to this main manuscript. step three, three authors (GP, DL, JC) completed the initial The fourth author (MT) deliberately did not participate in thematic analysis, whilst the fourth author (MT) provided the initial selection or synthesis of included studies, rather detailed critique and deliberate challenge once the initial performing the role of ‘red teaming’, in other words he delib- analysis was complete. Any disagreements were resolved erately and critically attacked the study method and analyses through discussion. in an effort to overcome cognitive errors including group think and confirmation bias.. 3 Findings 2.3 Phase 3: bibliometrics and narrative synthesis 3.1 Enquiriy line one: bibliometrics The narrative synthesis of findings was selected as it has proven useful for providing a comprehensive picture of the Database searches yielded a total of 10,084 articles, how- subject matter in question (McNeill and Chapman 2005) to ever, less than 1% (n = 94) met the full inclusion criteria 1 3 Cognition, Technology & Work (2022) 24:423–439 427 Table 2 Publication area Category Description categories and descriptions Emergency management The organization and management of the resources and responsibilities for dealing with all humanitarian aspects of emergencies (prepared- ness, response, mitigation, and recovery) Emergency medicine Medical and paramedical care in the prehospital environment Fire technology Fire science (not a trade magazine) Human factors Ergonomics—human abilities and limitations Medicine Medicine in the hospital and clinic environment Military Military studies (not including military psychology) Nursing Nursing care and related studies Policing Police trade journals Psychiatry Psychiatry specific journals Psychology Psychology specific journals (including military psychology) Risk Risk assessment and management Safety Safety and occupational health hand safety Not otherwise classified Not otherwise classified and were selected for the study (refer to the Supplemen- the UK and USA equally published the most studies relating tary Table S1). Seminal research, theories and definitions, to military contexts (n = 5). for example, work by Endsley (1995), and Kahneman and By year of publication, 2018 to 2020 collectively Klein (2009), did not meet the specific search criteria but accounted for 39% (n = 37) of all studies, with the remain- were cited by multiple included publications. They are, ing years resulting in a mean 3.3 studies published per year. therefore, discussed as an additional text to this study but Analysis by year of publication and service identified 78% is not included as part of the systematic search results. A (n = 18) of all ambulance paramedic related studies were majority of all studies (n = 52) utilised a qualitative research completed between 2011 and 2020. By comparison, 80% methodology that did not result in the creation of numeri- (n = 12) of all firefighting related studies, 58% (n = 14) of cal data, 17% (n = 16) used a quantitative methodology, all military related studies, and 84% (n = 26) of all police and 29% (n = 27) used a mixed method approach. Of the related studies were published in that same date range. qualitative studies 18 were literature reviews. A further four Of the 94 publications, only four authors (Anderson, were systematic literature reviews having a mean 27.5 stud- Cohen-Hatton, Jensen, and Shortland) published more than ies included for analysis. By service type, research related one study meeting the criteria. Whilst Shortland published to ambulance paramedics accounted for 24% (n = 23) of three studies and examined both police and military con- the studies, firefighting for 16% (n = 15), military for 26% texts, the remaining authors published two studies each and (n = 24), police for 33% (n = 31), and blended research within a single service context. across services accounting for only 2% (n = 2). None of the The results of the descriptive analysis suggest that literature included in the study addressed more than two research into threat assessment and decision-making has service types. been historically ‘siloed’ from a service context perspec- By publication area, Psychology accounted for the highest tive, without institutional consideration of how results and number of included studies at 29% (n = 27), with Emergency lessons learned may be applied across service contexts and Medicine (prehospital) accounting for the second highest at jurisdictions. The recent popularity of research into the field 19% (n = 18), and both Medicine and Emergency Manage- (40% of the studies being published since 2018), in addition ment accounting for the third highest at 5% (n = 5 each). The to the limited number of authors with multiple publications, remaining studies were reasonably distributed throughout suggests that the study of threat assessment and decision- publication areas. By country of origin, the USA and UK making, whilst not a new field, may be far from mature in tied for the most research at 23% (n = 22), with collaborative regard to the identification of best practice decision making research across countries accounting for 12% (n = 11), and methods that are transferable across services and the var- Australia accounting for the third highest at 11% (n = 10). ied contexts in which they must be applied. Our research Analysis by country of origin and service identified the UK suggests that there may be far more commonality regarding published the most studies in the ambulance (n = 9), Aus- decision-making theory and processes between service con- tralia published the most firefighting studies (n = 5), the USA texts than is currently acknowledge within both the academia published the most studies related to policing (n = 14), and, and the services themselves. 1 3 428 Cognition, Technology & Work (2022) 24:423–439 3.2 Enquiry line two: language 3.3 Enquiry line three: situational awareness Whilst absolutely consistency between service contexts During this initial phase, the decision-maker makes sense (and even to some degree within service contexts) was not of their surroundings by gathering and interpreting situ- found, similar terminology, definitions and descriptions ational cues to establish what is currently on what is likely were present within the literature reviewed. In particular, to happen. The most commonly applied term for this pro- fire services and the military regularly made reference to cess across firefighting and military literature is situational ‘situational awareness’ (Stanton et al. 2009; Launder and awareness (Cohen-Hatton and Honey 2015; Launder and Perry 2014; Marusich et al. 2016; Catherwood et al. 2012; Perry 2014; Shortland et al. 2018). Noting the identified Godwin et al. 2015; Shortland et al. 2018), or synonyms differences, the seminal definition of situational awareness including ‘assessment’ (Penney 2019; Martínez-Fiestas (SA) by Endsley (1995, p. 36), being the “perception of the et  al. 2020; Okoli et  al. 2016), ‘situation assessment’ elements in the environment within a volume of time and (Cohen-Hatton et  al. 2015; Cohen-Hatton and Honey space, the comprehension of their meaning, and the projec- 2015), ‘orientation’ (Seiler et al. 2010; Bryant 2006) and tion of their status in the near future”, appears to define the ‘perception’ (Dodd et  al. 2006; Martínez-Fiestas et  al. process of information gathering, analysis and understand- 2020; Prati et al. 2013). In these texts, clear distinction ing across the dynamic environments of all service contexts was made between situational awareness, decision-mak- (regardless of whether this process is considered intuitive ing, plan formation, plan execution and dynamic review or deliberate). The literature provides broad support that the which ultimately formed part of the decision-making development of situational awareness is a critical precursory process. Alternative terminology included ‘recognition’ phase of decision-making. For example, Cohen-Hatton et al. (Klein et al. 2010; Thomas 2020), whereby it was reported (2015), Perona et al. (2019), Penney (2019), Launder and firefighters intuitively analysed dynamic information, and Perry (2014), Marusich et al. (2016), Godwin et al. (2015). ‘anomaly detection’ (Curnin et  al. 2020) whereby the Endsley (1995) defines three levels of situational aware- study participant had to rely on critical analysis in the ness that remain applicable and relevant regardless of ser- absence of identifiable cues or patterns. By comparison, vice or situational context. Level I situational awareness within ambulance contexts the terms ‘decision making’, concerns knowing what information to look for and how ‘recognition’, ‘hypothetico-deductive reasoning’ or ‘fluid to obtain that information. Level II situational awareness sense making’ were applied (Ryan and Halliwell 2013). involves the comprehension and understanding of these Both military and police studies referenced ‘perceiving’, situational cues to establish an understanding of the current ‘threat assessment’, ‘high stress decision making’ (Akinci situation. Finally, level III situational awareness refers to the and Sadler-Smith 2020; Bonner 2018; Gamble et al. 2018; ability to use the available information and understanding Harris et al. 2017; Jederberg et al. 2002). of what is happening to accurately predict future situations. Consideration of ‘Naturalist Decision Making’, and Although different terminology is used, this requirement to ‘Heuristics/Biases’ approach (Launder and Perry 2014; identify and understand situational cues is consistently iden- Wilson et al. 2011; Akinci and Sadler-Smith 2020), ‘expe- tified across the literature and service contexts. rience’, ‘bias’ and ‘accountability’ was present across all There are specific differences in the nature of situational services (Cohen-Hatton et al. 2015; Perona et al. 2019; information that is required across police, paramedic, fire- Launder and Perry 2014; Marusich et al. 2016; van den fighting and military settings. For example, in high-risk Heuvel et  al. 2014; Gunnarsson and Warrén Stomberg police situations key situational information may include 2009; Bakken and Gilljam 2003; Banks et al. 2020; Nja the incident type in risk level, the location (open or con- and Rake 2009; Verhage et al. 2018; Vickers and Lewinksi fined), and the number of persons involved and the level of 2012). The theory of Recognition Primed Decision mak- public visibility. Consideration is also given to a potential ing was also cited repeatedly through the texts and across suspect’s build, gender, behavior and proximity. For exam- service streams (Cohen-Hatton et al. 2015; Cohen-Hatton ple, Harman et al. (2019), Hine et al. (2019), and Verhage and Honey 2015; Klein et al. 2010; Bonner 2018; Hine et al. (2018). In the literature describing paramedic decision- et al. 2019). making, an analogous patient diagnostic process is described ‘Morality’, ‘ethics’, and ‘moral/ethical decision mak- that highlights the required ability to critically analyse and ing’ themes were present across all services (Penney 2019; rapidly form clinical impressions with minimal information. Seiler et al. 2010; Harman et al. 2019; Ishoy 2016; Leibold For example, Perona et al. (2019), Reay et al. (2018), and et al. 2018; Murphy-Jones and Timmons 2016; Thompson Murdoch (2019). In addition to identifying clinical symp- et al. 2018), however, the full impact of these factors was toms, paramedics, like police officers must also consider the not universally explored. presence of bystanders and persons close to the patient being treated (Anderson et al. 2018). Furthermore, a distinction is 1 3 Cognition, Technology & Work (2022) 24:423–439 429 made between experts and novice paramedics, with experts and what it means (Kahneman and Klein 2009; Ågård et al. applying greater interconnectedness of conscious and sub- 2012; Harman et al. 2019). conscious processing to draw on information from multiple In contrast, experts have developed the ability to filter sources including professional learning and personal expe- (or batch) critical situational information thereby reducing riences (Perona et al. 2019). The same distinction is made the total amount of information requiring mental consid- between expert and novice military personnel in dynamic eration (Okoli et al. 2016). Experts employ interconnected high threat situations (Godwin et al. 2015). Similarly, the conscious and subconscious processes that draw information literature concerning firefighting also supports this need to from multiple sources that include professional training and obtain key situational information that may include life risk, personal experience (Perona et al. 2019). In these circum- visible smoke and flames behavior, fuel load, occupancy, stances the process of both identifying situational cues and utilities, and the presence of hazardous materials (for exam- establishing awareness of their meaning may be intuitive ple, Stanton et al. (2009), Launder and Perry (2014), Maru- and nearly instantaneous (Kahneman and Klein 2009; Bak- sich et al. (2016), and Catherwood et al. (2012)). ken and Gilljam 2003). Finally, experts may progress nearly There are commonalities in the information required instantaneously from observing situational cues, establish- across these first responder situations. For example, police, ing a mental model of what is happening and identifying a paramedics and firefighters frequently must gather situ- potential course of action (for example, Cohen-Hatton and ational information under intense time pressure (Penney Honey (2015), Kahneman and Klein (2009), and Launder 2019; Cohen-Hatton and Honey 2015; Launder and Perry and Perry (2014)). It is consequently reasonable to expect 2014; Ågård et al. 2012; Anderson et al. 2018). In addition experts and novices may apply different strategies for estab- to the cues that are specific to each industry, these decision- lishing situational awareness that shape how they subse- makers consistently seek information concerning the level quently make decisions. of perceived risk, the availability of resources to manage the risk/threat and the presence of victims or civilians any infor- 3.4 Enquiry line four: critical decision making mation considered (for example, Penney (2019), Ågård et al. (2012), Anderson et al. (2019), and Hemmatjo et al. (2019)). The literature identifies that personnel employ a range (or Next, as information is gathered it is used to establish spectrum) of decision-making strategies, each defined by a mental model of the situation or schemata (for example, distinct characteristics (Seiler et al. 2010; Launder and Perry Cohen-Hatton et al. (2015), Reay et al. (2018), and Kahne- 2014; Bakken and Gilljam 2003). man and Klein (2009)). This mental model summarises the The fastest decision strategies, including recognition key situational information into a holistic picture that tells primed, intuitive, value-based, or heuristics-based decisions the decision-maker what is going on, including the level are frequently classified as naturalistic (alternately Type 1 of risk/threat, the key factors that must be addressed, and or System 1) strategies (Kahneman 2011; Klein et al. 2010; potentially, how the situation will evolve (Endsley 1995). Kahneman and Klein 2009). These decisions may appear to The ability to develop and maintain effective situational seamlessly and instantaneously follow the development of awareness may be impacted by a range of factors. These situational awareness. Experts can apply these rapid deci- factors include both implicit and explicit biases (Harman sion-making strategies by immediately identifying infor- et al. 2019), the volume of information and time available mation they have learned is critical, rapidly developing a to process it (Penney 2019), cognitive limitations (Marusich mental model (schema) and recalling a satisfactory decision et al. 2016), and the extent to which a situation is threaten- or solution from prior experience (Klein et al. 2010; Godwin ing to themselves or their colleagues. For example, sensory et al. 2015; Oosterwold et al. 2018). Furthermore, experts processes in police officers are affected in personally threat- may be able to make decisions on the basis of level II situ- ening situations have reported ‘tunnel-vision’ when attention ational awareness (Cohen-Hatton et al. 2015; Cohen-Hatton becomes focused on potential weapons and other potentially and Honey 2015). Although differing terminology may be critical situational information may be missed (Akinola and applied, the literature describes the frequent use of these Mendes 2012; Harman et al. 2019; Verhage et al. 2018). rapid decision strategies by police, firefighting, paramedic Differences in the way novices and experts establish and and military personnel in low-time, high-risk settings (for maintain situational awareness is also identified in the litera- example, Cohen-Hatton et al. (2015), Bakken and Gilljam ture. For example, novices (and specifically inexperienced (2003), and Harman et al (2019)). paramedics) demonstrate reliance on rule-based aide-mem- A key advantage of these naturalistic decision strategies oires or checklists to ensure they consider critical factors and is the speed by which an effective decision can be made. patient symptoms (Perona et al. 2019; Anderson et al. 2018). Indeed, it has been posited that the management of low-time Therefore, novices must be informed, taught or advised what critical incidents such as fire require not only that accurate constitutes critical situational information (in their context), decisions are made; it also requires that such decisions are 1 3 430 Cognition, Technology & Work (2022) 24:423–439 made intuitively (Okoli et al. 2016). The majority of deci- evaluation) and the identification and comparison of multi- sions made by first responding fire officers are naturalistic ple options or courses of action. Prior to the development of (Cohen-Hatton et al. 2015; Cohen-Hatton and Honey 2015), naturalistic decision theory these formal strategies were used and more specifically recognition primed, including up to extensively to describe and teach decision processes across 80% of initial fire ground decisions (Klein et al. 2010). Simi- firefighting, policing, paramedic and most prominently, mili- larly, naturalistic decision strategies are described in low- tary settings (Klein et al. 2010; Banks et al. 2020; Shortland time policing situations that include ‘shoot or no shoot’ inci- et al. 2018, 2020a, b). dents (Harman et al. 2019; Verhulst and Rutkowski 2018). A finding from the literature is that formal decision strate- Military literature also describes the extensive use of a range gies remain in widespread use across the police, fire, para- of naturalistic decision strategies applied in dynamic situ- medic and military sectors (Penney 2019; Reay et al. 2018; ations. Sometimes referred to as combat dynamic intuition Seiler et al. 2010; Ågård et al. 2012; Akinci and Sadler- (Bakken and Gilljam 2003). This describes the ability of Smith 2020; Bakken and Gilljam 2003; Banks et al. 2020; military personnel to make nearly instantaneous decisions in Harman et al. 2019; Hine et al. 2019; Murdoch 2019; Okoli uncertain dynamic environments with low cognitive control et al.2016). In particular, the use of formal analytical deci- and low conscious awareness (Militello et al. 2015). The sion-making processes is supported in situations where there application of naturalistic decision strategies appears less is sufficient time to consider multiple options, for example, well defined in paramedic emergency situations. Although strategic military decisions that are not made in the field the use of these strategies by highly experienced paramedics (Seiler et  al. 2010; Shortland et  al. 2018, 2020a, b(a)), is supported, they are often described in conjunction with where the consequences of deviating from the described prescriptive processes and protocols such as the emergency process or previously identified solution are extreme, for ambulance triage system (Reay et al. 2018; Murdoch 2019). example, police shoot—no shoot situations and paramedic Furthermore, there are limitations to these naturalistic emergency triage situations (Ågård et al. 2012; Hine et al. decision strategies. First, their effective use is reliant on 2019; Murdoch 2019). Despite their potential rigor, the extensive prior experience in an area of expertise (Klein practical shortcomings of formal decision strategies in low- et al. 2010). They should not be applied by less experienced time environments have become more obvious (Okoli et al. decision-makers who are unable to filter and interpret key 2016). In low-time environments decision-makers can be situational information and recall a satisfactory solution overwhelmed by the influx of situational information (Banks from prior experience (Bang and Liwång 2016). Further- et al. 2020; Okoli et al. 2016). Furthermore, the need to fol- more, concerns were identified that these strategies may be low a prescribed sequential process when there is limited susceptible to misdiagnosis and decision errors, particu- time may cause considerable tension or anxiety (Reay et al. larly where a rapidly evolving situation is chaotic with time 2018). and emotional pressure (Perona et al. 2019; Marusich et al. A hard distinction between naturalistic decision and 2016; Murdoch 2019). Experienced personnel may make formal decision strategies may not accurately reflect a poor decisions through overconfidence in areas outside their more complex relationship between intuition and analysis own field of expertise (Kahneman and Klein 2009). Finally, observed in practice (Akinci and Sadler-Smith 2020). In naturalistic strategies may not be appropriate in new or novel particular, police and paramedics described challenges and situations where the decision-maker lacks an experiential stress associated with balancing the application of natural- base (Curnin et al. 2020). istic and formal decision strategies (Reay et al. 2018; Akinci Despite the reported limitations, a key finding from the and Sadler-Smith 2020; Verhage et al. 2018) during what literature is that the majority of initial decisions made in have been termed ‘fuzzy tasks’ (Verhulst and Rutkowski rapidly changing, high-risk and uncertain situations by per- 2018). Additionally, decision strategies based on over- sonnel across the sectors are naturalistic in nature (Cohen- learning of evidence-based knowledge such as procedures, Hatton and Honey 2015; Klein et al. 2010; Launder and guidelines/protocols, mnemonics and aide-memoirs may Perry 2014; Bakken and Gilljam 2003; Banks et al. 2020; also occupy a grey area in the middle of the decision-making Harman et al. 2019; Murdoch 2019; Okoli et al. 2016). spectrum (Perona et al. 2019). Procedures may be applied In contrast, decision strategies that involve the considera- by experts when performing recurrent or routine aspects of tion of multiple options are more time intensive. These strat- tasks (Kahneman 2011), or to provide a predetermined deci- egies, referred to as formal/classical (alternately Type 2 or sion for less experienced personnel (Perona et al. 2019; Reay System 2) include decision ladders, step-based protocols and et al. 2018; Seiler et al. 2010). procedures, complex problem-solving, creative, analytical In summary, personnel across the sectors establish situ- and rational decision-making. These formal decision strate- ational awareness and then make decisions using a range of gies share common elements including extended situational strategies from the potential spectrum. Although the major- analysis (for example, risk identification, assessment and ity decisions made by experts in low-time situations are 1 3 Cognition, Technology & Work (2022) 24:423–439 431 naturalistic decisions may also be made using formal ana- responsible for completing the physical tasks was considered lytical strategies when time is available, there is a prescribed an essential action (Launder and Perry 2014; Marusich et al. organisational solution to a high-risk problem or where the 2016; Bakken and Gilljam 2003; Verhulst and Rutkowski decision-maker is an experienced (Perona et al. 2019; Pen- 2018). The level of trust subordinates had in decision-mak- ney 2019; Curnin et al. 2020; Harris et al. 2017). ers was also identified as a factor influencing whether the Whilst the literature reviewed provides significant discus- subordinate would execute the directed action or complete sion regarding decision-making theory and methods, and their own analysis of the situation and take a different course what can affect an individual’s ability to make a decision, it of action (Marusich et al. 2016). does not directly address how to determine whether a deci- Where the decision-maker was also responsible for com- sion is indeed good or bad. From the research the resultant pleting actions, a number of findings were identified. In the outcome is paramount to whether a decision is considered absence of immediate personal threat and when faced with ‘good’ after the fact, perhaps the strongest example of this either high levels of uncertainty, situations not familiar to the is the multiple police shooter-simulation studies where per- responder, or where a fear of personally adverse outcomes ceived bias is heavily scrutinised. The question of whether are present, inexperienced personnel and those seeking outcome is indeed the most appropriate measure of the suit- confirmation of their decision theories are likely to be risk ability of a decision remains unanswered. It is also impor- adverse, default to following standardised protocols and may tant to consider that whilst an effective and correct decision ignore more dynamic and potentially beneficial processes regarding an outcome or action may be made, plan formation (Reay et al. 2018; Ågård et al. 2012; Anderson et al. 2018; and plan execution remain critical components to achieving Bakken and Gilljam 2003; Burrell et al. 2013; Knighton a satisfactory outcome. Indeed, the research suggests that 2004; Larsen 2001; O’Hara et al. 2015; Oosterwold et al. in many high threat and dynamic military, police, fire and 2018; Vickers and Lewinski 2012). In the presence of per- ambulance environments, even if a perfect decision is made ceived immediate personal physical threat, actions are more and effectively executed, the outcome may remain unsatis- likely to be self-preservative even when further analysis may factory or even bad, albeit not as bad as it had the potential have resulted in either the perceived threat being dismissed, to be. For example, consider an unavoidable situation that or more appropriate courses of action being identified (Cor - necessitates a difficult decision. A suitable decision-making rell et al. 2007; Gamble et al. 2018; Harman et al. 2019; process is followed, commensurate with the expertise and Lima and de Araujo 2018; Nieuwenhuys et al. 2015). In experience of the decision-maker, and results in the death such instances, there was some evidence to suggest there of two personnel. The potential outcome arising from any is little difference between inexperienced and experienced other decision, being the death of six personnel, is avoided. personnel in the time taken to complete the action, however, Without the worse outcome to compare the original result to, experienced personnel took less time to initiate that course how would the decision be reviewed? The limited research to of action compared to inexperienced personnel (Vickers and explore this area (Penney 2019) occurred in the firefighting Lewinski 2012). context and suggests that suitably experienced and qualified peers would be equally as likely to identify a decision as cor- 3.6 Enquiry line six: evaluation rect as incorrect across a range of incident contexts. The literature identifies two distinct forms of ‘evaluation’ 3.5 Enquiry line five: actions behaviors that occur across the industry contexts examined. First, there are dynamic review processes that occur during Analysis of the actions arising from the decision-making an extended situation where multiple decisions are made process was not addressed in the literature as the formation (Launder and Perry 2014; Ågård et al. 2012; Bakken and of situational awareness or the decision making process. One Gilljam 2003). Next, there are review behaviors and subse- aspect that was identified, however, was that regardless of quent actions that may be undertaken following the conclu- service, in the absence of translating decisions into timely sion of a situation to determine whether ‘good decisions’ and appropriate physical action, in other words ‘Plan Execu- have been made. tion’ (Cohen-Hatton et al. 2015; Cohen-Hatton and Honey Dynamic review occurs in the majority of incident set- 2015; Shortland et al. 2018), even ‘good’ decisions become tings where once one decision is made further decisions ineffective (Launder and Perry 2014; Bakken and Gilljam will usually be required subsequently (Banks et al. 2020). 2003; Harman et al. 2019). These processes involve the reconsideration of situational Where the decision-maker was in a position of command factors to identify whether, following the implementation authority and not personally able to complete the required of initial decisions, the situation has changed as predicted physical tasks, for example an Incident Controller or rank- (for better or worse) (Launder and Perry 2014). Consist- ing officer, clear and effective communication to those ent with the previous themes, prior experience influences 1 3 432 Cognition, Technology & Work (2022) 24:423–439 the effectiveness of this dynamic review across each of the no better alternative. For example, resuscitating decision- disciplines reviewed (Cohen-Hatton et  al. 2015; Perona making research designs commonly involve retrospective et al. 2019; Launder and Perry 2014; Banks et al. 2020). analysis of cardiac registry data and clinical records. How- First, experience allows decision-makers in complex, rap- ever, these methodologies may not capture the complex and idly evolving situations to more rapidly identify deviations idiosyncratic experience of resuscitating decision-makers or (or threats) from the predicted mental model and generate other operating in dynamic, high-risk situations (Anderson a larger number of possible causes and consequences to et al. 2019). explain events due to their broader perspective than novices Effective experiential learning may only occur under cer - (Launder and Perry 2014; Bakken and Gilljam 2003). Next, tain conditions: it requires accurate and immediate feedback highly experienced personnel are less likely to react emo- about the relation between situational conditions and the tionally or employ excessive force under stress than novices appropriate response (Kahneman 2011; Bakken and Gilljam (Harman et al. 2019). Furthermore, if emerging situational 2003). The inability to identify common and consistently cues imply intuitive decisions could be wrong, experienced applied review strategies in the literature may be sympto- decision-makers may shift to formal or system 2 strategies, matic of the broader lack of a common and consistent inci- replacing intuition with careful reasoning (Kahneman 2011; dent decision-making framework at this time. In the absence Kahneman and Klein 2009). of such a framework paramedic, fire, police and military Next, consider the review actions that may occur follow- agencies are independently developing localised solutions ing an emergency, police or military incident. These actions with the effectiveness dependent on each agencies under - involve retrospective analysis and evaluation of events and standing and application of research and evidence-based decisions made. However, there is minimal evidence of practices. structured review process in critical decision making in the reviewed literature that guides practitioners in evaluation of decisions either real time or post event. Of the services 4 Discussion examined, literature concerning prehospital care identified a framework of decision review and care intervention based 4.1 Commonalities between service disciplines on changes in patient presentation due to treatment effect (or lack thereof). However, like many services this deci- In regard to the question of commonality across the dis- sion review was predominantly informed by experience and ciplines explored, in other words, “to what extent is there pattern recognition. Interestingly, Gunnarsson and War- commonality between military and emergency services in rén Stomberg (2009) noted that nonverbal expressions and regards to research and evidence-based threat assessment behaviors by team members resulted in decision making and decision making?”, we propose that there is greater com- reflection, it would appear that decision reflection was driven monality than currently identified in the individual pieces of by behavior rather than an unbiased evaluation to validate research reviewed. Commonality across services was found (on invalidate) decisions. The findings of Gunnarsson and in language, theory, and processes. Although there are dif- Warrén Stomberg (2009) are congruent with Bakken and ferences in the nature of the information considered across Gilljam (2003) who showed evidence of confirmation bias police, paramedic, firefighting and military settings there in decision-making and failure to critically analyse decisions are nonetheless commonalities in the processes by which where outcomes were accepted. information is gathered, interpreted and applied as a precur- The literature supports a belief that post-incident review sor to decision-making. This commonality suggests Ends- through reflection, debriefing, and coaching, supports learn- ley’s (1995) seminal definition of Situational Awareness, ing and the collective development of intuitive expertise being the “perception of the elements in the environment and decision-making (Akinci and Sadler-Smith 2020). Fur- within a volume of time and space, the comprehension of thermore, reflection and feedback appear vital to the devel- their meaning, and the projection of their status in the near opment and maintenance of expertise by facilitating the future”, not only remains current 26 years after its publica- restructuring of knowledge as experiences and outcomes are tion, but the most encompassing term and accurate definition appraised and measured against actions (Perona et al. 2019). for this initial phase of the decision-making process regard- Moreover, there are factors that influence the effectiveness less of context. Situational Awareness provides a transfer- of review actions in developing future decision-making. For able terminology and definition that can be applied across example, shallow reflections on action and lack of knowl- multiple industry contexts more effectively than more nar - edge of outcomes are likely to create or develop biased, prej- row and specific terms such as diagnosis, threat assessment udice, and inaccurate intuitions (Akinci and Sadler-Smith or size-up. Additionally, situational awareness provides a 2020). However, the development of highly prescriptive and conceptual framework describing a common process of iden- inflexible post-incident review methodologies may provide tifying and interpreting contextually specific information 1 3 Cognition, Technology & Work (2022) 24:423–439 433 and projecting potential outcomes. Within this framework, major decision-making methodologies. First, the literature knowing what information to seek, how to find it and what describes naturalistic (or intuitive/type 1) strategies that are it means becomes critical. employed in the majority during low-time situations. These The term situational awareness better describes the intuitive strategies may be further delineated to include rec- broader and more holistic cues and information sets identi- ognition-primed, value-based, and ‘overlearned procedural’ fied in the literature and considered by decision-makers than decisions. The naturalistic strategies involve a nearly seam- more narrow terms such as ‘threat assessment’. For example, less transition from the development of situational awareness a soldier, paramedic, police officer, and firefighter will regu- to a decision. However, the effectiveness of these decisions larly find themselves in danger, however, to make sense of is dependent on the experience, knowledge and confidence a threat without greater appreciation of the true context of of the decision-maker and the relevance, clarity and sim- the situation (regardless of whether it is an explosive device, plicity of organisational procedure and preparatory training. combative brain-injured patient, unstable structure, or armed The literature identifies the widespread use of ‘formal’ offender) is to ignore the relevant political, moral, legal, (or analytical/type 2) decision strategies across the police, organisational, cultural, and other factors that may influ- fire, paramedic, and military sectors. These formal strategies ence whether the decision is acceptable, suitable or correct. involve the consideration of multiple options and, therefore, Furthermore, situational awareness describes processes are primarily employed in situations where an immediate that are applicable where there is time to identify, inter- decision is not required. Another commonality across ser- pret and analyse information as well as low-time, high-risk vice streams linked to formal decision-making is the depend- situations. Specifically, the term encompasses both formu- ence of the success of the decision-making process, is the laic, deliberate and analytical processes that may be taught setting of goals or objectives. Contrary to a small minority explicitly to novices and intuitive nearly instantaneous pro- of the studies reviewed, the greater majority of the research cesses applied by experts. suggests that almost all personnel have either inherent or Therefore, although differences will remain in the nature deliberate goals they are trying to achieve. These goals may of information considered by the services examined in this be automatic or subconscious, for example staying alive research, we find there are significant and important com- during a shoot-out with an armed offender; determined by monalities concerning the behaviors employed to establish organisational doctrine, for example the protection of life, ‘situational awareness’ and that there is consensus that this property and the environment; or deliberately determined by awareness is the precursor to effective decision-making. an individual, for example where conflicts between goals, Significantly, this identified commonality has implications values or ethics occur. The research supports the notion that for developing greater consistency between the fire, police, depending on the experience and personal attributes of the military and paramedic sectors included in this research both individual, the speed and success of the formation of the operationally and in the training and development of per- plan will vary. sonnel. The results of the study suggest that by embedding During initial learning, novice military and emergency knowledge of the process of looking for, and assessing all services personnel require assistance and supporting physi- the elements of Situational Awareness, and recognising that cal stimuli (otherwise known as perceptual clues) to enable all dynamic situations are governed by ‘rules of engage- neural pathways to be developed and ‘sense’ to be made ment’, both decisions and outcomes may be improved across from the overwhelming data and sources of information that service contexts. Further, the extent of research supporting they are exposed to (Kahneman 2011; Kahneman and Klein Situational Awareness as a foundation of decision making 2009; Launder and Perry 2014). As neural pathways and in part addresses the questions regarding scientific validity pattern matching occur over time, the students can make of the concept of situational awareness raised by Carsten sense of increasingly complex information within reduced and Vanderhaegen (2015), as it is indeed a concept that  is timeframes (Kahneman 2011), allowing them to effectively not only common across services but has a wealth of deep assess and manage risk (Penney 2019). As their decision- scientific support across decision-making models and theo- making abilities develop, experienced firefighters, incident ries, even when those theories that do not necessarily agree managers, and emergency responders are able to progres- on other aspects. sively extend and adapt decision making to situations with greater speed than previously able (Kahneman and Klein 4.2 Commonality in theory 2009). With experience and mastery of their profession, emergency responders are able to recognise patterns from The researched literature identifies commonality in the prior incidents, subconsciously plan and even pre-emptively description of decision-making processes employed across respond to changes in incident dynamics (Cohen-Hatton and these industries. Although industry specific terms are Honey 2015; Klein et al. 2010). Although a hard delineation applied, these terms repeatedly identify two common and between naturalistic and formal decision-strategies may not 1 3 434 Cognition, Technology & Work (2022) 24:423–439 reflect the manner in which decision-makers select from a a specific situation depends as much on the decision maker’s ‘spectrum’ of decision strategies, the terminologies nonethe- individual characteristics (training, bias, utility, expertise, less provide a practicable and common nomenclature that prior experience, intelligence, self-awareness, health, emo- may be applied and communicated across these industries. tion etc.) as it does on the context of the individual situation Next, the literature established that the effectiveness of (time available, level of self-threat, consequences etc.). decisions is dependent on the effectiveness of their transla- tion into action. Areas of commonality across fire, police, 4.3 Commonality in processes military and paramedic settings included the individual capabilities and experience of the decision-maker, or where Variance in the accepted process by which decisions are this individual was reliant on the actions of others, the effec- made between services was identified. Popular amongst fire tiveness of communication, coordination and control and services and based on seminal research by Klein et al. in credibility and confidence of personnel involved. This identi- 1995, published in (Klein et al. 2010), the theory of Recog- fied commonality of ‘action’ behaviors supports the ongoing nition Primed Decision Making (RPDM), provided a model development of systems such as the Australasian Interagency to describe the process used by firefighters to make critical Incident Management Systems (AIIMS) that seek to foster decisions during complex and dynamic operations. Recently, consistency of incident management practice and behavior however, alternate theories (SAI Global 2013; Burrell et al. across multiple responding agencies. 2013), and variations (Cohen-Hatton et al. 2015; Cohen- Finally, the literature identifies commonality concerning Hatton and Honey 2015) to RPDM have been proposed. the review of decisions in fire, police, military and para - Within military contexts, various command decision mak- medic settings. Across these industries both dynamic review, ing frameworks exist including the Interactional Dual-Pro- that is review of the evolving situation, decisions made and cess model of moral decision making (Seiler et al. 2010); their execution during an incident, as well as more formal Observe-Orient-Decide-Act Loop and Critique-Explore- and considered review that occurs following the conclu- Compare-Adapt Loop (Bryant 2006). Cognitive processes sion of an incident. Whereas the effectiveness of dynamic and threat assessment within ambulance and police contexts review appears to be strongly linked to the experience of the are typically identified as fluid sense making and experi- decision-maker (irrespective of industry) the effectiveness of ence or bias centered as opposed to the defined processes of post-incident review is dependent on the presence of a con- other services (Perona et al. 2019; Marusich et al. 2016; van sistent framework for both making and evaluating decisions. den Heuvel et al. 2014; Gunnarsson and Warrén Stomberg This research supports the notion that an individual’s 2009). Whilst the contribution of service specific research experience and personal attributes strongly influences their to the military, police, fire and ambulance contexts cannot ability to make sense of a situation and respond appropri- be denied, there is an absence of cross-disciplinary research ately. It is almost impossible for inexperienced personnel in the field. to successfully utilise Recognition Primed Decision (RPD) However, our research identifies common threat assess- making, regardless of service context. In the same man- ment and decision-making elements that can potentially be ner, even highly experienced and capable personnel will used to develop a framework or spectrum of decision-mak- be unable to exercise RPD in unfamiliar unique experi- ing across these dynamic settings. These common elements ences. Further, the research suggests that there is a unique include the development of situational awareness (Endsley threshold, dependent on both the individual and the situ- 1995), the application of decision strategies from a potential ation encountered, for which RPD will be able to be suc- spectrum that includes both rapid, naturalistic (intuitive) and cessfully implemented to achieve an acceptable outcome. formal (analytical) decisions, as well as behaviors required to Inexperienced personnel will almost always use a deliber- enact and review decisions (both dynamically and formally). ate analytical decision process, which may be enhanced by One member of the research team has previously published organisational guidelines or protocols aligned to a certain a decision framework consistent with this approach within outcome or goal. As an individual gains greater knowledge, the specific context of rapidly evolving urban firefighting and becomes more experienced and skillful, their ability to (Launder and Perry 2014). However, this framework did make sense of a situation, formulate a plan, and execute not consider or seek to address commonality across para- it increases. With true expertise, the speed at which this medic, police or military settings. However, this research process occurs may make it appear that the individual is provides the opportunity to consider the broader extension of pre-emptively responding even before a threat is appar- a consistent and common model that includes the identified ent. In this way, the research suggests that as opposed to decision-making elements across these industries. the decision-making process being naturalistic, heuristic Therefore, we suggest a framework or spectrum of or analytical, these processes are actually part of a single decision-making which provides consideration of existing decision-making spectrum. We argue the process applied in prominent and future relevant decision-making models, and 1 3 Cognition, Technology & Work (2022) 24:423–439 435 which is transferable across the industries studied, can be principles of mathematics are established and built upon to developed. We suggest that by understanding the types of enable students to progress from basic addition, to calculus, available decision-making processes and methodologies to differential equations and so on. identified in the research and available on the decision mak - Within the operational environment the findings of this ing-spectrum, as opposed to confining operational decision- research can be applied through the potential adoption of making to a single process or method, all of the processes frameworks such as the Cynen fi framework (Snowden 2002) identified in the texts reviewed can be readily adapted to or SPAR framework (AFAC 2020) which promote adaptable suit situational contexts within each service. The research and different sense-making and decision-making approaches, suggests that the processes employed to make decisions may such as those models discussed in this study, depending on only be half the issue. Much like learning styles, the most the complexity and novelty of the situation encountered. The appropriate decision-making process for an individual will findings can also be applied through deliberate efforts to vary depending on the individual’s unique characteristics increase commonality between services through joint learn- or attributes including but not limited to experience, utility, ing and exercises involving decision-making personnel from intelligence, emotional intelligence, and education. The most different services who will be required to work effectively appropriate decision-making process will also depend on the together to successfully coordinate the safe resolution of health of the individual, with fatigue, emotion and pain all high consequence low frequency and time critical events. having the potential to impact the decision arrived at in any From an autonomous systems perspective such as those given situation. The research suggests that whilst experience proposed by Vanderhaegen (2021), the findings of this cannot be ‘trained into’ a person, one of the most effective research and proposed applications may be perceived as a ways to pre-emptively embed an effective decision-making double-edged sword. Whilst increased commonality between process is regular high fidelity (potentially deconstructed) human systems involving multiple decision-makers may training environments that can introduce uncertainty, time assist the development of automated systems within the restriction, and the perception of danger in a controlled man- decision-making domain, increasing the range of processes ner. In the field, practices such as team decision-making relied upon by human decision-makers may potentially com- (similar to that used by airline cockpit crews during emer- plicate attempts to automate such processes. It is suggested gencies), and distributed decision making so that an indi- further research is required in this specific field to fully vidual’s decision-making utility is not exceeded, may also appreciate any impacts. enhance the use of appropriate decision-making processes. 4.5 Limitations 4.4 Application In excess of 10,000 separate research artifacts were initially The potential practical application of these findings within captured across six academic databases in this systematic the various contexts extends to both the training and opera- literature review and 94 studies were ultimately included tional environments. Using the field of mathematics as for full analysis, being 3.4 times greater than the average an analogy, it is inappropriate to apply calculus in every number of studies reviewed in other systematic literature situation such as simple addition just as it is inappropri- reviews completed in the field to date. Despite this, it is ate to expect a lower school student to complete advanced acknowledged that research in other languages and non-peer differential equations. In the same way, to develop a broad reviewed studies may provide additional and valuable infor- range of decision-making abilities for different situations, mation. New research in the field is also constantly being students and novice commanders within emergency and published so it is important to acknowledge this study is military services should be taught a range of decision mak- completed at a point of time. ing theory and models from which they can then select the The search strategy for the study was specifically designed most appropriate for the specific situation they find them- to be ‘highly sensitive’ and retrieve a large proportion of var- selves in. At the same time, emergency and military ser- ied studies across the various emergency service and mili- vices may need to consider whether they require students tary contexts, as opposed to a ‘highly specific’ study which to have a minimum level of experience if they are going identifies a smaller number of more specific studies which to teach experience reliant decision-making models such as would result in reduced studies being reviewed. Following RPDM and naturalist decision making, particularly for high several reviewers’ comments regarding the original search consequence low frequency events that students and even not being broad enough, the terms were increased to include experienced personnel may have limited exposure to. Where “law enforcement”, “wildfire” and “bushfire”. Whilst these such models are intended to be taught in the absence of the yielded an additional 391 initial results (four being duplica- required foundation experience, services may need to invest tions of already included studies), no additional studies were in scaffolded learning much in the same way that the basic ultimately included for full review as they did not meet the 1 3 436 Cognition, Technology & Work (2022) 24:423–439 required inclusion criteria. This provides a level of confi- communication and trust between decision-makers and dence that whilst the search may not have been exhaustive, it those executing actions was consistently identified across certainly met the criteria for a plateau of diminished returns all services. and the final set of included studies remains a reasonable We suggest that institutional restriction of decision-mak- basis for drawing conclusions. However, as we discussed in ing to a single process at the expense of the consideration of our findings regarding the commonality of language between others (for example institutional requirement to use RPDM services, absolute commonality was not present. This leaves as opposed to considering System 1 and 2), or the inap- open the possibility that some relevant yet uncommon terms, propriate training and application of otherwise appropriate and, therefore, relevant studies, may have been missed. decision-making processes in certain circumstances may Acknowledging the potential for bias in the selection increase the potential for adverse outcomes, or at the very of studies for inclusion in the research, the study deliber- least restrict peak performance being achieved. For exam- ately required three authors to independently assess poten- ple, attempting to apply RPDM where the user has insuffi- tial studies for suitability with any disputes addressed by cient experience with which to appropriately recognize the consensus decision. The fourth author deliberately did not situation and recall an appropriate response, or attempting participate in the initial selection or synthesis of included to apply a deliberate analytical approach where an instant studies, effectively performing the role of ‘red teaming’, i.e. decision is required. Whilst the specific contexts and cir - in other words he deliberately and critically attacked the cumstances of incidents between military, police, fire and study method and analyses in an effort to overcome cog- paramedic operations and incidents will inevitably differ, nitive errors including group think and confirmation bias.. ignoring the potential application of research across service Despite this, it is acknowledged that the research team are streams may also serve to limit improvements in perfor- all Australians (albeit from different service and research mance. To improve threat assessment and decision-making backgrounds) and may be biased by their shared cultures. in military and emergency services contexts, and to address the uncertainties identified in this study, further research is recommended to define what differentiates a good and bad 5 Conclusions decision, and how this determination can be made. The apparent lack of a framework or spectrum of deci- To better understand the potential for improvement within sion-making common across service contexts in itself individual services, and during inter-agency emergency and limits the potential to evaluate decisions (and their out- disaster response, we attempted to discern commonalities comes) across distinct industry settings. For example, across threat assessment, sense making, and decision mak- although firefighters, police officers and paramedics may ing in dynamic emergency contexts between military, police, respond to a single multi-agency emergency incident they ambulance, and fire services. We systematically identified will at present apply differing terminology, procedures, and critically appraised relevant studies, before completing controls structures and review processes. Without a com- a narrative synthesis and thematic analysis of those relevant mon framework or spectrum to work within, or at least to the research theme. increased commonality between services, we posit that the Whilst absolutely consistency in language between ser- inconsistency in conclusions as to whether a decision was vice contexts (and even to some degree within service con- good or bad between personnel within the same service texts) was not found, similar terminology, definitions and context as previously reported in Penney (2019), let alone descriptions were present within the literature reviewed, different services, will continue unaddressed. The develop- in particular fire services and the military. Despite the ment of a common yet scalable framework or spectrum of differences in operating environment and the nature of decision-making which provides consideration of existing situational information required between services, com- prominent models such as those reviewed in this paper, as monality was found in the way novices in the different well as allowing for the incorporation of future relevant services make sense of their environments compared to decision-making models, will have the additional benefit more experienced personnel within the same service. The of providing a consistent evaluative framework that allows application of mental models, both intuitive and deliber- the evaluation of both the decision-making processes and ate, to process this information and make critical deci- behaviors applied, and their ultimate outcome. sions was also common across services, even if the mod- Supplementary Information The online version contains supplemen- els themselves differed. Common across all services and tary material available at https://doi. or g/10. 1007/ s10111- 022- 00694-3 . contexts was the belief that in the absence of translating decisions into timely and appropriate physical action, even Acknowledgements Laura Toose, Alecia Wood and Clare Wallwork ‘good’ decisions become ineffective. To execute the neces- are thanked for their proofing and formatting assistance. sary actions to support good decisions, the need for clear 1 3 Cognition, Technology & Work (2022) 24:423–439 437 Author contributions GP, DL, JC: conceptualization; GP, DL, JC, MT: decision-making. Emerg Med J 35(4):208. https:// doi. org/ 10. methodology; GP, JC: validation; GP, DL JC, MT: formal analysis; GP, 1136/ emerm ed- 2017- 206743 DL, JC: investigation; GP: data curation; GP, DL, JC: writing—original Anderson NE, Slark J, Faasse K, Gott M (2019) Paramedic student draft preparation; GP, DL, JC, MT: writing—review and editing; GP: confidence, concerns, learning and experience with resuscita- project administration. All authors have read and agreed to the pub- tion decision-making and patient death: a pilot survey. Austral- lished version of the manuscript. ian Emerg Care 22(3):156–161. https:// doi. org/ 10. 1016/j. auec. 2019. 07. 001 Bakken BT, Gilljam M (2003) Dynamic intuition in military com- Funding Open Access funding enabled and organized by CAUL and mand and control: why it is important, and how it should be its Member Institutions. This research received no external funding. developed. 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Mil Psychol 18(3):183– Open Access This article is licensed under a Creative Commons Attri- 206. https:// doi. org/ 10. 1207/ s1532 7876m p1803_1 bution 4.0 International License, which permits use, sharing, adapta- Burrell L, Noble A, Ridsdale L (2013) Decision-making by ambu- tion, distribution and reproduction in any medium or format, as long lance clinicians in London when managing patients with epi- as you give appropriate credit to the original author(s) and the source, lepsy: a qualitative study. Emerg Med J 30(3):236. https:// doi. provide a link to the Creative Commons licence, and indicate if changes org/ 10. 1136/ emerm ed- 2011- 200388 were made. The images or other third party material in this article are Carsten O, Vanderhaegen F (2015) Situational awareness: vallid or included in the article's Creative Commons licence, unless indicated fallacious? Cogn Technol Work 17:157–158. https://doi. or g/10. otherwise in a credit line to the material. 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Threat assessment, sense making, and critical decision-making in police, military, ambulance, and fire services

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Springer Journals
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Copyright © Crown 2022
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1435-5558
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10.1007/s10111-022-00694-3
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Abstract

Military and emergency response remain inherently dangerous occupations that require the ability to accurately assess threats and make critical decisions under significant time pressures. The cognitive processes associated with these abilities are complex and have been the subject of several significant, albeit service specific studies. Here, we present an attempt at finding the commonalities in threat assessment, sense making, and critical decision-making for emergency response across police, military, ambulance, and fire services. Relevant research is identified and critically appraised through a systematic literature review of English-language studies published from January 2000 through July 2020 on threat assessment and criti- cal decision-making theory in dynamic emergency service and military environments. A total of 10,084 titles and abstracts were reviewed, with 94 identified as suitable for inclusion in the study. We then present our findings focused on six lines of enquiry: Bibliometrics, Language, Situation Awareness, Critical Decision Making, Actions, and Evaluation. We then thematically analyse these findings to reveal the commonalities between the four services. Despite existing single or dual service studies in the field, this research is significant in that it is the first examine decision making and threat assessment theory across all four contexts of military, police, fire and ambulance services, but it is also the first to assess the state of knowledge and explore the extent that commonality exists and models or practices can be applied across each discipline. The results demonstrate all military and emergency services personnel apply both intuitive and formal decision-making processes, depending on multiple situational and individual factors. Institutional restriction of decision-making to a single process at the expense of the consideration of others, or the inappropriate training and application of otherwise appropriate decision-making processes in certain circumstances is likely to increase the potential for adverse outcomes, or at the very least restrict peak performance being achieved. The applications of the findings of the study not only extend to facilitating improved practice in each of the individual services examined, but provide a basis to assist future research, and contribute to the literature exploring threat assessment and decision making in dynamic contexts. Keywords Situational awareness · Decision making · Firefighter · Police · Ambulance · Military · Recognition primed · Heuristics · Bias · Threat assessment 1 Introduction * Greg Penney Effective emergency response to natural events, such as greg.penney@dfes.wa.gov.au earthquakes, and deliberate events, such as terrorist attacks, involves the anticipation of emergency events and the actions Department of Fire and Emergency Services, Perth, Australia taken during and immediately after to ensure that its affects are minimized (AIDR 2013). Within police, military, ambu- South Australian Metropolitan Fire Service, Adelaide, Australia lance and fire service contexts this requires that responding personnel can (1) accurately make sense of dynamic and St John Ambulance Western Australia, Perth, Australia unfamiliar environments, (2) assess potential opportunities School of Psychology, Murdoch University, Perth, Australia and threats to develop response plans, and (3) make critical Biosecurity and One Health Research Centre, Harry Butler decisions under significant time pressures (Cohen-Hatton Institute, Murdoch University, Perth, Australia et  al. 2015; Perona et al. 2019; Penney 2019; Reay et al. Edith Cowan University , Perth, Australia Vol.:(0123456789) 1 3 424 Cognition, Technology & Work (2022) 24:423–439 2018). When confronted with a structure fire emergency, for and leveraged. A common understanding between services example, a fire officer must process large amounts of visual could then be developed, and existing research could be and auditory information within short timeframes, including translated from service area to another. In turn this could fire behavior, the location of casualties, available resources, promote research and resulting theories around emergency and the construction of the structure involved. Simultane- management that are service general rather than service ously, they must be formalizing plans and contingencies to specific. maximize the opportunity to rescue casualties, and to con- Here, we present an attempt at finding the commonalities tain and extinguish the fire whilst also managing operations in threat assessment, sense making, and critical decision- within the incident area and minimizing risk to responding making for emergency response across police, military, firefighters. The cognitive processes associated with these ambulance, and fire services. We present a review of rel- abilities are complex (Reay et al. 2018; Stanton et al. 2009), evant research across these areas of research and across these susceptible to bias (Kahneman 2011; Seiler et al. 2010) and emergency services. First, we describe our aims and objec- difficult to master (Perona et al. 2019). tives, follow by our method. We then present our findings Where incidents increase in scale and complexity, impact- focused on five lines of enquiry that are relevant to emer - ing large populations and geographic areas, response can gency management: Language, Situation Awareness, Critical last weeks or even months. Incidents now regularly cross Decision Making, Actions, and Evaluation (terms defined regional, state, and national borders, resulting in a greater in “ Sect.1.1” below). We then consolidate these findings to need to share information across agencies and for coordi- reveal the commonalities between the four services. nated inter-agency response (Wilkinson et al. 2021). This This study is significant in that not only is it is the first subsequently poses additional challenges for decision- to bridge this gap and examine decision making and threat makers (Alison and Crego 2008; Comfort 2007; Flin 1996; assessment theory across the multiple contexts of military, House et  al. 2013; Pollock 2013; Coskun and Ozceylan police, fire and ambulance services, but it is also the first 2011). Front line responders and incident managers alike to assess the state of knowledge and explore the extent that must cooperate with different people in different organiza- commonality exists and models or practices can be applied tions. In the UK, representatives from several organizations across disciplines. The applications of the findings of the form Strategic Coordinating Groups that include fire, police, study not only extend to facilitating improved practice in ambulance, civil resource organizations, health agencies, each of the individual services examined, but provide a and government (Wilkinson et  al. 2021). In the US and basis to assist future research, and contribute to the literature Australia equivalent personnel and agencies form Incident exploring threat assessment and decision making in dynamic Management Teams (AIDR 2013; NIFC 2021). However, contexts. the challenge of multiple agencies in working together effec- tively during large scale disasters is ongoing (Alison and 1.1 Aims Crego 2008; Wilkinson et al. 2021; Pollock 2013). It is tempting to think that the cause of the problem is The scope of this study is multi-disciplinary, covering one of communication breakdown between different person- nel from differing agencies, and so collective understanding dynamic environments within civilian emergency services of policing, prehospital ambulance care, firefighting, and of the situation and operational requirements being lost in translation. Rather, we suggest the cause is that each service military operations. We aim to distill research in threat assessment, sense making, and critical decision making in member is viewing the situation quite differently, through the lens of their training and standard operating proce- dynamic emergency service and military environments. We also aim to discern the commonalities between services. In a dure. In part this arises from variance in theories of deci- sion making and threat assessment (Coskun and Ozceylan similar approach to House et al. (2013), the aim was decon- structed into six distinct lines of enquiry: 2011), which ultimately guides operational response. And, traditionally, these theories have been segregated by ser- 1. Bibliometrics, allowing the ‘spread’ of research to be vice stream. The human factors of firefighters, paramedics, police, and military personnel are considered in isolation categorized by research design, service type, country of origin, year of publication, and, publication area; despite the similar circumstances of their dynamic and high consequence environments. 2. Language, the terminology, definitions and descriptions within the research; We posit that these services share greater similarities in operation and theory than previously identified. We suggest 3. Situational Awareness (SA), threat assessment and sense making; that progress can be made to improve inter-agency coor- dination as well as performance within individual service 4. Critical Decision Making (CDM), the process used to decide on a course of action; contexts if commonalities between services can be discerned 1 3 Cognition, Technology & Work (2022) 24:423–439 425 5. Actions, the tasks both attempted and completed to exe- cute the decision; and 6. Evaluation, the reflection of the decision and subsequent actions to determine whether or not a “good decision” has been made. Whilst the justification for bibliometrics is self-explana- tory, an iterative approach (Morgan and Nica 2020) to select- ing lines of enquiry 2 to 5 was applied. In this way, initial lines of inquiry were revised by the research team during the conceptual phase of the study and refined, with the final lines of inquiry designed to bring meaning and identity a recurrent trends and variant manifestations as described by DeSantis and Ugarriza (2000). As such, the lines of enquiry were designed to capture and unify the nature or basis of the various context specific studies into a meaningful whole (DeSantis and Ugarriza 2000). 2 Method Adapting the approach applied by House et al. (2013), this systematic review adhered to the set of scientific methods described by Petticrew and Roberts (2006) to limit bias. The resulting review presents a narrative approach adapted from Perona et al. (2019), and Launder and Perry (2014). The pro- cess comprised of four distinct phases (Fig. 1): (1) system- atic identification of relevant studies; (2) critical appraisal of studies; (3) bibliometrics and narrative synthesis of data; and, (4) thematic analysis of findings. To achieve this a sys- tematic literature review was completed. 2.1 Phase 1: systematic identification of relevant studies To retrieve a large proportion of varied studies the search strategy was designed to be ‘highly sensitive’, as opposed to a ‘highly specific’ study which identifies a smaller num- ber of more specific studies (Petticrew and Roberts 2006). Literature meeting the following criteria was included in the Fig. 1 Phases of the study analysis: published peer-reviewed studies; reports; consen- sus guidelines; academic center, or professional association protocols detailing SA & CDM in civilian emergency ser- in the last twenty years (2001–2020) to ensure currency of evidence. Seminal papers from outside the date range vice or military environments; statistical analysis; and post- incident reviews, inquiries, and inquests after incidents, pub- were considered for inclusion where appropriate. Data- bases included Australian Federal Police Digest (Informit lished by government and non-government organizations. The search strategy included only terms relating to, or SA AFPD); ProQuest; Sage Journals Online; Science Direct; PubMed; and Cochrane Library. Non-English speaking & CDM in dynamic emergency service and military envi- ronments (Table 1) that were identified during the prelimi- literature, abstracts, citations, thesis, unverified or unsub- stantiated opinion pieces, press or news media reports, non- nary literature review when determining the feasibility of the full study. A secondary search of bibliographies identified peer reviewed conference proceedings, articles that are not related to threat assessment and decision making in these further literature for inclusion. Completed in October 2020, the review included English-language papers published environments were excluded. 1 3 426 Cognition, Technology & Work (2022) 24:423–439 Table 1 Search terms used in the systematic literature review Sources Informit AFPD, ProQuest, Sage Journals Online, Science Direct, PubMed and Cochrane Library Search terms (Military OR Soldier OR Paramedic OR Ambulance OR Fire* OR Wildfire OR Bushfire OR Polic* OR Law Enforcement OR Command*) AND (Decision OR Risk OR Threat Assess- ment OR Dynamic) Limits English Language AND Published Between 2001 and 2020 Two review authors (GP & JC) independently tested the guide new findings and conclusions (Fielding and Thomas search criteria and completed the initial search. 2001). Data were initially quantitatively analysed, allowing the 2.2 Phase 2: critical appraisal of studies ‘spread’ of research to be categorized by research design, service type, country of origin, year of publication, and pub- The initial search strategy yielded 10,084 studies for poten- lication area. Research design was categorized as qualitative tial inclusion. Three authors (GP, JC & DL) completed this (did not yield numerical data/analysis), quantitative (yielded process, with each stage initially completed independently numerical data/analysis) or mixed method. Publication area by each author before group evaluation occurred. At each was categorized as detailed in Table 2. stage, a minimum of two of the three authors in the process Three authors (GP, DL, JC) completed the initial narrative had to agree for a study to progress to the next stage of synthesis in line with the five remaining lines of enquiry: review. Using this process, of the 10,084 records identified Language, Situational Awareness (SA), Critical Decision through the initial search strategy, 377 (excluding dupli- Making (CDM), Actions, and Review. In an attempt to mini- cates) had titles that were broadly identified as potentially mize bias that may develop by the authors working closely relevant to the current study and progressed to a review of together on the study over a period of time, the fourth author the abstract. The process was repeated with the abstracts (MT) was deliberately excluded from the initial synthesis reviewed against the eligibility criteria of the study, with and subsequently provided detailed critique and deliberate 135 progressing to full manuscript review. Ninety-four (94) challenge once the initial review was complete. Any disa- studies were ultimately included in the study. Results are greements were resolved through discussion. presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist 2.4 Phase 4: thematic analysis (Fig. 1). Applying the approach described by House et al (2013, Thematic analysis is a method for identifying, analysing p. 3), a framework of assessment quality was established to and reporting patterns or themes within the data (Braun and critically appraise the 94 included studies. The framework Clarke 2006). An inductive thematic analysis, which seeks appraised studies for their internal validity (the degree to to identify broad trends arising from the literature itself which the research design, analysis and presentation have (Braun and Clarke 2006), was applied to the results of lines avoided biased comparisons), their external validity (the of enquiry two to six, being: Language, Situational Aware- extent to which one can generalize findings to other set - ness (SA), Critical Decision Making (CDM), Actions, and tings) and the appropriateness of the data analysis and pres- Review. In the context of the study, a centralized theme of entation. The findings of this analysis assisted prepare the commonality, or sharing of language, theories and processes reviews of each included study, which are provided as a sup- was realized and explored. Applying the same approach as plementary file to this main manuscript. step three, three authors (GP, DL, JC) completed the initial The fourth author (MT) deliberately did not participate in thematic analysis, whilst the fourth author (MT) provided the initial selection or synthesis of included studies, rather detailed critique and deliberate challenge once the initial performing the role of ‘red teaming’, in other words he delib- analysis was complete. Any disagreements were resolved erately and critically attacked the study method and analyses through discussion. in an effort to overcome cognitive errors including group think and confirmation bias.. 3 Findings 2.3 Phase 3: bibliometrics and narrative synthesis 3.1 Enquiriy line one: bibliometrics The narrative synthesis of findings was selected as it has proven useful for providing a comprehensive picture of the Database searches yielded a total of 10,084 articles, how- subject matter in question (McNeill and Chapman 2005) to ever, less than 1% (n = 94) met the full inclusion criteria 1 3 Cognition, Technology & Work (2022) 24:423–439 427 Table 2 Publication area Category Description categories and descriptions Emergency management The organization and management of the resources and responsibilities for dealing with all humanitarian aspects of emergencies (prepared- ness, response, mitigation, and recovery) Emergency medicine Medical and paramedical care in the prehospital environment Fire technology Fire science (not a trade magazine) Human factors Ergonomics—human abilities and limitations Medicine Medicine in the hospital and clinic environment Military Military studies (not including military psychology) Nursing Nursing care and related studies Policing Police trade journals Psychiatry Psychiatry specific journals Psychology Psychology specific journals (including military psychology) Risk Risk assessment and management Safety Safety and occupational health hand safety Not otherwise classified Not otherwise classified and were selected for the study (refer to the Supplemen- the UK and USA equally published the most studies relating tary Table S1). Seminal research, theories and definitions, to military contexts (n = 5). for example, work by Endsley (1995), and Kahneman and By year of publication, 2018 to 2020 collectively Klein (2009), did not meet the specific search criteria but accounted for 39% (n = 37) of all studies, with the remain- were cited by multiple included publications. They are, ing years resulting in a mean 3.3 studies published per year. therefore, discussed as an additional text to this study but Analysis by year of publication and service identified 78% is not included as part of the systematic search results. A (n = 18) of all ambulance paramedic related studies were majority of all studies (n = 52) utilised a qualitative research completed between 2011 and 2020. By comparison, 80% methodology that did not result in the creation of numeri- (n = 12) of all firefighting related studies, 58% (n = 14) of cal data, 17% (n = 16) used a quantitative methodology, all military related studies, and 84% (n = 26) of all police and 29% (n = 27) used a mixed method approach. Of the related studies were published in that same date range. qualitative studies 18 were literature reviews. A further four Of the 94 publications, only four authors (Anderson, were systematic literature reviews having a mean 27.5 stud- Cohen-Hatton, Jensen, and Shortland) published more than ies included for analysis. By service type, research related one study meeting the criteria. Whilst Shortland published to ambulance paramedics accounted for 24% (n = 23) of three studies and examined both police and military con- the studies, firefighting for 16% (n = 15), military for 26% texts, the remaining authors published two studies each and (n = 24), police for 33% (n = 31), and blended research within a single service context. across services accounting for only 2% (n = 2). None of the The results of the descriptive analysis suggest that literature included in the study addressed more than two research into threat assessment and decision-making has service types. been historically ‘siloed’ from a service context perspec- By publication area, Psychology accounted for the highest tive, without institutional consideration of how results and number of included studies at 29% (n = 27), with Emergency lessons learned may be applied across service contexts and Medicine (prehospital) accounting for the second highest at jurisdictions. The recent popularity of research into the field 19% (n = 18), and both Medicine and Emergency Manage- (40% of the studies being published since 2018), in addition ment accounting for the third highest at 5% (n = 5 each). The to the limited number of authors with multiple publications, remaining studies were reasonably distributed throughout suggests that the study of threat assessment and decision- publication areas. By country of origin, the USA and UK making, whilst not a new field, may be far from mature in tied for the most research at 23% (n = 22), with collaborative regard to the identification of best practice decision making research across countries accounting for 12% (n = 11), and methods that are transferable across services and the var- Australia accounting for the third highest at 11% (n = 10). ied contexts in which they must be applied. Our research Analysis by country of origin and service identified the UK suggests that there may be far more commonality regarding published the most studies in the ambulance (n = 9), Aus- decision-making theory and processes between service con- tralia published the most firefighting studies (n = 5), the USA texts than is currently acknowledge within both the academia published the most studies related to policing (n = 14), and, and the services themselves. 1 3 428 Cognition, Technology & Work (2022) 24:423–439 3.2 Enquiry line two: language 3.3 Enquiry line three: situational awareness Whilst absolutely consistency between service contexts During this initial phase, the decision-maker makes sense (and even to some degree within service contexts) was not of their surroundings by gathering and interpreting situ- found, similar terminology, definitions and descriptions ational cues to establish what is currently on what is likely were present within the literature reviewed. In particular, to happen. The most commonly applied term for this pro- fire services and the military regularly made reference to cess across firefighting and military literature is situational ‘situational awareness’ (Stanton et al. 2009; Launder and awareness (Cohen-Hatton and Honey 2015; Launder and Perry 2014; Marusich et al. 2016; Catherwood et al. 2012; Perry 2014; Shortland et al. 2018). Noting the identified Godwin et al. 2015; Shortland et al. 2018), or synonyms differences, the seminal definition of situational awareness including ‘assessment’ (Penney 2019; Martínez-Fiestas (SA) by Endsley (1995, p. 36), being the “perception of the et  al. 2020; Okoli et  al. 2016), ‘situation assessment’ elements in the environment within a volume of time and (Cohen-Hatton et  al. 2015; Cohen-Hatton and Honey space, the comprehension of their meaning, and the projec- 2015), ‘orientation’ (Seiler et al. 2010; Bryant 2006) and tion of their status in the near future”, appears to define the ‘perception’ (Dodd et  al. 2006; Martínez-Fiestas et  al. process of information gathering, analysis and understand- 2020; Prati et al. 2013). In these texts, clear distinction ing across the dynamic environments of all service contexts was made between situational awareness, decision-mak- (regardless of whether this process is considered intuitive ing, plan formation, plan execution and dynamic review or deliberate). The literature provides broad support that the which ultimately formed part of the decision-making development of situational awareness is a critical precursory process. Alternative terminology included ‘recognition’ phase of decision-making. For example, Cohen-Hatton et al. (Klein et al. 2010; Thomas 2020), whereby it was reported (2015), Perona et al. (2019), Penney (2019), Launder and firefighters intuitively analysed dynamic information, and Perry (2014), Marusich et al. (2016), Godwin et al. (2015). ‘anomaly detection’ (Curnin et  al. 2020) whereby the Endsley (1995) defines three levels of situational aware- study participant had to rely on critical analysis in the ness that remain applicable and relevant regardless of ser- absence of identifiable cues or patterns. By comparison, vice or situational context. Level I situational awareness within ambulance contexts the terms ‘decision making’, concerns knowing what information to look for and how ‘recognition’, ‘hypothetico-deductive reasoning’ or ‘fluid to obtain that information. Level II situational awareness sense making’ were applied (Ryan and Halliwell 2013). involves the comprehension and understanding of these Both military and police studies referenced ‘perceiving’, situational cues to establish an understanding of the current ‘threat assessment’, ‘high stress decision making’ (Akinci situation. Finally, level III situational awareness refers to the and Sadler-Smith 2020; Bonner 2018; Gamble et al. 2018; ability to use the available information and understanding Harris et al. 2017; Jederberg et al. 2002). of what is happening to accurately predict future situations. Consideration of ‘Naturalist Decision Making’, and Although different terminology is used, this requirement to ‘Heuristics/Biases’ approach (Launder and Perry 2014; identify and understand situational cues is consistently iden- Wilson et al. 2011; Akinci and Sadler-Smith 2020), ‘expe- tified across the literature and service contexts. rience’, ‘bias’ and ‘accountability’ was present across all There are specific differences in the nature of situational services (Cohen-Hatton et al. 2015; Perona et al. 2019; information that is required across police, paramedic, fire- Launder and Perry 2014; Marusich et al. 2016; van den fighting and military settings. For example, in high-risk Heuvel et  al. 2014; Gunnarsson and Warrén Stomberg police situations key situational information may include 2009; Bakken and Gilljam 2003; Banks et al. 2020; Nja the incident type in risk level, the location (open or con- and Rake 2009; Verhage et al. 2018; Vickers and Lewinksi fined), and the number of persons involved and the level of 2012). The theory of Recognition Primed Decision mak- public visibility. Consideration is also given to a potential ing was also cited repeatedly through the texts and across suspect’s build, gender, behavior and proximity. For exam- service streams (Cohen-Hatton et al. 2015; Cohen-Hatton ple, Harman et al. (2019), Hine et al. (2019), and Verhage and Honey 2015; Klein et al. 2010; Bonner 2018; Hine et al. (2018). In the literature describing paramedic decision- et al. 2019). making, an analogous patient diagnostic process is described ‘Morality’, ‘ethics’, and ‘moral/ethical decision mak- that highlights the required ability to critically analyse and ing’ themes were present across all services (Penney 2019; rapidly form clinical impressions with minimal information. Seiler et al. 2010; Harman et al. 2019; Ishoy 2016; Leibold For example, Perona et al. (2019), Reay et al. (2018), and et al. 2018; Murphy-Jones and Timmons 2016; Thompson Murdoch (2019). In addition to identifying clinical symp- et al. 2018), however, the full impact of these factors was toms, paramedics, like police officers must also consider the not universally explored. presence of bystanders and persons close to the patient being treated (Anderson et al. 2018). Furthermore, a distinction is 1 3 Cognition, Technology & Work (2022) 24:423–439 429 made between experts and novice paramedics, with experts and what it means (Kahneman and Klein 2009; Ågård et al. applying greater interconnectedness of conscious and sub- 2012; Harman et al. 2019). conscious processing to draw on information from multiple In contrast, experts have developed the ability to filter sources including professional learning and personal expe- (or batch) critical situational information thereby reducing riences (Perona et al. 2019). The same distinction is made the total amount of information requiring mental consid- between expert and novice military personnel in dynamic eration (Okoli et al. 2016). Experts employ interconnected high threat situations (Godwin et al. 2015). Similarly, the conscious and subconscious processes that draw information literature concerning firefighting also supports this need to from multiple sources that include professional training and obtain key situational information that may include life risk, personal experience (Perona et al. 2019). In these circum- visible smoke and flames behavior, fuel load, occupancy, stances the process of both identifying situational cues and utilities, and the presence of hazardous materials (for exam- establishing awareness of their meaning may be intuitive ple, Stanton et al. (2009), Launder and Perry (2014), Maru- and nearly instantaneous (Kahneman and Klein 2009; Bak- sich et al. (2016), and Catherwood et al. (2012)). ken and Gilljam 2003). Finally, experts may progress nearly There are commonalities in the information required instantaneously from observing situational cues, establish- across these first responder situations. For example, police, ing a mental model of what is happening and identifying a paramedics and firefighters frequently must gather situ- potential course of action (for example, Cohen-Hatton and ational information under intense time pressure (Penney Honey (2015), Kahneman and Klein (2009), and Launder 2019; Cohen-Hatton and Honey 2015; Launder and Perry and Perry (2014)). It is consequently reasonable to expect 2014; Ågård et al. 2012; Anderson et al. 2018). In addition experts and novices may apply different strategies for estab- to the cues that are specific to each industry, these decision- lishing situational awareness that shape how they subse- makers consistently seek information concerning the level quently make decisions. of perceived risk, the availability of resources to manage the risk/threat and the presence of victims or civilians any infor- 3.4 Enquiry line four: critical decision making mation considered (for example, Penney (2019), Ågård et al. (2012), Anderson et al. (2019), and Hemmatjo et al. (2019)). The literature identifies that personnel employ a range (or Next, as information is gathered it is used to establish spectrum) of decision-making strategies, each defined by a mental model of the situation or schemata (for example, distinct characteristics (Seiler et al. 2010; Launder and Perry Cohen-Hatton et al. (2015), Reay et al. (2018), and Kahne- 2014; Bakken and Gilljam 2003). man and Klein (2009)). This mental model summarises the The fastest decision strategies, including recognition key situational information into a holistic picture that tells primed, intuitive, value-based, or heuristics-based decisions the decision-maker what is going on, including the level are frequently classified as naturalistic (alternately Type 1 of risk/threat, the key factors that must be addressed, and or System 1) strategies (Kahneman 2011; Klein et al. 2010; potentially, how the situation will evolve (Endsley 1995). Kahneman and Klein 2009). These decisions may appear to The ability to develop and maintain effective situational seamlessly and instantaneously follow the development of awareness may be impacted by a range of factors. These situational awareness. Experts can apply these rapid deci- factors include both implicit and explicit biases (Harman sion-making strategies by immediately identifying infor- et al. 2019), the volume of information and time available mation they have learned is critical, rapidly developing a to process it (Penney 2019), cognitive limitations (Marusich mental model (schema) and recalling a satisfactory decision et al. 2016), and the extent to which a situation is threaten- or solution from prior experience (Klein et al. 2010; Godwin ing to themselves or their colleagues. For example, sensory et al. 2015; Oosterwold et al. 2018). Furthermore, experts processes in police officers are affected in personally threat- may be able to make decisions on the basis of level II situ- ening situations have reported ‘tunnel-vision’ when attention ational awareness (Cohen-Hatton et al. 2015; Cohen-Hatton becomes focused on potential weapons and other potentially and Honey 2015). Although differing terminology may be critical situational information may be missed (Akinola and applied, the literature describes the frequent use of these Mendes 2012; Harman et al. 2019; Verhage et al. 2018). rapid decision strategies by police, firefighting, paramedic Differences in the way novices and experts establish and and military personnel in low-time, high-risk settings (for maintain situational awareness is also identified in the litera- example, Cohen-Hatton et al. (2015), Bakken and Gilljam ture. For example, novices (and specifically inexperienced (2003), and Harman et al (2019)). paramedics) demonstrate reliance on rule-based aide-mem- A key advantage of these naturalistic decision strategies oires or checklists to ensure they consider critical factors and is the speed by which an effective decision can be made. patient symptoms (Perona et al. 2019; Anderson et al. 2018). Indeed, it has been posited that the management of low-time Therefore, novices must be informed, taught or advised what critical incidents such as fire require not only that accurate constitutes critical situational information (in their context), decisions are made; it also requires that such decisions are 1 3 430 Cognition, Technology & Work (2022) 24:423–439 made intuitively (Okoli et al. 2016). The majority of deci- evaluation) and the identification and comparison of multi- sions made by first responding fire officers are naturalistic ple options or courses of action. Prior to the development of (Cohen-Hatton et al. 2015; Cohen-Hatton and Honey 2015), naturalistic decision theory these formal strategies were used and more specifically recognition primed, including up to extensively to describe and teach decision processes across 80% of initial fire ground decisions (Klein et al. 2010). Simi- firefighting, policing, paramedic and most prominently, mili- larly, naturalistic decision strategies are described in low- tary settings (Klein et al. 2010; Banks et al. 2020; Shortland time policing situations that include ‘shoot or no shoot’ inci- et al. 2018, 2020a, b). dents (Harman et al. 2019; Verhulst and Rutkowski 2018). A finding from the literature is that formal decision strate- Military literature also describes the extensive use of a range gies remain in widespread use across the police, fire, para- of naturalistic decision strategies applied in dynamic situ- medic and military sectors (Penney 2019; Reay et al. 2018; ations. Sometimes referred to as combat dynamic intuition Seiler et al. 2010; Ågård et al. 2012; Akinci and Sadler- (Bakken and Gilljam 2003). This describes the ability of Smith 2020; Bakken and Gilljam 2003; Banks et al. 2020; military personnel to make nearly instantaneous decisions in Harman et al. 2019; Hine et al. 2019; Murdoch 2019; Okoli uncertain dynamic environments with low cognitive control et al.2016). In particular, the use of formal analytical deci- and low conscious awareness (Militello et al. 2015). The sion-making processes is supported in situations where there application of naturalistic decision strategies appears less is sufficient time to consider multiple options, for example, well defined in paramedic emergency situations. Although strategic military decisions that are not made in the field the use of these strategies by highly experienced paramedics (Seiler et  al. 2010; Shortland et  al. 2018, 2020a, b(a)), is supported, they are often described in conjunction with where the consequences of deviating from the described prescriptive processes and protocols such as the emergency process or previously identified solution are extreme, for ambulance triage system (Reay et al. 2018; Murdoch 2019). example, police shoot—no shoot situations and paramedic Furthermore, there are limitations to these naturalistic emergency triage situations (Ågård et al. 2012; Hine et al. decision strategies. First, their effective use is reliant on 2019; Murdoch 2019). Despite their potential rigor, the extensive prior experience in an area of expertise (Klein practical shortcomings of formal decision strategies in low- et al. 2010). They should not be applied by less experienced time environments have become more obvious (Okoli et al. decision-makers who are unable to filter and interpret key 2016). In low-time environments decision-makers can be situational information and recall a satisfactory solution overwhelmed by the influx of situational information (Banks from prior experience (Bang and Liwång 2016). Further- et al. 2020; Okoli et al. 2016). Furthermore, the need to fol- more, concerns were identified that these strategies may be low a prescribed sequential process when there is limited susceptible to misdiagnosis and decision errors, particu- time may cause considerable tension or anxiety (Reay et al. larly where a rapidly evolving situation is chaotic with time 2018). and emotional pressure (Perona et al. 2019; Marusich et al. A hard distinction between naturalistic decision and 2016; Murdoch 2019). Experienced personnel may make formal decision strategies may not accurately reflect a poor decisions through overconfidence in areas outside their more complex relationship between intuition and analysis own field of expertise (Kahneman and Klein 2009). Finally, observed in practice (Akinci and Sadler-Smith 2020). In naturalistic strategies may not be appropriate in new or novel particular, police and paramedics described challenges and situations where the decision-maker lacks an experiential stress associated with balancing the application of natural- base (Curnin et al. 2020). istic and formal decision strategies (Reay et al. 2018; Akinci Despite the reported limitations, a key finding from the and Sadler-Smith 2020; Verhage et al. 2018) during what literature is that the majority of initial decisions made in have been termed ‘fuzzy tasks’ (Verhulst and Rutkowski rapidly changing, high-risk and uncertain situations by per- 2018). Additionally, decision strategies based on over- sonnel across the sectors are naturalistic in nature (Cohen- learning of evidence-based knowledge such as procedures, Hatton and Honey 2015; Klein et al. 2010; Launder and guidelines/protocols, mnemonics and aide-memoirs may Perry 2014; Bakken and Gilljam 2003; Banks et al. 2020; also occupy a grey area in the middle of the decision-making Harman et al. 2019; Murdoch 2019; Okoli et al. 2016). spectrum (Perona et al. 2019). Procedures may be applied In contrast, decision strategies that involve the considera- by experts when performing recurrent or routine aspects of tion of multiple options are more time intensive. These strat- tasks (Kahneman 2011), or to provide a predetermined deci- egies, referred to as formal/classical (alternately Type 2 or sion for less experienced personnel (Perona et al. 2019; Reay System 2) include decision ladders, step-based protocols and et al. 2018; Seiler et al. 2010). procedures, complex problem-solving, creative, analytical In summary, personnel across the sectors establish situ- and rational decision-making. These formal decision strate- ational awareness and then make decisions using a range of gies share common elements including extended situational strategies from the potential spectrum. Although the major- analysis (for example, risk identification, assessment and ity decisions made by experts in low-time situations are 1 3 Cognition, Technology & Work (2022) 24:423–439 431 naturalistic decisions may also be made using formal ana- responsible for completing the physical tasks was considered lytical strategies when time is available, there is a prescribed an essential action (Launder and Perry 2014; Marusich et al. organisational solution to a high-risk problem or where the 2016; Bakken and Gilljam 2003; Verhulst and Rutkowski decision-maker is an experienced (Perona et al. 2019; Pen- 2018). The level of trust subordinates had in decision-mak- ney 2019; Curnin et al. 2020; Harris et al. 2017). ers was also identified as a factor influencing whether the Whilst the literature reviewed provides significant discus- subordinate would execute the directed action or complete sion regarding decision-making theory and methods, and their own analysis of the situation and take a different course what can affect an individual’s ability to make a decision, it of action (Marusich et al. 2016). does not directly address how to determine whether a deci- Where the decision-maker was also responsible for com- sion is indeed good or bad. From the research the resultant pleting actions, a number of findings were identified. In the outcome is paramount to whether a decision is considered absence of immediate personal threat and when faced with ‘good’ after the fact, perhaps the strongest example of this either high levels of uncertainty, situations not familiar to the is the multiple police shooter-simulation studies where per- responder, or where a fear of personally adverse outcomes ceived bias is heavily scrutinised. The question of whether are present, inexperienced personnel and those seeking outcome is indeed the most appropriate measure of the suit- confirmation of their decision theories are likely to be risk ability of a decision remains unanswered. It is also impor- adverse, default to following standardised protocols and may tant to consider that whilst an effective and correct decision ignore more dynamic and potentially beneficial processes regarding an outcome or action may be made, plan formation (Reay et al. 2018; Ågård et al. 2012; Anderson et al. 2018; and plan execution remain critical components to achieving Bakken and Gilljam 2003; Burrell et al. 2013; Knighton a satisfactory outcome. Indeed, the research suggests that 2004; Larsen 2001; O’Hara et al. 2015; Oosterwold et al. in many high threat and dynamic military, police, fire and 2018; Vickers and Lewinski 2012). In the presence of per- ambulance environments, even if a perfect decision is made ceived immediate personal physical threat, actions are more and effectively executed, the outcome may remain unsatis- likely to be self-preservative even when further analysis may factory or even bad, albeit not as bad as it had the potential have resulted in either the perceived threat being dismissed, to be. For example, consider an unavoidable situation that or more appropriate courses of action being identified (Cor - necessitates a difficult decision. A suitable decision-making rell et al. 2007; Gamble et al. 2018; Harman et al. 2019; process is followed, commensurate with the expertise and Lima and de Araujo 2018; Nieuwenhuys et al. 2015). In experience of the decision-maker, and results in the death such instances, there was some evidence to suggest there of two personnel. The potential outcome arising from any is little difference between inexperienced and experienced other decision, being the death of six personnel, is avoided. personnel in the time taken to complete the action, however, Without the worse outcome to compare the original result to, experienced personnel took less time to initiate that course how would the decision be reviewed? The limited research to of action compared to inexperienced personnel (Vickers and explore this area (Penney 2019) occurred in the firefighting Lewinski 2012). context and suggests that suitably experienced and qualified peers would be equally as likely to identify a decision as cor- 3.6 Enquiry line six: evaluation rect as incorrect across a range of incident contexts. The literature identifies two distinct forms of ‘evaluation’ 3.5 Enquiry line five: actions behaviors that occur across the industry contexts examined. First, there are dynamic review processes that occur during Analysis of the actions arising from the decision-making an extended situation where multiple decisions are made process was not addressed in the literature as the formation (Launder and Perry 2014; Ågård et al. 2012; Bakken and of situational awareness or the decision making process. One Gilljam 2003). Next, there are review behaviors and subse- aspect that was identified, however, was that regardless of quent actions that may be undertaken following the conclu- service, in the absence of translating decisions into timely sion of a situation to determine whether ‘good decisions’ and appropriate physical action, in other words ‘Plan Execu- have been made. tion’ (Cohen-Hatton et al. 2015; Cohen-Hatton and Honey Dynamic review occurs in the majority of incident set- 2015; Shortland et al. 2018), even ‘good’ decisions become tings where once one decision is made further decisions ineffective (Launder and Perry 2014; Bakken and Gilljam will usually be required subsequently (Banks et al. 2020). 2003; Harman et al. 2019). These processes involve the reconsideration of situational Where the decision-maker was in a position of command factors to identify whether, following the implementation authority and not personally able to complete the required of initial decisions, the situation has changed as predicted physical tasks, for example an Incident Controller or rank- (for better or worse) (Launder and Perry 2014). Consist- ing officer, clear and effective communication to those ent with the previous themes, prior experience influences 1 3 432 Cognition, Technology & Work (2022) 24:423–439 the effectiveness of this dynamic review across each of the no better alternative. For example, resuscitating decision- disciplines reviewed (Cohen-Hatton et  al. 2015; Perona making research designs commonly involve retrospective et al. 2019; Launder and Perry 2014; Banks et al. 2020). analysis of cardiac registry data and clinical records. How- First, experience allows decision-makers in complex, rap- ever, these methodologies may not capture the complex and idly evolving situations to more rapidly identify deviations idiosyncratic experience of resuscitating decision-makers or (or threats) from the predicted mental model and generate other operating in dynamic, high-risk situations (Anderson a larger number of possible causes and consequences to et al. 2019). explain events due to their broader perspective than novices Effective experiential learning may only occur under cer - (Launder and Perry 2014; Bakken and Gilljam 2003). Next, tain conditions: it requires accurate and immediate feedback highly experienced personnel are less likely to react emo- about the relation between situational conditions and the tionally or employ excessive force under stress than novices appropriate response (Kahneman 2011; Bakken and Gilljam (Harman et al. 2019). Furthermore, if emerging situational 2003). The inability to identify common and consistently cues imply intuitive decisions could be wrong, experienced applied review strategies in the literature may be sympto- decision-makers may shift to formal or system 2 strategies, matic of the broader lack of a common and consistent inci- replacing intuition with careful reasoning (Kahneman 2011; dent decision-making framework at this time. In the absence Kahneman and Klein 2009). of such a framework paramedic, fire, police and military Next, consider the review actions that may occur follow- agencies are independently developing localised solutions ing an emergency, police or military incident. These actions with the effectiveness dependent on each agencies under - involve retrospective analysis and evaluation of events and standing and application of research and evidence-based decisions made. However, there is minimal evidence of practices. structured review process in critical decision making in the reviewed literature that guides practitioners in evaluation of decisions either real time or post event. Of the services 4 Discussion examined, literature concerning prehospital care identified a framework of decision review and care intervention based 4.1 Commonalities between service disciplines on changes in patient presentation due to treatment effect (or lack thereof). However, like many services this deci- In regard to the question of commonality across the dis- sion review was predominantly informed by experience and ciplines explored, in other words, “to what extent is there pattern recognition. Interestingly, Gunnarsson and War- commonality between military and emergency services in rén Stomberg (2009) noted that nonverbal expressions and regards to research and evidence-based threat assessment behaviors by team members resulted in decision making and decision making?”, we propose that there is greater com- reflection, it would appear that decision reflection was driven monality than currently identified in the individual pieces of by behavior rather than an unbiased evaluation to validate research reviewed. Commonality across services was found (on invalidate) decisions. The findings of Gunnarsson and in language, theory, and processes. Although there are dif- Warrén Stomberg (2009) are congruent with Bakken and ferences in the nature of the information considered across Gilljam (2003) who showed evidence of confirmation bias police, paramedic, firefighting and military settings there in decision-making and failure to critically analyse decisions are nonetheless commonalities in the processes by which where outcomes were accepted. information is gathered, interpreted and applied as a precur- The literature supports a belief that post-incident review sor to decision-making. This commonality suggests Ends- through reflection, debriefing, and coaching, supports learn- ley’s (1995) seminal definition of Situational Awareness, ing and the collective development of intuitive expertise being the “perception of the elements in the environment and decision-making (Akinci and Sadler-Smith 2020). Fur- within a volume of time and space, the comprehension of thermore, reflection and feedback appear vital to the devel- their meaning, and the projection of their status in the near opment and maintenance of expertise by facilitating the future”, not only remains current 26 years after its publica- restructuring of knowledge as experiences and outcomes are tion, but the most encompassing term and accurate definition appraised and measured against actions (Perona et al. 2019). for this initial phase of the decision-making process regard- Moreover, there are factors that influence the effectiveness less of context. Situational Awareness provides a transfer- of review actions in developing future decision-making. For able terminology and definition that can be applied across example, shallow reflections on action and lack of knowl- multiple industry contexts more effectively than more nar - edge of outcomes are likely to create or develop biased, prej- row and specific terms such as diagnosis, threat assessment udice, and inaccurate intuitions (Akinci and Sadler-Smith or size-up. Additionally, situational awareness provides a 2020). However, the development of highly prescriptive and conceptual framework describing a common process of iden- inflexible post-incident review methodologies may provide tifying and interpreting contextually specific information 1 3 Cognition, Technology & Work (2022) 24:423–439 433 and projecting potential outcomes. Within this framework, major decision-making methodologies. First, the literature knowing what information to seek, how to find it and what describes naturalistic (or intuitive/type 1) strategies that are it means becomes critical. employed in the majority during low-time situations. These The term situational awareness better describes the intuitive strategies may be further delineated to include rec- broader and more holistic cues and information sets identi- ognition-primed, value-based, and ‘overlearned procedural’ fied in the literature and considered by decision-makers than decisions. The naturalistic strategies involve a nearly seam- more narrow terms such as ‘threat assessment’. For example, less transition from the development of situational awareness a soldier, paramedic, police officer, and firefighter will regu- to a decision. However, the effectiveness of these decisions larly find themselves in danger, however, to make sense of is dependent on the experience, knowledge and confidence a threat without greater appreciation of the true context of of the decision-maker and the relevance, clarity and sim- the situation (regardless of whether it is an explosive device, plicity of organisational procedure and preparatory training. combative brain-injured patient, unstable structure, or armed The literature identifies the widespread use of ‘formal’ offender) is to ignore the relevant political, moral, legal, (or analytical/type 2) decision strategies across the police, organisational, cultural, and other factors that may influ- fire, paramedic, and military sectors. These formal strategies ence whether the decision is acceptable, suitable or correct. involve the consideration of multiple options and, therefore, Furthermore, situational awareness describes processes are primarily employed in situations where an immediate that are applicable where there is time to identify, inter- decision is not required. Another commonality across ser- pret and analyse information as well as low-time, high-risk vice streams linked to formal decision-making is the depend- situations. Specifically, the term encompasses both formu- ence of the success of the decision-making process, is the laic, deliberate and analytical processes that may be taught setting of goals or objectives. Contrary to a small minority explicitly to novices and intuitive nearly instantaneous pro- of the studies reviewed, the greater majority of the research cesses applied by experts. suggests that almost all personnel have either inherent or Therefore, although differences will remain in the nature deliberate goals they are trying to achieve. These goals may of information considered by the services examined in this be automatic or subconscious, for example staying alive research, we find there are significant and important com- during a shoot-out with an armed offender; determined by monalities concerning the behaviors employed to establish organisational doctrine, for example the protection of life, ‘situational awareness’ and that there is consensus that this property and the environment; or deliberately determined by awareness is the precursor to effective decision-making. an individual, for example where conflicts between goals, Significantly, this identified commonality has implications values or ethics occur. The research supports the notion that for developing greater consistency between the fire, police, depending on the experience and personal attributes of the military and paramedic sectors included in this research both individual, the speed and success of the formation of the operationally and in the training and development of per- plan will vary. sonnel. The results of the study suggest that by embedding During initial learning, novice military and emergency knowledge of the process of looking for, and assessing all services personnel require assistance and supporting physi- the elements of Situational Awareness, and recognising that cal stimuli (otherwise known as perceptual clues) to enable all dynamic situations are governed by ‘rules of engage- neural pathways to be developed and ‘sense’ to be made ment’, both decisions and outcomes may be improved across from the overwhelming data and sources of information that service contexts. Further, the extent of research supporting they are exposed to (Kahneman 2011; Kahneman and Klein Situational Awareness as a foundation of decision making 2009; Launder and Perry 2014). As neural pathways and in part addresses the questions regarding scientific validity pattern matching occur over time, the students can make of the concept of situational awareness raised by Carsten sense of increasingly complex information within reduced and Vanderhaegen (2015), as it is indeed a concept that  is timeframes (Kahneman 2011), allowing them to effectively not only common across services but has a wealth of deep assess and manage risk (Penney 2019). As their decision- scientific support across decision-making models and theo- making abilities develop, experienced firefighters, incident ries, even when those theories that do not necessarily agree managers, and emergency responders are able to progres- on other aspects. sively extend and adapt decision making to situations with greater speed than previously able (Kahneman and Klein 4.2 Commonality in theory 2009). With experience and mastery of their profession, emergency responders are able to recognise patterns from The researched literature identifies commonality in the prior incidents, subconsciously plan and even pre-emptively description of decision-making processes employed across respond to changes in incident dynamics (Cohen-Hatton and these industries. Although industry specific terms are Honey 2015; Klein et al. 2010). Although a hard delineation applied, these terms repeatedly identify two common and between naturalistic and formal decision-strategies may not 1 3 434 Cognition, Technology & Work (2022) 24:423–439 reflect the manner in which decision-makers select from a a specific situation depends as much on the decision maker’s ‘spectrum’ of decision strategies, the terminologies nonethe- individual characteristics (training, bias, utility, expertise, less provide a practicable and common nomenclature that prior experience, intelligence, self-awareness, health, emo- may be applied and communicated across these industries. tion etc.) as it does on the context of the individual situation Next, the literature established that the effectiveness of (time available, level of self-threat, consequences etc.). decisions is dependent on the effectiveness of their transla- tion into action. Areas of commonality across fire, police, 4.3 Commonality in processes military and paramedic settings included the individual capabilities and experience of the decision-maker, or where Variance in the accepted process by which decisions are this individual was reliant on the actions of others, the effec- made between services was identified. Popular amongst fire tiveness of communication, coordination and control and services and based on seminal research by Klein et al. in credibility and confidence of personnel involved. This identi- 1995, published in (Klein et al. 2010), the theory of Recog- fied commonality of ‘action’ behaviors supports the ongoing nition Primed Decision Making (RPDM), provided a model development of systems such as the Australasian Interagency to describe the process used by firefighters to make critical Incident Management Systems (AIIMS) that seek to foster decisions during complex and dynamic operations. Recently, consistency of incident management practice and behavior however, alternate theories (SAI Global 2013; Burrell et al. across multiple responding agencies. 2013), and variations (Cohen-Hatton et al. 2015; Cohen- Finally, the literature identifies commonality concerning Hatton and Honey 2015) to RPDM have been proposed. the review of decisions in fire, police, military and para - Within military contexts, various command decision mak- medic settings. Across these industries both dynamic review, ing frameworks exist including the Interactional Dual-Pro- that is review of the evolving situation, decisions made and cess model of moral decision making (Seiler et al. 2010); their execution during an incident, as well as more formal Observe-Orient-Decide-Act Loop and Critique-Explore- and considered review that occurs following the conclu- Compare-Adapt Loop (Bryant 2006). Cognitive processes sion of an incident. Whereas the effectiveness of dynamic and threat assessment within ambulance and police contexts review appears to be strongly linked to the experience of the are typically identified as fluid sense making and experi- decision-maker (irrespective of industry) the effectiveness of ence or bias centered as opposed to the defined processes of post-incident review is dependent on the presence of a con- other services (Perona et al. 2019; Marusich et al. 2016; van sistent framework for both making and evaluating decisions. den Heuvel et al. 2014; Gunnarsson and Warrén Stomberg This research supports the notion that an individual’s 2009). Whilst the contribution of service specific research experience and personal attributes strongly influences their to the military, police, fire and ambulance contexts cannot ability to make sense of a situation and respond appropri- be denied, there is an absence of cross-disciplinary research ately. It is almost impossible for inexperienced personnel in the field. to successfully utilise Recognition Primed Decision (RPD) However, our research identifies common threat assess- making, regardless of service context. In the same man- ment and decision-making elements that can potentially be ner, even highly experienced and capable personnel will used to develop a framework or spectrum of decision-mak- be unable to exercise RPD in unfamiliar unique experi- ing across these dynamic settings. These common elements ences. Further, the research suggests that there is a unique include the development of situational awareness (Endsley threshold, dependent on both the individual and the situ- 1995), the application of decision strategies from a potential ation encountered, for which RPD will be able to be suc- spectrum that includes both rapid, naturalistic (intuitive) and cessfully implemented to achieve an acceptable outcome. formal (analytical) decisions, as well as behaviors required to Inexperienced personnel will almost always use a deliber- enact and review decisions (both dynamically and formally). ate analytical decision process, which may be enhanced by One member of the research team has previously published organisational guidelines or protocols aligned to a certain a decision framework consistent with this approach within outcome or goal. As an individual gains greater knowledge, the specific context of rapidly evolving urban firefighting and becomes more experienced and skillful, their ability to (Launder and Perry 2014). However, this framework did make sense of a situation, formulate a plan, and execute not consider or seek to address commonality across para- it increases. With true expertise, the speed at which this medic, police or military settings. However, this research process occurs may make it appear that the individual is provides the opportunity to consider the broader extension of pre-emptively responding even before a threat is appar- a consistent and common model that includes the identified ent. In this way, the research suggests that as opposed to decision-making elements across these industries. the decision-making process being naturalistic, heuristic Therefore, we suggest a framework or spectrum of or analytical, these processes are actually part of a single decision-making which provides consideration of existing decision-making spectrum. We argue the process applied in prominent and future relevant decision-making models, and 1 3 Cognition, Technology & Work (2022) 24:423–439 435 which is transferable across the industries studied, can be principles of mathematics are established and built upon to developed. We suggest that by understanding the types of enable students to progress from basic addition, to calculus, available decision-making processes and methodologies to differential equations and so on. identified in the research and available on the decision mak - Within the operational environment the findings of this ing-spectrum, as opposed to confining operational decision- research can be applied through the potential adoption of making to a single process or method, all of the processes frameworks such as the Cynen fi framework (Snowden 2002) identified in the texts reviewed can be readily adapted to or SPAR framework (AFAC 2020) which promote adaptable suit situational contexts within each service. The research and different sense-making and decision-making approaches, suggests that the processes employed to make decisions may such as those models discussed in this study, depending on only be half the issue. Much like learning styles, the most the complexity and novelty of the situation encountered. The appropriate decision-making process for an individual will findings can also be applied through deliberate efforts to vary depending on the individual’s unique characteristics increase commonality between services through joint learn- or attributes including but not limited to experience, utility, ing and exercises involving decision-making personnel from intelligence, emotional intelligence, and education. The most different services who will be required to work effectively appropriate decision-making process will also depend on the together to successfully coordinate the safe resolution of health of the individual, with fatigue, emotion and pain all high consequence low frequency and time critical events. having the potential to impact the decision arrived at in any From an autonomous systems perspective such as those given situation. The research suggests that whilst experience proposed by Vanderhaegen (2021), the findings of this cannot be ‘trained into’ a person, one of the most effective research and proposed applications may be perceived as a ways to pre-emptively embed an effective decision-making double-edged sword. Whilst increased commonality between process is regular high fidelity (potentially deconstructed) human systems involving multiple decision-makers may training environments that can introduce uncertainty, time assist the development of automated systems within the restriction, and the perception of danger in a controlled man- decision-making domain, increasing the range of processes ner. In the field, practices such as team decision-making relied upon by human decision-makers may potentially com- (similar to that used by airline cockpit crews during emer- plicate attempts to automate such processes. It is suggested gencies), and distributed decision making so that an indi- further research is required in this specific field to fully vidual’s decision-making utility is not exceeded, may also appreciate any impacts. enhance the use of appropriate decision-making processes. 4.5 Limitations 4.4 Application In excess of 10,000 separate research artifacts were initially The potential practical application of these findings within captured across six academic databases in this systematic the various contexts extends to both the training and opera- literature review and 94 studies were ultimately included tional environments. Using the field of mathematics as for full analysis, being 3.4 times greater than the average an analogy, it is inappropriate to apply calculus in every number of studies reviewed in other systematic literature situation such as simple addition just as it is inappropri- reviews completed in the field to date. Despite this, it is ate to expect a lower school student to complete advanced acknowledged that research in other languages and non-peer differential equations. In the same way, to develop a broad reviewed studies may provide additional and valuable infor- range of decision-making abilities for different situations, mation. New research in the field is also constantly being students and novice commanders within emergency and published so it is important to acknowledge this study is military services should be taught a range of decision mak- completed at a point of time. ing theory and models from which they can then select the The search strategy for the study was specifically designed most appropriate for the specific situation they find them- to be ‘highly sensitive’ and retrieve a large proportion of var- selves in. At the same time, emergency and military ser- ied studies across the various emergency service and mili- vices may need to consider whether they require students tary contexts, as opposed to a ‘highly specific’ study which to have a minimum level of experience if they are going identifies a smaller number of more specific studies which to teach experience reliant decision-making models such as would result in reduced studies being reviewed. Following RPDM and naturalist decision making, particularly for high several reviewers’ comments regarding the original search consequence low frequency events that students and even not being broad enough, the terms were increased to include experienced personnel may have limited exposure to. Where “law enforcement”, “wildfire” and “bushfire”. Whilst these such models are intended to be taught in the absence of the yielded an additional 391 initial results (four being duplica- required foundation experience, services may need to invest tions of already included studies), no additional studies were in scaffolded learning much in the same way that the basic ultimately included for full review as they did not meet the 1 3 436 Cognition, Technology & Work (2022) 24:423–439 required inclusion criteria. This provides a level of confi- communication and trust between decision-makers and dence that whilst the search may not have been exhaustive, it those executing actions was consistently identified across certainly met the criteria for a plateau of diminished returns all services. and the final set of included studies remains a reasonable We suggest that institutional restriction of decision-mak- basis for drawing conclusions. However, as we discussed in ing to a single process at the expense of the consideration of our findings regarding the commonality of language between others (for example institutional requirement to use RPDM services, absolute commonality was not present. This leaves as opposed to considering System 1 and 2), or the inap- open the possibility that some relevant yet uncommon terms, propriate training and application of otherwise appropriate and, therefore, relevant studies, may have been missed. decision-making processes in certain circumstances may Acknowledging the potential for bias in the selection increase the potential for adverse outcomes, or at the very of studies for inclusion in the research, the study deliber- least restrict peak performance being achieved. For exam- ately required three authors to independently assess poten- ple, attempting to apply RPDM where the user has insuffi- tial studies for suitability with any disputes addressed by cient experience with which to appropriately recognize the consensus decision. The fourth author deliberately did not situation and recall an appropriate response, or attempting participate in the initial selection or synthesis of included to apply a deliberate analytical approach where an instant studies, effectively performing the role of ‘red teaming’, i.e. decision is required. Whilst the specific contexts and cir - in other words he deliberately and critically attacked the cumstances of incidents between military, police, fire and study method and analyses in an effort to overcome cog- paramedic operations and incidents will inevitably differ, nitive errors including group think and confirmation bias.. ignoring the potential application of research across service Despite this, it is acknowledged that the research team are streams may also serve to limit improvements in perfor- all Australians (albeit from different service and research mance. To improve threat assessment and decision-making backgrounds) and may be biased by their shared cultures. in military and emergency services contexts, and to address the uncertainties identified in this study, further research is recommended to define what differentiates a good and bad 5 Conclusions decision, and how this determination can be made. The apparent lack of a framework or spectrum of deci- To better understand the potential for improvement within sion-making common across service contexts in itself individual services, and during inter-agency emergency and limits the potential to evaluate decisions (and their out- disaster response, we attempted to discern commonalities comes) across distinct industry settings. For example, across threat assessment, sense making, and decision mak- although firefighters, police officers and paramedics may ing in dynamic emergency contexts between military, police, respond to a single multi-agency emergency incident they ambulance, and fire services. We systematically identified will at present apply differing terminology, procedures, and critically appraised relevant studies, before completing controls structures and review processes. Without a com- a narrative synthesis and thematic analysis of those relevant mon framework or spectrum to work within, or at least to the research theme. increased commonality between services, we posit that the Whilst absolutely consistency in language between ser- inconsistency in conclusions as to whether a decision was vice contexts (and even to some degree within service con- good or bad between personnel within the same service texts) was not found, similar terminology, definitions and context as previously reported in Penney (2019), let alone descriptions were present within the literature reviewed, different services, will continue unaddressed. The develop- in particular fire services and the military. Despite the ment of a common yet scalable framework or spectrum of differences in operating environment and the nature of decision-making which provides consideration of existing situational information required between services, com- prominent models such as those reviewed in this paper, as monality was found in the way novices in the different well as allowing for the incorporation of future relevant services make sense of their environments compared to decision-making models, will have the additional benefit more experienced personnel within the same service. The of providing a consistent evaluative framework that allows application of mental models, both intuitive and deliber- the evaluation of both the decision-making processes and ate, to process this information and make critical deci- behaviors applied, and their ultimate outcome. sions was also common across services, even if the mod- Supplementary Information The online version contains supplemen- els themselves differed. Common across all services and tary material available at https://doi. or g/10. 1007/ s10111- 022- 00694-3 . contexts was the belief that in the absence of translating decisions into timely and appropriate physical action, even Acknowledgements Laura Toose, Alecia Wood and Clare Wallwork ‘good’ decisions become ineffective. To execute the neces- are thanked for their proofing and formatting assistance. sary actions to support good decisions, the need for clear 1 3 Cognition, Technology & Work (2022) 24:423–439 437 Author contributions GP, DL, JC: conceptualization; GP, DL, JC, MT: decision-making. Emerg Med J 35(4):208. https:// doi. org/ 10. methodology; GP, JC: validation; GP, DL JC, MT: formal analysis; GP, 1136/ emerm ed- 2017- 206743 DL, JC: investigation; GP: data curation; GP, DL, JC: writing—original Anderson NE, Slark J, Faasse K, Gott M (2019) Paramedic student draft preparation; GP, DL, JC, MT: writing—review and editing; GP: confidence, concerns, learning and experience with resuscita- project administration. All authors have read and agreed to the pub- tion decision-making and patient death: a pilot survey. Austral- lished version of the manuscript. ian Emerg Care 22(3):156–161. https:// doi. org/ 10. 1016/j. auec. 2019. 07. 001 Bakken BT, Gilljam M (2003) Dynamic intuition in military com- Funding Open Access funding enabled and organized by CAUL and mand and control: why it is important, and how it should be its Member Institutions. This research received no external funding. developed. Cogn Technol Work 5(3):197–205. https:// doi. org/ 10. 1007/ s10111- 003- 0123-1 Availability of data and material The summary of all studies included Bang M, Liwång H (2016) Influences on threat assessment in a mili - in the final review are provided as a supplementary file. tary context. Def Secur Anal 32(3):264–277. https://doi. or g/10. 1080/ 14751 798. 2016. 11991 18 Declarations Banks AP, Gamblin DM, Hutchinson H (2020) Training fast and fru- gal heuristics in military decision making. Appl Cogn Psychol 34(3):699–709. https:// doi. org/ 10. 1002/ acp. 3658 Conflict of interest Two authors (G.P. & D.L.) work for state govern- Bonner HS (2018) The decision process: police officers’ search for ment fire and emergency services. J.C. works for a not-for-profit ambu- information in dispute encounters. Polic Soc 29(1):90–113. lance service. All statements expressed in this article are those of the https:// doi. org/ 10. 1080/ 10439 463. 2016. 11470 40 authors and do not necessarily reflect the official opinion or policies Braun V, Clarke V (2006) Using thematic analysis in psychology. of any of their affiliated institutions, civilian, military, government, or Qual Res Psychol 3(2):77–101. https:// doi. org/ 10. 1191/ 14780 other. Two of the authors (G.P. and D.L.) have previously published in 88706 qp063 oa this field and each have a single research paper included in the study. Bryant D (2006) Rethinking ooda: toward a modern cognitive frame- work of command decision making. Mil Psychol 18(3):183– Open Access This article is licensed under a Creative Commons Attri- 206. https:// doi. org/ 10. 1207/ s1532 7876m p1803_1 bution 4.0 International License, which permits use, sharing, adapta- Burrell L, Noble A, Ridsdale L (2013) Decision-making by ambu- tion, distribution and reproduction in any medium or format, as long lance clinicians in London when managing patients with epi- as you give appropriate credit to the original author(s) and the source, lepsy: a qualitative study. Emerg Med J 30(3):236. https:// doi. provide a link to the Creative Commons licence, and indicate if changes org/ 10. 1136/ emerm ed- 2011- 200388 were made. The images or other third party material in this article are Carsten O, Vanderhaegen F (2015) Situational awareness: vallid or included in the article's Creative Commons licence, unless indicated fallacious? Cogn Technol Work 17:157–158. https://doi. or g/10. otherwise in a credit line to the material. 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Journal

"Cognition, Technology & Work"Springer Journals

Published: Aug 1, 2022

Keywords: Situational awareness; Decision making; Firefighter; Police; Ambulance; Military; Recognition primed; Heuristics; Bias; Threat assessment

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