EMS Special Ops: Behavioral Changes Affecting Decision Making Capabilities

In March 2006, the Center for Special Operations Training will conduct a functional exercise in a five-county region in Pennsylvania. The exercise will consist of four county Emergency Operations Centers (EOC) and four hospital EOCs with various incidents testing the level of preparedness and capability of each EOC. I had the opportunity to observe how an exercise of this scale is prepared and the extraordinary amount of time and commitment it requires for those participating.

During a controller pre-planning meeting, I had an informal discussion where I asked if there was documented research showing how emergency managers and other decision makers reacted when a significant amount of stress was placed upon them. I continue to remain curious about how people think, react, and delegate authority during a disaster. It always seems the topic of "what went wrong" occurs after the incident, as if this is time to place blame on someone or some agency.

With the dedicated help from highly knowledgeable professionals at the Center for Special Operations Training, our attention now focuses on a possible formal study using the Erie Functional Exercise as the framework for our research. Needless to say, this is an exciting time--to be able to track and record verbal and non-verbal behaviors of emergency managers during a functional exercise. Below is an excerpt from the controller pre-planning meeting announcing why this topic is worthy of study.

Introduction
As professionals, the goal of a functional exercise is to understand and recognize the level of capability in response to a mass casualty event. For some, a functional exercise is a partial look into the future which allows all participants to assess, recognize and implement ways for improvement. The reality is, the days of algorithm decision making, or following a set of protocols, can only help those involved in a disaster to a certain point. Today's disaster management focuses on how and why we do things and what could be used as the best decision making practices (Ormrod, 2004, p. 116).

An important consideration when disaster planning is most will agree that in the event of a disaster, people are going to get hurt (Schnepp, 2004, p. 44). We can have all of the resources possible, but it does not diminish the risk of casualty. While we can never predict a disaster, planning for any type of exercise allows those involved to evaluate decisions, assess why they were made, and work together to solve problems.

Crash Course in Behaviorism
Robert M. Hutchins (1950), a past President of the University of Chicago, wrote a position paper describing the ideal aspect of a college environment. He stated, "A college should not seek to adjust its students to their environment, because it cannot tell what their environment will be" (¶ 6). In short, we must continually adapt to our current environment. It is how we react in a given situation that defines us, especially in times of crisis.

During a functional exercise, evaluators are recognizing not only the specific protocols, but how participants think and learn. Learning is defined as a change in behavior (Ormrod, 2004, p. 3). Cognitive thinking focuses on the behavioral outcomes of learning (Ormrod, 2004, p. 3). The goal of a functional exercise should not only be to evaluate resource management, but to rigorously assess those making decisions and probe further as to why those decisions are being made. We need to figure out why participants react the way they do not after the incident, but during the exercise. Hutchins stated with regard to students and college, "...certainly our object must not be merely to prepare students for any possible environment, but also to induce them to try and get a better one" (¶ 7). In reference to incident planning, not only should we prepare for the incident, but we must also prepare how to actively handle and adapt to the incident.

Interpretation
Many who participate in a functional exercise bring a wealth of experience, creativity, and a willingness to learn as a means to test the level of capability of disaster management. I wish I could say common sense is the truest sense of decision making while under stress (Mikolaj, 2005, p. 61). But "my common sense" is different from everyone else's view, and this can be a foolhardy way of handling a crisis. We must go with what works best, and by this I mean through a scientific study. It seems this is the formal means to evaluate and reassess concepts, and develop them further into universal guided practices (Mikolaj, 2005, p. 62). A simple study could be implemented to evaluate the behavioral changes that occur during an incident. Components of this study could be but are not limited to: (a) observation of behaviors, (b) forming cause and effect explanations, (c) testing explanations, and (d) retesting explanations (Mikolaj, 2005, p. 62).

Structure and Capability
In order to implement a "behavioral evaluation plan" for a functional exercise there must be critical criteria for desired success. First, those involved must have excellent skill sets and become knowledgeable in behavioral changes and cognitive reflection. Second, a team environment facilitates completion of the project and allows for different perspectives. Lastly, the more information gathered, the better the outcome for cause and effect explanations.

Deficiencies in What We Know
What we do know is from past disaster experiences. The real-time disaster is the actual means to gather accurate information. It is quite possible that during the functional exercise, the evaluator may not be observing the "fight or flight" behaviors which may accompany multiple stressors placed on those who will make critical decisions in a real-time scenario. However, either setting focuses on the question, "Did learning occur?" Moreover, if learning did occur--positive or negative--how did it occur, why, when, and where? These are questions which can be assessed at the debriefing.

Conclusion
To review, even though resource management and planning play a major role for disaster preparedness, we must also evaluate the behavioral changes that occur during an exercise. This can become valuable information which could be applied for future exercises. The goal of evaluating behavioral changes and desired responses is to test new ideas, observe how thought processes are coordinated, and test individual capabilities during a critical incident. Much can be learned about how stimuli affect behavioral responses, but additional research is needed to present a formal study.

Biography
Joseph D. Palmieri recently joined the Center for Special Operations Training and currently one his tasks is to assess and evaluate the Erie Functional Exercise (March, 2006) from a behavioral standpoint. As a graduate student at Capella University, Joe is studying how adults rely on experience to guide them through the cognitive learning process. In coordination with CSOT and the participants at the Erie Functional Exercise, he hopes to explore and evaluate critical decision capabilities in a hazard environment. This potential study aims to correlate the various stressful stimuli placed upon emergency managers and hospital staff as a means to assess expected behavioral responses during an active hazard.

Joe currently is a Fire Service Paramedic for the Philadelphia Fire Department with over ten years experience in emergency medical services. He has lectured in educational settings about the role of EMS and its responsibilities to the general public. Joe holds several certifications relevant to the fields of EMS and weapons of mass destruction (WMD). He holds a bachelor of arts in Communications-Public Relations from Susquehanna University and continues to pursue a Master of Science degree in Post Secondary and Adult Education at Capella University. Questions or feedback can be directed to joseph.palmieri3@verizon.net.

References
Hutchins, R.M. (1950). The idea of a college. Measure 1, 363-371.
Mikolaj, A. A. (2005). Stress management for the emergency care provider. Upper Saddle River, NJ: Pearson Education, Inc.
Ormrod, J.E. (2004). Human learning (4th ed.). Upper Saddle River, NJ: Merrill Prentice Hall, Inc.
Schnepp, R. (2004, November). Weapons of mass destruction: handling the human element. Fire Engineering, 43-45.