Decision making  The Hill-Billy Brain

Ken MacIver relates the story and thinking behind his Back country decision-making checklist.

Ken teaches paramedic undergraduate students at Whitireia Polytechnic in Porirua. You’ll probably want to download the PDF of his Decision Making Tool to have open as you read this article; The Hill-Billy Brain back country decision making checklist. 

In 2013 our family of six headed into the Tararua Ranges for a couple of nights’ tenting at Totara Flats. My wife and I were briefly delayed at the start prior to crossing the swing bridge sorting out some gear for the littlest children. By the time we reached the other side our 13 year old son was nowhere to be seen. He had become bored waiting for us (ten minutes is an eternity at that age!) and headed off along the track. Now, the problem was that the route split almost immediately at this point and we didn’t know if he’d taken the correct trail.

Off goes the family… Photo/Ken MacIver

It was a nervy four or so hours for my wife and me as we struggled in the heat with heavy packs containing food and tents for six, both of us relatively unfit and coaxing along three small children aged ten, eight and five. It was with great relief when we found our son at Totara Flats lying in his one-person tent completely absorbed in novel.

Totara Flats Hut. Photo/Dan Clearwater

We had avoided catastrophe by chance, rather than good management. The first lesson was clearly establishing the “stick with the group” rule. But over the next few weeks the ‘What ifs?’ kept running through my head. What if our son had faced a river crossing? What if it had been winter? What if he’d headed off on the wrong track by turning left instead of right across the bridge at the very start? What if someone in the main party had had an accident and we’d been unable to continue on to meet him at Totara Flats? It got me thinking about how to prepare him for these and similar scenarios. To arm him with the knowledge that would enable him to cope with the unlikely, but entirely predictable things that typically result in trips going awry.

I spent a lot of time thinking about how to share my own backcountry situational awareness (SA) with the children and about how they might develop their own. There are a number of dry, academic definitions of situational awareness, but one of the simplest and most helpful is, “What was, what is, and what might be” 1. This means that to have SA you need to understand the trend of what’s been happening, what the current situation is, and crucially, what this means for the immediate future. This includes the ability to anticipate the worst, or to play the ‘What if?’ game.

My job is teaching paramedic undergraduate students at Whitireia Polytechnic in Porirua. As part of a Master’s thesis, I drafted a decision-making model for paramedic students, one aspect of which was to improve their situational awareness. I was keen to adapt the same principles to a backcountry setting.

Family tramps provided the testing ground for start-of-trail briefings. Photo/Ken MacIver

Each trip had different specific elements to cover, depending on the time of year, the number in the party and the levels of experience, the weather forecast, the length of the trip and so on. In the weeks prior, I would prepare a mental checklist for the specific situation. Then, at the road end I listened to myself repeating variations on a theme and wondered if it would be easier just to compile a hardcopy checklist of every element that could be considered. That way I could just read down the list selecting the elements that applied to the current trip and avoiding overloading my extremely limited working memory.

So I began listing elements to consider based on trips that I’d been on, or trips I’d heard about from friends. I learnt the most from tales of trips that had gone wrong and I’m very grateful to everyone who shared their tramping disaster stories! Another source of information came from a research project that I was involved in: a study that looked at seven years’ worth of New Zealand Search and Rescue (NZSAR) data. Deaths in the outdoors were detailed in approximately 200 police reports over the period, and as I read through them certain patterns began to emerge. It was clear that the three biggest killers in the backcountry were falls, drowning and medical events 2. This knowledge helped shape some of the elements of the checklist.

The avalanche safety literature provided the so-called ‘hazardous attitudes’ 3 concept, which have been adapted to a number of domains, including healthcare 4.

I’m grateful for the feedback I received from experienced outdoors people. Ian Flaws suggested a double-sided A5 sheet that could be laminated and fitted into the pocket of a tramping pack.

If you haven’t already, download the Hill-Billy Brain: Backcountry decision making checklist and have it open as you read the article!

Shaun Barnett provided suggestions (including the catchy name, ‘Hill-Billy Brain’) and helped workshop the final content and layout. Hayden Richards added the ‘Trends: are things getting better or worse?’ and the ‘Consequences of risk’ considerations.

Many of the elements included in Hill-Billy Brain will be familiar to experienced trampers or hunters. Experts tend to develop mental models (or schemas) which help them visualise or imagine how things are and how to deal with them 5. However, ask them to write down or sketch out their schema and they’ll often struggle. This is as true for expert paramedics as it is for expert outdoors-people; indeed, one characteristic of expertise is that it is largely subconscious in nature 6,7. But many of the strategies are easily recognisable, even if not by name. When I present the diagnostic strategies of ‘Rule out worst scenario’ and ‘Address anomalies’ to experienced paramedics, they often have never heard of them by those names, but they’ll frequently say, “Yes, that’s what I do in this or that situation.” Plucking these strategies from the brains of experts means they can be used by less experienced people. And writing them down moves them from the subconscious to the conscious, with the result that they can be deliberately considered every time.

One of the things that takes the most getting used to is the contrived feeling (at least at first) of a briefing. Few of us were raised with briefings. Indeed, trying to get my paramedic colleagues to engage in a briefing before starting a shift is often a challenge. Until you get used to them it just feels unnatural and perhaps a little over-the-top. “Do we really need to cover these things, Ken? This is basic stuff!” Yes, it is, but medical teams who include the obvious ‘What ifs?’ in briefings significantly outperform those who don’t 8.

Similarly, once the trip is underway, verbalising things that seem obvious takes a little getting used to. But this strategy is increasingly being promoted for use in high-stakes team endeavors, such as resuscitation 9. Hence the suggestion to verbalise a transition, for example, “Just a heads-up guys, we’re transitioning here into the sub-alpine zone. This is a high risk region for falls, so let’s stay focused and make sure of our footing.” This explicit communication helps people change gears and adapt to the new situation more rapidly 10.

Pausing for a briefing; “We’re about to transition from open river flats to rough bush bashing… Lets ensure we can always see the person in front and behind of us, and if not, then yell out to re-gain contact”. Photo/Richard Sidey.

One of the events I cover in class is the 1995 Cave Creek disaster that occurred on the West Coast of the South Island, where 17 young outdoor trainees and one DOC worker fell 30 metres when a viewing platform collapsed. The Commission of Inquiry Report details a number of minor issues with the rescue effort, some as a direct result of the remote location 11. Two of the survivors ran approximately two kilometres to the carpark to raise the alarm on the DOC vehicle’s two-way radio. Once there, they realised the radio wouldn’t work without the keys, which were in the pocket of one of the victims back at the bottom of the cliff. One of them had to continue running and then cycling (on a borrowed bicycle) for a further 30 minutes to reach a landline and activate the rescue.

These events are a good prompt for a little planning prior to setting off. Who has the keys? The cell phone? The PLB or mountain radio? Does everyone know how to activate the PLB? Is everyone clear on the circumstances which would warrant an activation? Who has the first aid kit? It’s not much help if the only first aid kit is with the person who strides ahead of the rest of the party, not to be seen again until reaching the hut at the end of the day.

If you’re not certain of some of these answers, you might want to take a look at another useful Wilderlife article: Where and how do you carry your PLB?

Time to call the chopper. Photo: Max Olsen

I remember asking my boys if they knew what to do if someone had a medical event or accident on one of our tramps. Their answers were fairly casual; after all, there was an experienced paramedic coming with them. But they began to take the question more seriously when I asked what they would do if it was me who slipped off the track and was knocked unconscious. It was heartening to watch them mentally changing gears once it dawned on them that they might have to deal with a crisis on their own. They seemed to snap out of zombie mode and began taking more responsibility for their own situational awareness. For example, checking the route on the map and discussing what to do if they got far ahead of the rest of us, an increasingly common situation as I get slower and they get faster!

Using the Hill-Billy Brain prompt sheet gives our children access to strategies that experienced outdoors people have compiled over many years. When we go into the backcountry now I feel confident that they with be able to cope if they become separated from the group. Or this more likely scenario: what to do if Dad collapses under the weight of his pack!

References

  1. Civil Aviation Authority. Situational awareness. Vector 3–6 (2013). doi:doi:10.1201/9780849375477.ch182\r10.1201/9780849375477.ch182
  2. Thirkell, C., MacIver, K., Mitchell, G. & Asbury, E. NZSAR Fatality Study. (2017).
  3. McCammon, I. Heuristic traps in recreational avalanche accidents: Evidence and implications. Avalanche News 1–10 (2004).
  4. New Zealand Resuscitation Council. Making teams work : Introduction. in Resuscitation: A gudie for advanced rescuers (ed. Frengley, R.) 30–42 (2016).
  5. Anders Ericsson, K. & Towne, T. J. Expertise. Wiley Interdiscip. Rev. Cogn. Sci. 1, 404–416 (2010).
  6. Perona, M., Rahman, M. A. & O’Meara, P. Paramedic judgement, decision-making and cognitive processing: a review of the literature. Australas. J. Paramed. 16, 1–12 (2019).
  7. Gladwell, M. Blink: The power of thinking without thinking. (Barnes and Noble, 2005).
  8. Haynes, A. B. et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360, 491–499 (2009).
  9. Agency for Healthcare Research and Quality. TeamSTEPPS 2.0 Pocket Guide. (2013).
  10. Brindley, P. G. & Reynolds, S. F. Improving verbal communication in critical care medicine. J. Crit. Care 26, 155–159 (2011).
  11. Noble, G. Commission of inquiry Cave Creek report. (1995).

 

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