Cognitive Overload – Panic PCM

Understanding Cognitive Overload in Paramedic Practice

As paramedics, managing multiple tasks and making quick decisions under pressure is part of the job. Understanding how our brain handles this process, and more importantly, how it can become overwhelmed, is crucial to improving our performance in high-stress situations. This chapter will explore cognitive load, the limitations of our working memory, and how experience and automaticity can help reduce the burden on our minds.

What is Cognitive Load?

Cognitive load refers to the amount of mental effort required to perform a task. In the context of paramedicine, cognitive load is the amount of attention and mental resources needed to complete tasks like starting an IV, taking a patient history, or assessing a scene. The more complex the task, the more cognitive load it demands.

For example, starting a simple IV might require minimal effort if you’re experienced. However, a more difficult IV start, such as with a patient who has poor veins, requires more attention, increasing the cognitive load. As paramedics gain experience, many tasks become automatic (a concept called automaticity), which decreases the cognitive load. Automaticity allows experienced paramedics to perform tasks with minimal mental effort, freeing up their working memory for other important tasks.

Working Memory and Cognitive Overload

Working memory is like the brain’s sticky notes, temporarily holding a small amount of information to complete tasks. It has a limited capacity, typically tracking only four items at a time. In a paramedic scenario, working memory is engaged when you are processing the scene, recalling protocols, managing patient care, and communicating with your partner.

As more information comes in, working memory can quickly become overwhelmed. For instance, walking into a quiet senior’s home with a single patient allows for manageable information processing. But walking into a chaotic scene, like a party where multiple people are involved and there are environmental hazards, can rapidly fill up your mental “sticky notes,” leading to cognitive overload.

Once working memory reaches its capacity, it cannot process new information effectively, which can lead to mistakes or even a mental shutdown.

Experience and Automaticity

Automaticity develops through repeated practice and exposure to similar tasks. Tasks that once required intense focus become second nature over time. This process is critical in reducing cognitive load during high-pressure situations. For instance, experienced paramedics can start an IV while simultaneously obtaining a patient’s history, because the IV procedure has become automatic.

Paramedics also build mental flowcharts, which help them navigate decisions quickly without consciously thinking about each step. These flowcharts are part of the brain’s long-term memory. When faced with a new call, paramedics can access these pre-built decision trees, allowing them to perform tasks more efficiently and make quick, sound decisions.

Managing Cognitive Load on Scene

In paramedicine, managing cognitive load is essential to effective call management. When cognitive load becomes too high, it can lead to confusion, delayed responses, and even panic. This is especially true in high-stress calls, such as pediatric cardiac arrests or trauma scenes. Paramedics who are not familiar with the principles of cognitive load may struggle to handle the influx of information, potentially jeopardizing patient care.

Understanding your mental limitations and knowing when you’re reaching overload is the first step in managing it. Here are some common factors that can contribute to cognitive overload:

• Stress: Calls with high emotional or physical stakes can increase stress and consume mental resources.
• Fatigue: Lack of sleep or long shifts can reduce your ability to process information, increasing the likelihood of cognitive overload.
• Experience: Paramedics with less experience or exposure to certain types of calls may struggle more with cognitive load, as their decision-making processes are less automatic.
• Distractions: Environmental distractions, such as loud music, crowded scenes, or bystanders, can increase cognitive load by adding more information for the brain to process.

Strategies to Reduce Cognitive Load

To manage cognitive load and avoid mental overload, paramedics can employ several strategies:

1. Chunking: Break tasks down into smaller, more manageable pieces. For example, when dealing with a complex trauma patient, focus on stabilizing the airway first before moving on to circulation or bleeding control.
2. Scripting: Pre-plan your approach to common scenarios. Have a mental script for how to handle certain call types, which can reduce the need to make multiple decisions in the moment.
3. Controlling the Environment: Whenever possible, reduce distractions. This could mean asking bystanders to leave, turning off loud music, or controlling who has access to the scene.
4. Delegation: Work with your partner or team to share the cognitive load. Delegating tasks like monitoring vitals or handling documentation can free up mental resources for more critical thinking.

The Role of Long-Term Memory

Our brain has two memory systems that work together during calls: working memory and long-term memory. Working memory is limited in capacity, but long-term memory stores experiences and learned patterns. When faced with a new situation, paramedics pull from long-term memory to access similar past experiences. The more calls you handle, the more you build your long-term memory and the more automatic your responses become.

Think of long-term memory as a hard drive. It stores information and experiences that are not actively being used but can be accessed when needed. With experience, paramedics develop algorithms and decision-making trees stored in long-term memory, reducing the strain on working memory.

Recognizing Panic and Overload

When cognitive load exceeds working memory’s capacity, paramedics may experience a sense of panic. This can manifest as freezing, confusion, or an inability to think clearly. In extreme cases, the brain may shut down to prevent further overload.

A common scenario is being in a calm state one moment, such as watching TV during downtime at the station, and suddenly being dispatched to a high-stakes pediatric cardiac arrest. The drastic shift from low to high cognitive load can overwhelm even experienced paramedics, especially if they have not had positive experiences with similar calls in the past.

Conclusion

Cognitive load is an inherent part of paramedicine. By understanding how our brain processes information and how it can become overloaded, paramedics can adopt strategies to minimize stress, delegate tasks, and make more effective decisions on scene. Mastering cognitive load management leads to better call management, fewer mistakes, and improved patient care outcomes.