Decision Making and Dealing with Ambiguity

“Ambiguity is central to Boyd’s vision… not something to be feared but something that is a given…We never have complete and perfect information. The best way to succeed is to revel in ambiguity.” –Grant Hammond, The Mind of War: John Boyd and American Security

I’ve often been asked over my career what I really do as a paramedic. Regardless of whether I’m working on a 911 ambulance, deployed supporting a remote operation, or on the stack with a tactical team, I tell people I do two things: make decisions and deal with ambiguity. Critical thinking and decisions making take practice and emotional intelligence to develop and implement. One of the tools I have applied, that translate well to everything in life, not just emergency medicine or tactical situations is the OODA Loop.

John Boyd was a highly influential, if little known military strategist. It has not been to more modern times that he has become popular amongst. Boyd was known firstly for his combat air strategy and is credited with setting new standards in combat aviation during the 1960s. While he wrote books and strategy guides, it is perhaps his briefings that made him the legend he is.

The OODA Loop can seem very basic when you first look at it. I think most originally learn about it from a simple four-point system, Observe, Orient, Decide, Act. Seems pretty simple? But is so much more complex, but very useable. It is a method for dealing with ambiguity head on, and making decisions during high acuity, dynamic situations. This translates well to combat, tactical situations, emergency medical scenarios… and even day to day crisis situations. ,

No matter you do for a living, or where you live, at some point you are going to face uncertainty and ambiguity. Imagine today you were on the scene of the violence that happened in London, where you have gone from minding your own business to a vehicle running folks down, and folks armed with knives. Humans often fail to change their mental perspective when something like this happens, we rather stay in a mindset of what we want to see or happen, we have to embrace the ambiguity in order to thrive in it. Accepting things are dynamic, going wrong, and having a mental concept of what is happening is key.

Boyd viewed the idea of mental models allowing for paradigms to be applied to current situations. Broadly, they could be paradigms cover a certain academic topic, specifically, they could be one of the critical care patients I take care of… very sick, ventilated, on a ventilator, with multiple drips of medications and a stack of paperwork for me to go through and make sense of it all. Having a mental paradigm as to how I can approach this patient is the groundwork needed to make successful decisions.

Boyd points out that where these models fail is, is when they do not interact with what is truly going on at the moment they are applied. The end user tries to apply old models to new problems over and over, instead of understanding they need to change the tool they are using.

It is a state of mind, a learning of the oneness of things, an appreciation for fundamental insights known in Eastern philosophy and religion as simply the Way [or Tao]. For Boyd, the Way is not an end but a process, a journey…The connections, the insights that flow from examining the world in different ways, from different perspectives, from routinely examining the opposite proposition, were what were important. The key is mental agility.” –Grant Hammond

And here enters the OODA Loop. Boyd saw this as a process or a journey when faced with critical decision making, agility is the key to success. The below graphic can be a touch daunting, but you have to take it as Boyd meant it to be, an organic, dynamic tool. None of the parts happen in a vacuum, and every piece provides feedback.

This is worth breaking down, though… section by section. So we should start at the begging with Observing.

“If we don’t communicate with the outside world–to gain information for knowledge and understanding–we die out to become a non-discerning and uninteresting part of that world.” –John Boyd

Situational awareness, being in condition “Yellow” allows for the best observation stance possible. You have to adopt the stance of being an open system, allowing you to break apart your old paradigms, and create new ones with the new reality you are facing. When I have that critical patient, I have to view not only the big picture, but understand each part of the whole that is care of the patient, from breathing tubes to IV access, to their labs, current medications, and so on. Failure to fully observe the situation can lead me to failure in the future, you have to interaction and interpret your changing environment.

Once the new situation and data has been collected, you have to be able to orient yourself to what is going on. With the patient above, each intervention, medication, tubes and so forth are for nothing if I am unable to orient myself to the big picture as to what is going on with the patient as the whole.

One of the ways Boyd broke down this idea of mental paradigms and orientation was a mental exercise he deployed:

“Imagine that you are on a ski slope with other skiers…that you are in Florida riding in an outboard motorboat, maybe even towing water-skiers. Imagine that you are riding a bicycle on a nice spring day. Imagine that you are a parent taking your son to a department store and that you notice he is fascinated by the toy tractors or tanks with rubber caterpillar treads.

Now imagine that you pull the skis off but you are still on the ski slope. Imagine also that you remove the outboard motor from the motorboat, and you are no longer in Florida. And from the bicycle you remove the handle-bar and discard the rest of the bike. Finally, you take off the rubber treads from the toy tractor or tanks. This leaves only the following separate pieces: skis, outboard motor, handlebars and rubber treads.”

Being able to build the snowmobile in this example, makes you a winner. Boyd felt the essence of the entire OODA loop was that the winners did the best observations, as this lays the ground loop.

If I decide I need to change the patient’s ventilator settings, this happens during the action phase, after I’ve developed a hypothesis as to what corrections I need to make for the patient. During the action phase the all the mental paradigms one has developed earlier making snowmobiles are applied and tested.

“We gotta get an image or picture in our head, which we call orientation. Then we have to make a decision as to what we’re going to do and then implement the decision...Then we look at the [resulting] action, plus our observation, and we drag in new data, new orientation, a new decision, new action, ad infinitum…” –John Boyd

The information on Boyd and the OODA available can go even further in depth than what has presented above and can be easily accessed with a simple internet search. Understanding how to apply this to any crisis or critical situation we may face can improve the odds of us coming out on top… from using our med kits or our firearms under duress. However, you have to practice and be comfortable with this tool.

Until next time, stay frosty… and apply the loop.