MotR – Mike Lauria on “Making the Call”

Mind of the Resuscitationist Wee

MikeLauriaMike Lauria is the @resuspadawan. You’ll be hearing a lot more about Mike when he comes on the show for an interview. For now, know that he was Air Force Pararescue, now a medic on the Dartmouth-Hitchcock Advanced Response Team (DART), and will be starting medical school in the Fall. He has a special interest in cognitive decision making under stress, aka the Mind of the Resuscitationist.

Recognition Primed Decision Making (RPD)

Sources of Power by Gary Klein


From 40-second Boyd. Read a summary on wikipedia


Cognitive Unloading

  • Standardization & Preparation
  • Checklists
  • Premade Decision Points and Triggers

Cognitive Rally Points (Stop Points)

  • Hard and Soft Rally Points
  • Take a Deep Breath

Build Decision Making Power

  • Deliberate Practice
  • Review Experiences
  • Timely Expert Feedback
  • Socratic Method-Suck it Up!
  • Simulation

Stress Inoculation

  • Cognitive Tempering
  • The Rule of 130%-do the basics better than anyone else
  • Limbic Learning-emotional reaction burns it in
  • Train until you can’t get it wrong
  • You fall to the level of your training

Stay Flexible

  • Cognitive Flexibility
  • Acknowledge BIases
  • Ask disconfirming questions

The Slides



See this amazing comment on Mike’s Lecture

Now on to the Lecture…

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  1. says

    Phenomenal content. Thanks, Mike and Scott!

    I think there are four natural rally points in HEMS / PHARM / retrieval med / CCTM:
    1. While en route to wherever the patient is, I review with my partner what we know clinically (which is often pretty limited), discuss what equipment we are and are not going to take with us out of the helicopter / ambulance, and review our plan of attack (ie. for a trauma scene where the patient is inside an ambulance on our arrival to the LZ: “I’ll enter the back door of the ambulance with the monitor, you enter the side door with the jump bag, and if the patient needs an airway, you’ll be primary.”) All this in addition to simultaneous work to assist the pilot in maintaining aviation safety, of course.
    2. At the scene or the referring hospital, 2-3 minutes after arrival at the patient’s bedside, after getting report and performing primary survey: a very quick discussion with my partner prioritizing both ddx and necessary interventions, particularly the decision of what interventions must be done right now prior to moving the patient, and which can wait until we’re en route.
    3. As Mike said in his talk, once we lift from the scene or referring hospital with the patient and reach cruise flight: a review of the patient’s response to our initial interventions, reprioritization and assignment of additional interventions that need to be done in flight, and clarification of our appropriate destination, if there’s any doubt. This rally point often involves conversation with online medical control via radio.
    4. After landing at the destination hospital, while en route to whichever unit the patient is going: a discussion in order to plan a safe, efficient, and effective handoff to the receiving team. This rally point for me always involves rehearsing in my head the verbal report that I’m going to give upon rendezvous with the receiving team.

    Mike gave this talk at #CCTMC14 in Nashville, and it was phenomenal. Minh Le Cong recently said of CCTMC (Critical Care Transport Medicine Conference): “Sounds like a SMACC for PHARM,” and he’s right. Mike’s talk is an excellent representation of the sort of educational awesomeness CCTMC delivers consistently. It is the premier clinical HEMS / CCTM / PHARM conference in North America. #CCTMC15 will be April 20-22 in Charlotte, NC, and the speaker submission deadline is only two weeks away. Go to to learn more, and plan to get to Charlotte! I know Mike will be there. Scott, we’d love to see you there, brother…

    • Mike Lauria says

      I am definitely planning on being there. Awesome people, incredible ideas, wonderful lectures by EM/critical care/transport providers, nurses, and paramedics from around the world! I would encourage people to come.

  2. Sean Marshall says

    Fantastic talk! Lots of respect for the PJs being a former army medic myself.
    Militi Succurrimus.

    • Mike Lauria says

      Thank you very much, Sean. Glad you enjoyed it. Any feedback is welcome. I’m always looking to change/modify/add to the presentation. Take care.

      “These things we do, that others may live…”


  1. […] **I just about hit the “red zone” (in joke for those who were there or have heard of the zone concept from the book ‘On Combat’) when Dr Burns starting laying it down on stress inoculation and critical care medicine in the retrieval setting. For those interested in finding out more on this go check out Scott Weingart’s EMCrit podcast ( […]

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