Backcountry Decision Making

Due to the absence of simple black and white answers to very important questions, backcountry emergencies poise unique challenges. Rescuer needs, patient needs, and group needs are of absolute priority at every step of the process, as is gathering and sorting information for proper decision making.

As an outdoor leader with responsibility for friends, family, clients, students or even as an independent traveler with some medical knowledge, others look to me for guidance and order during a potentially chaotic situation. I have learned that this role requires an efficient system for gathering information, formulating a plan that addresses the needs of those involved, and delegating responsibility to others. While each event or situation will be unique, I have been taught throughout my backcountry medical training a system used for decision making in the backcountry that can be essentially universal.

In the medical field, we have five steps to decision making.
1. Scene Survey

• Scene Safety
• Number of patients- Is everyone accounted for? 

2. Patient Assessment

• Primary Survey
• Triage if there are multiple patients -Sort by injury/ patient priority
• Secondary Survey

3. Patient Needs

• Injury Severity
• Injury Management 
• Ambulatory Status

4. Situational Variables

• Group status: nutrition, hydration, rest, number
• Location: distance, terrain, time of day, and season
• Weather: worsening/ clearing, wind precipitation
• Resources available: splint/ litter materials, personnel, camping gear, communications, gear, first aid kits, etc. 

5. Developing a plan

• Should you stay or should you go?
• How/ when will you go?
• Do you require assistance?

These same points and sub points if you will can be used outside an emergency medical scenario. 

The three biggest things to remember; aside from keeping in mind the nasty little heuristics that easily impair ones judgement, are Developing a plan, prevention, and details. 

In the backcountry developing a plan is important for patient assessment, it is also critical when managing the scene and evacuation. It is just as important in the front country making so-called "simple" decisions such as when, where, and how to begin a large project for a class. Backcountry situations usually require a more comprehensive evaluation of the resources available, the personnel available, the patient's condition, the number of patients, the location and environmental conditions, and the condition of the remainder of the group. Considering each component of a good backcountry emergency plan is essential to ensuring proper patient care and group safety. However, it need not be overwhelming and can, in fact, be relatively straightforward. A plan is a guideline to keep everybody safe. It works almost the same way I use sticky notes and lists in my daily life. I use it as a guideline to follow so I don't become distracted and/ or become consumed in something that is not in need of immediate attention. If the plan needs to change, change it, but only for a good reason. Developing contingency plans is especially helpful in the ever-changing backcountry environment. 

Formulating a strategy for possible evacuation before entering the backcountry is the best way to mitigate many of the complications that are bound to arise during an emergency situation. This includes forethought on communications (eg. radio. spot phone, evacuation points) terrain hazards and evacuation routes, skills among your group and the other possible resources available to you. Careful planning takes time. Recognize this and your stress will immediately be reduced greatly. STOP and THINK. The operational principle in developing an effective plan is prioritization; taking the extra few minutes to organize your thoughts and consider the options will allow you to prioritize well. 

One thing to remember when you are busy developing plans, laying out prevention tools and remembering the details is to keep in mind of your own judgement. Our own heuristics and our judgement call in a situation can lead to complete failure in a medical call or completing a class project. John S. Hammond, Ralph L. Keeney, and Howard Raiffa refer to these heuristics as "traps" in their article, "The hidden Traps in Decision Making."

Many of the "traps" listed throughout this article are ultimately the same as the heuristics I learned in my medical training in backcountry medicine. The Heuristics such as familiarity, availability, frequency, hero, zero- sum, self- serving, gender, and affect are just a few mentioned throughout my medical training. Within the article of "The Hidden Traps in Decision Making," Hammond, Keeney and Raiffa have mentioned traps such as the status-quo, sunk- cost, confirming- evidence, framing,  estimating and forecasting, overconfidence, prudence.... All of these listed so far play into the ones I have been previously familiar with. 

We have all heard a story a skier or possibly a group of skiers out in mid february trying to make the first turns through the bowl after a long spell of now snow and now blessed with a heavy dump. But it's sunny out. The bowl isn't part of a resort. Its too early for an avalanche crew to hit it. And sure enough, the individuals who have been skiing this very bowl for years and years end up on the front page of the paper. Many, many decision making traps play into a tragic, yet common day such as this. Familiarity, availability, frequency, status- quo, hero, over- confidence and many more play into a day gone south.

To wrap all of this together, when we are out making decisions, we need to keep in mind our scene survey, patient assessment, patient needs, situational variables, and developing a plan. By following these five steps and taking preventative steps in the first place as well as remembering the tiny details, we can try our best to dodge those tricky traps and carry out our decisions in the best way possible. 

Kouses Exercise Chapter 3

I. Discovering my values
1. Embracing
2. Challenging
3. Encouraging
4. Supportive
5. Personal responsibility
6. Teaching
7. Commitment
8. Preparation and performance

1. Determined Commitment
2. Faith
3. Quality Improvement
4. Honesty
5. Strength
6. Insight

II. What Values Matter to me? 
1. Autonomy. Having the freedom to self- direction and self-sufficiency is a value I hold strong to. With Autonomy comes self-discipline and humility. 
2. Harmony. I value finding the balance in my life. The balance of my different roles- roles as a student, daughter, sister, significant other, athlete, community member and citizen. It is important to find a happy balance between every hat in life. 
3. Honesty and Integrity. This goes hand in hand with commitment. When I make a commitment with an individual I make it a priority to not back out under almost any circumstances. My word is my word. I chose to have enough integrity to follow through with my actions and words. 
4. Patience. I value my practice of patience. I use my practice daily, hourly even. The saying "patience is a virtue," holds true to my virtues. As an individual who needs to practice patience minute by minute I value myself more when I take a step back and breathe. I believe my family values me much more when I do the same. 
5. Spirituality and faith. Without my faith in creator, in my future I would have nothing to look forward to. My spirituality is my rock when I feel like I am falling and have nothing to lean against. 

III. Putting My Values Into Practice
Patience. In a previous blog I talked about my practice of patience this summer. As a camp counselor there is almost nothing more important than having patience. Whether it's patience with a difficult camper or having the ability to sit back and watch a moment of personal self discovery and improvement of a girl with a troubled history.
 I am not a prime example of patience; however, I greatly value it in my daily life and strive to consciously practice it whenever an opportunity arrises. 

Farmers Market! Hours 3&4

On Tuesday I headed town to the Farmers Market at Bogart Park. The process getting there was an adventure in itself. I realized I had never actually DRIVEN to Bogart before haha. I kept thinking in my head. "That moment when you can't find the Farmers Market because you've only run or biked there..." Perfect Facebook status, right?
Side note: Isn't it weird that this is how we think now? We don't take pictures just to take, we take them to post. We don't ask our friends about the new guy we just met, we stalk them on facebook. And we don't just blurt out witty sentences, we post them to see how many people "like" it. God we're weird. What would our grandparents think?
Anywayyy! I FINALLY made it right at 5:30 and donned my best smile and headed towards the delicious smells and wonderful music.
At first it was awkward. Unlike Safeway, I just had a clipboard and was expected to roam around, approaching anybody and everybody. I found I felt I was being intrusive on peoples evenings and not allowing them to just enjoy themselves. After making a couple laps around the pavillion I decided to post up near the entrance so I didn't feel as if I were disrupting shoppers.
It was interesting working there rather than out in front of the doors of Safeway. The energy for one is very different and the audience, well it's a bit selective at the Farmers Market; lets be honest. But it is also an audience that politicians are really wanting to hear from. My generation of audience in particular.
The highlight of my night no doubt was registering a convicted felon. In Montana, if you are not in prison and no longer serving your sentence in any way, you still have a right to vote. I honest to god almost started crying when we had completed the process. I made sure he was signed up for the monthly "in the know" newsletter and told him of a few other ways to get voter information. He was completely honest about not knowing a thing of what was going on, but I promised with our help he would be more informed than the majority of people. He was thrilled!
It gives me flutterbees just thinking about the feeling of elation I had while talking to him. There's something about giving an individual back a basic right that really makes you appreciate what you have and appreciate your own personal rights. I can't imagine living in a country where voter oppression is still happening. Especially women voter oppression. Or just the oppression of women. Wow. We have it pretty dang good here!
The beginning of the night started off slow but I managed to rake in 11 applications by the end. I assume I could've gotten a few more but I only had 11 blank ones on me! So either way, the night was absolutely a success.
My next shifts are this weekend, Saturday from 4-6 and Sunday 11-1 at Safeway!

Condoleezza Rice Convocation

Following our final applause of the night I quickly took a moment to reflect on the evening's events. It begun with a beautiful introduction speech by Kia Abbey, president of ASMSU. President Wadad Cruzado followed by giving an incredibly personable and empowering performance drawing upon three up and coming freshman students each with their own incredible background story. Then came the time of the night that everyone had been anticipating, the reason the entire Brick Breeden Field House had been filled to the brim. The introduction of Dr. Condoleezza Rice.
For some reason I was slightly shocked when she began to speak. I remember listening to her countless times on TV, watching her as she navigated press conference after press conference and countless interviews. There was something though, about listening to her through a television, then hearing her speak directly in front of me. She was soft. Her demeanor was light and relaxed. She was joking, laughing and smiling. I'll admit, it was a relief to see and it further fueled my excitement.
However, I was slightly taken aback when she dove into her speech and began listing off tragedies our country has suffered throughout our history. It was almost exactly what I had been expecting to hear. Political blabber. I've heard enough political blabber in the past months and plenty of political blabber from Dr. Rice throughout her position of Secretary of State. I wanted to reject her words in a way a sick body rejects a healthy transplant. Instead I remained patient, hoping the topic would switch into more inspiring tones. Thank goodness, because switch it did!
I began to relate to her words. The way she talked about her circular search for the right path to her future. The way it felt when she finally found her passion. I felt as though she was telling my very own story to the 8,000 some odd people in front of her.
I was particularly inspired when she encouraged us as students to challenge ourselves. I love pushing my own boundaries emotionally and physically. But when it comes to academics I tend to be more timid, carefully choosing classes that will; inevitably, be challenging but well worth it in the end. I do not however choose classes that are not "worth it." Say, for example being a Nursing student whose sore subject is math, I would not be one to willingly put myself in an upper division calculus class just for shits and giggles. You know what I mean? But after hearing her speak with such passion about the benefits of challenging oneself in every way you can, I'm inspired to continue to push my boundaries. Maybe not jump all the way up to calc 4 but maybe sign up for a public speaking class or maybe get involved in a new role around campus. The possibilities are endless!
In sum, I honestly did enjoy having Dr. Rice as convocation speaker for 2012. Although there may have been parts that didn't sit quite well, I was nevertheless impressed and pleased with the outcome. Especially the grand finale performance with Ilse-Mari Lee. The room was most definitely filled with inspiration as we all stood and gave our standing ovation and farewell.

Journal #3 Positive deviance

Behind every cohesive community, stands a good leader.What qualities do we look for in our leaders? Is it someone who will stick to the party platform? Someone with the largest cadre of foot soldiers and advisors? Someone who is sound bite savvy? Or, as I submit, someone with less tangible but more substantive virtues of soul, spirit, and faith. As citizens, we have the responsibility to be a leader, and create positive change. The way and why we view the world in terms of “doing good” is as important to the actions and examples of actually doing good.

Being a leader calls for creativity. When infusing incentives in a creative and innovative way the work place becomes a playground for success.   Leadership skills can be directed by encouraging a sense of connection and a sense of belonging within one’s social group. Reminding another of their accomplishments, taking responsibility for independent acts, and being generous with one’s time, values and taking a responsibility for their community creates respect and makes you a conscious leader. 

 Dan Pink submits there are three factors to better performance. Autonomy, mastery, and purpose. When one has the desire to be self directed, the urge to improve, and a feeling of use incredibly magical things happen. As seen in MIT studies, at a certain point high monetary incentives no longer are anomalous to higher performance. As David Rock claims, the brain is a social organ. Many of our psysiological and neurological reactions are exceptionally shaped by social interaction. He contradicts Maslow's theory of social needs to be in the middle of the pyramid, rather he submits it is on the same level as our instinctual need of survival.

How do our social needs connect to being a good employee or boss? Because when social interaction and innovation is encouraged, productivity increases. As leaders we can also follow Rock's 5 social qualities. These are status, certainty, autonomy, relatedness, and fairness. Formed into a fun little SCARF acronym Rock says you can visualize it as the "headgear an organization can wear to prevent exposure to dysfunction." 

When we utilize our SCARF as well as Pink's three factors to better performance; autonomy, mastery, and purpose, we can become better leaders of tomorrow. 

MWV Introduction and hour 1&2

Today was the beginning of my career in political advocacy. Yes, I have been involved with political advocacy before but it was all high school politics.  I managed to work my way up to student body vice president, but today was what I consider to be my first day of helping my community in a bigger way.

Thanks to my dear friend and mentor Jan Strout I became involved with Montana Women Vote. Montana Women Vote is a non-profit organization that focuses primarily on mobilizing and educating low-income women and those in the lower demographics. It is their/ our mission to support these women and their allies into becoming informed voters, community leaders and policy advocates.
Here is the Montana Women Vote link for further information http://www.montanawomenvote.org/

It just took a simple 30 minutes for me to realize how incredibly amazing this organization truly is. While being trained by Jan I learned so many little details that this organization does to make the voters experience as easy and educational as possible. Informational paper after informational paper was flying at me every five seconds. From a free voters guide to a non-partisan action alert email that sends out monthly updates on recent actions on the political battle field. After updating my own voter registration I was set to work.

Stationed outside the front doors of Bozeman's Safeway I; in a very mild and sincere way, badgered every individual who was about to go shopping. Sweetly asking "Hey there, is your voter registration up to date?" or "Hi, have you been registered to vote!?" When registering, we assume that most people are already registered and when someone does happen to say no it's always a little exciting. It feels so empowering to be able to assist an individual to get their right to have a vote, whether it's left, right, or upside down. But within the "no's" I'll still get a few who continue to walk away and not turn towards my little card table full of voter registrations, information pamphlets, and e-mail sign ups. When I ask the inevitable question, "Well, would you like to be registered?" and they answer, "Because I hate politics," or simply, "I don't vote," I always stop and wonder. Is our political system THAT messed up for individuals to quite literally not give a damn about what happens next? Or is it a personal choice to remain ignorant and uninformed? Whichever it is, I wish they would choose to take the few minutes to become educated. I believe it is our duty to be knowledgable and informed. As an American citizen it is our right to cast a vote and have a voice, no matter how tiny we believe it to be.

Anyways, back to my fabulous day! I worked for two hours, collecting a total of 12 new or updated voter registrations. I am so incredibly excited to have this opportunity to help out our community in such a detrimental way. It is one thing to get a person to register, it is another to get them to make it to the polls. When an individual registers with MWV they receive a free, non-partisan voters guide and have an opportunity to join a free "In the know" e-mail list where they receive monthly updates and invitations to open information forums and panels spread throughout the community. My next volunteer date is on Tuesday and I will be down at the farmers market in Bogart Park. So excited!

Journal #2 To be or not to be

What makes a good leader?
Answer: a servant leader. An individual who is there for the improvement and aspirations of their people, not for their personal glorification. Someone who is present, passionate and inspiring.
But as a female, is it that easy? Sheryl Sandburg believes there is a fine line between success and personal fulfillment. As women, we put daily pressures upon ourselves to strive to be better, reach farther and push longer. But we strive to do this in every aspect of our lives, not just in the professional sector. And inevitably, when things become too much to handle, it is more often than not the professional part of ourselves that we let go.
We are nurturing, compassionate and caring. We are mothers, it is in our genes! We are servant leaders to our world. We give everything we can to every other person in our lives before we step back and give to ourselves. But how much can we give before giving up too much of ourselves?
I've experienced this a few times already in my many roles as a leader and busy life schedule. There were times that I gave so much to everyone else that by the end of the day I had nothing left of myself. My many positions and duties overwhelmed my daily life and left no time for my personal enjoyment. Like my passion for dancing. As a student athlete I've always looked at running as a part of me and now even a job. Dance however, is a hobby and an outlet to release stress. As my running career continued to excel and my duties as a leader in multiple organizations began to grow, my time for dance began to shrink. Eventually I had to quit.
Sandburg tells us to stay in the workforce and always keep pushing. To keep our foot on the pedal. But at what point do we finally let off the gas?