Redundant deliberation about negative consequences: Decision inertia in emergency responders.

Major emergencies are high-stakes, ambiguous, dynamic and stressful events. Emergency response commanders rely on their expertise and training to mitigate these factors and implement action. The Critical Decision Method was used to interview n=31 commanders from the Police (n=12), Fire and Rescue (n=15) and Ambulance Services (n=4) in the UK about challenges to decision making. Transcripts were analysed in two ways: (i) using thematic analyses to categorise the challenges to incident command; and (ii) grounded theory to develop a theoretical understanding of how challenges influenced decision processing. There were nine core challenges to incident command, themed into two categories: (i) those relating to the perceived characteristics of the incident itself; and (ii) those relating to uncertainties about (inter)personal dynamics of the team(s) responding. Consideration of challenges featured prominently in decision makers' prospective modelling, especially when thinking about goal accomplishment (i.e., 'What if I deploy now? What if I don't?'). Commanders were motivated to 'save life' (attack/approach goal), yet also sought to 'prevent harm' (defend/avoid goal). Challenges led commanders to redundantly deliberate about what to do; their prospective modelling was related to the anticipation of potential negative consequences that might arise both for acting (attack) and not acting (defend). Commanders identified this difficult trade-off, yet described how experience and their 'responsibility as a commander' gave them confidence to overcome decision inertia. Future research is needed to identify whether decision making training on how to anticipate and overcome difficult cognitive trade-offs would lead to more flexible and expedient commanding.