Being proficient means more than just knowing how to do something. We have to be able to do whatever "it" is consistently, completely, and under pressure. It's difficult to become proficient in a classroom setting for a few reasons: 

  • there isn't usually enough time available in a classroom setting to master skills
  • the environment in a classroom is very different than it is in the real world
  • the internal environment (your state of mind and emotional control) is very different in the classroom than it is in the real world

The "Flow Method" isn't some official program I've heard of in training circles or read in a book. It's a practical method for gaining proficiency that I've found works in a variety of settings. It's a way to give yourself the muscle memory you need to perform under pressure. It works like this:

Start in the same place. Run through a series of carefully studied and well practices series of steps - each time, every time. Get qualified instruction to help tweak your flow. Practice your flow so many times you can do it without really thinking about it. 

When I learned to fly airplanes, I was intimidated by the huge number of switches, buttons, levers, and gauges. Most students are. We were taught over and over and over again to "flow" across the buttons, switches, dials, etc. We always did it in the same order. We physically reached out and touched every switch. We did it so often that our hands just seem to do it automatically. Like driving a car, we don't really think about the details. Our minds master the little things. Our conscious brains are free to focus on other stuff. When a real emergency occurs and the brain freezes, the muscles and routine take over and can save your life. 

Learning to conduct physical assessments works the same way. Using a method like "HNS-CASPER," and doing the same thing over and over and over again - flowing from the top of the body to the toes - we can give ourselves the muscle memory we need to do it without thinking much. 

Do this often enough, and instead of thinking about what DCAP-BTLS stands for, you'll find yourself wondering if your in a safe place or whether your patient is comfortable as you conduct your assessment. In other words, you'll be able to take in more of the big picture. Things that are out of place will grab your attention, but things that are normal will be checked by not take up a lot of mental processing power. 

Addressing a dangerous scene works the same way. By getting into a "flow" of checking the wind direction while en route, noting the weather conditions, writing down dispatch times and arrival times, scanning for unusual crowd behaviors, items that look out of place, placards for HAZMAT, power, etc., you will train yourself into a routine that becomes second nature. You'll develop a "gut" for situations and be able to judge the level of danger. You may not be able to put your finger on it, but something may just feel off. More careful analysis often reveals the source of your instinctual concern. 

There's nothing mysterious about "The Flow Method" as I've described it here. It's really a combination of muscle memory and experience. It means starting in the same place each time and going through a well practiced "flow" of activities each and every time. It comes from repetition and commitment - both in and out of the classroom. To do this right: 

  • Pay careful attention to the details when you're learning it for the first time. Understand, for example, exactly what each of the DCAP-BTLS items are, what causes them and why they are significant. 
  • Perform the action you want to master along with a qualified instructor or experienced mentor
  • Repeat the action you want to master on your own. Take it home. Do it often. I used to sit in an empty cockpit for hours - just running the "flow" when I learned to fly. I used to perform physical assessments on furniture in my house when I learned emergency medicine. 
  • Come back and perform the action you want to master again with your instructor. This will help to catch and correct any bad habits you may have unintentionally picked up. 
  • Do the same thing in "live" environments. 

Continue to be safe and be competent! 

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Comment by Jeff Alderdice on May 17, 2013 at 12:05pm

Great points, Dave. I have also seen the value of muscle memory and installed instinct. It is a very powerful tool of human nature, especially in stressful situations, when you often have nothing but your instinct to rely on. It is also very true that classroom settings do not generally allow for the skills taught to be mastered, which is why, as you’ve stated, it should be incumbent on each responder to take that new knowledge home with them, practice it, and master it. “Repetition and commitment” truly are the pathways to “safe and competent.” Thanks for this forum!



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