 So he called this an OODA loop. An OODA stands for Observe, Orient, Decide, and Act, okay? So when you're thrust into a stressful situation, and that could be anything. That could be walking into work at the ER. It could be the pipes busted and your kitchen's flooding. I mean, it could be any different sort of stressful event. The first thing that happens is that you observe. There's unfolding circumstances. There's outside information. There's interaction with your environment, and that's something that just happens to us, okay? And any human does this. The problem is, is almost every human stops right there, okay? This, right there, the observations, is thinking, okay? That's cognition. What happens next is we feed forward into Orient. And Orient is where your mind really comes in. That's called metacognition. And this is something that objectivist epistemology talks about, is that the human animal is the only animal that has to voluntarily turn on its consciousness. In Orient, you are thinking about your thinking, okay? And no one else can do this for you. Only you as an individual can do it. And you may not be able to do it in this given circumstance, as well as another individual, but you cannot borrow another individual's Orient. It's all you, baby, because it's all your cultural traditions. It's your genetic heritage. It's new information, and it's your previous exposure, and that's completely and utterly unique to you, okay? When you're thinking about thinking and you're having metacognition, what you're doing there is you are narrowing your focus and you are formulating a plan slowly. But once you've oriented, once you've thought about your thinking, that automatically feeds forward into decision, okay? This, you don't have a choice about. Between here and here, you choose whether or not to turn on your brain or not and perform metacognition. A choice, actually, you have no choice about, because like the band Rush says, if you choose not to decide, you still have made a choice. That's very true here. So you form a decision about what's going on around you, and in this decision, you're forming a hypothesis, and you have to test that hypothesis with action so that feed forwards again into an action which tests your hypothesis. But you need to do that quickly, and what I have found in emergency medicine is the greater your need to act decisively and rapidly, the greater will be your need to hesitate, okay? So you have to do that quickly. Now, in this realm, under Orient, is a very big danger that we see all the time, and that danger is called normalcy bias, okay? When things go bad, if you have an active shooter incident, or your plane catches on fire, anything really bad starts to happen. The tsunami is coming. If a plane's been flown into your tower, there is a strong tendency on the part of your brain to shut down and try to pretend like everything's normal. It defends the normal. I see this all the time in the emergency room. Early on, I saw it myself. The first time I remember having it, we were at the end of shift, and I was coming on, and we were talking about the patients. The ambulance rolled between us with this well-dressed, middle-class-looking guy curled up on the stretcher, moaning and groaning, and acting dramatic, and I thought, oh, brother. That guy rolled between us, and my attending said, keep a close eye on that guy. He's got mesenteric ischemia, meaning one of the arteries to his bowels is blocked and he's dying. I'm like, shit, how did he do that? Well, two and a half hours later, after multiple testing in an angiogram of the gut, he was right, okay? And I realized, because this guy was well-dressed and he was acting dramatic, I made an assumption about him, and I latched on to that for normal C-bias. I see it with nurses. They'll bring back a patient and if you ever show up in an ER, kind of look a little scrungy, my friends. Don't wear your clean underwear, because the more normal you look, the more normal C-bias will kick in for the people taking care of you. We can believe that some derelict that we pulled out of the gutter is going down the drain, but you come in with your khakis on and a nice pressed shirt and you're doubled over, it's kind of like, whatever. Because your brain seeks normal C. See them bring someone that's actively dying and put them in a non-acute room. And if you're seeing a really sick patient in a room that's designated for not sick people, your brain will run to normal C-bias and you have to protect against that. Now, as you feed forward and you go into decision and action, this is another real danger point right here is after you take your action, you're not done. Okay, what your action is, is your contribution to the chaos. That's it, that's all you're doing. Just because you're taking an action and it seems to have worked, it's not like, woo-hoo, celebration time. I see this every time I do a major resuscitation. The most stressful point in a major resuscitation typically is securing an airway in the patient, getting them intubated. And a huge amount of tension builds up to that point. And then all of a sudden the tube goes in and the oxygen level comes up and everyone breathes this collective sigh of relief. There's high-fives all around and then the patient crumps because they've been paralyzed, they've lost all their tone and they crash. The other thing is just don't celebrate. So, let's move forward. And before you start this, the real key of an oodaloupe when you're competing with someone or the environment is to turn it quickly. As soon as you've added to the chaos, then you observe again and you go through the loop. And if you can turn your loop faster than your opponent can, then you win. That's another, and that brings us to Dr. Doug McGuff. Let's bring it home. Great to see you. Thanks for having me. First time I remember having it, we were at the end of shift and I was coming on and we were talking about the patients. The ambulance rolled between us with this well-dressed, middle-class-looking guy curled up on the stretcher, moaning and groaning and acting dramatic. And I thought, oh, brother, that guy rolled between us and my attending said, keep a close eye on that guy, he's got mesenteric ischemia, meaning one of the arteries to his bowels is blocked and he's dying. I'm like, shit, how did he do that? Well, two and a half hours later after multiple testing in an angiogram of the gut, he was right, okay? And I realized because this guy was well-dressed and he was acting dramatic, I made an assumption about him and I latched on to that for normal C-bias. I see it with nurses, they'll bring back a patient that, and if you ever show up in an ER, kind of look a little scrungy, my friends, don't wear your clean underwear because the more normal you look, the more normal C-bias will kick in for the people taking care of you. We can believe that some derelict that we pulled out of the gutter is going down the drain. But you come in, you know, with your, you know, khakis on and a nice pressed shirt and you're doubled over, it's kind of like, eh, whatever. Because your brain seeks normalcy. I see them bring someone that's actively dying and put them in a non-acute room. And if you're seeing a really sick patient in a room that's designated for not sick people, your brain will run to normal C-bias and you have to protect against that. And then finally, we want to be able to bend the curve. And what we're looking at here on this curve is you have performance on the Y-axis and heart rate on the X-axis. And what you'll see is as heart rate goes up, you reach this optimal performance zone here at the top. If you get too stressed out, you start to go into that realm where everything starts to go to pot. Well, there is a way of performing stress inoculation to bend that curve. So you go from condition red, instead of going into condition black, you just extend condition red out further. Udaloops and think in terms of breathing, self-talk, actually do all those things.