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Just as emergency physicians do when they pick up a medical chart, view the chief complaint, and begin their approach to the patient with some element of preconceived notions based on the recorded chief complaint, so do field personnel when they are approaching the patient after being dispatched with some form of information. This can be beneficial in that it may immediately confer some sense that the patient has no high‐priority symptoms, thereby compelling the EMS clinician to delve further into the reason for the EMS call. It can also be detrimental, in that it may mislead the clinician into assuming that no priority symptoms are present when in reality there are one or more. The result may obviously affect the patient, whose problem is potentially minimized or underestimated, and for whom inappropriate or ineffective protocols are applied. This may convey actual risk to the patient if it leads to a negative interaction between EMS clinician and patient, resulting in mistrust and, in some cases, no transport to a hospital [4].

EMS personnel must compile a massive amount of information in a relatively short period. They must incorporate this information with their prehospital clinical skills and baseline knowledge in their clinical decision making, which is necessary to assess and treat patients effectively. Similar to emergency physicians, EMS clinicians become expedient decision makers, using strategies to improve efficiency and thoroughness. They sometimes call on certain rules of thumb, shortcuts, and abbreviated thinking to make fast, efficient, and accurate decisions, or what clinical decision experts term “heuristics” [4]. Various ethnographic and descriptive studies exploring medical errors, adverse events, and near misses in EMS have shown that EMS clinician decision making is a predominant factor influencing patient safety in EMS [5, 6].

When EMS clinicians are interacting with a patient, there is clinical reasoning related to both the line of medical inquiry, such as the history, physical examination, and diagnostic tests, and the clinical decision making (i.e., the cognitive process of using data to evaluate, diagnose, and treat the patient) [8]. Clinical reasoning is a tremendously complex process and is under intense continuing investigation. There is no single model of clinical decision making that adequately relates to the very complex environment that exists in the emergency setting. Rather, there are several models or strategies that individuals use in clinical decision making or cognitive performance including:

 pattern recognition or skill‐based (e.g., making a diagnosis immediately on entering the room, which is frequently unconscious, automatic, and based on years of experience)

 rule based (e.g., advanced cardiac life support algorithms)

 hypothetical deductive or knowledge based (considered the highest level of deduction; a clinician generates a hypothesis and uses existing and new knowledge to find an answer) [79–11].

Some experts describe a fourth model of a naturalistic or event‐driven process of decision making (i.e., treating the patient first and then making the diagnosis) [7]. Interestingly, how and where EMS clinicians make decisions and the density of decision making during the patient journey are postulated to differ from those of other health care practitioners and are the subject of continuing research [12].