Administration and Leadership, EMS Insider

Critical Thinking, Part One

Critical thinking is a formal process.  Carl von Clausewitz, in his treatise “On War” stated it much more eloquently when he wrote “Any complex activity, if it is to be carried on with any degree of virtuosity, calls for appropriate gifts of intellect and temperament.”  A simple definition of critical thinking is: the formal process of evaluating information to objectively evaluate and act.  The important word in the definition is formal.  Critical thinking is a formal process.  It is unfortunate that critical thinking is not routinely taught in schools or even in our EMS training courses.  Critical thinking is not intuitive; this article is the first in a series to help understand and use critical thinking.

Why is a formal critical thinking process important?  Personal experience and beliefs such as prejudices, stereotypes, caricatures, oversimplifications, generalizations, illusions, delusions and rationalizations can affect the way we interpret information as well as the decisions we make.  This occurs in the subconscious and we don’t realize it’s occurring.  A formal critical thinking process helps you to identify these mindsets so we may make better decisions.

Experts have developed different approaches to critical thinking.  Some are industry specific, such as those in medicine and aviation.  This article will review three critical thinking methods.


The Sponge Approach

The Sponge Approach is a simple and passive technique, and involves the thinker absorbing as much information as possible concerning the question or belief.  For example, during the recent presidential election, I spent time researching the facts of each candidate’s platform, history and proposed policies.  It took a lot of work, but gave me the facts I needed to make a decision, rather than relying on the interpretation of a friend or news agency. 

Two disadvantages of the Sponge Approach are the recency effect and the anchoring bias.  The recency effect occurs when we rely on information or experience that is most recent.  The classic example is falling off a horse and not wanting to get back on.  The anchoring bias occurs when we allow an initial reference point to distort our viewpoint. 

A common way to expose the anchoring bias is to divide people into two groups and give them the same scenario with a different anchor.  For the first group, describe an event where there are some climbers trapped on a mountain with 24 hours of supplies remaining.  If a rescue team leaves now, there is a 75% chance the climbers and rescue team will come back safely.  If they don’t leave, severe weather will prevent another attempt for 72 hours.  The other group is given the same scenario with the anchor of if they leave now, there is a 25% chance the climbers and rescue team will not all survive. 

Once you get past the bravado of “we’re rescuers, we put our lives on the line every day,” it affects the decision the group makes.  It was the same information, but in the first group they anchored their decision on the 75% (a high number for success) and the second group anchored their decision on the 25% (a high number for failure).


The Eller and Paul Approach

The Foundation for Critical Thinking ( has a more formal approach, also known as the Eller and Paul approach.  The process begins with understanding the purpose and objective, as this helps to clarify what decision needs to be made.  Next, the thinker states what the question is (what answer are you looking for?), then the process of gathering information begins. 

The next processes help us to avoid mindsets and biases by watching for interpretations or conclusions (which may come from the people providing the information to you), and then checking your assumptions to make sure they are correct.  Finally, you need to clarify concepts, take time to understand your point of view and then think through the implications.  Two disadvantages of this approach are that it takes time to implement (so it is better for long term events or projects) and it requires focus.  A loss of focus in one step will affect all of the other steps.


The Standard Form Approach

The third method is the Standard Form.  In this approach, the thinker first identifies the conclusion. This does not mean identifying what you want the answer to be, but rather what you are trying to prove.  An example would be “Adding paralytics to our EMS agency will help save lives by allowing advanced airway control in conscious patients.” 

The next step would be to gather the facts that are related to the above conclusion.  This includes premises that may not support your case, such as increased airway trauma or infections, difficulty in maintaining competencies, or shortage of medications. 

Lastly, you write your final conclusion, based upon the facts.  The disadvantage of the Standard Form is that we tend to have a bias towards data that supports our argument, which may skew that conclusion.



Finding the right method for critical thinking is personal.  Try each one and then see which fits best.  A great free resource is the website, which has specific critical thinking tools for healthcare.  For general critical thinking tools, visit this link:

It would be easy for us to assume that we don’t have time for critical thinking, that the lives of our patients could be at risk.  However, the exact opposite is true.  Being an uncritical thinker or a weak-sense critical thinker (skilled manipulator) is what can be detrimental to our patients.  With practice, critical thinking can be a thoughtful, important process in the management of our agencies and the care of our patients.  Even during times when a quick decision needs to be made, understanding the shortcomings of uncritical thinking can help us to more objectively interpret the data being presented.


Scott Cormier is a nationally registered paramedic and serves as the Vice-President of Emergency Management, Environment of Care, and Safety for Medxcel Facilities Management.  He is also a board member of the International Association of EMS Chiefs.  Please join us for the IAEMSC annual summit in Washington, DC in October. Visit for further details.