SESSION SPOTLIGHT: Decision Making Under Pressure: How Commanders Think When Certainty Isn’t Possible

One of the most compelling sessions from The Blue Light Show 2025 explored a reality every incident commander faces: making critical decisions with limited information and rising pressure. Led by Dr Phillip Cowburn, Medical Director of the NHS Emergency Capabilities Unit, the session brought together Christian Cooper, National Head of Operations for the NHS ECU, and Olly Sapsford, Lecturer at Coventry University, two respected voices on operational decision-making and human performance under stress.

Together, they examined how responders balance instinct, analysis and uncertainty when time is short and consequences are significant.

Key takeaways from the session:

✅ Experience shapes instinct
Many rapid decisions are made through recognition of patterns built over years on the frontline. This intuitive thinking is powerful but must be checked for bias during evolving incidents.

✅ The 40 to 70 percent rule helps avoid hesitation
Waiting for complete certainty can delay action. Effective commanders act once they have enough information to make a safe, reasoned judgement, even if details are still emerging.

✅ Frameworks guide decision making but should not restrict it
Models like the Joint Decision Model are valuable for structured thinking, but frontline situations often demand flexibility. Commanders must adapt the model to reality, not force reality into the model.

✅ Uncertainty is unavoidable
Commanders must accept that incomplete information, shifting conditions and competing risks are part of any major incident. Embracing uncertainty allows for clearer thinking and faster, safer decisions.

✅ Tacit knowledge is essential
Training that replicates real conditions builds the tacit, experience-based judgement that responders rely on during time-critical situations. Classroom knowledge alone is not enough.

✅ Technology can help but must be used carefully
Tools such as AI, digital triage and VR simulation can reduce cognitive load, but they must assist decision makers rather than overwhelm them with unnecessary information.