A Mixed-Methods Delphi Study of In-Extremis Decision-Making Characteristics: A Mixed-Methods Model

Researchers have identified an academic insufficiency in investigating leadership during in-extremis situations both by emphasis and through difficulty in researching real-time events. These situations can and do commonly occur in settings involving the military and domestic safety forces such as police, fire, and emergency medical teams (EMS). This research has defined in-extremis circumstances as when the participants, whether civilians caught up in the circumstances, first responders to emergency incidents, or military personnel involved in combat situations are vulnerable to incurring significant injuries up to and including death. In plainer words, when people’s lives are on the line and the decisions and actions performed during the event could greatly impact the outcome.This research utilized a mixed-methods design gathering online quantitative data from 401 fire officers (grouped into Exemplars and General Fire Officers) and qualitative data from a Delphi panel of Exemplars only. A purpose of this mixed-methods study was to investigate how career fire officers who were identified by their fire departments as exemplars in field command reported they make critical decisions during in-extremis moments and to explore whether there are commonalities in their leadership approaches. This was attained through a Delphi panel composed of 14 Exemplar fire officers. Three rounds of semi-structured interviews were conducted that attempted to reach consensus among the Delphi panel members. In addition, the Rational-Experiential Inventory-40 (REI-40) was offered online to 17 career fire department officers to help evaluate their tendencies towards rational/analytical and experiential/intuitive thinking.Results from the online REI-40 survey and findings from the Delphi interviews revealed that the Exemplars rely upon their experience and intuition to a greater extent and rely less upon written procedures than did their General Fire Officer counterparts. The Delphi panel interviews indicated that personal experience was essential in developing their skill and faith in making improvised decisions based upon situational awareness of the emergency scene. The Delphi panel reached consensus and stated their ability to ‘think outside the box’ and develop unique best-case solutions was a requirement to achieving a higher level of expertise and success.