Anchors in the Noise

Using System 2 Thinking When the Shift Won’t Slow Down

By The Reflective Responder

There are moments on shift when everything feels loud.

Not just the sirens.
The radio chatter.
The bystanders.
The ticking clock.
The internal pressure to move faster.

For responders with ADHD, introverted processing styles, or other neurodivergent traits, those moments don’t just feel busy—they feel cognitively dangerous. That’s when shortcuts creep in. That’s when we default to pattern-matching. That’s when System 1 takes over.

And sometimes, that’s exactly what gets us into trouble.

This article explores how anchors—simple, repeatable cognitive touchpoints—help neurodivergent responders slow the chaos just enough to access System 2 thinking, using the framework taught in the Handtevy System for both pediatric and adult patients.

Not to change standards.
Not to lower expectations.
But to help the brain perform when it’s overloaded.

System 1 vs System 2 — In the Real World

System 1

• Fast

• Automatic

• Pattern-based

• Emotionally driven

• Efficient… until it isn’t

System 2

• Deliberate

• Analytical

• Structured

• Slower—but safer

• Resistant to cognitive bias

On a calm call, most clinicians naturally drift into System 2.

On an overworked, understaffed, overstimulated shift, System 1 dominates—especially for responders whose brains already run fast and loud.

That’s not a flaw.
That’s neurology.

The solution isn’t “try harder.”
The solution is anchoring.

What Is an Anchor?

An anchor is a deliberate pause point that forces structure back into thinking.

Not a meditation.
Not a deep breath exercise.
A clinical checkpoint.

Anchors:

• Interrupt runaway cognition

• Reduce working-memory overload

• Re-route decision-making back to System 2

• Create consistency under pressure

For neurodivergent responders, anchors are lifelines, not crutches.

The First Anchor: Sick vs Not Sick

(Before Airway, Breathing, Circulation)

Before ABCs.
Before vitals.
Before equipment.

Anchor #1:

Is this patient sick or not sick?

This applies to:

• Pediatric patients

• Adult patients

• Medical and trauma calls

This single question does something powerful:

• Narrows the decision tree

• Reduces option overload

• Sets urgency and tone

• Prevents premature fixation

For ADHD brains especially, this anchor contains the chaos.

The Handtevy Flow as a System 2 Framework

The Handtevy approach doesn’t just give numbers—it gives order.

For neurodivergent responders, that order is what allows System 2 to engage.

Handtevy-Aligned Cognitive Flow (Adults & Pediatrics)

1. Sick vs Not Sick (Anchor #1)

2. Airway – Is it patent? At risk?

3. Breathing – Adequate? Inadequate? Assisted?

4. Circulation – Perfusion, bleeding, shock

5. Weight-Based / Size-Based Reference (when applicable)

6. Medication & Intervention Selection

7. Reassessment Loop

Each step:

• Limits choices

• Prevents skipping ahead

• Forces sequential thinking

• Reduces impulsive action

This is System 2 in motion.

Why This Matters for ADHD & Introverted Responders

ADHD

• Working memory overload happens fast

• Stress accelerates impulsive decisions

• Anchors act as external memory scaffolding

Introversion

• Internal processing needs structure, not speed

• Noise drains cognitive bandwidth

• Predictable frameworks preserve clarity

Neurodivergence (Broadly)

• Consistency reduces threat response

• Structured thinking lowers emotional flooding

• Repetition builds safety under stress

Anchors don’t slow good clinicians down.
They protect them from bad environments.

When System 1 Is Most Dangerous

Watch for these conditions:

• Back-to-back calls with no reset

• High-noise scenes

• Emotional pediatric or adult patients

• Performance pressure from peers

• Fatigue masked as confidence

These are the moments when anchors matter most.

Reflective Responder Sidebar

For Probationary Firefighters & EMS Students

You are not slow.
You are not behind.
You are learning how your brain works under pressure.

If you need anchors, use them.
If you need structure, lean into it.
If you think differently, good—medicine needs that.

Mastery isn’t speed.
It’s consistency under stress.

And consistency is built through System 2 thinking, one anchored decision at a time.

Closing Reflection

Chaos will always exist in Fire and EMS.
What changes is how we meet it.

Anchors don’t remove pressure.
They give your brain a place to stand inside it.

That’s not just good medicine.
That’s sustainable practice.

— The Reflective Responder