Table 1 Analogies between clinical and defense decisions

Urgency, need for rapid initial response

Emergency department triage. Triage requires near-instantaneous decisions, in order to avoid delaying critical treatment for high-priority patients[49].

Command centers. The air force command center, which controls all available aircraft, must decide which requests for air support from ground forces in trouble get priority, with timeliness sometimes being essential.

Adaptation to changing circumstances, new information

Ventilator management. As patient respiratory function changes, ventilators must adjust accordingly[50].

Improvised explosive device (IED) disarmament. The tactics and technology of IEDs changes over a period of weeks, so the strategy to disarm them must do so also. DS includes real-time surveillance and computer models that help anticipate adversary actions.

High consequence, life or death implications

Many, for example cancer chemotherapy order sets, dose checking; radiation therapy planning.

Mission choice. Send troops on a dangerous mission from which they may not return. The decision to send a SEAL team in to get bin Laden risked lives of the team and international crisis, but was in pursuit of a compelling objective.

Uncertain possibilities due to incomplete, imperfect information

Diagnostic expert systems. Diagnosis relies upon accurate assessment of signs and symptoms, but these do not always provide reliable information, such as when the patient is unable to communicable effectively.

War planning. Enemy behavior cannot be predicted with full precision, information on the enemy is incomplete[20] and imperfect, with deep uncertainty[18]. War planners must anticipate and be ready to deal with many adversary tactics. In the 2003 war with Iraq, U.S. forces prepared for chemical-weapon attacks, mass movement of refugees, burning of oil facilities, etc.

Balancing disparate types of risks and benefits

Treatment selection. The effectiveness of adjuvant chemotherapy, which has its risks and side effects, depends on patient factors and tumor stage[51].

Attacks near population centers. Air force attacks must evaluate how weapons used affect target accuracy, the risk of civilian casualties, and effectiveness. This balances risks of collateral damage, international incident, and effectiveness. DS includes accurate computer maps, weapon-effects models, and rigid doctrine and discipline.