Michael Lauria: lessons from the Air Force and Emergency medicine.

Welcome to my conversation with former US Air Force Pararescueman and currently Emergency Medicine Physician EMS/Critical Care Fellow Michael Lauria. His mission today is to draw from the fields of psychology, cognitive science, organizational behavior, performance science, and Human Factors to improve the way that we provide emergency medical care inside and outside of the hospital setting. I learned about Michael because of his research and articles about psychological skills to improve emergency care providers performance under stress. In our Dutch training programs for emergency care providers we used his Beat the Stress Fool Protocol (BTSF) for mental skill training. In this conversation we also talk about Mike his interest in the fascinating Cynefin Framework to understand that every situation is different and requires a unique approach to decision making. Visit Michael on https://www.michaellauria.com/.


Lauria enlisted in the Air Force in July 2005 and completed the rigorous Pararescue (PJ) training pipeline. Following training, he served at the 321st Special Tactics Squadron, RAF Mildenhall, UK, Air Force Special Operations Command as a Pararescueman. During this assignment he deployed to OPERATION IRAQI FREEDOM as part of a Combat Search and Rescue Team and in support of the C Company, 1st Battalion, 10th Special Forces Group (Airborne). In addition to his service awards and ribbons, Michael was named Air Force Special Operations Command Outstanding Airman of the Year and Pararescue Airman of the Year in 2009.

After being honorably discharged from the military in 2011, he accepted a position at Tier 1 Group, LLC in Crawfordsville, AR. While there, he was a lead instructor providing education and training for a variety of military special operations units in weapons, tactics, and operational medicine. He went on to become the Manager of Training and Standards for the medical division of the company, developing curriculum, training instructors, and providing quality assurance.

In October 2012, Michael returned to New Hampshire after taking a position as a Critical Care and Flight Paramedic for the Dartmouth-Hitchcock Advanced Response Team (DHART) based out of Dartmouth-Hitchcock Medical Center in Lebanon, NH. During his tenure at DHART he was very involved in the Clinical Guidelines Review Group and Professional Development Committee.

Michael graduated with honors from the Geisel School of Medicine at Dartmouth in 2018. He went on to complete his residency in Emergency Medicine at the University of New Mexico Health Science Center in 2021. He is currently a Fellow in Emergency Medical Services and Critical Care. Outside of fellowship, he continues to fly as a flight physician for Lifeguard, actively teaches prehospital providers, is a regular contributor to the EMCrit Podcast and Blog, and is acting Chief Medical Director for FlightBridgeED.


Introduction and Michael Lauria’s Background
The Role and Training of a Pararescue Specialist
Lauria’s Transition to Emergency Medicine
Development and Application of the Beat the Stress Fool Protocol
Explanation of the Cynefin Framework
Practical Tips for Managing Stress in High-Pressure Situations
Decision-Making Processes in Emergency and Tactical Environments
Relevance of Lauria’s Experience to Police and Other First Responders
Recommendations for Further Reading and Learning
Conclusion and Final Thoughts