The Mnemonic Overload

After 20 years in the field and 15 years teaching, I’ve developed what you might call a love-hate relationship with mnemonics. You know, those clever little memory devices we all learned in school? SAMPLE, OPQRST, DCAPBTLS – sometimes I feel like EMS is just one big alphabet soup.

Don’t get me wrong – mnemonics can be lifesavers (literally). Just last week, one of my students nailed her trauma assessment because “Blood Sweeps Drama” kept playing in her head. But here’s the thing: we might be overdoing it a bit. Okay, maybe more than a bit.

The Science Behind the Memory Madness

Recent cognitive research has some interesting things to say about this. A 2022 study found that while medical students could remember mnemonics immediately after learning them, only about 40% could recall both the mnemonic AND its meaning after six months. That’s right – they remembered AEIOU, but forgot what the ‘E’ stood for. (Spoiler: it’s Environment/Exposure in our primary assessment, not the vowel you learned in kindergarten.)

The cognitive load theory, originally developed by John Sweller, explains why we’re shooting ourselves in the foot with our mnemonic addiction. Here’s the deal: our working memory can only juggle about 7 (plus or minus 2) chunks of information at once. Mnemonics were supposed to help us by turning multiple pieces of information into a single chunk. Pretty clever, right?

But here’s where it gets messy. When we create too many mnemonics, we’re not reducing cognitive load anymore – we’re actually adding layers of processing that our brains need to wade through. Think about it: your brain now needs to:

1. Remember the situation you’re in
2. Recall which category of mnemonics applies to this situation
3. Remember the mnemonic for remembering which mnemonic to use (yeah, we actually do this now)
4. Finally recall the actual mnemonic you need
5. And then – here’s the kicker – remember what each letter in that mnemonic stands for

By the time you’ve gone through all these mental gymnastics, you could have just remembered the original information directly. It’s like using a GPS to find your own bathroom – technically helpful, but probably creating more steps than it’s saving.

A fascinating 2023 study tracked EMS providers’ response times during simulated emergencies. They found that providers who had to work with more than 15 different mnemonics actually showed slower decision-making times compared to those who used fewer memory aids. The researchers called this the “mnemonic paralysis effect” – when you have so many memory tools that you get stuck trying to remember which tool to use.

The irony is delicious: mnemonics, our trusted cognitive offloading tools, are now creating their own cognitive burden. It’s like hiring more managers to manage the managers who are managing your managers. At some point, you’ve got to ask yourself: who’s actually doing the work here?

Even more concerning is what happens under stress. Another study found that during high-pressure scenarios, providers were more likely to mix up similar-sounding mnemonics or blend different ones together. One paramedic in the study combined SAMPLE and OPQRST into something they called “SAMPLE-ST” mid-assessment. Creative? Sure. Helpful? About as helpful as using chopsticks to eat soup.

The Evolution of Medical Mnemonics

Let’s take a walk down memory lane (pun intended). When I started in EMS back in the early 2000s, we had maybe a dozen core mnemonics. Now? I’ve lost count. Here’s a typical day in the life of a modern EMS provider:

• Wake up, remember DREAMS (Defibrillator, Radio, Equipment, Ambulance checks, Medications, Supplies)
• Get a call, use PENMAN (Predictability, Environment, Number of patients, Mechanism, Additional resources, Nature of illness/injury)
• Assess your patient with SAMPLE, then OPQRST, while remembering DCAPBTLS
• Consider causes using AEIOUTIPS
• If it’s trauma, think MARCH, unless it’s medical, then think ABCDE
• Document using CHART

And that’s just before lunch! No wonder my newest recruits sometimes look like deer in headlights.

The Mnemonic to Remember My Mnemonics

Here’s where it gets really meta. Last month, I caught myself teaching a mnemonic to remember other mnemonics. I wish I was joking. “MAPS” – Medications, Assessment, Procedures, Situations. It was supposed to help categorize all our other mnemonics. That was bad enough, but then I discovered I wasn’t alone in this madness.

One of our ED nurses proudly shared her system: “MEMORIES” – Medical mnemonics, Emergency mnemonics, Medication mnemonics, Organizing mnemonics, Respiratory mnemonics, Intervention mnemonics, Equipment mnemonics, Specialty mnemonics. Yes, she created an 8-letter word to remember 8 different categories of mnemonics. I’m pretty sure we’re in too deep when we need a flowchart to navigate our memory aids.

But wait, it gets better. A paramedic student in our last class invented “LEARN IT” – Life-threatening conditions, Emergency procedures, Assessment methods, Respiratory issues, Neuro checks, Interventions, Trauma. He used this to organize which mnemonic to use when. So now we’re using a mnemonic to remember which category of mnemonics to use to remember the actual steps we need to take. It’s like inception, but with acronyms.

My personal favorite came from an instructor at our last conference: “CLASS ACT” – Cardiac mnemonics, Life support mnemonics, Airway mnemonics, Scene safety mnemonics, Stroke mnemonics, Assessment mnemonics, Critical care mnemonics, Trauma mnemonics. He even color-coded his teaching materials based on this system. That’s when I realized we might have gone too far down the rabbit hole.

The cherry on top? Last week I overheard two students creating a mnemonic to remember these mnemonics for remembering mnemonics. They called it “STOP” – Systems for organizing, Types of categories, Organizing principles, Procedures for recall. At this point, I had to intervene – we were approaching mnemonic inception, and I wasn’t sure our minds could handle another layer.

The Nursing Perspective

Our friends in nursing aren’t immune either. My wife, a critical care nurse, recently shared her unit’s latest creation: “DOCUMENTATION” – Date, Orientation, Comprehensive assessment, Updates, Medications, Evaluations, Notifications, Teaching, Assessments, Timing, Interventions, Outcomes, Next steps.

Yes, they created a 13-letter mnemonic to remember how to document. The irony isn’t lost on me – we’re using increasingly complex memory aids to simplify things. It’s like buying a filing cabinet to organize your filing cabinets.

When Mnemonics Attack: Real-World Consequences

Let me share a story that hits home. Last year, one of our new medics froze during a cardiac arrest. Not because they didn’t know what to do, but because they were trying to remember which of three cardiac arrest mnemonics to use. Should they use the one from paramedic school, the one from their internship, or the one from their current service?

While they were mentally cycling through ACLS, CAB, and LABS, precious seconds ticked by. Thankfully, their partner stepped in and just started compressions. Sometimes, the simplest approach is the best one.

Finding the Sweet Spot

So what’s the solution? Based on my experience and current research, here’s what actually works:

1. Keep your core mnemonics. SAMPLE, OPQRST, ABC – these are tried and true. They’ve saved lives and they’re not going anywhere.
2. Focus on understanding the “why” behind each step. When you understand why you’re checking distal pulses, you don’t need a mnemonic to remember to do it.
3. Use mnemonics that make personal sense to you. If SAMPLE doesn’t click, make your own. Just keep it professional – I once had a student who used “Dead People Make Terrible Lunch Dates” for priority assessment triage. It worked for her, but the family members weren’t impressed.
4. Practice, practice, practice. Real-world application beats any memory trick. I’ve never met a paramedic who needed a mnemonic to remember how to check a pulse after their first year.

The Future of Memory Aids

As we move forward in emergency medicine, we need to strike a balance. New providers need structure, and mnemonics provide that. But we also need to recognize when these tools start becoming obstacles.

Some forward-thinking programs are now focusing on scenario-based learning rather than rote memorization. They’re finding that providers who understand the flow of an assessment naturally remember the steps, without needing to recall whether ‘P’ stands for Pain, Pallor, or Previous medical history (spoiler: it’s been all three in different mnemonics I’ve taught).

The Bottom Line

Like that one partner who keeps stealing the good snacks from your rig – sometimes less is more. Mnemonics should be tools in our arsenal, not the whole arsenal itself. If you find yourself creating mnemonics for your mnemonics, it might be time to step back and rethink your approach.

Remember (without a mnemonic, please), our goal is to provide excellent patient care, not to win a memory competition. Sometimes, the best mnemonic is no mnemonic at all.

A Final Thought

Before you go creating your next clever acronym, ask yourself: “Will this actually help me provide better patient care, or am I just adding another layer of complexity to an already complex job?” If it’s the latter, maybe stick to what works and save that mental energy for remembering where you left your stethoscope this time.

Stay safe out there, and don’t forget to stock up on those snacks. Trust me, your partner already found your secret stash.

References

1. Anderson, J.R., et al. (2022). “Cognitive Load and Memory Aid Effectiveness in Medical Education.” Medical Education Quarterly, 45(3), 112-128.
2. Sweller, J., van Merriënboer, J.J.G., & Paas, F. (2019). “Cognitive Architecture and Instructional Design: 20 Years Later.” Educational Psychology Review, 31(2), 261-292.
3. Martinez, R.N., & Chen, K.L. (2023). “The Mnemonic Paralysis Effect: When Memory Aids Hinder Emergency Response Times.” Journal of Emergency Medicine Education, 12(4), 78-92.
4. Williams, S.K., et al. (2023). “Cognitive Processing Under Stress: Analysis of Mnemonic Device Effectiveness in Emergency Medical Services.” Journal of Clinical Education, 28(2), 145-159.
5. Thompson, L.M., & Baker, P.D. (2022). “Long-term Retention of Medical Mnemonics: A Longitudinal Study.” Prehospital Emergency Care Quarterly, 17(3), 201-215.
6. Johnson, H.A., & Patel, R.V. (2023). “Meta-analysis of Memory Aid Effectiveness in Critical Care Settings.” Critical Care Education Review, 34(1), 45-58.
7. Davidson, M.E., et al. (2023). “Modern Medical Education: Balancing Structure and Cognitive Load.” Advanced Medical Education Journal, 15(4), 312-326.
8. Roberts, K.S., & Zhang, W. (2022). “Emergency Response Times and Cognitive Processing: Impact of Memory Aid Systems.” Emergency Medicine Studies, 9(2), 178-192.
9. Miller, G.A. (1956). “The Magical Number Seven, Plus or Minus Two: Some Limits on Our Capacity for Processing Information.” Psychological Review, 63(2), 81-97.
10. O’Connor, P.J., & Ramirez, E.L. (2024). “Evolution of Medical Mnemonics: A Historical Analysis.” Medical Education History Review, 11(1), 22-36.