Naturalistic decision-making (NDM) research offers important guidance for designing information technology to be used by people who conduct extreme activities in extreme environments, such as military special operators. Recent advances in technology make it possible to deploy information technology in extreme environments (e.g., desert, arctic, high altitude, underwater) to support people who engage in complex and dangerous activities. This practitioner case integrates and operationalizes relevant NDM research including an NDM perspective, methods (cognitive task analysis, staged world exercise, and functional analysis), and frameworks (macrocognition, Laws that Govern Cognitive Work in Action, and Cognitive Performance Indicators) to inform design and identify the potential pitfalls associated with introducing information technology into extreme environments. A project conducted with the United States Air Force pararescue jumpers illustrates the complexity and relevance of NDM research in this challenging design space. Pararescue jumpers are military personnel who specialize in recovering personnel and administering life-saving medical treatment in a wide variety of operational environments. Practitioner pointsRecent technological advances make it possible to introduce information technology into domains requiring extreme activities in extreme environments. Naturalistic decision-making research offers perspective, methods, and frameworks relevant to designing for extreme activities in extreme environments. Naturalistic decision-making research provides guidance for anticipating potential pitfalls in introducing information technology.The Naturalistic decision-making (NDM) community has long-studied decision-making in situations characterized by high stakes, time pressure, team dynamics, organizational constraints, and dynamic conditions. In this practitioner case, we address a specialized *Correspondence should be addressed to Laura Militello, 5335 Far Hills Ave.,

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