Regular Partner Pairings a Detriment to Safety?

[MMiz]

I've been following the MedJet crash on a piloting forum and there are several comments noting that the two pilots working having worked together extensively may be a contributing cause to the incident.

Several posters have remarked that two pilots with an extensive history of working together often means that they aren't as likely to speak up when something one deems unsafe takes place.

Many seem to suggest that random pilot pairings promote an atmosphere where pilots are more comfortable speaking up and intervening.

Does the same apply to EMS in any way?

 

[mgr22]

I've been following the MedJet crash on a piloting forum and there are several comments noting that the two pilots working having worked together extensively may be a contributing cause to the incident.

Several posters have remarked that two pilots with an extensive history of working together often means that they aren't as likely to speak up when something one deems unsafe takes place.

Many seem to suggest that random pilot pairings promote an atmosphere where pilots are more comfortable speaking up and intervening.

Does the same apply to EMS in any way?

The tendency to speak up, in my opinion, has more to do with the personalities of both partners -- including comfort with giving and receiving advice, in general -- and the perception of one's own expertise compared to the partner's.

 

[ffemt8978]

Not to mention it may be more difficult to speak up with someone you don't know well, especially if they are senior to you.

 

[Tigger]

I think the opposite is also true, putting two strangers together and expecting one to speak up is probably asking for trouble.

 

[Aprz]

I think pairing up two pilots that both know how to fly a plane is different than pairing up a medic and an EMT. The EMT usually doesn't know how to paramedic. EMTs know how to assess patients, but aren't usually strong in ALS treatment plans, dosages, or procedures. Would I appreciate if an EMT spoke up if they noticed I was making a med error or was concerned about my treatment plan? Absolutely. Do I expect them to be aware or know what's going on? Not really. At least in California, most of them are essentially drivers that have some first aid training. When I left the ambulance, they were just starting to be able to do blood sugars and give aspirin. Even if you aren't the captain of the plane, at least you know how to fly the plane. I think pilots trade off with landing and takeoff. My EMT and I rarely traded off on calls. The patient had to have a beyond basic complaint where all they needed was a ride and had very little to no chance of deteriorating. The majority of our calls weren't crazy emergencies eg abdominal pain, chest pain. Of course, the EMTs I worked with couldn't take those calls. I'd run like 10+ calls before my EMT took 1-2 calls. We weren't really trading off on calls.

 

[CCCSD]

My SGT and I flew together for years. We practiced CRM et al and never had issues over who was PIC, or what to do or when to speak up.

As said, it’s quite a bit different than running a rig.

 

[DrParasite]

Absolutely... this is my regular partner, and I will defend them from others. I need to rely on them, and trust them, just like they would for me. We are friends. We know each others strengths and weaknesses, we have our quirks, and are aware of our quirks.

But what is the alternative? a random partner? are they going to feel comfortable speaking up (esp with the EMT/Paramedic power dynamic?) I can speak up about this horrible paramedic, or I can just avoid them and after this shift they are someone else's problem.

If it's a major issue, I don't see it a a problem, however, I do think rotating partners every 3 months or so, staying on the same tour and schedule, is not a bad idea.

The majority of our calls weren't crazy emergencies eg abdominal pain, chest pain.

as an aside, in my old system (and I think ProQA agrees), abdominal pain is a non-emergent BLS dispatch.

 

[EpiEMS]

If you're not rotating, how are you making sure that people aren't covering for significant deficits until it's too late? That would be my main worry.

 

[DesertMedic66]

If you're not rotating, how are you making sure that people aren't covering for significant deficits until it's too late? That would be my main worry.

Exactly this, at least when both clinicians are preforming on the same level. For your normal ground ambulance that is staffed EMT/Medic I think it’s less of an issue because everything falls on the medic but on the flight side where both clinicians are fully responsible for knowing every aspect.

 

[EpiEMS]

Exactly this, at least when both clinicians are preforming on the same level. For your normal ground ambulance that is staffed EMT/Medic I think it’s less of an issue because everything falls on the medic but on the flight side where both clinicians are fully responsible for knowing every aspect.

I agree I’d be more concerned for people at the same level but even for riding EMT/medic, i can imagine circumstances where the EMT might have cause to question the medic’s judgement - maybe not clinically but operationally.

 

[Carlos Danger]

Exactly this, at least when both clinicians are preforming on the same level. For your normal ground ambulance that is staffed EMT/Medic I think it’s less of an issue because everything falls on the medic but on the flight side where both clinicians are fully responsible for knowing every aspect.

But at the HEMS level, by the time you are in a position to have a regular partner, your experience and skills have been vetted by numerous people in several different ways. Even once you are in that permanent position, any decent place has frequent education, testing, chart review, etc that would shed light on any real issue.

Even when I have had regular partners, there was still plenty of exposure to other clinicians due to vacations, shift swaps, illnesses, etc. There's no way that one person would have been able to hide their partner's deficit for very long.

 

[EpiEMS]

But at the HEMS level, by the time you are in a position to have a regular partner, your experience and skills have been vetted by numerous people in several different ways. Even once you are in that permanent position, any decent place has frequent education, testing, chart review, etc that would shed light on any real issue.

Even when I have had regular partners, there was still plenty of exposure to other clinicians due to vacations, shift swaps, illnesses, etc. There's no way that one person would have been able to hide their partner's deficit for very long.

This makes sense, assuming management and QA/QI are watching closely!

 

[E tank]

If there is a systemic detriment to safety according to the composition of the crews, there are bigger problems there than scheduling....

 

[Barsa]

I have definitely noticed a difference (on ground at least) with a regular partner versus a "partner of the day." I wouldn't be at all worried on a high acuity call with my current partner's abilities to handle themselves, especially considering we are 45-60 minutes from any back up. When I have one of the part timers, it is much harder to be able to delegate "you start here, I'll start there, we'll meet in the middle" as I can with a regular partner. I think it also helps with some degree of cognitive offloading in some cases, where a regular partner knows what is expected from call to call.