Columns, Operations

Does A New Partner Increase Your Risk of On-the-Job Injury?

Issue 10 and Volume 41.

Partner Familiarity

Patterson PD, Weaver MD, Landsittel DP, et al. Teammate familiarity and risk of injury in emergency medical services. Emerg Med J. 2016;33(4):280–285.

Have you ever arrived at work and met a new partner just minutes before responding to a call together? This is an all-too-common scenario for many of us. Whether our regular co-worker was on vacation, or we simply worked an extra shift, we can find ourselves on a critical, complex and dangerous scene with a new partner.

Background: In this column we feature not only medical research, but also EMS operations research that helps improve patient care and provider safety. Our April 2015 column looked at the effectiveness of crew resource management, a teamwork concept borrowed from the aviation industry—a similarly high-risk and unpredictable work environment. It showed that teamwork reduces errors, crashes and worker injury. This study links familiarity of “dyadic” teams (teams of two) to a reduction in prehospital worker injury. 

Kudos to Patterson, an EMS provider turned full-time researcher, and his co-authors for using formal research to explore teamwork and its connection to patient and provider safety. This work is a shining example of how prehospital providers can and must build a scientific basis for the work we do.

Methods: A retrospective records review was performed utilizing occupational injury and shift scheduling records from 14 EMS organizations across the United States. The researchers calculated familiarity between EMS practitioners based on the number of shifts worked together. A statistical analysis was then performed to determine if there was a correlation between occupational injury and familiarity between EMS partners. 

Results: A large number of shifts (715,826) with 4,197 providers over 29 months were analyzed. The first­—and concerning—key finding is a confirmation of prior research showing a higher than normal incidence rate of injury among EMS workers: An average of 17.5 injuries per 100 full-time personnel.

The study also found that working with a new partner was a common occurrence. The average number of partners an EMS practitioner had was 18.6. Slightly more than half (53.9%) of partners worked together once, 24.7% worked together 2–3 times, 11.8% worked together 4–9 times, 9.6 % worked together 10 or more times.

Partners with 10 or more shifts of familiarity were the less likely to experience an injury while working together compared to teams working with a new partner. There was an increase in injury as familiarity decreased, with the highest rates of injury occurring between partners working only one shift together. The model used by researchers determined each shift of familiarity correlated with a 2% reduction in injury rate. 

Discussion: The authors point out several serious limitations to this study. They didn’t account for length of employment, age, gender and other factors that might influence teamwork. It’s possible that a new employee orientation or continuing education training could help to build team cohesion, encourage more effective communication, and thus help to improve familiarity so that it’s not tied to the number of shifts worked together.

Conclusion: EMS practitioners work with various partners on a frequent basis. It’s surprising how often partners changed within the agencies in this study. It makes intuitive sense that partner familiarity would decrease injury, so it’s good it’s now supported in the literature. This also has an impact from a managerial level because EMS leaders may find reduced injuries among their workforce by actively working to routinely pair personnel together to improve familiarity among all the agency’s providers.

Bottom Line

What we already know: Research in aviation and other parts of medicine links partner familiarity and teamwork with improved care and reduced injuries.

What this study adds: Evidence that familiarity between teams of two EMS providers is variable, and less familiarity is linked to workplace injury.

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Prehospital care research forum at UCLA

The deadline to submit abstracts on clinical system management research is Oct. 31, 2016. Learn more here.

Prehospital care research forum at UCLA

Learn more from David Page at the EMS Today Conference & Exposition, Feb. 23–25, in Salt Lake City. EMSToday.com

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