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Teamwork and Focus

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It is well known that the actions of an individual not only impact that person, but can also impact the entire team. This applies to EMS. The ability to work with various team members is critical in promoting success on projects or running calls.

Marti has been involved in EMS for 4 years. She is an EMT-Intermediate and is considered to be a great partner and valuable leader on any call. Marti and her EMT partner, Simon, respond to the scene of an overdose. While responding to the call, they are notified that there are "numerous patients" and it is suspected that a bad batch of drugs is involved.

Marti and Simon arrive on scene and quickly assess the situation. Within seconds they determine that there are several patients and that the patients will need to be evaluated in emergency departments. Because of this situation, additional ambulances are requested. Marti and Simon continue triaging the call and begin to treat the most acute patients.

The next closest ambulance is only a few minutes away and is staffed by Ace and Alex. They are both paramedics and have been working in the system for more than 5 years. Within a couple of minutes of being dispatched they arrive on the same scene. Ace approaches Marti and inquires what needs to be done. Marti begins to provide a brief overview of the situation. Suddenly, in mid-sentence, Ace interrupts Marti. He then essentially yells to Alex to re-assess the patients to confirm that triage has been done correctly. When Marti questions Ace to confirm that he really wants to re-triage the call, Ace spins around and announces in an aggressive manner "Absolutely. I'm the senior medic here. I don't think this call was triaged appropriately and I'm taking over."

For the next few seconds the scene seems to be very quiet. Marti does a double take of Ace. She cannot believe what she is hearing or seeing. She was not prepared for this. Ace has already started to walk around helping Alex to re-triage the patients. He is also treating patients based on his new assessment.

A 3rd ambulance arrives to offer assistance. The crew of the ambulance approaches Marti to ask how they can help. Ace intercepts the crew before they contact Marti and he starts to essentially bark orders. The ambulance crew exchange glances, look at Marti, and then look at Ace. Reluctantly they start to acknowledge Ace and follow his orders.

As this takes place, other responders, including the police and fire crews, are watching as the scene dynamics unfold. They are now sharing surprised and confused looks as Ace continues to re-arrange Marti and Simon's initial assessment. The tension in the air is essentially palpable.

The call continues to proceed with Ace essentially taking over. The other crews continue with the operations and the call ends a few minutes later. Alex notices that several of the other crews have concerned looks on their faces after witnessing the scene dynamics.

When the call ends Alex and Ace talk for a few minutes. Alex asks Ace, "Are you okay?" Ace appears genuinely surprised and asks Alex -- "Why? Something wrong?" Alex nods his head in the affirmative and says, "I think you owe Marti an apology. She had everything on scene under control. I don't think you helped things run smoothly." Alex and Ace continue to discuss the call with Alex providing examples of the scene dynamics from his perspective.

Ace ponders the feedback. He recognizes that he was probably not performing with the big picture in mind. He also recognizes that he has been under a lot of pressure lately and that something on scene most likely triggered his response. He can appreciate that his actions may not have been appearing to be supportive of the big picture. He essentially arrived on scene, demanded control, and began to run things "his way".

Ace recognizes that team members must focus on working together to accomplish the bigger picture -- whether it involves providing patient care or working on a project. While he technically was the senior medic on scene, leveraging the "authority" did not benefit anyone. His actions did not reflect the big picture.

He also recognizes that even though their approaches varied, he and Marti probably would have achieved a similar outcome: all patients would have received treatment. In hindsight, Ace could have acknowledged Marti's initial assessments and followed her lead. He realizes that during a real event it is not the ideal time to start a turf battle. Instead of focusing on the fine details of how the call was being managed, Ace could have focused on the big picture of providing care and following the initial triage crew's lead.

A major drawback on the scene was the duplication of triage and the re-assessment of the patients. When this occurred, valuable time was lost. The duplication was not necessarily needed and it immediately influenced the scene dynamics, including the flow of patient care. Other crews were distracted by the interactions.

Ace and Marti also met to discuss the scene. Ace apologized for his on-scene manner. In response, Marti, while maintaining a calm voice, replied that the ultimate goal was achieved: the patients were taken care of appropriately. It was also mentioned that while their approaches were on the opposite ends of the spectrum, the ultimate goal was still achieved. It was also noted that while Ace was the senior medic on the call, that does not mean that he must always be in charge. The ability to respect different approaches to achieve the same results is key in working together.

While the above scenario is not an ideal situation, it does shed light on how individual actions can impact the team and the final outcome. While not everyone will agree with the actions taken by Marti or Ace, they provide examples of different styles and the ability to work with others. For example, Marti's style included not questioning Ace during the call. She also modified her plans to support the ultimate goal of providing optimal care. By taking this approach, the amount of on-scene confusion was most likely minimized.

The ability to quickly assess a situation and to intervene is often a fine line. Regardless of the role a person has, keeping the ultimate outcome in mind and working with team members to achieve that outcome is essential. This applies to any situation including EMS and healthcare in general.


Paul has been involved in healthcare for more than a decade. During this time has held clinical and administrative roles and has functioned as a Paramedic and Flight Paramedic. He is a published author and has spoken at healthcare conferences. Paul has Master degrees in Computer Resources/Information Management and Healthcare Administration.

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