Morning Rounds: Buddy System Works on Mountains and in Emergency Departments
To Your Health —
Thursday, October 15, 2015 1:41 PM
As in most professions, there are plenty of stereotypes about physicians. For emergency physicians, the stereotype is adrenalin junkie.
There is some truth to this. Emergency physicians must be able to thrive in an incredibly unpredictable work atmosphere.
Nobody wakes up in the morning and says to their wife: “Honey, I am going to attack that 12 inches of wet snow in our driveway like the linebacker I was in high school instead of as the out-of-shape 50-year-old I am today. Could you call Dr. Fourre and let him know I may be stopping by the ED with a massive heart attack?”
Or, “Mom, my boyfriend and I are going through a difficult time right now so I am going to be texting and driving quite a bit today. Could you give Dr. Fox a call and make sure he has a few extra units of type AB positive on hand?”
In the emergency department, our job is to handle the unexpected. On any given day that might mean a mental health crisis, a stroke, a multi-vehicle car accident or all of the above. Time is limited, resources are sometimes scarce and the needs of patients are acute.
That environment is probably why a lot of the emergency physicians I know enjoy sports like rock climbing, surfing, backcountry skiing or backpacking. For one thing, getting outdoors is a great antidote for stress, but they also tend to be the type of people who enjoy pursuits where the environment can be unpredictable and even flat-out dangerous.
They are also, however, the type of people who understand how to manage the variables they can control. They use the right equipment, plan their trip and check the weather forecast. Most importantly, emergency physicians tend to use the buddy system.
Every kindergarten teacher knows that giving two students responsibility for each other makes both safer. The same principle is used in the military, where two members of a missile launch crew have to agree that an order is valid before launching, and in the corporate world, where the four-eye principle helps safeguard big transactions.
When I heard about the death of a young woman who had attempted a traverse of the Presidential Range in New Hampshire’s White Mountains last February, my first thought was: she had no business attempting that traverse alone at that time of year, especially with an unfavorable weather forecast. Having spent a great deal of time in the White Mountains, including summitting Mt. Washington and other peaks in the middle of winter, I would never attempt that winter hike alone.
Kate Matrosova, who was by all accounts strong, healthy, intelligent and an experienced hiker, got out of her husband’s car at 5 a.m. in Randolph, N.H., walked past a sign that warns hikers they are entering a place that has some of the most dangerous weather in the country, and began a trip that she hoped would take her to the top of four mountains and back down to her waiting husband by 6 p.m.
She sounded her locator beacon about 3:30 p.m. At that point, according to news reports, the temperature at the nearby Mount Washington Observatory was 21 degrees below zero. The wind was blowing at 77 miles an hour with gusts of 100 miles per hour and the wind chill was 67 degrees below zero.
Rescuers found her body about 22 hours later. She had been blown a few hundred feet off the trail while hiking on an exposed section of the mountain. She had tried to turn back and reach shelter, but by that point it was too late.
A number of articles have been written about that day and all paint a portrait of a goal-oriented, driven young woman who had limited time. Matrosova did a lot of things right in preparing for her hike. The mistake she made was in deciding to go forward in the face of worsening conditions.
The problem with decision-making is that it is always to some degree a personal process. We all tend to weigh different factors differently. That reality is the reason joint decision-making is much safer.
While one hiker may weigh heavily the risk of missing a narrow window for a much-anticipated hike, another may think more about safety. When two people make a decision together they are more likely to bring important data to the discussion.
If Matrosova checked the forecast that morning, she may have seen that the worst weather was not expected until after she expected to be off the mountain. A hiking companion may have noticed that the weather had worsened steadily over the past several days.
Emergency physicians are constantly confronted with serious medical issues and making the right decision can mean life or death just as surely as it can on the Presidentials in February.
Part of how we control decision-making is with systems — electronic medical records allow us to see patients’ past medical history, which can help us double-check decisions to some degree.
But the most important system that emergency doctors and nurses have to avoid errors is other emergency providers. Think of it as the emergency department buddy system.
It is critically important that emergency physicians partner not only with the patient and family members, but also with consultants and nurses, when a crucial decision is made. If doctors and nurses operate as a team and share responsibility for decisions, the chance of errors is much less, according to several studies.
Kindergarten teachers and rock climbers have known it for years. Having a buddy doesn’t just help you get out of trouble; it can prevent you from getting into trouble in the first place.
Mark Fourre, MD, is an emergency physician and Chief Medical Officer of LincolnHealth. He also serves on their Board of Trustees. Prior to joining LincolnHealth, Dr. Fourre was an attending faculty at Maine Medical Center where he developed the Emergency Medicine Residency Program and served as Residency Director.