Toxic Partners: The damage they do in EMS

The next generation of EMTs can’t learn if we’re not kind or patient enough to teach them


“When you wake up in the morning and meet an a**hole, you met an a**hole. But if you keep meeting a**holes all day, YOU are the a**hole.” — Raylan Givens, "Justified"

We’ve all had that favorite partner, the one who knew our moves, knew their lines in that well-rehearsed banter with patients and family, could finish our sentences, and knew our favorite places to eat. Partners like that make a shift pass in what seems like half the time. Reach out a hand on that tough airway call, and magically there appears in it a laryngoscope with your Mac 3 already locked in, a 7.5 tube already set up. Think to yourself, “we need a 12-lead ECG on this guy,” and before you can articulate the request, electrodes are being applied to the patient’s chest. Miss a critical detail or a crucial history question, and she’s ready to back you up or cover your mistake. Relationships with partners like that grow beyond the hours you spend on shift together, into friendship.

Likewise, we’ve probably had that bad partner who makes every second of a shift drag on interminably. He’s a disagreeable companion who is in your way on calls, listens to godawful music on the radio, and generally annoys you until you resent even his most innocuous quirks ... like breathing.

A good partner is trusted family, and a bad partner is more like a prison sentence. (AP Photo/Chris Post)
A good partner is trusted family, and a bad partner is more like a prison sentence. (AP Photo/Chris Post)

A good partner is trusted family, and a bad partner is more like a prison sentence.

This rumination is spurred by the recent story of the FDNY medic assaulted by her partner. While posting in their ambulance outside Harlem Hospital, the two medics got into an altercation that resulted in one allegedly bashing the other in the head with the ePCR tablet hard enough to cause a wound that required staples to close.

No matter what the provocation, physically assaulting a colleague is indefensible. I’m a 50-something male raised in a Southern culture that still holds, “he needed a butt-whoopin’” as a valid defense, and even I can’t envision a scenario that justifies striking a colleague. Whatever the impetus of this altercation, it moves beyond the realm of bad partners into toxic partners.

Bad partners: setting expectations

We’ve all had the bad partner, and if we’re honest with ourselves, there are probably times when we’ve been the bad partner. Whether it be fatigue, stress from home, or simply waking up on the wrong side of the bed that morning, there are times when we’ve all been less than the professional partner than we’d like to be. Chris Cebollero pointed this out in our Inside EMS podcast on the subject, and highlighted the elements of emotional intelligence necessary to recognize the dynamics of partner relationships, and our contributing role in the dysfunctional ones.

Listen: What the FDNY medic partner attack says about toxic EMS culture

With any dysfunctional relationship, it takes a healthy degree of introspection to admit that our own behavior may be causing it (see the Raylan Givens quote at the beginning of this column).

I’m as guilty of it as anyone else. I have a getting-to-know-you speech I give to any new partner, a distressing number of which these days tend to call me “Sir,” or “Mr. Grayson,” and look barely old enough to shave. I tell my new partner that I consider them more than an equipment Sherpa. I expect them to do all the medical care an EMT is trained to do, and they don’t need to wait for an order from me to do it. I explain that 70% of our patients don’t need an emergency department, much less an ALS ambulance to get there, and that the vast majority of EMS calls need only BLS care, and what little ALS I deem necessary is usually done with the wheels rolling. That makes the EMT’s job on a scene every bit as important as mine. I tell them that patients rarely take note of our skill or knowledge, but they always notice our attitude, and that kindness and a blanket are the most important tools an EMS provider can have.

I also promise that I will praise them in public and criticize them in private, that any issues I have will be addressed with them privately before taking it to management, and that I expect the same courtesy. I explain my philosophy of scene choreography – you do assessments, I obtain history.

And almost invariably, after those expectations have been set, I have a good relationship with that partner. We get along, with a minimum of personal conflict. Only occasionally has one refused to or been unable to work within those parameters, and I’ll confess that the more fatigued and burned out I am, the less patience I have with the ones who catch on a little slower. Likely, there have been a few kids to whom I was more silent critic than mentor, more Sphinx than sage. Those, I regret. When I recognize that attitude in myself, it’s time for a change of scenery. I don’t need a new partner, I need a break so that I can be a better partner.

How are we introducing rookies to EMS?

I’ve been lucky in my career in that I’ve only had one toxic partner. She was narcissistic, rude to patients and hospital staff alike, and refused to take responsibility for her own behavior. When she was insubordinate to a supervisor and called on the carpet for it, her attempt to deflect blame by making up lies about me spelled the end of her employment at our agency.

But even now, I wonder, “why did she act the way she did? Was it something in me that rubbed her the wrong way?” Ultimately, I found comfort in knowing I was far from the only person she didn’t get along with.

I also remind myself that I have advantages at this point in my career that the rookie EMT does not. If I were to have an irreconcilable issue with a new partner, likely as not, it would be the partner who is moved to a new assignment, not me. But when you’re a rookie hire at an EMS agency, you usually get plugged into the first opening on a truck. Quite often, that truck has an opening because the medic can’t get along with anyone, and nobody with any seniority wants to work with him. The rookie doesn’t have a choice, and winds up being “mentored” by some burnout who can’t teach an armadillo to dig a hole in the ground. That is the introduction to EMS for far too many rookies, and it’s the primary flaw in the “education vs. experience” argument in EMS. Experience is only valuable if it’s good experience, and too many impressionable EMTs wind up partnered with someone who is more cautionary tale than mentor.

You’d do well to keep that in mind when you’re annoyed with your new partner. Ask yourself honestly if the problem is them, or you. The next generation can’t learn if we’re not kind or patient enough to teach them.

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