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Comment & Response
August 2018

The Health Care System Flies in the Face of Airline Security Concepts

Author Affiliations
  • 1University Hospital, Amiens, Picardie, France
  • 2Department of Women's Health, St Thomas' Hospital, London, United Kingdom
  • 3London, United Kingdom
JAMA Intern Med. 2018;178(8):1142-1143. doi:10.1001/jamainternmed.2018.3550

To the Editor Freund et al must be commended for their randomized trial showing an association with systematic cross-checking between emergency physicians and reduced adverse events.1

This raises 2 major questions. First, when will cross-checking be implemented so that these findings are not overlooked as previous studies of cross-checking have been?2 Although the airline industry has long been hailed as an inspiring beacon for security, its concepts have still not yet been transferred into the health care system. The airline industry, thankfully, did not perform randomized trials to require 2 pilots in the cockpit. Second, when will adequate training be introduced into the curriculum? Training is a prerequisite that must consider attitudes toward fatigue management, team building, communication, recognizing adverse events, team decision making, and performance.3 In airplanes, 1 of the 2 pilots—regardless of rank—acts as “pilot flying” while the other acts as “pilot monitoring.” Owing to highly competitive selection, cross-checking is far from being our natural mindset.

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