Patient safety in emergency medical services: executive summary and recommendations from the Niagara Summit

Abstract

Emergency medical services (EMS) personnel care for patients in challenging and dynamic environments that may contribute to an increased risk for adverse events. However, little is known about the risks to patient safety in the EMS setting. To address this knowledge gap, we conducted a systematic review of the literature, including nonrandomized, noncontrolled studies, conducted qualitative interviews of key informants, and, with the assistance of a pan-Canadian advisory board, hosted a 1-day summit of 52 experts in the field of EMS patient safety. The intent of the summit was to review available research, discuss the issues affecting prehospital patient safety, and discuss interventions that might improve the safety of the EMS industry. The primary objective was to define the strategic goals for improving patient safety in EMS. Participants represented all geographic regions of Canada and included administrators, educators, physicians, researchers, and patient safety experts. Data were collected through electronic voting and qualitative analysis of the discussions. The group reached consensus on nine recommendations to increase awareness, reduce adverse events, and suggest research and educational directions in EMS patient safety: increasing awareness of patient safety principles, improving adverse event reporting through creating nonpunitive reporting systems, supporting paramedic clinical decision making through improved research and education, policy changes, using flexible algorithms, adopting patient safety strategies from other disciplines, increasing funding for research in patient safety, salary support for paramedic researchers, and access to graduate training in prehospital research. RÉ SUMÉLe person-nel des services mé dicaux d'urgence (SMU) doit souvent intervenir dans des contextes difficiles et instables pouvant accroître les risques d'é vé nements indé sirables. Or, les risques pour la sé curité des patients dans ce contexte sont mé connus. Pour remé dier à cette situation, nous avons effectué une analyse documentaire complè te, y compris des é tudes non randomisé es et non contrô lé es, ré alisé des entrevues qualitatives d'informateurs clé s et, avec l'assistance d'un conseil consultatif pancanadien, organisé une table ronde d'une journé e ré unissant 52 experts dans le domaine de la sé curité des patients et des SMU. Le but de cette rencontre é tait d'examiner les recherches disponibles, de discuter des questions touchant la sé curité des patients en milieu pré hospitalier et de discuter des interventions pour amé liorer leur sé curité . Notre principale intention é tait de dé finir les objectifs straté giques pour amé liorer la sé curité des patients dans les SMU. Les participants repré sentaient toutes les ré gions gé ographiques du Canada et incluaient des administrateurs, des é ducateurs, des mé decins, des chercheurs et des experts en sé curité des patients. Les donné es ont é té recueillies à l'aide d'un vote é lectronique et d'analyses qualitatives des discussions. Le groupe d'e...

Patient Safety in Emergency Medical Services: A Systematic Review of the Literature

“…19,20 There is encouraging attention by the EMS community to enhancing patient safety; in 2010, the National Highway Traffic Safety Administration partnered with the American College of Emergency Physicians to promote an "EMS Culture of Safety," and a 2009 Summit on Patient Safety hosted in partnership with the EMS Chiefs of Canada and the Canadian Patient Safety Institute identified nine strategic priorities to improve patient safety and enhance research activities related to harm reduction and safety. 21 Acting on these priorities will improve the patient safety research enterprise in two ways. First, by encouraging high-quality data reporting and the use of standardized definitions, 22 EMS systems will accumulate data allowing for comparisons within and between systems.…”

“…22 Systems and processes must be put in place to better define threats to patient safety specific to EMS, and rigorous research-quality databases are needed to track adverse events in the prehospital setting. 21 As the safety landscape becomes defined, interventions to improve EMS practice can be collaboratively developed, evaluated, and implemented.…”

Las emergencias extrahospitalarias ante la cultura de seguridad

“…Debemos señalar que gran parte de las percepciones positivas obtenidas en nuestros resultados se encuentran moduladas porque los profesionales que trabajan en este ámbito cuentan con una formación específica para el desempeño de su actividad asistencial 28,29 , a diferencia de lo que sucede en otros países donde mayoritariamente la asistencia es realizada por personal paramédico [30][31][32] , que si bien es posible que cuente con un entrenamiento adecuado, no cuenta con la capacitación específica para tomar decisiones clínicas.…”

Analysis of the Root Causes of an Undesirable Incident in a Hospital in Mashhad, 2013

“…Other benefits of the analysis of the root causes can be named as modifying the deficiencies and using suitable methods which can improve service offering, reducing the costs on the patient and healthcare system as well as improving the output of the medical team in times of crisis all of which result in the accurate identifying the main cause of an incident 12,13 . The results of Sanvl and colleagues 14 and Packstone 15 studies reported that applying the strategy of clear, transparent and implementation procedures are considered to be effective strategies as to prevent medical errors.…”