Preventing Errors in EMS

It seems that one of the hottest topics in EMS right now is patient safety. Everyone wants to provide patients with the safest and highest quality care possible, but errors do occur, and it seems many providers are reluctant to report them.

"EMS grew up out of the military model, which many EMS agencies still operate under," says Gary Wingrove, president of the Center for Leadership, Innovation and Research in EMS and director of strategic affairs for Mayo Clinic Medical Transport/Gold Cross. "The basis for that model is 'make a mistake and you get punished,' so I think there are a lot of places where people know that reporting yourself is a recipe for losing your job and they don't do it." The good news, says Wingrove, is that anonymous reporting is finally becoming more available.

A presentation at the National EMS Advisory Council (NEMSAC) meeting about an anonymous event-reporting site successfully being used in Pennsylvania gave Wingrove an idea.

"Matt Womble, who works in the state Rural Health Office in North Carolina, and I started a dialog last year about how we might engage people in safety with a site like the one used in Pennsylvania, where people can report events anonymously," he says.

After numerous calls to Pennsylvania's EMS Medical Director Doug Kupas and research on the Denver-based CONCERN Network, which does air ambulance safety reporting, the Center for Leadership, Innovation and Research in EMS (CLIR), along with its sponsoring organizations, the EMS Chiefs of Canada, National EMS Management Association and the North Central EMS Institute recently announced a new patient safety initiative--the EMS Voluntary Event Notification Tool (EVENT), which provides a tool for EMS providers and others to anonymously report events that have occurred, could have occurred or could potentially occur.

"One example of the things we hope to capture is incidences of equipment failure," says Wingrove. "Say there's a report today of structural failure of a stretcher in Southern California, another one tomorrow in Montana and a third the next day in Orlando. Before now, we didn't have a way to connect those reports. The three companies would know they had a problem and would get their stretcher repaired and the others inspected, but there was no coordinated effort to know there might be a manufacturing problem with that particular model stretcher. When isolated incidents like that happen, they may be fairly meaningless, but when you put them together they have some serious implications for the entire industry."

To report an adverse event, providers can go to https://event.clirems.org and click on "Submit an Event." Drop-down boxes will capture the information in a database and an email will be sent to the site managers, who will then forward it to state EMS directors.

"The only place a person can tell us who they are is in the text field," says Wingrove. "If someone includes his or her name, a medical director's name or company name, we'll delete that before we forward the email."

One word of caution: This is a site for legitimate complaints only. "Individual mistakes or problems should be handled internally or through the state regulator," says Wingrove. "Right at the top of our reporting form, in big, red, bold letters is a statement that says, 'This is not a complaint tool. If you wish to file a complaint, contact the state or provincial EMS office that regulates you.' If we get those kinds of reports, we'll just delete them."

If event reporters expect to see results from what they submit, that may be difficult, says Wingrove.

"Somebody asked me last week how we'll get back to people to let them know what happened with their case, and the answer is, we can't. We won't know who they are, and we don't want to know, so the only way someone could see anything would be at the end of the quarter when we publish the aggregate statement on the website. Even then it will be tough to know if their report is there, because it's an aggregate and there's no specific information about any incidents."

Right now, says Wingrove, the top priority is getting the word out to providers that they can submit reports anonymously.

"The state EMS directors have already signed on, and we hope to create a host of other national associations like AAA, NAEMT and others to partner with us," he says. "Partnership requires no cash, but our request is that if we promote them as partners of the system, they will use their electronic newletters, print journals and other means of distribution to get the word out."