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Adverse Events in EMS: Symptom of a Larger Problem

Supported by Award Number KL2 RR024154 from the National Center for Research Resources. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the National Institutes of Health. Additional grant support was provided by the North Central EMS Institute (NCEMSI) and Pittsburgh Emergency Medicine Foundation (PEMF). In reply:—We applaud the National Study to Prevent Blood Exposure in Paramedics (NSPBEP) and its contribution to the knowledge base on safety in emergency medical services (EMS).1 This study will undoubtedly increase awareness of the magnitude of injuries and threats to paramedic safety. The NSPBEP and our effort using the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ) highlight the challenges of measuring culture and adverse events in EMS and their interaction. Dr. Boal and colleagues used specific questions to link adverse events to safety culture. Our efforts using the EMS-Safety Inventory (EMS-SI) and the EMS-SAQ sought to link broader collective adverse event inventories with a comprehensive measure of workplace culture.2 The EMS-SAQ has demonstrated high reliability and content, construct, and predictive validity among EMS respondents, thus affirming the quantifiable nature of workplace culture.2–4 We also remain concerned that to unduly focus on adverse events may inadvertently deflect attention away from more far-reaching and influential factors such as beliefs and practices of the workers. An adverse event is often a symptom of larger cultural issues. The latter may be harder to detect and far more difficult to modify. However, we also believe that the converse relationship is possible; that is, improvements in workplace culture could indirectly result in downstream improvements across a range of individual safety events—even those not directly measured. We continue to work towards this goal as a viable strategy for improving EMS safety.