National EMS Culture of Safety Strategy Summary

Emergency medical services (EMS) is a critical component of the nation’s healthcare system. In the U.S., EMS personnel respond to an estimated 37 million calls per year.[1] EMS is also an integral component of the nation’s disaster response system.[2]

In recent years, cultural and operational safety advances have been broadly implemented in many healthcare settings, as well as aviation and other high-consequence fields. Yet, too often, the very emergency medical system that people count on for help unintentionally risks or even causes preventable harm to three related groups: EMS personnel, patients and members of the community.

Risk of Harm to EMS Personnel: Regardless of their location or the type of system in which they work, EMS personnel are expected (and often expect themselves) to do their work under difficult, unpredictable and rapidly changing circumstances. They may work long hours, in harsh environments, with limited information, assistance, supervision and resources to accomplish their mission. In the course of their work, they may be exposed to risks such as infectious organisms, emotional stress, fatigue, physical violence, occupational injury, vehicle crashes, and personal liability. They are more than 2-1/2 times likelier than the average worker to be killed on the job,[3] and their transportation-related injury rate is five times higher than average.[4]

Risk of Harm to Patients: In 1999, the Institute of Medicine report To Err Is Human called the attention of the public and the medical community to the topic of preventable adverse medical events. Since then, the nation’s healthcare system has moved toward a culture of safety in many inpatient and outpatient settings. But these concepts and practices have yet to be widely embraced in the EMS community.

Risk of Harm to Members of the Community: EMS risks causing harm to the public. An example of this is the interaction between an ambulance responding to an emergency event and the general motoring public.

An Urgent Problem of Unknown Scope

It is difficult to measure the extent of harm caused to each of these three groups, and thus to create tailored solutions and measure their effect. Because reporting requirements and mechanisms are incomplete at best, reliable data are sparse and capacity for research is limited. Concerns over privacy laws, tort liability, trade secrets and potential public embarrassment hamper sharing of information that could be used to understand risks and identify system-level opportunities for improvement. A lack of standardization complicates efforts to aggregate and assess even available data. Because of these and related factors, EMS is severely limited in its ability to support policy initiatives, funding requests, quality improvement or even many day-to-day operational decisions on scientifically defensible, data-driven information.

Read More


[1]  Federal Interagency Committee for Emergency Medical Services. National EMS Assessment. 2011.

[2]  Maguire BJ, Dean S, Bissel RA, et al. Epidemic and Bioterrorism Preparation Among EMS Systems. Prehospital and Disaster Medicine. 2007; 22(3): 237-242.

[3]  Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services: a hidden crisis. Ann Emerg Med. 2002 Dec;40(6):625-32.

[4]  Maguire BJ: Transportation-related injuries and fatalities among emergency medical technicians and paramedics. Prehosp Disaster Med 2011;26(4):1–7.