Culture of Safety Strategy To-Do Lists: Individuals

Achieving a national culture of safety in EMS is a long process, notes Sabina Braithwaite, MD, chair of the Culture of Safety Strategy Project’s steering committee, but one that comes with intermediate wins. What that means is that stakeholders of all stripes can take positive steps today, even unilaterally, that contribute to a safer work environment.

The strategy document lists some of these. See below to learn what you can do as an individual (e.g., single provider, physician/medical director, educator, researcher, vendor) to enhance the safety cause and help develop our much-needed safety culture. For what groups (e.g., provider agencies, associations, standard-setting bodies, local/state government, media) can do, see this list.

Individual Practitioners

Be open to any team members raising safety concerns, regardless of their tenure and rank;

Be willing to report errors;

Collaborate with management;

Seek opportunities to expand knowledge base on culture, patient safety, latest info and research on clinical safety, responder safety, personal protective equipment, etc., and be willing to bring these to the attention of management;

Ask medical director what can be done to improve safety for responders, patients and the public;

Report safety hazards;

Perform safety checks, vehicle inventory and safety inspections conscientiously;

Be willing to speak up when a partner or other responder seems fatigued or under mental or emotional stress;

Maintain personal physical well-being, get enough sleep and exercise;

Take advantage of CE opportunities to learn about your own physical and mental wellness.

EMS Physicians & Medical Directors

Work to ensure that local EMS services are addressing EMS safety through current training and updated operational procedures;

Continue to ensure EMS safety is a priority in local EMS services through training and operational procedures that are developed based on evidence-based research and national standards.


Encourage development of curricula that introduce safety culture and safety practices related to patient safety, occupational safety and public safety;

Future editions discuss safety;

Education for leaders;

ID high-risk individuals in class;

Focus on education that builds clinical judgment beyond technical skills;



Establish a better understanding of safety culture in EMS nationwide by encouraging local EMS agencies to measure their safety culture using reliable and valid tools (e.g., the EMSSAQ). This may be accomplished individually by the agency or by taking part in a national effort (e.g.,;

There is a lack of reliable and valid tools to measure safety in EMS. Continue to develop and test measurement tools to quantify the magnitude of problems in EMS responder safety, patient safety and safety of the public;

Develop research to define fatigue mitigation and fatigue modeling for ground service personnel as is done with air medical teams. Develop risk assessment tools to measure fatigue;

Build confidence in measurement before moving to research on interventions to impact behavior and practices at the front line;

Examine the evidence of how EMS workers get injured and the reasons EMS workers leave the profession, and then develop and evaluate evidence-based interventions to prevent their injuries and improve their health.

EMS Vendors and Manufacturers

Engineer fail-safe devices and mechanisms to increase both provider safety and patient safety—i.e., features that make it difficult to be unsafe;

Directly engage end users (providers) in product development and marketing;

Focus on how engaging end users/customers makes EMS safer in product design and development phases;

Participate in discussions with providers regarding their culture of safety;

Search throughout the world to find solutions that could be brought to the U.S.;

Openly report on product testing and evaluation, initially and periodically as necessary;

Release conflict of interest statements while attending all conferences, seminars or educational functions (other than the obvious);

Identify “off-label” uses of equipment and provide statements directly addressing the potential impacts to provider, patient and public safety;

Consider a product failure notification network for equipment and product failure not covered under existing law;

Adopt cost/safety model in the development of products (i.e., safety at what cost; options for those who can’t afford).