Are We Safe?

The public assumes the EMS industry is safe. Patients even bet their lives on it. But as safe as EMS agencies and providers try to be, there’s always room for improvement.

Researchers have even begun examining just how safe we really are, and how we can be safer. It is possible to measure EMS safety attitudes with the tools we have today, and already preliminary associations among safety culture, safety-related behaviors and safety outcomes have been observed.

EMS World recently spoke with safety researcher Daniel Patterson, PhD, about introducing two key instruments to the EMS profession: the EMS Safety Attitudes Questionnaire (EMS-SAQ) and the EMS Safety Inventory (EMS-SI).

As part of the EMS Culture of Safety Strategy Project, investigators employed two tools (EMS-SAQ and EMS-SI) to measure existing safety attitudes. What do the tools encompass?

The tools are surveys administered to individual EMS clinicians. We developed the EMS-SAQ in 2008 and tested the tool’s reliability and validity. Our initial tests confirmed the tool is highly reliable and has high construct validity. Results from this study were published in the American Journal of Medical Quality in 2010.

We have completed additional studies to further confirm the tools’ positive psychometric properties of reliability and validity and to determine if safety culture scores are associated with self-reported safety outcomes, such as injury, error, adverse events and safety compromising behavior. Both the EMS-SAQ and EMS-SI are easy to use as cross-sectional surveys.

How they were developed?

We developed the EMS-SAQ by adapting the 30 core items from the ICU-Safety Attitudes Questionnaire (ICU-SAQ) for the EMS setting. We adapted this previously used tool by changing the wording of the tool to be calibrated for the EMS setting. The details of the EMS-SAQ development appear in the 2010 American Journal of Medical Quality article. The EMS-SI was developed and used in 2010 as part of the Emergency Medical Services Agency Research Network (EMSARN) 2010 cohort. We developed the EMS-SI with input from emergency medicine physicians, paramedics and epidemiologists. The content of this tool was evaluated by these experts for content validity. The details of the EMS-SI appeared in a special safety section of the Prehospital Emergency Care journal, 2012, volume 1.

What, if anything, do the tools miss?

The tools capture a great deal and can be used as a quick barometer of safety conditions. There are numerous threats and safety outcomes (events) that the tools may miss due to underreporting or lack of specification in the questions/items used to measure safety culture or self-reported safety outcomes. We continuously examine the tools and plan to improve them over time.

What do they tell us about current EMS attitudes toward safety?

Findings from our multiple studies across diverse EMS agencies show wide variation in perceptions of safety culture in EMS. Data from our research provides a base-rate of scores on safety culture that EMS agencies can use for benchmarking purposes.

What is your ongoing role in the project and EMS safety research?

We continue to examine safety culture in diverse EMS agencies from all across the U.S. and Canada. We annually invite and enroll any agency that wants to measure its safety culture. We provide free detailed reports on safety culture to the participating agencies. These reports show graphical comparisons between their agency and the agencies in the cohort, and compared to previous cohorts and published data from our previous research. These reports are a valuable tool for agencies to use (annually) in their pursuit of safety improvement. To begin to improve safety, one must first know where they stand. Our EMSARN network and safety culture tools and report-generating services provide that resource, free of charge. The benefit to us as academics is the ability to collect data from diverse agencies and evaluate the tool’s reliability and validity.