with the federal agencies that support the EMS mission along with quality focused entities like the National Quality Forum, the Agency for Health care Research and Quality and other national health care stakeholders to support initiatives like the Compass project to further develop and continually evaluate performance measures for both traditional EMS and future EMS-based innovative health care delivery services. State and local EMS leaders seeking to promote quality and improved regional coordination could employ a range of incentives and/or penalties but ultimately must find a way to achieve compliance with the reporting of validated quality measures. States should also work with EMS stakeholders to develop and pilot new measures, which could then further inform national efforts. FOSTERING A CULTURE OF SAFETY As a critical component of the nation’s public safety, public health, and health care systems, the EMS industry must adopt a culture of safety. EMS Providers in the course of their duties may find themselves exposed to a myriad of risks such as infectious diseases, emotional stress, fatigue, physical violence, vehicle crashes, environmental hazards, and personal liability. Each provider, regardless of the type of agency he or she works for, or the community or state in which he or she practices, deserves to be protected. Likewise, the patients we serve deserve the very best care with the minimum risk of additional harm that we can provide. The primary objective of the National EMS Culture of Safety was to develop a strategy for a robust culture of safety within the EMS profession. 93 The strategy acknowledges the unique and varied nature of
EMS provider agencies throughout the United States, as well as a number of cultural influencers that are believed to be relevant to the success of the strategy. It provides a framework with which to create measurable outcomes that improve the effectiveness and safety of prehospital health care for responders, patients, and the public. The framework includes encouraging the reporting of errors and “near misses”, protecting individuals from retribution, and utilizing a root cause analysis approach to evaluate incidents. Having been developed in response to a recommendation from the National Emergency Medical Services Advisory Council (NEMSAC), and with consultation from a broad array of internal and external stakeholders, it is time for the National EMS Culture of Safety (Strategy) to be widely disseminated and implemented at the local level. While the strategy necessitates that each organization’s core values imbue principles relevant to responder and patient safety, the culture must transcend the level of the organization. In a multi- agency community, a region within a state, or even at the statewide level, the culture of EMS is a fragile communal asset that must be constantly nurtured. It has the power to influence our providers’ shared beliefs, practices, rituals, norms and behaviors related to safety. A positive safety culture is associated with fewer errors, adverse events and other negative outcomes. 94,95 Perhaps most importantly, it fosters integration of EMS with health care and supports innovation. By pursuing each of the above strategies, the EMS industry is likely to achieve better quality and greater harmonization of care, all while better enabling us to speak with one voice about the issues that matter.
93 “Strategy for a National EMS Culture of Safety.” National EMS Advisory Council. Last modified May 16, 2012. http://www.ems.gov/pdf/nemsac/may2012/ems_culture_of_safety-draft_3-1_05162012.pdf 94 Weaver, Matthew D., Henry E. Wang, Rollin J. Fairbanks, and Daniel Patterson. “The association between EMS workplace safety culture and safety outcomes.” Prehospital emergency care 16, no. 1 (2012): 43-52. 95 Singer, Sara, Shoutzu Lin, Alyson Falwell, David Gaba, and Laurence Baker. “Relationship of safety climate and safety performance in hospitals.” Health services research 44, no. 2p1 (2009): 399- 421.
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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