By Daniel P. Burke, MBA, NRP
Patient Safety Awareness Week (PSAW), observed from March 9-15, 2025, is a vital opportunity to spotlight the principles of safety, reliability and just culture in health care.
While hospitals and brick-and-mortar health care institutions have made strides in embedding patient safety frameworks into their operations, EMS has lagged behind in adopting these same principles.
Now is the time for EMS agencies to recognize the importance of patient safety initiatives and make meaningful progress in improving safety culture within the prehospital setting.
The Disparity in Patient Safety Adoption
Over the past two decades, hospital systems have increasingly prioritized patient safety through structured frameworks, transparency, and accountability.
Regulatory changes, such as the Centers for Medicare & Medicaid Services (CMS) Patient Safety Structural Measure (PSSM) introduced in 2025, further hold hospitals accountable for leadership commitment, strategic planning, and a culture of safety.
These structured safety measures drive improvements in hospital settings by ensuring that organizations proactively mitigate risks and enhance patient outcomes.
Conversely, EMS operates in an unpredictable, high-pressure environment where formal patient safety initiatives remain inconsistent across agencies.
Many EMS systems lack robust safety reporting mechanisms, data-driven performance improvements, and a culture that encourages learning from adverse events.
The absence of systematic patient safety structures leaves EMS agencies vulnerable to preventable harm and limits opportunities for continuous improvement.
The Timely Importance of Just Culture in EMS
As highlighted by the recent March 2025 publication of the Joint Position Statement on Criminal Liability for Alleged Deviations from Clinical Standards of Care in Emergency Medical Services by leading national EMS organizations, the fear of punitive action in EMS contributes to underreporting of errors, a challenge also highlighted in discussions on criminal liability for EMS clinicians.
Just culture, a principle widely adopted in hospital systems, encourages a balanced approach to accountability—distinguishing human errors from reckless behavior while promoting learning and improvement.
Without embracing just culture, EMS clinicians may hesitate to report incidents, depriving agencies of critical data necessary for safety enhancements.
The statement further warns that criminalizing medical errors undermines patient safety by discouraging self-reporting and stifling quality improvement efforts.
The timing of this statement underscores the urgency of implementing just culture principles in EMS, perfectly aligning with PSAW 2025, when the focus is on fostering environments where learning from errors leads to systemic improvements rather than punitive measures.
Moving Toward High Reliability in EMS
High Reliability Organizations (HROs) maintain a commitment to zero harm, recognizing that safety is not just a priority but a fundamental operational principle. EMS must adopt HRO strategies such as:
- Leadership Engagement: Agency leadership must visibly support and invest in patient safety initiatives.
- Proactive Risk Identification: Implementing reporting mechanisms to track and analyze safety events.
- Continuous Learning: Providing training that fosters a safety-first mindset among EMS personnel.
- Transparency and Accountability: Encouraging open discussions about safety issues without fear of retaliation.
A Call to Action: Celebrate and Commit
As we recognize PSAW 2025, EMS agencies have an opportunity to both celebrate PSAW and commit to meaningful change. Agencies can take the following steps:
- Engage Personnel: Host workshops, safety stand-downs and training sessions focused on patient safety.
- Implement Just Culture: Review and refine policies to ensure a balanced approach to accountability.
- Adopt Safety Metrics: Develop internal patient safety tracking and reporting similar to CMS’s PSSM framework.
- Collaborate with Experts: Utilize resources from organizations like the Center for Patient Safety (centerforpatientsafety.org) and EMS Forward (emsforward.org) to integrate best practices.
Patient safety is not exclusive to hospitals—EMS is a critical component of the health care continuum and must be held to the same standards.
By embracing patient safety principles, just culture, and high reliability, EMS can foster a safer environment for both patients and providers. Let PSAW 2025 serve as the catalyst for this transformation.
Download the Center for Patient Safety PSAW EMS Toolkit here.
About the Author
Dan Burke is a Nationally Registered Paramedic (NRP) who primarily practices in Maryland. He is a volunteer EMS chief, former state EMS director and currently the EMS director at the non-profit Patient Safety Organization (PSO) The Center for Patient Safety.
