Experts Discuss EMS Safety and the Future of EMS

This article is sponsored by Ferno’s 2020 Vision series.

Personnel involved in EMS safety gathered at Ferno’s Wilmington, Ohio, headquarters on Monday, Feb. 25, to discuss the latest draft of the National EMS Advisory Council (NEMSAC) Strategy for a National EMS Culture of Safety document , which  is scheduled for finalization and distribution in September.

The project is being produced under a cooperative agreement between the National Highway Traffic Safety Administration (NHTSA), with support from the Health Resources and Services Administration’s (HRSA) EMS for Children (EMSC) Program, and the American College of Emergency Physicians (ACEP). 

Executive Summary
Strategy for a National EMS Culture of Safety document includes the following executive summary:

EMS operations nationwide potentially expose EMS personnel, patients and members of the community to preventable risk of serious harm, in contrast with advances in safety practices that have been broadly implemented in many healthcare and other settings in recent years.

Safety culture refers to a collection of core values related to EMS personnel and patient safety. These core values provide a frame of reference for leadership and workers, and influence shared beliefs, practices, rituals, norms and behaviors related to safety. A positive safety culture is associated with fewer errors, adverse events and other negative safety outcomes.

This Strategy stems from a 2009 recommendation by the National Emergency Medical Services Advisory Council (NEMSAC) for the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) to create a strategy for building a culture of safety in EMS. NEMSAC is a Federal advisory committee that serves as a nationally recognized council of EMS representatives and consumers to provide advice and recommendations regarding EMS to NHTSA.

The Strategy has been developed in a three-year, iterative process to allow for collaboration and input from a broad group of stakeholders both inside and outside the EMS community.

The process has involved public review and comment and will be completed in September 2013.The Strategy acknowledges the unique and varied nature of EMS provider agencies throughout the U.S., as well as a number of cultural influencers that are believed to be relevant to the success of the Strategy.

This Strategy envisions six key elements for advancing a culture of safety in EMS:

  • Advancement of values similar to those in a school of thought known as “Just Culture”;
  • Coordinated support and resources for provider agencies and other stakeholders
  • A national data system for responder safety and patient safety in EMS;
  • Evolution of the EMS education system;
  • Promulgation of safety standards and related information; and
  • Reporting/investigation of applicable incidents.

The Strategy is also linked to a number of concrete steps that can be taken by a broad spectrum of stakeholders, some of them possibly even before the Strategy is finalized.

To download the latest version of the NEMSAC – Strategy for a National EMS Culture of Safety document in pdf format, click here.

Advancing the Discussion
Building on the draft NEMSAC document, JEMS Editor-in-Chief A.J. Heightman moderated an in-depth panel on EMS safety and changes that are forecast for EMS in the U.S. as part of the comprehensive EMS 2020 Vision initiative sponsored by Ferno.

The EMS 2020 Vision program is a multi-faceted, comprehensive program designed by Ferno and being implemented in a cooperative effort between Ferno, JEMS and EMS World to educate and inform EMS agencies and their personnel on myriad topics. Agencies and personnel are encouraged to join the EMS 2020 Vision Project, watch the EMS Culture of Safety panel discussion and other important EMS 2020 Vision interviews, and learn more about innovations and changes in EMS at:

Participating in the informative EMS Culture of Safety discussion and panel were:

  • Heightman, a long-time advocate of EMS safety and the use of High Reliability Organization (HRO) principles by emergency service agencies. HROs, like the U.S. Navy, make safety their #1 priority. (For HRO background, go to and
  • Sabina Braithwaite, MD, EMS medical director for Wichita and Sedgwick County, Kansas, past chair of ACEP’s EMS Committee and a member of the NESAC/NHTSA work group developing the comprehensive NEMSAC Strategy for a National EMS Culture of Safety document.
  • Wayne Zygowicz, BA, EFO, EMT-P, Littleton (Colo.) Fire Rescue EMS Division Chief, who has 30 years of experience in the fire service and is a member of JEMS Editorial Board. Wayne has studied ambulance construction methods for 15 years and attended the Rettmobile Expo in Germany to examine ambulance design and construction.
  • Chuck Kearns, incoming president of the National Association of EMTs (NAEMT) and chief operating officer of Prompt Ambulance. 
  • Jerry Socha, Ferno marketing director and producer of the EMS 2020 Vision video project;
  • Chris Montera, Eagle County  (Colo.) Paramedic Service EMS director, EMS blogger, EMS Community Practice Paramedic innovator and director of the video project.

Critical Topics
Topics discussed by the EMS Culture of Safety panel included:

Risk & EMS
Factors that create risk in EMS include:

  • Lack of proper training or protocols that encourage a culture of safety;
  • The dangerous effects of EMS worker fatigue;
  • The poor wages of many EMS personnel which force them to work multiple jobs or EMS shifts to make ends meet;
  • Employee fatigue, poor physical conditioning and the effects of working long or back-to-back shift schedules;
  • The need for quality equipment design, weight, weight distribution or deployment;
  • Lack of protective gear supplied to, or used by, EMS personnel;
  • Failure by EMS crews to use “spotters” when backing up EMS vehicles;
  • Poor equipment and/or vehicle maintenance;
  • Failure to utilize and/or follow dispatch screening  protocols, and allowing crews to run HOT when it is not necessary;
  • Excessive speed by EMS units and the risks it causes to the public;
  • Lack of consistent driver training in EMS;
  • False sense of security and too much reliance on sirens to gain the attention and compliance of drivers inside nearly sound-proof vehicles with surround sound stereo systems;
  • Failure by crews to wear seatbelts;
  • Personnel standing and moving (unsecured) around the patient compartment; and
  • Failure to use shoulder straps on patients positioned on the primary stretcher.

The panel discussed how serious these risks are in EMS; the impact of lax safety practices on providers, patients and the community; and the issues that need to be addressed to reduce these risks and the need for EMS managers and crew to adopt an EMS Culture of Safety.

National EMS Culture of Safety Project
Participants in the discussion also touched on the National EMS Culture of Safety Project–what it is, who the stakeholders are and what issues are addressed in the project. They explored the three important domains the project covers (EMS responder safety, patient safety and community safety) as well as parallel projects from other organizations that have been effective.

Applications from Other Industries
The solutions that lead to greater safety in EMS will likely be strongly influenced by other industries. The panel identified two main areas that EMS can look to as it attempts to build and advance a Culture of Safety:

  • High Reliability Organization (HRO) principles used by the Navy, NASA, off-shore oil rigs and other high-risk industries.
  • Crew Resource Management, used by the airline Industry and closely studied and promoted by the International Association of Fire Chiefs (IAFC).

The panel reflected on what these systems have done that has been so successful, what these examples can teach EMS, and how we must learn and adapt.

Forecast for Change
Envisioning an environment of greater safety is just the first step; any meaningful progress must be accompanied by concrete steps to make such change happen. The panel discussed what some of these changes might be, as well as what commitment will be needed by the manufacturers of the equipment and vehicles we use in the field. Panel members identified administrative, workforce, traditional-thinking and budgetary barriers we must overcome to change, and the stakeholders we need to influence.

The final topic of discussion: Where we should strive to be by 2020? By bringing together experts like those who served on this panel, Ferno’s 2020 Vision program will continue to shape an answer to that question.

Join the Movement
Take action by Joining the EMS 2020 Vision Program! Participate in the discussions on how to make the EMS industry safer, tell us what your agency is doing to make your work environment safer and contribute to positive changes in the EMS safety culture in the USA. Visit today!

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