Trending Topics

Why your EMS agency needs near-miss reporting

Near-miss reporting can help build a culture of safety in your agency and improve the EMS profession as a whole


It is the responsibility of every EMS organization to do all it can to ensure that its EMS providers can remain as safe and operationally effective in their work as possible.

Photo/USMC, Pfc. Jake M.T. McClung

Emergency medical service delivery presents inherently dangerous situations, not only for patients and bystanders, but also for responders themselves. It is the responsibility of every EMS organization to do all it can to ensure that its EMS providers can remain as safe and operationally effective in their work as possible.

Fortunately, a valuable and free resource can help: The EMS Voluntary Event Notification Tool (E.V.E.N.T.) front line offers lessons learned from EMS agencies of all types to help make individual organizations and the industry as a whole safer. The key is knowing how to use it.

Launched in 2012, E.V.E.N.T. allows individuals and organizations to anonymously and voluntarily share near-miss stories through a simple online reporting tool. This anonymous information is then shared quarterly and annually with state EMS offices and appropriate federal agencies to give these offices better information upon which to base EMS policy and regulation. These reports are also available to all EMS providers through the E.V.E.N.T. website to improve policy and decision making within their own agencies.

E.V.E.N.T. is available for use by any individual or EMS organization in North America and is a program of the Center for Leadership, Innovation and Research in EMS, with sponsorship provided by the National Association of Emergency Medical Technicians, the National EMS Management Association, the North Central EMS Institute, the Paramedic Chiefs of Canada, and the National Association of State EMS Officials, working in partnership with more than a dozen other state and regional EMS organizations.

Near-miss reporting

Bringing an EMS agency officially onboard with the anonymous and non-punitive EMS Voluntary Event Notification Tool can help improve the safety of EMS providers across the country, as well as develop a culture of knowledge sharing, openness and true on-the-job learning within their own organizations. Adopting and promoting the in-house identification of near-miss events with a non-punitive problem-solving attitude is important to help EMS providers and front-line supervisors seek out and analyze such events, and think about how systems can be improved to help prevent them in the future. Cultures can be slow to change, but for any organization that espouses lifelong learning and critical thinking, this action is key.

Use EMS data to improve policy and operations

A lot can be learned from individual cases, but even more can be learned when information is grouped together.

The quarterly and annual reports issued by E.V.E.N.T. can be downloaded directly from their site and analyzed according to:

  • Reporting location (state, Canadian province or U.S. territory).
  • Agency characteristics (urban, suburban, rural or remote).
  • Agency ownership (governmental, non-profit, third service, hospital, etc.).
  • Pay type (paid, volunteer or combination).
  • Level of service (first response, BLS, ALS or air-medical).
  • Time of occurrence (month, time of day and number of hours into shift).
  • Contributive factors (communication, decision-making, equipment, fatigue, distracted driver, teamwork, violent patient, etc.).

Of course, data means little until it is used to improve state and federal EMS policy or department operations. Whether drafting new or updating existing policies, consider looking at relevant E.V.E.N.T. Reports. Use them to prioritize how you direct time and resources to resolve issues and grasp opportunities for improvement in your agency. Ask how a good policy or departmental practice might help avoid these safety issues.

How to put near-miss reporting to work

There are five steps to fully implementing E.V.E.N.T. in your agency:

  1. Establish a project team. For E.V.E.N.T. to be as helpful as it can be to your organization, all staffing levels should be represented on a team that will help bring the department on board. Their support will be crucial in deciding how the implementation, communication and training are rolled out, as well as the details of who will input near-misses and evaluate reports.
  2. Develop standard operating guidelines. Include key points (e.g., participation in E.V.E.N.T. is completely voluntary, anonymous and non-punitive.) E.V.E.N.T. should be used only to improve the safety culture of the agency and the department.
  3. Train the organization. Communication is always key. Effective E.V.E.N.T. integration in your agency will thoroughly depend on how it is presented to your staff. EMS providers who have never been part of an agency that values openness in problem reporting and focuses on fixing a system rather than punishing an employee may be rightly skeptical. This is where your project team can be advocates not only to promote the system, but also to make sure that continues to work as intended.
  4. Submit reports. Reports can be submitted online via the E.V.E.N.T. website. On average, it only takes about 10 minutes to enter information and answer the questions on the form.
  5. Use quarterly and annual E.V.E.N.T. reports. There is clear benefit to EMS providers knowing that they can safely and securely share the lessons of a near-miss report, but the real benefit is in learning the lessons from others and using them to build quality policies and practices for your department.

This article, originally published Aug. 16, 2018, has been updated

Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private EMS. He is a career fire captain and paramedic EMS coordinator for the Ridgefield (Connecticut) Fire Department and the founder of the New England Center for Rescue and Emergency Medicine. Duckworth is recipient of the American Red Cross Hero Award, Sepsis Alliance Sepsis Hero Award, and the EMS 10 Innovators Award in addition to numerous awards and citations for excellence in education and dedication to service. Duckworth is a member of numerous national education, advisory and editorial boards, as well as a contributing author to more than a dozen EMS, fire and rescue books, including the IFSTA Pumping Apparatus Driver/Operator textbook as well as over 100 published articles in fire and EMS journals, magazines and websites. Duckworth has a bachelor’s degree in public safety administration from Charter Oak State College in Connecticut. Connect with Duckworth via or or on LinkedIn.