Trending Topics

Patient Safety Organization: 5 things EMS providers need to know

EMS agencies can utilize PSOs to improve the safety culture, protect data and receive expert assistance

ems graph_2.jpg

The national average is 2.

By Matt Womble

PSO is not an emerging infectious disease or a new RSI drug. PSO stands for Patient Safety Organization and they will do more to improve the safety of our profession for providers and patients than any single advance in our profession’s history.

The rate of transportation injuries among EMS providers is 30 times higher than the U.S. workforce average [1]. Dr. Brian Macguire, EMT-P, worked to keep that statistic from getting categorized as, “just part of the job.” Macguire also found our transportation related fatality rate is almost five times the average worker and almost as much as fire and police combined (see graph: Transportation related occupational injuries) [2].

These and other statistics confirm what many of us already know; EMS is a high-consequence field. PSOs can help minimize those consequences – injury and death – so we can take the best care of our patients and make sure each of us goes home at the end of our shift.

Here are five things every EMS chief and field provider needs to know about PSOs:

1. Created by Patient Safety and Quality Improvement Act

Patient Safety Organizations (PSOs) were created 10 years ago by the Patient Safety and Quality Improvement Act (2005). This law was in direct response to the 1999 report by the Institute of Medicine (IOM), “To Err is Human”, which identified among many startling facts that as many as 98,000 people die annually due to unintentional medical errors. The law states that healthcare organizations need to be able to gather, analyze and learn from incidents without the fear of this information being used against them.

2. Membership organizations protected from legal discovery

PSOs are membership organizations provided with the federal authority to protect quality and safety data and analysis from legal discovery. This “peer-review protection” is especially advantageous to EMS where studies have shown that almost 50 percent of states have no peer review protections for EMS and those that do vary widely from state to state[3]. PSO protections can apply to information within the member organization and any submissions to the PSO.

3. Just two PSOs are focused on EMS

PSOs are most commonly non-governmental organizations with their own specific area(s) of focus. They must be listed by the Secretary of the Department of Health and Human Services, a process managed by the Agency for Healthcare Research and Quality (AHRQ). There are currently 84 PSOs and two of these provide focused work on EMS: the Center for Patient Safety and the Emergency Medical Error Reduction Group (EMERG).

4. Identify root causes of safety issues

PSOs typically utilize data, analysis, event investigations, round-table conferences, and direct reports to help identify the root causes of safety issues. Ideally the PSO takes this information and generates evidenced-based models for improvement that can then be shared and promoted widely. This is critically important for us in EMS; traditionally left out of the healthcare circles we now find ourselves squarely in the middle of the discussion with the momentum of bundled payments, accountable care organizations (ACOs), and community paramedicine/mobile integrated health.

5. Deliver safety culture training

PSOs protect vital and sensitive information, help find ways to keep issues from being repeated, and provide training to help improve your organization’s safety culture. Training can range from basic principles of continuous quality improvement to more advanced education on things like Just Culture and process improvement. Improving the safety culture of any organization is a heavy lift and doing it with expert direction and peer support is essential.

By effectively using PSOs to help improve the organization’s safety culture, EMS organizations can be confident in the protection of their data, gain expert assistance and learn from each other. While all PSOs are different because of their focus it is in your organization’s best interest to protect data from legal discovery, improve your safety culture and ultimately make our profession the safest it can be for our patients and providers.

About the Author

Matt Womble, MHA, paramedic is the executive director of the Emergency Medical Error Reduction Group (EMERG), which is part of the Center for Leadership, Innovation and Research in EMS. CLIR introduced the first national, free and anonymous incident reporting system, the EMS Voluntary Event Notification Tool (E.V.E.N.T.) over five years ago.


1. Maguire BJ. Hunting KL. Smith GS. Levick NR. “Occupational Fatalities in EMS: A Hidden Crisis.” Annals of Emergency Medicine. 2002; 40(6): 625 - 632.

2. Maguire BJ. Hunting KL. GuidottiTL. Smith GS. The Epidemiology of Occupational Injuries and Illnesses Among EMS Personnel.” Prehospital Emergency Care.” 2005; 9: 405–411.

3. Federal Interagency Committee on Emergency Medical Services. 2011. National EMS Assessment. U.S. Department of Transportation, National Highway Traffic Safety