Moving EMS from IOM 'To Err Is Human' report to a culture of safety

EMS safety has recently taken on a new sense of importance, if not urgency


Updated May 11, 2016

What will it take to create a “culture of safety” in EMS in the U.S.?  If everything works out, we’ll find out in about three years.

In case you haven’t noticed, the whole issue of EMS safety—from vehicle collisions to back injuries to elimination of clinical errors — has recently taken on a new sense of importance, if not urgency. One of the drivers has been the National EMS Advisory Council, the group of experts representing every aspect of the profession whose aim is to provide guidance to the federal government. The Council has made safety a top priority.

Now the National Highway Traffic Safety Administration is following up, having issued a Request for Applications this past June. The goal? No less than a national strategy to literally create a “culture of safety” in EMS. They plan to have the winner of the bid do this over 36 months with a series of high-level stakeholder meetings and by convening a national conference, to not only highlight the issue but to leverage the best brainpower in the country to come up with innovative solutions.

In the RFA, NHTSA cites an Institute of Medicine report as supplying the underlying principles for the initiative. “To Err is Human: Building a Safer Healthcare System” was published more than 10 years ago but still resonates. To get a better grasp of the topic, we went to the source (and suggest you do, too).

The IOM report recommends a four-tier approach to safety:

  1. Establish a national focus to create leadership, research, tools and protocols to enhance the knowledge base about safety.
  2. Indentify and learn from errors through mandatory and voluntary reporting systems.
  3. Raise performance standards and expectations for improvements in safety through oversight organizations and group purchasers of health care.
  4. Implement safety systems in health care organizations to ensure safe practices at the delivery level.

The report goes on to say: “... mistakes can best be prevented by designing the health system at all levels to make it safer — to make it harder for people to do something wrong and easier for them to do it right. Of course, this does not mean that individuals can be careless. People still must be vigilant and held responsible for their actions. But when an error occurs, blaming an individual does little to make the system safer and prevent someone else from committing the same error.”

It’s in point four above that “culture of safety” makes it debut. The IOM defines the term as “an explicit organizational goal that is demonstrated by strong leadership on the part of clinicians, executives and governing bodies.” This will mean, the report continues, “incorporating a variety of well understood safety principles, such as designing jobs and working conditions for safety; standardizing and simplifying equipment, supplies and processes ... .”   In other words, institutionalizing safety so it is blended seamlessly in every aspect of the profession, from who you hire, to how you train, to how you equip—and how you report your mistakes (and collisions).

NHTSA notes that while the IOM recommendations have begun to take root in the broader health care system, they have yet to be ingrained in the EMS community. They hope to change that — and soon.

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