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O’Connor P, O’Malley R, Lambe KA, et al. Int J Qual Health Care. 2021;33(4):mzab138.
Patient safety incidents occurring in prehospital care settings are gaining increasing attention. This systematic review including both peer-reviewed studies and grey literature found that the incidence rate of prehospital patient safety incidents is similar to hospital rates. The authors identified an average of 5.9 patient safety incidents per 100 records/transports/patients occurring in prehospital care; approximately 15% of these incidents resulted in patient harm. The authors discuss methodological challenges to preshopital care research and make recommendations for future studies.
Ali A, Miller MR, Cameron S, et al. Pediatr Emerg Care. 2021;Epub Oct 26.
Interhospital transfer of critical care patients presents patient safety risks. This retrospective study compared adverse event rates between pediatric patient transport both with, and without, parent or family presence. Adverse event rates were not significantly impacted by parental presence.
Paulin J, Kurola J, Koivisto M, et al. BMC Emerg Med. 2021;21(1):115.
Emergency medical services (EMS) personnel are in the unique position of providing medical care outside of a healthcare facility. This prospective cohort study conducted in Finland explored the outcomes of patients who were treated by EMS personnel without going to the ED. Findings indicate that 80% of patients treated by EMS did not have any re-contact with the healthcare system (e.g., re-contacted EMS, went to the ED, were hospitalized), suggesting that EMS management of these patients is relatively safe.

American College of Emergency Physicians, National Association of Emergency Medical ServicesAnn Emerg Med. 2021;78(3):e37-e57. 

Emergency medical services (EMS) are often provided in stressful situations that require an orientation to safety to keep patients and staff from harm. This policy statement outlines components of an EMS safety orientation that rests on an established culture of safety in the field.
Bosson N, Kaji AH, Gausche-Hill M. Prehosp Emerg Care. 2021;Epub Jul 14.
Pediatric medication administration in prehospital care is challenging due to the need to obtain an accurate weight and calculate dosing. The Los Angeles County emergency medical services implemented a Medical Control Guideline (MCG) to eliminate the need to calculate the dose of a commonly administered medication. Following implementation of the MCG, dosing errors decreased from 18.5% to 14.1% in pediatric prehospital care.
Siebert JN, Bloudeau L, Combescure C, et al. JAMA Netw Open. 2021;4(8):e2123007.
Medication errors are common in pediatric patients who require care from emergency medical services. This randomized trial measured the impact of a mobile app in reducing medication errors during simulated pediatric out-of-hospital cardiac arrest scenarios. Advanced paramedics were exposed to a standardized video simulation of an 18-month of child with cardiac arrest and tested on sequential preparations of intravenous emergency drugs of varying degrees of difficulty with or without mobile app support. Compared with conventional drug preparation methods, use of the mobile app significantly decreased the rate of medication errors and time to drug delivery.
Mirarchi FL, Cammarata C, Cooney TE, et al. J Patient Saf. 2021;17(6):458-466.
Prior research found significant confusion among physicians in understanding Physician Orders for Life-Sustaining Treatment (POLST) documents, which can lead to errors. This study found that emergency medical services (EMS) personnel did not exhibit adequate understanding of all POLST or living will documents either. The researchers propose that patient video messaging can increase clarity about treatment, and preserve patient safety and autonomy.
Hoyle JD, Ekblad G, Woodwyk A, et al. Prehosp Emerg Care. 2021:1-8.
Inaccurate assessment of pediatric patient weight can lead to medication dosing errors. In simulated pediatric scenarios, pre-hospital emergency medical services (EMS) crews obtained patient weight using one or more of three methods: asking parent, using patient age, and Broselow-Luten Tape (BLT). BLT was the most frequent method used and patient age resulted in the most frequent dosing errors. Systems-based solutions are presented.

James Augustine, MD, is the National Director of Prehospital Strategy at US Acute Care Solutions where he provides service as a Fire EMS Medical Director. We spoke with him about threats and concerns for patient safety for EMS when responding to a 911 call.

Jakonen A, Mänty M, Nordquist H. Jt Comm J Qual Patient Saf. 2021;47(9):572-580.
Checklists have been implemented in a variety of specialties and settings to improve safe patient care. In this study, researchers developed and pilot-tested safety checklists for emergency response driving (ERD) and patient transport in Finland. Semi-structured interviews with paramedics and ERD drivers indicated that the safety checklists improved perceived safety.
Zimmer M, Czarniecki DM, Sahm S. PLoS One. 2021;16(5):e0250932.
Inadequate team communication is a marker of poor safety culture and can threaten patient safety. This survey of 714 medical and non-medical emergency medical services (EMS) employees in Germany found nearly three-quarters of respondents had been involved in a patient harm incident and that deficits in team communication were a primary contributor.  
Fuller G, Pandor A, Essat M, et al. J Trauma Acute Care Surg. 2021;90(2):403-412.
Prehospital triage tools are used to differentiate between patients who need emergency care at a major trauma center (MTC) and those that may receive adequate care at a non-MTC.  Accurate triage tools are necessary to ensure that patients are not over- or undertriaged. This review found high variability in sensitivity and specificity across geriatric triage tools indicating some patients may not be receiving the specialized trauma care they need. The authors highlight several future research targets including development of relevant reference standards and balancing the risk between over- and undertriage.
Sedlár M. Int J Occup Saf Ergon. 2021;Epub Mar 19.
Stress and fatigue experienced by healthcare workers can threaten patient safety. This survey of 131 emergency medical services (EMS) crew members identified a relationship between work-related factors (e.g., stress, fatigue), unsafe behavior, and safety incident involvement. Reducing stress and fatigue and improving cognitive skills, including situation awareness, can improve compliance with safe behaviors.
O’Connor P, O’malley R, Oglesby A-M, et al. Int J Health Care Qual. 2021;33(1):mzab013.
Patient safety problems can be challenging to detect. This systematic review identified a variety of methods for measuring and monitoring patient safety in prehospital care settings (e.g., emergency medical services, air medical transport). They include surveys, patient record reviews, incident reporting systems, interviews, and checklists.
Venesoja A, Castrén M, Tella S, et al. BMJ Open. 2020;10(1):e037488.
Safety problems in prehospital care can lead to adverse events. This qualitative study explored patients’ perceptions of safety in emergency medical services (EMS). While patients generally felt safe during their EMS encounter, lack of communication or professionalism among EMS personnel may hinder their sense of safety.
DiSilvio B, Virani A, Patel S, et al. Crit Care Nurs Q. 2020;43(4):413-427.
This article discusses several aspects essential to surge planning and preparing for the COVID-19 pandemic, including surge planning, limiting health care worker exposure, logistics for medication delivery, delivering emergent care in patients with COVID-19, and safe practices for patient transport.
Cicero MX, Adelgais K, Hoyle JD, et al. Prehosp Emerg Care. 2020;25(2):294-306.
This position statement shares 11 recommendations drawn from a review of the evidence to improve the safety of pediatric dosing in pre-hospital emergent situations. Suggestions for improvement include use of kilograms as the standard unit of weight, pre-calculated weight-based dosing, and dose-derivation strategies to minimize use of calculations in real time.   
Imach S, Eppich WJ, Zech A, et al. Simul Healthc. 2020;15.
This case study describes the use of root cause analysis to investigate a critical incident occurring during an emergency medicine simulation scenario, and discusses the importance of these investigations in furthering the training of emergency medicine personnel and instructors.