The fast-paced and unpredictable environments of emergency departments (EDs) and emergency medical services (EMS) are designed to save lives. Yet, the very nature of these high-pressure settings makes them especially vulnerable to patient safety risks.
Emergency care is uniquely complex. In the ED, providers often treat unfamiliar patients with limited information, under time constraints, and amidst frequent interruptions. In the field, EMS clinicians contend with dynamic environments, variable resources, and high-stakes decision-making in isolation. These realities create fertile ground for clinical errors, communication breakdowns, and unintended harm.
Recent data collected through our national Patient Safety Organization (PSO) at centerforpatientsafety.org has illuminated several persistent and emerging challenges:
- Communication Failures: Miscommunication during handoffs between EMS and ED teams continues to be a major source of preventable harm.
- Workforce Fatigue and Burnout: Staffing shortages, extended shifts, and repeated exposure to traumatic events are taking a toll on clinicians.
- Medication Errors Despite Improved Technology: As digital systems expand, poorly designed interfaces or insufficient training can inadvertently contribute to safety events.
The realities of EMS: a dynamic and demanding environment
EMS clinicians work in an environment unlike any other in healthcare. Every shift can bring a dramatically different experience, from navigating traffic during a busy urban rush hour to responding alone to a critical patient in a remote rural area. The unpredictability of EMS work means providers must be both clinically proficient and highly adaptable, but it also means EMS must embrace systems to reduce the risk of errors and harm. In the EMS environment, limited resources, poor historical patient information, high cognitive load, and poor provider rest factor into many potentially harmful events.
The rise of mobile integrated health and community paramedicine
In response to evolving healthcare needs, mobile integrated health (MIH) and community paramedicine (CP) programs are reshaping how care is delivered in the community. These innovative models extend the role of EMS beyond traditional 911 response, enabling clinicians to proactively address health issues, close care gaps, and reduce unnecessary hospital visits.
The success of MIH depends not just on innovative clinical models, but on collaborative safety management. It is imperative, due to the often collaborative nature of MIH programs between EMS and health system partners, that data be shared and analyzed. Participation in PSOs and a shared commitment to a just culture and high reliability ensure these programs maintain quality and accountability while navigating new clinical territory.
By collecting data, learning from adverse events and near misses, and sharing insights across organizations, MIH teams can better tailor care to individual and community needs without compromising safety. As these programs expand nationwide, their integration into formal safety and quality frameworks is essential.
A path forward: high reliability and just culture
Addressing today’s emergency care challenges requires more than clinical excellence — it demands a culture of safety. High reliability organizations (HROs) and just culture principles provide the foundation for consistent performance, learning, and accountability across high-risk environments. As technology continues to improve, organizations must learn collectively to leverage their tools to not only collect data but to actively reduce the potential for harm.
Organizations participating in a PSO can receive analysis, benchmarking, and feedback on their safety data — all de-identified and protected under federal law — in addition to sharing data with other participants. This not only uncovers hidden patterns but accelerates shared learning across systems. For EMS agencies, MIH programs, and EDs alike, this is an essential step in evolving toward safer care delivery.
Additionally, in events reviews, clinicians involved in a medical error frequently report tiredness as a contributing factor. Healthcare organizations must work to take innovative staffing approaches to reduce burnout.
Collaboration toward safer, smarter emergency care
The challenges in emergency medicine and EMS are immense, but so is the opportunity. With growing recognition of the need for a strong safety culture and increasing access to tools and data through PSO participation, the emergency care community is better equipped than ever to protect patients and providers alike.
As we look ahead, our focus must remain on collaboration, transparency, culture improvement, reduction in burnout, and a relentless commitment to learning.
