title: Emergency medical services provider perceptions of the nature of adverse events and near-misses in out-of-hospital care: an ethnographic view.
abstract: OBJECTIVE
  The objectives were to examine the perceptions of emergency medical services (EMS) providers regarding near-misses and adverse events in out-of-hospital care.
  
  
  METHODS
  This study uses qualitative methods (focus groups, interviews, event reporting) to examine the perceptions of EMS providers regarding near-misses and adverse events in out-of-hospital care. Results were reviewed by five researchers; analytic domains were assigned and emerging themes were identified. Descriptive statistics were calculated.
  
  
  RESULTS
  Fifteen in-depth interviews (73% advanced life support [ALS], 40% volunteer, and 87% male) resulted in 50 event descriptions. Eleven additional event reports were obtained from the anonymous reporting system. Of the 61 total events, 27 (44%) were near-misses and 34 (56%) were adverse events. Fourteen (23%) involved a child (< 19 years). Types of error included 33 clinical judgment (54%), 13 skill performance (21%), 9 medication event (15%), 3 destination choice (5%), and 3 others (5%). For the 21 cases where the provider discussed the event, 10 (48%) were reported to a physician, and 9 (43%) to a supervisor; 4 (19%) were not reported, and none were reported to the patient. Focus groups supported interview and event report data. Emerging themes included a focus on the errors of others and a "blame-and-shame" culture.
  
  
  CONCLUSIONS
  Adverse events and near-misses were common among the EMS providers who participated in this study, but the culture discourages sharing of this information. Participants attributed many events to systems issues and to inadequacies of other provider groups. Further study is necessary to investigate whether these hypothesis-generating themes are generalizable to the EMS community as a whole.
authors.affiliation: Department of Emergency Medicine, University of Rochester, Rochester, NY, USA. Terry.Fairbanks@Rochester.edu
authors.forename: Rollin J
authors.initials: RJ
authors.lastname: Fairbanks
authors.forename: Crista N
authors.initials: CN
authors.lastname: Crittenden
authors.forename: Kevin G
authors.initials: KG
authors.lastname: O'Gara
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Wilson
authors.forename: Elliot C
authors.initials: EC
authors.lastname: Pennington
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Chin
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
mesh_terms: D004632:Emergency Medical Services; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D019300:Medical Errors / Q000706:statistics & numerical data*; D010465:Perception; D000078329:Workforce