title: Initiation of risk management: incidence of failures in simulated Emergency Medical Service scenarios.
abstract: OBJECTIVE
  This study is a description of the rate of unsafe acts and communication events in simulations of Emergency Medical Service (EMS) mission-based scenarios as first response for risk management and patient safety.
  
  
  METHODS
  The study involved video-based observation of German paramedic teams (n=40) during simulated EMS missions. Teams were randomised to four types of scenarios: advanced life support (ALS), bronchial asthma (BA), pulmonary embolism (PE) and multiple trauma (MT). All predefined events were analysed.
  
  
  RESULTS
  In a total of 40 scenarios, paramedics committed more than seven unsafe acts per scenario (7.4+/-3.8, mean+/-standard deviation, 95% confidence interval (CI): 6.6-8.3). In detail, there were unsafe acts for ALS (6.8+/-3.9, 95% CI: 5.2-8.5), in BA (8.1+/-3.9, 95% CI: 6.4-9.8), in PE (4.0+/-1.6, 95% CI: 3.0-5.0) and in MT (9.3+/-3.2, 95% CI: 7.8-10.7). Strategies of diagnosis and treatment were heterogeneous chronologically and methodically. Bad communication events were noted with a mean of 3.9+/-1.6 (95% CI: 3.1-4.6) within the scenarios. All the handovers (100%) between paramedics and emergency physician were incomplete, and 53.7+/-11.0% (95% CI: 48.5-58.8%) of information of realised actions and status of patient were missed in handover.
  
  
  CONCLUSIONS
  A subset of German paramedics caused many unsafe acts and dangerous communication in simulations that may affect real-life work. We suggest paramedics should take part in a need-based education programme and communication training.
authors.affiliation: Clinics of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Zimmer
authors.forename: Rainer
authors.initials: R
authors.lastname: Wassmer
authors.forename: Leo
authors.initials: L
authors.lastname: Latasch
authors.forename: Dieter
authors.initials: D
authors.lastname: Oberndörfer
authors.forename: Volker
authors.initials: V
authors.lastname: Wilken
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Raoul
authors.initials: R
authors.lastname: Breitkreutz
mesh_terms: D000488:Allied Health Personnel / Q000458:organization & administration*; D001249:Asthma / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence; D003142:Communication; D016001:Confidence Intervals; D004630:Emergencies; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005858:Germany; D006801:Humans; D015994:Incidence; D007400:Interprofessional Relations; D008297:Male; D009104:Multiple Trauma / Q000628:therapy; D020380:Needs Assessment; D016544:Patient Simulation; D011655:Pulmonary Embolism / Q000628:therapy; D012308:Risk Management / Q000458:organization & administration*; D017211:Treatment Failure; D014741:Video Recording