title: Patient safety in emergency medical services: a systematic review of the literature.
abstract: BACKGROUND
  Preventable harm from medical care has been extensively documented in the inpatient setting. Emergency medical services (EMS) providers care for patients in dynamic and challenging environments; prehospital emergency care is a field that represents an area of high risk for errors and harm, but has received relatively little attention in the patient safety literature.
  
  
  OBJECTIVE
  To identify the threats to patient safety unique to the EMS environment and interventions that mitigate those threats, we completed a systematic review of the literature.
  
  
  METHODS
  We searched MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) for combinations of key EMS and patient safety terms composed by a pan-canadian expert panel using a year limit of 1999 to 2011. We excluded commentaries, opinions, letters, abstracts, and non-english publications. Two investigators performed an independent hierarchical screening of titles, abstracts, and full-text articles blinded to source. We used the kappa statistic to examine interrater agreement. Any differences were resolved by consensus.
  
  
  RESULTS
  We retrieved 5,959 titles, and 88 publications met the inclusion criteria and were categorized into seven themes: adverse events and medication errors (22 articles), clinical judgment (13), communication (6), ground vehicle safety (9), aircraft safety (6), interfacility transport (16), and intubation (16). Two articles were randomized controlled trials; the remainder were systematic reviews, prospective observational studies, retrospective database/chart reviews, qualitative interviews, or surveys. The kappa statistics for titles, abstracts, and full-text articles were 0.65, 0.79, and 0.87, respectively, for the first search and 0.60, 0.74, and 0.85 for the second.
  
  
  CONCLUSIONS
  We found a paucity of scientific literature exploring patient safety in EMS. Research is needed to improve our understanding of problem magnitude and threats to patient safety and to guide interventions.
authors: Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada. bighamb@smh.ca
authors: Blair L
authors: BL
authors: Bigham
authors: Jason E
authors: JE
authors: Buick
authors: Steven C
authors: SC
authors: Brooks
authors: Merideth
authors: M
authors: Morrison
authors: Kaveh G
authors: KG
authors: Shojania
authors: Laurie J
authors: LJ
authors: Morrison
mesh_terms: D000552:Ambulances; D064420:Drug-Related Side Effects and Adverse Reactions; D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D019300:Medical Errors; D018802:Patient-Centered Care / Q000379:methods* / Q000458:organization & administration; D018570:Risk Assessment; D012449:Safety