Critical incident reporting in emergency medicine: results of the prehospital reports.
BACKGROUND
Medical errors frequently contribute to morbidity and mortality. Prehospital emergency medicine is prone to incidents that can lead to immediate deadly consequences. Critical incident reporting can identify typical problems and be the basis for structured risk management in order to reduce and mitigate these incidents.


METHODS
We set up a free access internet website for German-speaking countries, with an anonymous reporting system for emergency medical services personnel. After a 7-year study period, an expert team analysed and classified the incidents into staff related, equipment related, organisation and tactics, or other.


RESULTS
845 reports were entered in the study period. Physicians reported 44% of incidents, paramedics 42%. Most patients were in a life-threatening or potentially life-threatening situation (82%), and only 53% of all incidents had no influence on the outcome of the patient. Staff-related problems were responsible for 56% of the incidents, when it came to harm, 78% of these incidents were staff related.


CONCLUSIONS
Incident reporting in prehospital emergency medicine can identify system weaknesses. Most of the incidents were reported during care of patients in life-threatening conditions with a high impact on patient outcome. Staff-related problems contributed to the most frequent and most severe incidents.
Department of Emergency Medicine, University Hospital Jena, Jena, Germany.
Christian
C
Hohenstein
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Dorothea
D
Hempel
Department of Medicine, University Hospital Gießen, Gießen, Germany.
Kerstin
K
Schultheis
Department of Trauma and Plastic Surgery, BG Unfallklinik Tuebingen, Tuebingen, Germany.
Oliver
O
Lotter
Department of Emergency Medicine, Salzgitter Hospital, Salzgitter, Germany.
Thomas
T
Fleischmann
D001317:Austria; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004635:Emergency Medicine; D005858:Germany; D006801:Humans; D020407:Internet; D019300:Medical Errors / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012308:Risk Management / Q000458:organization & administration* / Q000706:statistics & numerical data*
emergency ambulance systems; paramedics; prehospital care, doctors in PHC; quality assurance; risk management