When it comes to EMS safety, worker perception may reflect reality, Pitt study finds

(Press-News.org) PITTSBURGH, Nov. 17 – Poor perceptions about workplace safety culture among emergency medical services (EMS) workers is associated with negative patient and provider safety outcomes -- the first time such a link has been shown in the pre-hospital setting, according to a study by University of Pittsburgh researchers that now appears online in Prehospital Emergency Care and is scheduled to be published in the January-March print edition.

"There are sometimes drastic differences in how workers perceive their workplace safety from one EMS agency to the next," said senior author P. Daniel Patterson, Ph.D., EMT-B, assistant professor of emergency medicine at the University of Pittsburgh School of Medicine. "What we have found is that perceptions about safety may be reality."

Prior studies of the in-hospital setting and of high-risk occupations outside of health care have linked safety culture scores to such outcomes as injuries and accidents, but this is the first time that such a connection has been found in the EMS setting, noted Dr. Patterson.

The investigators measured EMS safety culture by surveying emergency medical technicians and paramedics at 21 EMS agencies across the U.S. They used a scientifically validated survey that collects EMS worker opinions regarding six key areas: safety climate, teamwork climate, perceptions of management, working conditions, stress recognition and job satisfaction. Safety outcomes were measured through a survey designed by EMS physician medical directors and investigators to identify provider injuries, patient care errors and safety-compromising behavior.

The analysis of 412 surveys showed that individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. Notably, the researchers found that 16 percent of all respondents reported experiencing an injury in the past three months; four of every 10 reported an error or adverse event; and 89 percent reported safety-compromising behavior. Respondents reporting injury scored lower on five of the six areas of safety culture, while those reporting an error or adverse event scored lower for four of six, and those reporting safety-compromising behavior had lower scores for five of the six domains.

"Measuring safety outcomes such as errors or adverse events is particularly difficult in the EMS setting. The EMS Safety Attitudes Questionnaire is helpful because it is fairly easy to administer and linked to safety outcomes, as shown in our study. This should provide EMS administrators or medical directors confidence in using this tool to evaluate safety conditions in their agencies," said Dr. Patterson.

### In addition to Dr. Patterson, authors of the study include Matthew D. Weaver, M.P.H., also of the University of Pittsburgh; Henry E. Wang, M.D., University of Alabama at Birmingham; and Rollin J. Fairbanks, M.D., National Center for Human Factors Engineering in Healthcare, Washington, D.C.

The study was supported by an award from the National Center for Research Resources. Additional support was provided by the North Central EMS Institute and Pittsburgh Emergency Medicine Foundation.