Initiation of risk management: incidence of failures in simulated Emergency Medical Service scenarios.

Abstract

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. 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. 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. 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.