What if we could foresee our bad days as EMS leaders? Every organization in emergency medical services faces very real, high-stakes, high-profile risks. The very nature of our profession puts our personnel in tough, unpredictable situations where mistakes, misjudgments, and system failures can lead to disastrous outcomes.
Most risk programs in EMS are designed to be retrospective. It’s understandable that this is the approach. For decades, the primary tool for risk management was chart review, or complaint-based. What if there was a proactive option?
Latent Patient Safety Threats (LPST) first appeared in the landmark 1999 report To Err is Human, by the Institute of Medicine (IOM). This was the first report to highlight that having a strong reactive patient safety and risk mitigation program is not enough.
Identifying Latent Patient Safety Threats (LPST) is like having a crystal ball into our teams.
For Example
Patient movement is one of the highest liabilities for an EMS service. “We dropped a patient” is a heart-stopping message for any Paramedic, EMT, and leader. There are reports of new EMT graduates trained entirely online, with no psychomotor practice or education on patient movement before their first shift. Unless an initial education is well-known to us or has a poor reputation, the likelihood of undertrained EMTs joining our team is high.
What if we could know, before a patient is dropped, that we are at risk?
Latent Patient Safety Threat programs, based on the principles of high-fidelity simulation (HFS), have been proven to deliver that insight. Consider this industry insight from accredited HFS programs
- 50% reduction in malpractice claims when physicians participated in regular HFS. (Mult-year retrospective study from Harvard)
- 2.5-5.0 Latent Patient Safety Threats are identified in each HFS evolution. (Multi-disciplinary team study)
Is it worth fixing?
Recent history shows patient claim drops ranging from $125,000 (RI, 2024) to $1.5 million (CA, 2015), with an additional legal cost of $40,000 to $100,000. There’s also an undisclosed percentage increase in the agency's General and Professional Liability premiums, often exceeding six figures. Conservatively, a single patient claim drop can cost $150,000. Plus, these cases often attract high-profile attention in local media and can hurt the organization’s reputation in the community.
Why traditional re-training often fails
Adults don’t learn or change a practice because we are told to; we change when we believe the information presented will lead to a better result. Durable learning occurs when learners are given relevant experiences in applicable environments under realistic conditions. Too often, while tools like simulators and educators are available within an operation, the level of experience, training, and programmatic accreditation rigor poses challenges.
Just as in-house mechanics handle certain maintenance tasks, certain components of the powertrain require other subject matter experts. Leaders who want a crystal ball often build strong partnerships between in-house experts and external subject matter experts, leveraging specialized training, tools, and expertise.
What leaders can do today.
Our world as EMS leaders is complex and demanding. It’s understandable that patient safety and risk mitigation resources are limited and focused on pattern recognition of issues that have already occurred. Budgets, staff expertise, and a changing workforce can seem to conspire to create a no-win reactive approach to patient safety.
We can have honest conversations with our education team about their capacity today. This can be a challenge because staff are rarely willing to acknowledge they are poorly prepared as educators to manage what they perceive as their core roles.
- We can ask the team about Latent patient safety threats and listen carefully to their responses.
- Organize and collect EHR data and identify the existing benchmarks for high-risk, low-occurrence events.
- Ask an accredited, subject matter expert for help surveying the EHR data with the research of LPST in high fidelity simulation to create an impact assessment.
- Determine the human, financial, and litigation ROI of an LPST program.
- Identify whether the impact on improved outcomes and less risk is a priority for the system.
Something to think about
Nearly every EMS leader I know was, at some point in their life, called to EMS to be a caregiver. Patient safety, clinical outcomes, and being prepared to do the job are tenets I believe we share. With more than 42,000 learner hours in HFS, I have seen firsthand the value of simulation and understanding the science of Latent Patient Safety Threats.
Bad days in EMS are inevitable; they are part of the very nature of our work. But we can take meaningful steps to improve outcomes, support our staff, and protect our organizations.
AI Disclosure - This article was not drafted or final edit reviewed by AI; the core content is derived from my 20 years of industry expertise and experience. AI was used to analyze some data; I independently verified each source as credible.