The association between EMS workplace safety culture and safety outcomes

Prehosp Emerg Care. Jan-Mar 2012;16(1):43-52. doi: 10.3109/10903127.2011.614048. Epub 2011 Sep 27.


Background: Prior studies have highlighted wide variation in emergency medical services (EMS) workplace safety culture across agencies.

Objective: To determine the association between EMS workplace safety culture scores and patient or provider safety outcomes.

Methods: We administered a cross-sectional survey to EMS workers affiliated with a convenience sample of agencies. We recruited these agencies from a national EMS management organization. We used the EMS Safety Attitudes Questionnaire (EMS-SAQ) to measure workplace safety culture and the EMS Safety Inventory (EMS-SI), a tool developed to capture self-reported safety outcomes from EMS workers. The EMS-SAQ provides reliable and valid measures of six domains: safety climate, teamwork climate, perceptions of management, working conditions, stress recognition, and job satisfaction. A panel of medical directors, emergency medical technicians and paramedics, and occupational epidemiologists developed the EMS-SI to measure self-reported injury, medical errors and adverse events, and safety-compromising behaviors. We used hierarchical linear models to evaluate the association between EMS-SAQ scores and EMS-SI safety outcome measures.

Results: Sixteen percent of all respondents reported experiencing an injury in the past three months, four of every 10 respondents reported an error or adverse event (AE), and 89% reported safety-compromising behaviors. Respondents reporting injury scored lower on five of the six domains of safety culture. Respondents reporting an error or AE scored lower for four of the six domains, while respondents reporting safety-compromising behavior had lower safety culture scores for five of the six domains.

Conclusions: Individual EMS worker perceptions of workplace safety culture are associated with composite measures of patient and provider safety outcomes. This study is preliminary evidence of the association between safety culture and patient or provider safety outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Chi-Square Distribution
  • Confidence Intervals
  • Cross-Sectional Studies
  • Data Collection
  • Emergency Medical Services*
  • Female
  • Humans
  • Job Satisfaction
  • Linear Models
  • Male
  • Medical Errors / statistics & numerical data*
  • Occupational Diseases / epidemiology
  • Occupational Diseases / prevention & control*
  • Occupational Health*
  • Organizational Culture*
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Reproducibility of Results
  • Safety Management / methods
  • Self Report
  • Statistics as Topic
  • Surveys and Questionnaires
  • United States / epidemiology
  • Workplace