Emergency Medicine

Vehicle accidents and patient mishandling are the most common reasons for legal claims against emergency medical services

As first responders, the emergency medical services (EMS) system delivers medical care in less than ideal settings outside of the hospital. Each year, 16 million patients are transported to emergency departments (EDs) in the United States. A variety of adverse events can occur, prompting legal action. A recent study found a low rate of medical care-related claims against EMS providers; however, when claims are filed, they are most often related to mishaps involving EMS vehicles and the handling of patients.

Researchers retrospectively analyzed 326 EMS liability insurance claims data provided by a major insurer of EMS systems. In each case, the adverse event was categorized. Characteristics on the emergency units, injured individuals, and associated injuries were also identified. The analysis also included either an estimate of or the actual total incurred costs.

The most common adverse events identified were crashes of EMS vehicles and the mishandling of patients. Both of these categories accounted for more than 70 percent of the claims studied. In the crash-related claims, those most often injured were pedestrians, bicycle riders, and the occupants of other vehicles. Patient handling mishaps most often involved dropping the patient. This was the result of stretcher collapse, dropping the stretcher or wheelchair, or dropping the patient during transfer. Among the clinical management adverse events, errors in airway management were the most common. Overall, a quarter of claimants either died or sustained a life-threatening or disabling injury.

The researchers point to the unique care elements associated with EMS. These include dispatch, response, patient extrication and movement, scene management, and transport. Efforts aimed at quality improvement in EMS must address these important and unique characteristics and not just the clinical aspects of care. The study was supported in part by the Agency for Healthcare Research and Quality (HS13628).

See "Tort claims and adverse events in emergency medical services," by Henry E. Wang, M.D., M.S., Rollin J. Fairbanks, M.D., M.S., Manish N. Shah, M.D., M.P.H., and others, in the September 2008 Annals of Emergency Medicine 52(3), pp. 256-262.

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