Tort Claims and Adverse Events in Emergency Medical Services
Study objective
Emergency medical services (EMS) provide care to acutely ill or injured patients in settings less controlled than other health care environments. Although reports describing individual EMS adverse events exist, few broader descriptions exist. The objective of the study is to characterize the types, frequencies, and outcomes of adverse events associated with insurance tort claims against EMS providers.
Methods
We performed a retrospective review of insurance liability claims from a national insurer of EMS agencies. We studied closed and open insurance liability claims from January 1, 2003, to December 31, 2004, arising from EMS response to or provision of patient care and associated with injury to patients or other individuals. We excluded events associated with employee injuries only, events with property or vehicle damage only, and emergency vehicle crashes with less than $10,000 in actual or predicted total incurred costs. We identified the category of the adverse event, the characteristics of the treating emergency units, the injured individuals, the associated injuries, and the estimated or actual total incurred costs.
Results
Among 326 claims included in the analysis, adverse events included emergency vehicle crash or movement (n=122; 37%; 95% confidence interval [CI] 32% to 43%), patient handling (n=118; 36%; 95% CI 31% to 41%), clinical management (n=40; 12%; 95% CI 9% to 16%), response or transport events (n=25, 8%; 95% CI 5% to 11%), and other events (n=33; 10%; 95% CI 7% to 14%). Associated injuries included death (n=54; 17%; 95% CI 13% to 21%), life-threatening or disabling injuries (n=25; 8%, 95% CI 5% to 11%), and non–life-threatening or other injuries (n=247; 76%; 95% CI 71% to 80%). The median estimated total incurred cost was $17,000 (interquartile range $7,000 to $42,000).
Conclusion
Emergency vehicle crashes and patient handling mishaps were the most common adverse events associated with tort claims against EMS agencies. Clinical management and other incidents were less common. This effort highlights potential areas for improving EMS operations and care.
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Supervising editors: Daniel W. Spaite, MD; Michael L. Callaham, MDDrs. Spaite and Callaham were the supervising editors on this article. Dr. Yealy did not participate in the editorial review or decision to publish this article.Author contributions: HEW conceived the study. HEW, RJF, MNS, and DMY designed the study. HEW, RJF, and MNS obtained funding. BNA oversaw the data collection process. HEW analyzed the data. HEW drafted the article, and all authors contributed substantially to its revision. HEW had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. HEW takes responsibility for the paper as a whole.Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. The authors declare no financial or other conflicts of interest. The funders had no direct role in the design or execution of the study or the composition of the resulting manuscript. McNeil and Company, Inc. did review, provide suggestions for, and approve of the article. This study was supported by grants from the Pittsburgh Emergency Medicine Foundation and the Rochester Ronald McDonald Children's Charity. Dr. Wang is supported by Clinical Scientist Development Award K08-HS013628 from the Agency for Health Care Research and Quality, Rockville, MD. Dr. Shah is supported by Paul B. Beeson Career Development Award K23-AG02898942 from the National Institute on Aging, Bethesda, MD. Dr. Fairbanks is supported by the Emergency Medicine Patient Safety Research Fellowship Award from the Society for Academic Emergency Medicine and the Emergency Medicine Patient Safety Foundation.Publication dates: Available online April 14, 2008.Reprints not available from the authors.
PII: S0196-0644(08)00494-0
doi:10.1016/j.annemergmed.2008.02.011
© 2008 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
