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Why every EMS agency needs a safety program

EMS is an inherently risky job. On any given shift, EMS practitioners may be called to respond to emotionally charged, potentially life- threatening situations.

These may be quickly followed by a routine patient transport, with little time for recovery. Research shows that rapidly cycling between high and low intensity routine work can lead to exhaustion and errors— whether it’s forgetting to be careful when lifting a gurney or making a small driving error that leads to serious consequences.

Even when fully alert, long hours spent driving on roadways, in all kinds of weather and traffic conditions, at all hours of the day and night, exposes EMS practitioners to the potential of motor vehicle collisions. EMTs and paramedics have also been injured while responding to accidents by the side of the road. EMS practitioners are also put into harm’s way every time they respond to a call that involves interacting with members of the public who are highly stressed, under the influence of drugs and alcohol or in a mental health crisis. Surveys of EMS practitioners have found that assaults, either intentional or unwitting, are all too common.

So what steps can EMS agencies take to protect the health and well-being of EMS practitioners and their patients? One of the most important steps is implementing a comprehensive workplace safety program.

A comprehensive workplace safety program establishes policies and procedures that reduce risks, a plan of action when accidents or occupational exposures occur, and the steps to take to conduct investigations and ensure that the same type of incident does not occur in the future.

To make it more feasible for EMS agencies of all sizes to establish safety programs, in late 2017 the National EMS Safety Council published the Guide for Developing an EMS Agency Safety Program. Available free of charge on the NAEMT website (, the guide covers the many potential risks faced by EMS professionals and how to mitigate them.

Recognizing that EMS agencies have differing levels of resources available for safety programs, the guide provides tools and templates that EMS agencies can use, including:

  • Specific steps and guidance on recommended policies and protocols to be included in a comprehensive safety program.
  • Sample policies currently in use by some of our nation’s most highly respected EMS agencies.
  • Other resources for educating yourself and your workforce about safety issues and injury prevention.


In 2013, the National EMS Culture of Safety Strategy, funded by the National Highway Traffic Safety Administration (NHTSA), brought together the EMS stakeholder community to identify what constitutes a safe environment for EMS patients and practitioners; barriers to achieving a safe EMS environment; and a strategy to overcome these challenges.

One of the central concepts of the Culture of Safety Strategy was the concept of “just culture,” which encourages EMS agencies to foster an environment in which employees are urged to report near-misses and errors, and to share safety concerns, without the fear of punishment. This openness allows the agency to identify issues and take action to prevent future incidents.

The strategy also envisioned the establishment of a national level organization to coordinate national EMS safety efforts and serve as a repository for information, data and resources. In 2015, 12 leading national EMS and safety organizations, including NAEMT, came together to form the National EMS Safety Council. The goals of the council are to:

  • Ensure that patients receive emergency and mobile healthcare with the highest standards of safety.
  • Promote a safe and healthy work environment for all emergency and mobile healthcare practitioners.

The first initiative, funded by NAEMT, the American College of Emergency Physicians (ACEP), and American Medical Response (AMR) was to develop a guide to help EMS agencies start safety programs.


Mitigating fatigue, reducing the risk of collisions, promoting scene safety and preventing violence against practitioners are among the major issues that the guide addresses. But there are many others, including facility safety and security, infection control, substance abuse prevention and all aspects of personal safety, from lift injury prevention to the mental health of practitioners.

The guide is divided into main topic areas, some of which are particular to EMS and others that could apply to many types of businesses, both within healthcare and outside of it. Chapters include:

  1. Facility Safety and Security
  2. Vehicle Operator Safety
  3. Scene Safety
  4. Infection Control
  5. Personal Health and Safety
  6. Patient Safety

By implementing policies that protect the health and well-being of EMS practitioners, agencies ensure that their employees can continue in their chosen line of work and continue to serve our nation’s communities for many years to come.





In the days and weeks after Hurricane Maria slammed Puerto Rico, one of the many narratives that emerged was the need for citizens to be trained in basic first aid and CPR.

Given the damage to infrastructure and the inability for crews to respond to the initial emergency, bystanders were forced to help.

When the severity of flooding in Houston was setting in—and forecasters predicting record rain—the Cajun Navy, a collection of volunteers with boats formed during Hurricane Katrina, began to mobilize. They headed to the region where they helped local EMS providers rescue residents unable to get to safety.

In the aftermath of the deadly mass shooting in Las Vegas, there was a call for more people to learn how to stop life-threatening bleeding before trained professionals get to the scene.


EMS providers have an active role in this process. EMS, while on the front lines of a disaster, also has a key part in building community resilience long before a crisis happens. From routine CPR classes to rolling out the “Stop the Bleed” training, EMS is critical in preparing the public to help themselves.

Likewise, EMS often helps through messaging on social media with important information before, during and after a disaster.

“We have to make sure the citizenry is prepared to deal with the first 24 hours until the government can respond,” says Jerry Romero, president of Acadian Ambulance. “A well-equipped, well-trained citizenry can save a lot of lives.”

As part of the response to the Port Arthur, Texas area after Harvey, Acadian providers worked hand-in-hand with the Cajun Navy to rescue people and confirm other homes were cleared.

“With the ‘Stop the Bleed’ campaign, now is the time to start training people,” says Dr. David Persse, Medical Director for the Houston Fire Department. “Tragically, we’re probably able to get people interested.”

As part of this new effort around the country, there’s been growth in training of local Community Emergency Response Teams. And recently, there has been a push for Teen CERT teams.


Former FEMA Administrator Craig Fugate says the public is going to act whether they’re trained or not, so there is a benefit to EMS stepping up and taking a lead on helping the community.

“The public’s a resource, not a liability. From Joplin and a whole host of other traumatic events, the stories you hear of people being saved, it’s very rarely the lights and sirens folks. They’re going to do it whether you’re there or not,” Fugate says.

In fact, it’s important to let the public know the reality of response times and how critical bystanders are in the process, whether it’s after a storm or a mass shooting.

“I think we need to be frank and honest with people, whether it’s a heart attack, a gunshot, or a fall from a ladder, the fastest response is not 9-1-1—it’s the bystander,” Fugate says.

When wrapping up the 2017 hurricane season, FEMA Administrator Brock Long put an emphasis on the part local community responders play in dealing with disasters.

“This historic hurricane season should serve as a gut check and an opportunity for citizens, businesses, state, local, tribal and federal officials to re-evaluate how we prepare for and respond to any disaster,” Long said in a statement. “Response and recovery is dependent upon the whole community to be successful. While we continue to support the recovery from these storms, we must also take the opportunity to become better prepared for future disasters.”

“State, local, tribal and territorial governments, along with the residents in the impacted areas, are the true first responders,” Long added. “FEMA alone cannot deliver assistance to this vast number of survivors. We must hit the reset button on the culture of preparedness in this country.”