E.V.E.N.T. Background and Why It's Important
The goal of every EMS practitioner (first responder, E.M.T., Paramedic, Flight Nurse, Physician and others) is to respond to patients in their time of need and to provide them with the most appropriate and highest quality care possible. This care is frequently critical to a patient’s health or survival and is often provided in settings that are challenging, chaotic and sometimes hazardous.
When EMS practitioners make decisions and choose a course of action they are often influenced by environmental factors. That said, decision and choices are always based upon the practitioner's experience, training, protocols, medical direction, common medical practice and ultimately the provider’s best judgment. Regardless of training, experience and especially the intent of the provider, medical errors in the EMS setting occur and cause harm or even take the life of the very patients the system is intending to save.
The national Institute of Medicine (IOM) studied medical errors in hospitals and reported that between 44,000 and 98,000 people die each year as a result of medical errors, preventable mistakes, oversights and omissions. This accounts for more deaths more deaths than motor vehicle accidents, breast cancer or AIDS. Similarly, the Institute for Healthcare Improvement estimated that 15 million medical mistakes occur in U.S. hospitals each year. Hospitals in the U.S. and Canada are focusing on quality improvement like never before. They are analyzing the failures in their systems of care, the processes that lead up to a mistake and are working hard to improve performance by making systemic changes. Hospitals are moving away from having a “culture of blame,” where one individual is singled out to carry the blame. Instead the desired work atmosphere is one of mutual accountability, where mistakes are viewed as the result of a series of system failures that allowed the error to occur. In that kind of work environment, when errors or even close calls occur, the duty of the entire organization is to transform the entire system; re-train every hand that touches a piece of the puzzle, re-tool every protocol, policy, practice and attitude in order to ensure that the mistake never happens again.
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