Wang Henry E, Fairbanks Rollin J, Shah Manish N, Abo Benjamin N, Yealy Donald M
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Ann Emerg Med. 2008 Sep;52(3):256-62. doi: 10.1016/j.annemergmed.2008.02.011. Epub 2008 Apr 14.
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.
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.
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).
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.
与其他医疗环境相比，紧急医疗服务（EMS）是在控制程度较低的环境中为急病或受伤患者提供护理。虽然存在描述个别EMS不良事件的报告，但更广泛的描述却很少。本研究的目的是确定与针对EMS提供者的保险侵权索赔相关的不良事件的类型、频率和结果。
我们对一家全国性EMS机构保险公司的保险责任索赔进行了回顾性研究。我们研究了2003年1月1日至2004年12月31日期间已结案和未结案的保险责任索赔，这些索赔源于EMS对患者护理的响应或提供，以及与患者或其他个人受伤相关的情况。我们排除了仅与员工受伤相关的事件、仅涉及财产或车辆损坏的事件，以及实际或预计总费用低于10,000美元的急救车辆碰撞事件。我们确定了不良事件的类别、治疗急救单位的特征、受伤个体、相关损伤以及估计或实际总费用。
在纳入分析的326项索赔中，不良事件包括急救车辆碰撞或移动（n = 122；37%；95%置信区间[CI] 32%至43%）、患者搬运（n = 118；36%；95% CI 31%至41%）、临床管理（n = 40；12%；95% CI 9%至16%）、响应或运输事件（n = 25，8%；95% CI 5%至11%）以及其他事件（n = 33；10%；95% CI 7%至14%）。相关损伤包括死亡（n = 54；17%；95% CI 13%至21%）、危及生命或致残性损伤（n = 25；8%，95% CI 5%至11%）以及非危及生命或其他损伤（n = 247；76%；95% CI 71%至80%）。估计总费用的中位数为17,000美元（四分位间距为7,000美元至42,000美元）。
急救车辆碰撞和患者搬运失误是与针对EMS机构的侵权索赔相关的最常见不良事件。临床管理和其他事件则较少见。这项研究突出了改善EMS运营和护理的潜在领域。
