Tort claims and adverse events in emergency medical services

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.