Development and Validation of a Safety Compliance Scale for Fire-Based Emergency Medical Services (EMS) Personnel

Ensuring occupational safety in high-risk professions requires validated tools to assess and promote safety behavior tailored to specific organizational contexts. Safety compliance, a specific form of safety behavior, refers to workers' adherence to safety policies, procedures, and standards within an organization. Current safety instruments adapted for emergency medical services (EMS) do not specifically measure safety compliance and may not capture the unique challenges and risk faced by fire-based EMS personnel. We developed and validated an EMS Safety Compliance scale for fire-based EMS personnel to address their occupational safety risks.

Items were developed by the research team and three EMS personnel using iterative item development. The items were field-tested as a scale of 15 items on the Fire service Organizational Culture of Safety (FOCUS) survey. The FOCUS survey is a validated safety climate survey specific for the United States (U.S.) fire and rescue service and is administered in U.S. fire departments that opt in. Our analysis included survey respondents that self-reported holding an EMS role (n = 3,117). We conducted exploratory factor analysis (EFA) (n = 1,041) to identify the number of factors for the scale through factor reduction and then we conducted confirmatory factor analysis (CFA) (n = 2,076) to confirm the measurement structure of the scale. We also tested the discriminant validity between this new scale and a previously developed Fire Safety Compliance scale.

The EFA identified a 1-factor 10-item EMS Safety Compliance scale among respondents self-reporting holding an EMS role within U.S. fire departments. The CFA results indicated support for the 1-factor structure and the fit statistics were indicative of a good fit. Further, we found discriminant validity between this new measure and an established measure of safety compliance related to fire suppression contexts measured on FOCUS.

Our results suggest the EMS Safety Compliance scale is a reliable and valid measure. This scale can be used in future research to gauge safety compliance among EMS personnel in U.S. fire departments that participate in FOCUS or as a standalone measure.