The #1 topic they didn’t teach you in Paramedic School: Culture

I have been working with the Center for Patient Safety (CPS) for about four months, and I’m learning something new every day.  As a Paramedic, patient safety has always been a high priority, but I didn’t know how an organization’s culture could impact the delivery of care.

Much of what we do at CPS is to educate, inform and help others make the connection between culture and safety.  While that might sound simple, it’s a rather complicated task.  Also, it’s about finding leaders and providers that are willing to listen and learn about these concepts that aren’t taught in Paramedic school.

Culture is comprised of many things including the collective beliefs, attitudes, perceptions, and values of the employees and the entire organization. How would you describe your organization’s culture? Did you know that you can measure it?

The EMS Safety Culture Assessment provided by CPS offers an organization the tools to understand their strengths and opportunities when it comes to their safety culture.  Many use it as a tool before implementation of just culture or as a baseline measurement of the values within their organization and then come back a year later and re-measure to see how their work has improved the safety culture.

The Safety Culture Assessment can also help with local or regional quality improvement projects and initiatives as it measures areas such as patient handoffs and communications between healthcare providers. These are just a few reasons why measuring your culture should be something that is not only accepted by EMS but expected in EMS just as it is in other healthcare settings.

Years ago I worked as a flight Paramedic and the safety culture in an air-based service seemed to be more advanced since it was linked to aviation. It was acceptable to turn down a flight and have a safe time-out due to severe exhaustion or if something didn’t seem right. As a ground paramedic, a safety time-out didn’t exist and many had never heard of it. Today, many years later, safety precautions like time-outs, are more common and practiced within a growing number of ground organizations.

One of the interesting things I get to do in my new position is listen to how leaders and providers describe their safety culture.  However, just like the safety time-out, many have never thought about it or can’t describe it.

One agency recently completed the EMS Safety Culture Assessment and learned of staff concerns regarding a change from 24-hour shifts to 48-hour shifts and how that change could impact patient and provider safety. As a result, the ground service implemented a time-out policy that addresses exhaustion, a pro-active approach to building a safe culture.

Do you have a safe organization where employees come to you with concerns about an unsafe situation or when a mistake occurs? Alternatively, are you the Chief that believes near misses and mistakes do not happen within your organization? How do you truly know the thoughts and feelings of the employees within your organization if you haven’t assessed the culture or given them the opportunity to speak up without the fear of repercussions from their colleagues and administration?

Our mission at the Center for Patient Safety is: Reducing preventable harm, but what does that mean and how do you accomplish that? The EMS Safety Culture Assessment is the first step in recognizing and learning about the culture component of your organization.

The EMS Safety Culture Assessment provided by CPS gives employees a voice that is trusted and de-identified so they can speak up without fear of retribution from colleagues or punishment from administration. The assessment also helps administration recognize the need to fulfill a safe practice and utilize the results to make positive changes within their organization.

Shouldn’t all first responders feel safe within the environment they call their second home?

Please contact me so we can start your EMS safety journey today! Your employees and your community are counting on you!

Shelby Cox

EMS Patient Safety Coordinator, Shelby Cox

The Center for Patient Safety is pleased to announce the recent hiring of Shelby Cox to the new EMS Patient Safety Coordinator position.  Shelby brings many years of EMS experience and a strong passion for improving patient care.  Please join us in welcoming Shelby to the CPS team.


As a Nationally Registered Paramedic with more than 20 years invested in emergency medical services, Shelby has served in varying capacities including  ground ambulance transport, air medical services, hospital liaison, EMS education and hospital outreach management. She has a passion for helping people and has always been drawn to making a difference.  Today she is inspired to help EMS colleagues reduce preventable harm.  She describes this new role as part of an amazing journey where she can use her experience on a larger scale.

CPS Safety Watch/Alert – Violence Against Healthcare Workers

SAFETY ALERT: Violence Against Health Care Workers


  • Verbal Threats
  • Hitting
  • Biting
  • Scratching
  • Kicking
  • Stalking
  • Harassment


  • Review policies and education of staff pertaining to the recognition and de-escalation of hostile and aggressive behavior by patients.
  • Evaluate the need for security personnel and mental health professionals to assist with identification and de-escalation of aggressive behavior.
  • Assess physical work environment to limit/eliminate the possibility of staff working in isolation without escape route in the possibility a patient becomes physically aggressive.


  • Ask your staff if they feel comfortable reporting aggressive behavior
  • Encourage staff to use teamwork strategies such as ensuring a second staff member is readily available to assist with procedures where patients have increased risk of becoming aggressive
  • Leadership should evaluate the culture and consider implementing a support system for staff members who feel threatened/intimidated by patients


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Patient Safety Awareness Week is March 11-17, 2018

Patient Safety Awareness Week (PSAW), an initiative from the National Patient Safety Foundation (NPSF) and the Institute for Healthcare Improvement, is designed to raise patient safety awareness among healthcare providers and consumers. This year, PSAW is March 11-17. It’s a great time to celebrate successes and re-focus on patient safety opportunities in your organization. The Center encourages providers and consumers to obtain information about patient safety issues. Below are highlights of Patient Safety Awareness Week activities.

Take advantage of the following resources and conferences to help launch a successful campaign! The Center’s highly anticipated Patient Safety Toolkit will be available for download by CPS Subscribers.

Join us on social media and check out these patient safety resources and tips we’re sharing during #PSAW2018!

Patient Safety Forum, March 14, 2018

Everyday across the country, healthcare is provided in many clinical settings and environments.  Likewise, the healthcare landscape is complicated as it evolves at an ever-quickening pace with new specialties, titles and tools.  Coupled with the growing demands placed on clinicians and healthcare leaders, how do we ensure the safety of our patients?  Join us for this collaborative opportunity to learn with other providers across the continuum of care how patient safety can be improved.
Added Bonus! All attendees of the forum will become a Subscriber to CPS’s online resource center, which provides toolkits, special previews to upcoming events, and a community forum. Find out more about becoming a subscriber!

Learn more about the Forum

Second Victim Experience, March 19, 2018

Most health care providers adjust well to the multitude of demands encountered during an unexpected or traumatic clinical event. Providers often have strong emotional defenses that carry them through and let them “get the job done.” Yet sometimes the emotional aftershock (or stress reaction) can be difficult. Signs and symptoms of this emotional aftershock may last a few days, a few weeks, a few months, or longer.

Added Bonus! All attendees of the workshop will become a Subscriber to CPS’s online resource center, which provides toolkits, special previews to upcoming events, and a community forum. Find out more about becoming a subscriber!

Learn more about the Second Victim Workshop

The CPS Patient Safety Improvement Approach

The Center for Patient Safety believes every patient safety improvement journey includes an evaluation of your current culture. It’s important to use meaningful data to understand how staff perceive the organization’s approach to patient care. Our bundled approach gives you peace of mind that you’re working with the patient safety experts – and we want YOU to be successful!

Step 1: CPS administers a survey to your staff and provides a detailed interpretation of your results.
Step 2: We work closely with you to develop your action plans and next steps.
Step 3: Our work continues with you over the next six months to a year to provide education and training, workshops, resources and tools. We support you in reaching your goals!
Learn more about the CPS Patient Safety Approach through Culture Change

Emergency Medical Services Agenda 2050. How do see the future of EMS?

The EMS Agenda 2050 “Envision the Future” Straw Man document has been released to the public for comments to guide the future direction of EMS.  The document is a comprehensive and robust body of work with a wide range of topics, all of which are important to the EMS profession.

The Center for Patient Safety (CPS) was founded in 2005 and shortly thereafter began working with EMS.  Over the years we have worked to raise awareness and offer creative solutions around patient safety.

Since our work at CPS is a specialized area of healthcare we are excited to see that the Technical Expert Panel has included a section on patient safety in the Straw Man document.  The document doesn’t merely mention the importance of patient safety but includes 9 areas that focus on the topic of patient safety and developing a culture of safety.  In addition, the areas listed offer innovative and actionable steps for EMS leaders to implement for the reduction of preventable harm.

Today, we see an opportunity to create action and change in the EMS profession regarding patient safety.  Please join us in reading the Straw Man document and then comment on it to let your voice be heard.  CPS will be advocating for the steps listed in the document and welcome your insights on this valuable document-with your input we can effectively address the issues surrounding patient safety.

To learn more about EMS Agenda 2050 and read the Straw Man document use this link.

Do you have an EMS Patient Safety Plan?

While we have all heard the old saying, “do you plan to fail or fail to plan,” this short statement has likely influenced many people to re-evaluate a current process or situation in their life.  The specialty area of preventable harm or patient safety is gaining strong momentum in Emergency Medical Services, which has relied on another common old saying “do no harm”.   While the desire to do no harm has always been present in EMS, it isn’t until recently that coordinated efforts have come forward to inform, organize and delineate actionable plans and steps to reduce preventable harm at the organizational level.

The EMS Patient Safety Boot Camp is a great way to get started, or to improve your current patient safety journey.  An opportunity in beautiful, cool Denver is waiting for you!


CPS Safety Watch/Alert: Elopement


  • Nursing, Medical & other Clinical Leaders
  • Clinical Educators
  • Patient Safety/Quality Improvement Leaders
  • Legal/Risk Management
  • And Leaders in:
    • Hospitals
    • EMS
    • LTC
    • Home Care

Safety Watch v4-2 Elopement

Emergency Services are increasingly dealing with patients who elope prior to receiving care, many times due to lengthy wait times. Patient safety issues associated with these scenarios include increased risk of:

  • Adverse events
  • Misdiagnosis
  • Mental health exacerbation
  • Diversion which can lead to dangerous delays of care


  • Review/establish an elopement policy
  • Review triage policy/process
  • Identify those at risk for elopement (such as those suffering with psychosis, dementia, drug or alcohol-related conditions)
  • Perform a gap analysis to address issues such as opportunities to reduce risk, assessing staffing, etc.


  • Open Communication: Interview staff to see if they have concerns regarding patient elopement
  • Teamwork: Develop a communication tool that will inform all ED staff of a high risk elopement patient.
  • Share: Openly share peer-reviewed best practices from the literature and processes that have been implemented at your facility or other facilities.



  • Share this watch with the target audience
  • Promote daily safety briefings
  • Continue to share incidents, near misses and unsafe conditions with the Center for Patient Safety

Patient Safety Boot Camp Now Available for EMS

Patient Safety Boot Camp Now Available for EMS

There’s lots of talk in the EMS world about patient safety and patient culture, but few resources to assist agencies in improving their culture and moving forward.

The Center for Patient Safety (CPS) has taken action. Based on similar work done in the acute setting several years ago, we have developed a day-long Patient Safety Bootcamp for EMS professionals.

Attendees will learn the basics of the science of patient safety, human factors, error reduction, process improvement and measurement. Presentations are in TED talk style, with “work-out” discussion sessions after each topic for attendees to analyze how their agency is fairing relative to the presented topic. Tools such as fishbone, root cause analysis, prioritization matrices and action plans are used throughout the day.

The goal is for each participant to leave the boot camp with either the start or refinement of a patient safety plan. Presenters are safety specialists with many years of experience in patient safety and quality improvement.

I encourage EMS personnel to consider this unique opportunity to dive in to patient safety!


JULY 25:  , BRANSON, MO Preconference workshop- MISSOURI EMS EXPO

  • Special guest speaker: TBA

AUGUST 2: Tomball, TX –Greater Houston area

  • Hosted by- Northwest Community Health
  • Special guest speaker: TBA

AUGUST 23-24: DENVER, CO as part of the National EMS Safety Summit


  • Special guest speaker: TBA

EMS Week Spotlight: Lee Varner

The Center for Patient Safety is proud of our diverse team and is especially proud of our Patient Safety Director, Lee Varner, MSEMS, EMT-P, CPPS. Having spent much of his time in EMS throughout his career, he now enters his third year with the Center in a supporting role. He is a valuable resource to all of our participating organizations. We recently sat down with Lee and asked him a few questions…

Q: What first interested you in healthcare?
I’ve always had an interest in science but it wasn’t until I took an EMT class that I made a connection between science and helping people.  From there I then went on to paramedic school and worked in various roles in EMS but some of my most rewarding years were working as a frontline paramedic.

Q: Why is patient safety important to you?
I find the topic of patient safety extremely interesting, specifically, understanding why mistakes occur in healthcare.  This in turn has offered me an opportunity to learn about new principles, philosophies and concepts and then how to apply them to EMS. 

Q: What do you miss most about working on the front lines (or in a care setting)?
I still live in the same community where I worked as a paramedic.  When I see an ambulance I always look to see if I know the crew  and wonder what type of call they might be running on.  I think it was that “wonder”  that I miss the most as you never knew what to expect one duty day from the next as each day was always different.  Some shifts operated at a very high level of intensity that might leave you drained physically, mentally and sometimes emotionally.  But I found it was the teamwork and coordinated efforts of everyone working together to help others very appealing.  

Q: What do you enjoy most about working at the Center for Patient Safety?
There are many areas I find rewarding, one of which is being part of a such a committed team .  In addition, the opportunity to always be learning from each other as we all come unique backgrounds in healthcare.  I also appreciate the culture of the Center as we truly practice what we preach when it comes to working in a culture that supports a model of shared accountability.  It’s a learning environment where we are always focused on improving the quality of our services that to the many organizations that we work with.  

Q: Based on your experience in the healthcare provider setting, and your experience at the Center, what is your message to other [nurses/LTC/EMS/Hospitals]?
As a provider, working day in and day out it’s easy to forget the positive impact that you make in people’s lives.  Recently our local  EMS responded to a family member and I was so thankful to see them.  My message is to never underestimate the difference you make in peoples lives.   

Q: What is your greatest achievement around patient safety (either in a previous job or current job)?
I would have to say it’s been the EMSFORWARD safety campaign that we started last year.  The project has been a collaborative effort at CPS so I can’t take all the credit but more importantly it’s been rewarding to watch it grow and gain more attention

Q: What was the last book you read?
The last book I read was “Talk like Ted”, the 9 Public Speaking Secrets of the World’s Top Minds by Carmine Gallo.  The book offered me a lot of inspiration in the development of patient safety content and material as we work with EMS

Q: Who do you admire?
I admire the many EMS professionals who are out there working every day  behind the scenes often with little recognition or support. 

Q: Anything else you’d like to share – interesting tidbits about where you’ve lived, where you’ve worked, about spouse, children or grandchildren, etc?
My wife and I recently downsized and moved to a town home on main street in Saint Charles, Missouri.  We are close to the Katy trail where we can bike and run as well as enjoy the many activities taking place in the community.

NAEMT and CPS Collaborate in Report – Patient Safety in EMS

The Center is excited to be part of the most recent NAEMT report, Patient Safety in EMS, which helps the EMS community understand the role of Patient Safety Organizations (PSO’s) in supporting an environment in which patient safety issues are reported and used as a basis for improvement and policy change.

Read the report!


PSO Case Law: Ungurian v. Beyzman, et al., 2020 PA Super 105:

A recent Pennsylvania case shows how courts narrowly interpret the PSQIA, ignoring the D & A pathway and the clear language of the Final Rule. (Ungurian v. Beyzman, et al., 2020 PA Super 105). The cour

Joint Commission New Sentinel Event Alert 61: Managing the Risks of Direct Oral Anticoagulants:

The Center for Patient Safety wants to share this important harm-prevention advice from The Joint Commission and its Sentinel Event Alert: Managing the Risks of Direct Oral Anticoagulants. The Joint Commis

CPS Safety Watch/Alert – Culture Can Improve the Control of Multi-Drug Resistant Organisms:

Issue: A number of events reported co CPS’ Patient Safety Organization (PSO) demonstrate poor handoff communication about the patients’ infectious disease status Examples include: Patient with

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The Center for Patient Safety believes that collaboration and sharing are the best ways to drive improvement. We strive to provide the right solutions and resources to improve healthcare safety and quality.