PROVIDED BY:
Welcome!
Welcome to the EMS Voluntary Event Notification
Tool (E.V.E.N.T.)!
This is an aggregate report of the near miss events reported to E.V.E.N.T. for
calendar year 2017. We want to thank all of our organizational site partners.
For a complete listing of site partners, see page 4. The Center for
Leadership, Innovation
E.V.E.N.T. is a tool designed to improve the safety, quality and consistent and Research in EMS
delivery of Emergency Medical Services (EMS). It collects data submitted
anonymously by EMS practitioners. The data collected will be used to
develop policies, procedures and training programs to improve the safe
delivery of EMS. A similar system used by airline pilots has led to important
airline system improvements based upon pilot reported "near miss" situations IN PARTNERSHIP WITH:
and errors.

Any individual who encounters or recognizes a situation in which an EMS

safety event occurred, or could have occurred, is strongly encouraged to
submit a report by completing the appropriate E.V.E.N.T. Notification Tool.
The confidentiality and anonymity of this reporting tool is designed to
encourage EMS practitioners to readily report EMS safety events without fear
of repercussion.

“Arrived on scene at police request to find subject and

officer in a tussle. Subject was trying to get the officer's
weapon and medics moved in to assist. The subject was
high on methamphetamines and other drugs, was tased
two times without effect… paramedic received scratches on
the arm from the subject, who was bleeding freely and
shared it with all parties. Once the subject was controlled
and handcuffed, he expressed he 'might' have Hepatitis B
or HIV...he didn't know..…” – 2H2017 EVENT Violence
Report #2

This is the aggregate Near Miss E.V.E.N.T. summary report for

calendar year 2017.

 2014 2015 2016 2017

Jan - Mar 0 4 4 4
As you review the data
Apr - Jun 1 2 0 3 contained in this report,
Jul - Sep 5 5 1 4 please consider helping us
advertise the availability of 

Oct - Dec 6 2 3 3 the report by pointing your
colleagues to
Total 12 13 8 14 www.emseventreport.com.

Near Miss E.V.E.N.T.

Report CLIR Notified of Quarterly Reports
Event Occurs
Completed EMS NME Generated
with EMS
Online

When an anonymous E.V.E.N.T. report is submitted, our team is notified by email. In the United States, the anonymous
event report is shared with the state EMS office of the state in which the event was reported to have occurred. The
state name in the report is then removed and the record is shared through our Google Group and kept for this
summary report. Canadian records have the Province name removed, and then the reports are shared through the
Paramedic Chiefs of Canada, and kept for inclusion in aggregate reports.

 0
1
2
3
Alabama
Alaska
Arizona

0 0 0 0
Arkansas

1
California

2
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Michigan

1
Minnesota
Mississippi
Missouri
Montana
Nebraska

0 0 0 0 0
Nevada
2

New Hampshire
New Jersey

0 0
New Mexico
2

New York

0
North Carolina
2

North Dakota
3

Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
0 0 0 0 0 0 0

Tennessee
1

Texas
0
Near Miss Events by State (United States of America)

Utah
Vermont
Virginia

Washington
West Virginia
Wisconsin
0 0 0 0 0

Wyoming
 ! ! ! !

!
! !
!

! ! ! !

!
! ! !

!
! !
!

! !
! !

! ! !

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 Near Miss Events Across Country/

Territories

N. Mariania Islands 0
American Samoa 0
Guam 0
Puerto Rico 0
US. Minor Islands 0
US. Virgin Islands 0
Canada* 0
US Total 14

Near Miss Events Across Agency Characteristics

Urban
Suburban
Rural
Remote/Frontier
Other/More than One Selected

 0
2
5
7
0 1 2 3 4

4
Governmental

4
Volunteer

0
State/Providencial

0
Tribal/First Nation

3
Combination, mostly volunteer
2

Non-Profit
0

Industrial

7
1

Paid Third Service

0

Department Type Federal

1

Private Non-Gov

0
Combination, mostly paid
3

Hospital
Frequency of NME by Agency Ownership

Training Academy
Other/More than One Selected 0
3

Other/More than one

 0
3
6
9

0
EMR or BLS First Response

0
3
7
10
0

10
ALS First Response

Full-Time
9

BLS Transport

0
Part-Time
Employment
Level of Organization

ALS Transport

Volunteer
0

Air Medical Transport

 0
2
5
7
9

0
During Routine Inspection

1
During Dispatch

11

0
4
7
14
0
During Emergent Response

0
0
During Non-Emergent Response

2015
9

On Scene

2
During Emergent Transport

0
2016
0
During Non-Emergent Transport

Occurred
0

At Destination Facility
0

Non-Response Oriented Driving

14

2017
Year Reported Near Miss Event
1

During Training Event

0

During Base Shift Duties

NME Occurrence During EMS Response Timeline

Other/Multiple Selected

 0
1
2

1
0001-0100

0
0101-0200

0
1
2
3

0
0201-0300

0
0301-0400 January

1
0401-0500

0
February

0
0501-0600
3

March

1
0601-0700

2
3

0701-0800 April

1
0801-0900

0
May

0
0901-1000

0
June

1
1001-1100

1
1101-1200
2

July

1
1201-1300
0
August

0
1301-1400
1

0
1401-1500 September

1
1501-1600
1

October
Time of Reported NME

0
1601-1700
2

November

1
1701-1800
Month of Reported Near Miss Event

2
1

1801-1900 December

0
1901-2000

1
2001-2100

0
2101-2200

0
2201-2300

0
2301-2400

 Hours into Shift at time of NME

8
8

3 2
1 1 1 1
0
0
0-4 Hours

5-8 Hours

9-12 Hours

13-16 Hours

17-20 Hours

21-24 Hours

More than 24 Hours

Contributing Factors to Near Miss Events:
As Reported by Providers
Frequency Frequency

Accountability 0 Situational Awareness 5

Command 0 SOP/SOG 1
Communication 3 Staffing 0
Decision Making 2 Task Allocation 0
Equipment 4 Teamwork 2
Fatigue 1 Training Issue 1
Distracted Driver/Pilot 0 Unknown 0
Horseplay 0 Weather 0
Human Error 6 Violent Patient 1
Individual Action 0 Violent Non-Patient 0
Procedure 0 Inadequate Lighting 1
Protocol 0 Care Coordination 1

10