Bijani M, Abedi S, Karimi S Major challenges and barriers in clinical decision-making as perceived by emergency medical services personnel: a qualitative content analysis. BMC Emerg Med. 2021; 21:(11)

NHS Improvement. 2019. (accessed 21 June 2022)

O'Connor P, O'Malley R, Lambe K How safe is pre-hospital care?: a systematic review. Int J Qual Health Care. 2021; 1-7

Panagioti M, Khan K, Keers R N Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis. BMJ. 2019; 366:(34)

Wilson MH, Habig K, Wright C, Hughes A, Davies G, Imray CH Pre-hospital emergency medicine. Lancet. 2015; 386:(10012)2526-34

World Health Organization. 2009. (accessed 21 June 2022)

Prevalence, severity and preventability of prehospital patient safety incidents

02 July 2022
Volume 14 · Issue 7


The provision of safe and effective healthcare is a mainstay for all services and clinicians associated with the delivery of prehospital care; however, little is empirically known about the prevalence and impact of harm caused in the prehospital phase. This commentary critically appraises a recent systematic review which sought to identify the frequency of patient safety incidents and the harm associated with them in prehospital care.

Prehospital care is an established element of the healthcare system, encompassing the emergency medical care given to patients at the scene of illness or injury, during transfer and prior to their arrival at a healthcare facility (Wilson et al, 2015). The undifferentiated presentation of patients to prehospital care services and the varied environments in which they present entails that decision-making is complex. Those decisions made in the prehospital period, and subsequent actions and interventions, can impact upon safe and effective patient outcomes (Bijani et al, 2021). However, the provision of healthcare services has been demonstrated to be associated with harm being caused to patients (Panagioti et al, 2019). The World Health Organization (WHO) defines patient harm as ‘an incident that results in harm to a patient such as impairment of structure or function of the body and/or any deleterious effect arising there from or associated with plans or actions taken during the provision of healthcare, rather than an underlying disease or injury, and may be physical, social or psychological (e.g. disease, injury, suffering, disability and death)’ (WHO, 2009: 16). These occurrences may be termed ‘patient safety incidents’ (PSIs), themselves defined as ‘unintended or unexpected incidents which could have, or did, lead to harm for one or more patients receiving healthcare’ (NHS Improvement, 2019). Acknowledging that compared to primary or secondary care, little is known about the extent of patient harm caused by the provision of prehospital care, the systematic review undertaken by O'Connor et al (2021) seeks to establish the prevalence and harm associated with PSIs in the prehospital setting.

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed