Links to important Safety Culture Documents


US EMS Culture of Safety effort:


Canadian EMS Culture of Safety effort:


IHI Culture of Safety



Published Research Library


Becker LR, Zaloshnja E, Levick NR, Li G, Miller TR. Relative risk of injury and death in ambulances and other emergency vehicles. Accid Anal Prev 2003;35(6):941–8.

Biggers WAJ, Zachariah BS, Pepe PE. Emergency medical vehicle collisions in an urban system. Prehosp Disaster Med 1996;11(3): 195–201.

Boal WL, Leiss JK, Ratcliffe JM, et al. The national study to prevent blood exposure in paramedics: rates of exposure to blood. Int Arch Occup Environ Health 2010;83(2):191–9.

Brice JH, Studnek JR, Bigham BL, et al. EMS provider and patient safety during response and transport. proceedings of an ambulance safety conference. Prehosp Emerg Care 2012;16(1):3–19.

Chapman SA, Lindler V, Kaiser JA, Nielsen CS, Bates T, Hailer- O’Keefe L. Emergency Medical Services Workforce for the 21st Century Project. Washington, DC: National Highway Traffic Safety Administration, 2008.

Cook RT, Meador SA, Buckingham BD, Groff LV. Opportunity for seatbelt usage by ALS providers. Prehosp Disaster Med 1991;6: 469–71.

Conrad KM, Reichelt PA, Lavender SA, Gacki-Smith J, Hattle S. Designing ergonomic interventions for EMS workers. concept generation of patient-handling devices. Appl Ergon 2008;39(6): 792–802.

Corbett SW, Grange JT, Thomas TL. Exposure of prehospital care providers to violence. Prehosp Emerg Care 1998;2(2):127–31.

Crill MT, Hostler D. Back strength and flexibility of EMS providers in practicing prehospital providers. J Occup Rehabil 2005;15(2): 105–11.

Custalow CB, Gravitz CS. Emergency medical vehicle collisions and potential for preventive intervention. Prehosp Emerg Care 2004;8(2):175–84.

Eliseo LJ, Murray KA, White LF, Dyer S, Mitchell PA, Fernandez WG. EMS providers’ perceptions of safety climate and adherence to safe work practices. Prehosp Emerg Care 2012;16(1):53–8.

Grange JT, Corbett SW. Violence against emergency medical services personnel. Prehosp Emerg Care 2002;6(2):186–90.
Cutter J, Jordan S. Uptake of guidelines to avoid and report exposure to blood and body fluids. J Adv Nurs 2004;46(4):441–52.

Kahn CA, Pirrallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective analysis. Prehosp Emerg Care 2001;5(3):261–9.

Larmon B, LeGassick TF, Schriger DL. Differential front and back seat safety belt use by prehospital care providers. Am J Emerg Med 1993;11(6):595–9.

Leiss JK, Ratcliffe JM, Lyden JT, et al. Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics. Ann Epdemiol 2006;16(9):720–5.

Patterson PD, Huang DT, Fairbanks RJ, Wang HE. The emergency medical services safety attitudes questionnaire. Am J Med Qual 2010;25(2):109–15.
Patterson PD, Huang

Patterson PD, Huang DT, Fairbanks RJ, Simeone SJ, Weaver MD, Wang HE. Variation in emergency medical services workplace safety culture. Prehosp Emerg Care 2010;14(4):448–60.

Lavender SA, Conrad KM, Reichelt PA, Gacki-Smith J, Kohok AK. Designing ergonomic interventions for EMS workers, Part I. transporting patients down the stairs. Appl Ergon 2007;38(1): 71–81.

Maguire BJ. Transportation-Related Injuries and Fatalities among Emergency Medical Technicians and Paramedics. Prehospital and Disaster Medicine. 2011; 26(4): 1-7.

Maguire BJ. Hunting KL. Guidotti TL. Smith GS. “The Epidemiology of Occupational Injuries and Illnesses Among EMS Personnel.” Prehospital Emergency Care. 2005; 9: 405–411.


Maguire BJ, Smith S. Injuries and fatalities among emergency medical technicians and paramedics in the United States. Prehosp Disaster Med 2013;28(4):376–82.

Maguire BJ, Hunting KL, Smith GS, Levick NR. Occupational fatalities in emergency medical services. A hidden crisis. Ann Emerg Med 2002;40(6):625–32.

McGinnis S, Moore J, Armstrong D. The Emergency Care Workforce in the U.S. New York: Rensselaer, 2006.

Mock EF, Wrenn KD, Wright SW, Eustis TC, Slovis CM. Prospective field study of violence in emergency medical services calls. Ann Emerg Med 1998;32(1):33–6.

Myers LA, Russi CS, Will MD, Hankins DG. Effect of an onboard event recorder and a formal review process on ambulance driving behavior. Emerg Med J 2012;29(2):133–5.

Pozzi C. Exposure of prehospital providers to violence and abuse. J Emerg Nurs 1998;24(4):320–33.

Reichard AA, Marsh SM, Moore PH. Fatal and nonfatal injuries among emergency medical technicians and paramedics. Prehosp Emerg Care 2011;15(4):511–17.

Schwartz RJ, Benson L, Jacobs LM. The prevalence of occupational injuries in EMTs in New England. Prehosp Disaster Med 1993;8(1):45–50.

Slattery DE, Silver A. The hazards of providing care in emergency vehicles. An opportunity for reform. Prehosp Emerg Care 2009;13(3):388–97.

Studnek JR, Ferketich A. Organizational policy and other factors associated with emergency medical technician seat belt use. J Safety Res 2007;38(1):1–8.

Studnek JR, Fernandez AR. Characteristics of emergency medical technicians involved in ambulance crashes. Prehosp Disaster Med 2008;23(5):432–7.

Studnek JR, MacCrawford J, Fernandez AR. Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers. Appl Ergon 2012;43(1):198–202.Suyama J, Rittenberger JC, Patterson PD, Hostler D. Comparison of public safety provider injury rates. Prehosp Emerg Care 2009;13(4):451–5.

Studnek J, Margolis G. What we know about the EMS workforce. JEMS 2006;31(1):30.
Heightman AJ. EMS workforce. A comprehensive listing of certified EMS providers by state & how the workforce has changed since 1993. JEMS 2000;25(3):108–12.

Sofianopoulos S, Williams B, Archer F, Thompson B. The exploration of physical fatigue, sleep and depression in paramedics: a pilot study. Journal of Emergency Primary Health Care. 2011; 9(1).

Thomas EJ, Studdert DM, Burstin HR, et al. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 2000;38:261–71 [PubMed]


Tinitnalli JE, McCoy M. Violent patients and the prehospital provider. Ann Emerg Med 1993;22(8):1276–9.

U.S. National Highway Traffic Safety Administration (NHTSA). National EMS Assessment (Final Draft). Available at: Accessed 31 December 2011.

Vilke GM, Tornabene SV, Stepanski B, Shipp HE, Ray LU, Metz MA, Vroman D, Anderson M, Murrin PA, Davis DP, Harley J. Paramedic self-reported medication errors. Prehosp Emerg Care. 2006; 10(4): 457-62.

Wang HE, Fairbanks RJ, Shah MN, Abo BN, Yealy DM. Tort claims and adverse events in emergency medical services. Ann Emerg Med 2008;52(3):256–62.

Weaver MD, Wang HE, Fairbanks RJ, Patterson PD. The association between EMS workplace safety culture and safety outcomes. Prehosp Emerg Care 2012;16(1):43–52.