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PATIENT SAFETY EVENT REPORT

 

NOTE: THIS SYSTEM SHOULD NOT BE USED TO FILE COMPLAINTS. COMPLAINTS SHOULD BE DIRECTED TO YOUR STATE, PROVINCIAL OR TERRITORIAL REGULATOR.

 

THIS FORM IS NOT FOR PRACTITIONER OR VEHICLE NEAR MISSES, PLEASE USE OUR NEAR MISS EVENT FORM FOR RESPONDER AND AMBULANCE CLOSE CALLS. THIS FORM IS ONLY APPROPRIATE FOR PATIENT SAFETY EVENT REPORTING.

 

Any individual who encounters or recognizes a situation in which a patient safety event occurred, or could have occurred, while a patient was being cared for by the EMS system is strongly encouraged to submit a report by completing the Patient Safety E.V.E.N.T. Notification Tool. The confidentiality and anonymity of this reporting system is designed to encourage EMS and other providers to readily report EMS patient safety events without fear of repercussion.

 

EVENT defines a patient safety event as any event or action that leads to or has the potential to lead to a worsened patient outcome related to the event or action: these may be related to systems, operations, drug administration or any clinical aspect of patient care. Patient safety events also include patient Near Misses (i.e. close calls) that are recognized before they actually occur.

 

This notification system is anonymous. Individuals who submit information to this website cannot be identified. Individuals must not submit information that identifies any patient, EMS practitioner, EMS service, air medical service, date of incident, location of incident, or any other information that may identify any of these entities. Submissions with these identifiers will be deleted from the system and the report will not serve the purpose of reducing future events.

 

Aviation accidents and incidents that involve precautionary landings or aircraft damage to medical helicopters or airplanes should be reported through the CONCERN Network.

 

EDUCATORS AND STUDENTS: If you want to practice submitting simulated events, do not use the form on this page, use our student practice form instead.

Contact Us

Center for Leadership, Innovation and Research in EMS • P.O. Box 2286 • St. Cloud, Minnesota 56302
800-342-7849 or 320-229-3621 • 320.251.8154 (fax) • Contact Us