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NEAR MISS EVENT REPORTING TOOL

Welcome to the EMS Near Miss Reporting Tool developed by the Center for Leadership, Innovation and Research in EMS in cooperation with the National Association of Emergency Medical Technicians (NAEMT). This tool has been created for EMS practitioners to anonymously share near-miss information by answering a series of questions in an online format. The data collected will be analyzed and possibly used in the development of EMS policies and procedures, as well as for the purpose of training, educating and preventing similar events from occurring in the future. No individual responses will be shared or transmitted to other parties.

Thank you very much for reporting your EMS Near Miss incident. The information you  provide will contribute to saving lives in the future.

EMS Near Miss Event: An unplanned event that did not result in injury, illness, or damage to an EMS practitioner, vehicle, aircraft, or equipment, but had the potential to do so. Only a fortunate break in the chain of events prevented an injury, fatality or damage. A near miss event that is patient related should be reported as a "Patient Safety Event". EMS Event Resulting in Illness, Injury or Damage: This tool is NOT designed to collect events involving illness, injury or damage. Those events should be reported to your EMS agency as directed by your agency policy.

THIS IS A PRACTICE AREA. USE THIS FORM TO PRACTICE ENTERING REPORTS. REPORTS ENTERED FROM THIS FORM WILL NOT BECOME PART OF THE REPORTING SYSTEM.

IF YOU WANT TO MAKE A REAL REPORT, CLICK HERE.

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  • Near Miss EVENT Report

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  • If the system change was implemented, how many weeks were there between the time you identified the change until it was implemented?

  • Describe the lessons learned as a result of the Near Miss Event.

    (What lessons were learned? What are your suggestions to prevent a similar event? What actions can correct the situation? Identifying department indicators, names or other information that may identify you or your department will not be included in reports.)

    Keep in mind the following topics when preparing your narrative: Chain of events, Communication, Decision making, Equipment, Incident command, Role, Sleep patterns, Situational awareness, SOP / SOG, Staff, Task allocation, Teamwork, Training, Weather.

  • Your Information































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