Volume 7 - Issue 19 (2026-10-20)

Patient Safety Incidents and Medical Errors in Prehospital emergency Medical Services: A Systematic Review

1- Researcher: Nabras Hassan Almubarak

2- Researcher: Hussam Abdullah Alobaidi

3- Researcher: Wesam Saud Busal

4- Researcher: Roaya Khalid Alansari

5- Researcher: Abdullah Mohammed Al-Sahli

6- Researcher: Ahmad Ayad Allihabi

7- Researcher: Saif Falah Al-Sahli

8- Researcher: Abdulmohsen Mutlaq Almuzaini

9- Researcher: Zainab Abdullah Almahasnah

10- Researcher: Omar Solaiman Alhazmi

11- Researcher: Mamdouh Mukhlid Almuteri

Researcher Institutional Affiliation:

Emergency Medical Services-Saudi Red Crescent - Medina

Abstract:

Background: Prehospital emergency medical services (EMS) operate in unpredictable, time-sensitive environments in which diagnostic uncertainty, communication breakdowns, medication errors, unsafe procedures and system constraints can threaten patient safety. The diversity of incident definitions and surveillance systems makes evidence synthesis difficult.

Objective: To synthesize original evidence on the types, measurement, consequences and contributing factors of patient safety incidents and medical errors in prehospital EMS, and to identify practical improvements and research priorities.

Methods: This structured systematic-review manuscript follows PRISMA 2020 reporting principles and summarizes 14 individually traceable empirical studies published from 2012 to September 2026. The author-supplied selection diagram contains 235 database records and 14 included studies; its provenance remains unverified. A design-sensitive narrative synthesis was undertaken across medication, diagnostic, airway, dispatch, non-conveyance, incident reporting and safety-culture domains. Preliminary study-level methodological concerns were documented using design-appropriate JBI concepts. Meta-analysis was not attempted because denominators, populations and outcomes were incompatible.

Results: Pediatric medication studies reported dosing deviations in 34.7% of 360 administrations and 35.2% of 1,078 administrations. A Qatari safety-register study detected medication adverse events in 150 of 3,475 records (4.32%). Among 750 hospital-confirmed stroke cases, 282 (38%) were missed as stroke in prehospital classification. In an English fatal-incident series, response delays accounted for 41 of 69 reports (59%). Prospective airway and national airway-data studies described complications in 14% of 1,915 intubations and physiologic adverse events in 27.5% of 11,525 selected airway cases, respectively. Patient/witness interviews found perceived incidents in 5.3% of 3,156 episodes. These figures measure different constructs and should not be pooled.

Conclusion: Reported prehospital safety problems span clinical and operational processes, with important roles for communication, decision-support, training, audit, and system design. Voluntary incident surveillance substantially limits prevalence inference, whereas clinical registries and systematic follow-up provide complementary information. No single overall EMS medical error rate can be inferred from the selected studies.