Of the 62 EMS agencies participating in the study, we excluded one agency due to low response rate (9.6%). The remaining 61 agencies were distributed across all 4 U.S. Census regions and included one EMS agency from Canada (). Most were rural-ground EMS agencies (). Most agencies employed between 21 and 50 employees and were affiliated with a private/freestanding model. Approximately 43% of all EMS agencies had ≤2,500 patient contacts in 2007.
Map of participating EMS agencies (n=61)
Demographics of EMS agencies
We received 1,715 completed surveys from 61 agencies. The mean survey response rate per EMS agency was 47% (95% CI 10%, 83%). Response rates varied slightly by method for survey completion (paper only [n=16]=52%, combination of electronic and paper [n=3]=49%, and electronic only [n=42]=45%). We excluded 120 surveys that were missing 2 or more demographic variables. The final analysis included 1,595 surveys.
In this sample of EMS personnel, the survey responses demonstrated good internal consistency (Cronbach’s alpha for safety climate, alpha=0.82; teamwork climate, alpha=0.83; perceptions of management, alpha=0.68; job satisfaction, alpha=0.8; working conditions, alpha=0.75, stress recognition, alpha=0.78). Instrument validity testing confirmed the presence of a 6 domain structure and good model fit properties: RMSEA= 0.04, CFI=0.97, NNFI=0.95.
Most respondents were male and EMT-Paramedic certified (). The most common stratums were 18-30 (27.4%) and 31-40 (37.3%). The most common stratum for total years of EMS experience was less than 5 years (28.5%). The most common stratum for total years of experience at the current EMS agency was less than 5 years (44.9%). Three quarters of respondents (77.6%) were career full-time employees and half (50.3%) had an associate’s or bachelor’s degree.
Characteristics of survey respondents
Agency mean domain scores varied across EMS agencies (); Safety Climate 74.5 (95%CI 72.4, 76.6; Min 49.9, Max 89.7), Teamwork Climate 71.2 (95%CI 68.6, 73.7; Min 45.1, Max 90.1), Perceptions of Management 67.2 (95%CI 63.9, 70.5; Min 31.1, Max 92.2), Job Satisfaction 75.4 (95%CI 72.8, 78.0; Min 47.5, Max 93.8), Working Conditions 66.9 (95%CI 64.0, 69.7; Min 36.6, Max 91.4), Stress Recognition 55.1 (95%CI 52.9, 57.2; Min 31.3, Max 70.6).
Mean domain scores across agencies for the 6 EMS-SAQ domains
The mean safety climate score for air-medical EMS agencies was greater than mean scores in private/free standing and fire based model agencies (). The mean safety climate score was also highest in agencies with fewer employees, agencies with lower annual patient contacts, and agencies with a higher proportion of acute patients.
Variations in EMS-SAQ domain mean scores across agency characteristics
The percentage of respondents with a positive perception (PPR) varied across EMS agencies for each domain: Safety Climate 58.6% (95%CI 52.7, 64.5; Min 0%, Max 100%), Teamwork Climate 52.8% (95%CI 46.5, 59.1; Min 0%, Max 100%), Perceptions of Management 43.8% (95%CI 36.7, 50.9; Min 0%, Max 90%), Job Satisfaction 63.4% (95%CI 57.5, 69.4; Min 0%, Max 100%), Working Conditions 46.3% (95%CI 41.4, 51.3; Min 0%, Max 100%), Stress Recognition 28.6% (95%CI 25.2, 32.0; Min 0%, Max 57.1%) ().
Percentage of positive responses (PPR) across agencies for the 6 EMS-SAQ domains
The PPR for safety climate was highest among air-medical only agencies, but did not differ significantly across categories of model affiliation (). A lower proportion of EMS agency patient contacts was associated with increased PPR for safety climate. EMS agencies with greater than or equal to 2% of trauma and cardiac related patient contacts had a higher PPR than agencies with less than 2%. Notably, the PPR for stress recognition did not vary across any of the selected agency characteristics.
Variations in the percentage of positive responses (PPR) across agency characteristics
The mean safety climate score was lower for EMT-Paramedics than the mean score for all other position types (). The mean safety climate scores were highest among respondents between the ages of 41 and 50, highest among respondents with less experience in EMS, and highest among respondents with less experience at the current EMS agency of employment when compared to their respective referent groups.
Variations in EMS-SAQ domain mean scores across individual characteristics
The PPR for safety climate did not differ across most respondent demographic factors (). The PPR for safety climate was highest among Prehospital Nurses and other positions and was lowest among paramedics (p<0.0001; ). The PPR for other domains of safety culture varied across some, but not all respondent demographic characteristics. Notably, the PPR for stress recognition varied across 1 of the 7 measured respondent demographics; Education. The PPR for stress recognition increased with categories of higher education.
Variations in the percentage of positive responses (PPR) across individual characteristics