Delphi Consensus on Never Events in Emergency Medical Services – NEEMS-1-Study

Background Prehospital emergency care is often conducted under challenging and unpredictable conditions, creating a high-risk environment for both patients and healthcare professionals. Despite its significance, the topic of safety has historically received limited attention in rescue sciences. Our study aimed to develop a consensus-based set of safety indicators for Emergency Medical Services (EMS). To achieve this, we adapted the "Never Event" concept - widely established in clinical settings in the United States and the United Kingdom over the past decade - to the context of prehospital emergency care. Methods A three-round web-based Delphi process was conducted in 2014 among experts in the field of emergency care to achieve consensus on Never Events specific to the prehospital environment. Primary outcome was the mean rating of item relevance on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Statements were considered consensual if they achieved a mean rating of ≥ 3.75 in rounds 1 and 2, and ≥ 2.5 in round 3. Results A total of 83 experts participated in round 1, with 68 completing rounds 2 and 3. The highest levels of agreement were reached for the following statements: “Patient death or serious disability associated with an airway management error”, “Omission of telephone-assisted CPR instructions despite identification of cardiac arrest and availability of trained personnel”, and “Patient death or serious disability associated with a medication error”. Overall, 32 events were regarded by the expert panel as “preventable by all means”. Conclusion Given the extensive list of 32 events, reaching the aforementioned study goal appeared to be doubtful. Further research is mandatory to establish broad expert consensus on Never Events in EMS.