Over the last several years, through my work at the Institute for Healthcare Improvement and as a subject matter expert in paramedic delivery systems, I’ve had the pleasure to work with the great team at Hamad Medical Corporation’s national ambulance service. HMC Ambulance leaders aspired to develop an ambulance trigger tool modeled after the IHI Global Trigger Tool for Measuring Adverse Events.

Beginning in 2013, as part of a 90-day cycle with IHI’s Research & Development team, we scanned the literature and best practices in EMS to identify potential triggers of patient harm and for trigger tool-like processes in use. This work led to the development and testing of a set of triggers published in 2017 in BMJ Emergency Medicine: Development of a trigger tool to identify Adverse Events and Harm in Emergency Medical Services.

The work continued at HMC Ambulance with developing the triggers into a tool for frequent sampling and using the process over an extended period of time. This resulted in the outlining of a clear process and the measurement of a harm rate over time. This second piece of work was published in 2018 in BMJ Emergency Medicine: Application of the emergency medical services trigger tool to measure adverse events in prehospital emergency care: a time series analysis.

This Ambulance Trigger Tool is the first method for ground ambulance service to understand patient harm and to do so with a low burden of effort.