**1. Introduction**

In the landmark document, "EMS Agenda 2050" leaders are challenged to create a people-centered emergency medical services (EMS) system that "serves as the front line of a region's healthcare system and plays a core role in supporting the well-being of community residents and visitors through data-driven, evidence-based, and safe approaches to prevention, response, and clinical care" [1]. While not a new topic in healthcare, the inclusion of safety in this statement represents the first time that the topic is introduced into a federal government publication on emergency medical services, marking the progress and importance of patient safety initiatives. The challenge is many of the interventions that increase safety can be difficult to implement for a number of reasons: cost, resistance to culture change, and a lack of knowledge of the risks involved, just to name a few. So how do we create a system that focuses on the patient first, but also is not wasteful? Can we create a system that takes into consideration the clinician and the patient together? Thankfully, there have been years of research into this question and many national stakeholders have provided resources to help inform our decision-making in this area. Patient safety endeavors not only keep

the patient safe but avoiding harm and errors can serve to enhance the well-being of the EMS system workforce, it is a topic that is widely discussed given developing shortages in staffing [2]. The burden that medical errors place on the healthcare system and the economy at large has come into clearer focus since the Institute of Medicine's landmark white paper "To Err is Human." Estimated to cost between \$17 and \$29 billion in 2000, "preventable adverse events" are a huge burden on the healthcare system, but errors are not the only aspect of the EMS system that focuses on patient safety [3]. As a system of care, there are many aspects of emergency medical services to explore that have an impact on patient safety.
