As part of a routine skin biopsy procedure at his dermatologist's office, a healthy 22-year-old male receives an injection of lidocaine with epinephrine. Within minutes, his heart starts pounding and he begins to feel anxious. The dermatologist believes the patient is having an anaphylactic reaction and calls 9-1-1.

     When EMS arrives at the scene, the dermatologist informs them that the patient is suffering from an anaphylactic reaction. The patient reports that his heart is pounding, and he feels short of breath and very anxious. En route to the hospital, the paramedic asks his EMT partner to get the diphenhydramine and epinephrine vials out of the drug box. The paramedic later recalls asking the BLS partner to draw up "all of the diphenhydramine," but the EMT recalls hearing the paramedic ask for "all of the epinephrine." The paramedic takes the prepared syringe from the EMT and administers the medication intravenously, without checking the amount or the vial it was drawn from. Within minutes, the patient's rhythm changes to sustained ventricular tachycardia, and the patient complains of severe chest pain and diaphoresis, becomes distraught and says, "I think I'm dying." At this point, the paramedic realizes that he has just delivered 1 mg of 1:1,000 epinephrine via rapid intravenous bolus. Later, in the emergency department, it is determined that the patient suffered a myocardial infarction during the event. A lab analysis shows a rise in troponin levels, and a wall motion abnormality is found on echocardiogram, indicating that the patient sustained permanent damage to his heart muscle.

     Adverse events like this are not uncommon. In fact, more deaths occur each year due to medical errors than from motor vehicle crashes, breast cancer or AIDS. Although there are currently no reports that specifically look at EMS error rates, several suggest that EMS is no different than the rest of medicine with regard to patient safety. This is especially significant considering that 15,000 EMS systems and upwards of 800,000 EMS personnel respond to more than 16 million transport calls annually.