Iran Journal of Nursing

Introduction
Patient safety is an important component of the health care system and it is one of the main pillars of quality in health care organizations. Improving safety culture is associated with safe practice and reduction of adverse events. Patient safety refers to avoiding harms or side effects to patients during the provision of health care. Side effects and medical errors are among the challenges facing health care providers in all countries. One out of ten patients admitted to hospitals experience unfortunate events, half of which are preventable. It is important to understand the patient safety in health care to provide safe patient care. Although the percentage of medical errors is high, the evaluation and promotion of safety culture is relatively low. The importance of monitoring patient safety, especially in pre-hospital emergency, is undeniable, considering the presence of unexpected and unfamiliar conditions, environmental stressors, and limited human and medical resources.
One of the most important causes of injury and death in patients is the poor delivery of pre-hospital emergency care. However, the patient’s safety status in the pre-hospital emergency system of Iran is unclear and there is a lack of information about the adverse complications. Clinical managers need to have a clear understanding of safety culture to make informed decisions and use strategies to improve patient safety. Assessing the current patient safety culture status can promote the safety attitude among the health care workers, including pre-hospital emergency medical staff (EMS), who are at the frontline of patient management in critical situations. This study aims to determine the attitude towards patient safety in pre-hospital EMS in Mashhad, northeastern Iran.
Materials and Methods
This descriptive cross-sectional study was conducted in in Mashhad city in 2019. Participants were 438 full-time pre-hospital EMS with at least 6 months of experience who were selected by a census method. Data were collected using the Emergency Medical Services Safety Attitudes Questionnaire (EMS-SAQ), which assesses six dimensions related to patient safety culture with 30 items. Data were analyzed in SPSS v. 16 software using Pearson correlation test, one-way analysis of variance, Chi-square, independent t-test and linear regression analysis.
Results
According to the results of the study, 13.75% of the subjects had a positive attitude towards patient safety (score >75) and 86.25% had a negative attitude (score <75). The mean total score of EMS-SAQ was 53.55±10.60. The highest positive attitude was related to stress recognition (34.2%) and the lowest positive attitude was related to safety climate and perception of management (5.7%). There was no statistically significant relationship between any demographic characteristics and the EMS-SAQ score (P>0.05).
Discussion
The patient safety culture among pre-hospital EMS in Mashhad need to be improved by further research and taking measures such as holding educational courses for them, increasing the number of staff, launching an error reporting system and including topics related to patient safety in the in-service training of staff.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1398.221).

Funding
This article was extracted from Majid Balouchi's master thesis in emergency nursing approved by Iran University of Medical Sciences, Tehran, Iran.

Authors' contributions
Conceptualization, supervision, preparing intervention protocols and educational materials, data analysis and interpretation, preparing the initial draft, and final approval: Tahereh Najafi; Preparation of intervention protocol and educational materials, data collection, data analysis and interpretation, and preparation of initial draft, and final approval: Majid Balouchi; Data analysis and interpretation, preparation of initial draft, and final approval: Shima Haghani.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank the deputy for research of Iran University of Medical Sciences, officials and staff of pre-hospital emergency services in Mashhad and Mr. Mohsen Zarghani and Mr. Omid Sabouri.


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