Editor’s Note: Read Dr. Cedric Dark’s commentary on this EMRA + PolicyRx Health Policy Journal Club article.

Recent research has provided insight into what could prove to be another example of systemic racism in the delivery of health care.¹ According to a 2019 study, EMS are more likely to transport a black or Hispanic patient to a safety-net hospital than their white counterparts even when such patients come from the same ZIP code. The authors used data from a nationwide Medicare data bank and then identified ZIP codes with an adequate amount of diversity as well as transports by EMS services. They also controlled for a multitude of variables, including socioeconomic status and location. Ultimately, they assessed whether the patient was transported to a safety-net hospital versus a reference hospital based on the patient’s race.

The point is quite clear: There are disparities in the way prehospital medicine is administered to minority patients. It is not understood whether this disparity has resulted in a difference in outcomes. However, it points to a need for more focused studies on prehospital medicine and the potential for racial disparities. 

There is more to be done, and it can be done now. Of the limitations with this paper, I find the most astonishing to be a product of American society: Out of 38,423 ZIP codes, only 5,606 of them had enough diversity to be included in the study. The requirements for diversity in this study meant having at least 10 percent white, black, and Hispanic patients in the same ZIP code. Only 15 percent of ZIP codes in America contain at least 10 percent of the three largest races and ethnicities in this country. These are the real-life ramifications of generations of segregation and redlining. Our generation must still actively and aggressively challenge segregation, a problem possibly now worse than ever due to gentrification.

Nationwide, EMS personnel are 83 percent white, and in the last 10 years, there has not been much increase in the 8 percent of black paramedics. This aspect of health care workforce diversity has not garnished as much attention as the racial disparities among physicians.

We don’t need a study to tell us this is unacceptable. We should diversify our EMS personnel, especially given that blacks are nearly 50 percent more likely to use the emergency department for health care than whites. 

Dr. Ellis is an emergency medicine medical education fellow at Beth Israel Deaconess Medical Center in Boston.

Reference

1. Hanchate AD, Paasche-Orlow MK, Baker WE, et al. Association of race/ethnicity with emergency department destination of emergency medical services transport. JAMA Netw Open. 2019;2(9):e1910816.