Examining Racial, Ethnic, and Gender Disparities in the Treatment of Pain and Injury Emergencies.

Background: Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers' use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender. Methods: This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in the sample when 1) the primary impression was pain or injury, 2) the type of service was a 911 response, 3) the patient received treatment from and was transported by the EMS unit completing the PCR, and 4) the responding unit included one or more providers authorized to administer opioids. Results: The analysis identified a disparity in opioid administration by EMS providers during emergency transport (N = 27 448). Logistic regression reveals that EMS providers administered opioids to American Indian/Alaska Native patients (AI/AN) [n = 1610; 5.9%; P < .001; OR = 0.44] and those of Hispanic ethnicity (n = 1351; 4.9%; P = .001; OR = 0.74) at statistically significant lower rates (n = 14 769; 53.8%; P = .004; OR = 0.90) than they administer opioids to White patients. The analysis found EMS providers administer opioids to females at significantly lower rates (P = .004) compared to males. Conclusion: Wyoming EMS providers administer opioids to White and male patients more often than non-White and female patients. Our results do not show a significant difference in the administration of opioids between White and Black patients. However, the data indicate a statistically significant difference between Hispanic, AI/AN, and White patients as well as between male and female patients.

Practices and concerns related to naloxone use among emergency medical service providers in a rural state: A mixed-method examination.

The rate of opioid misuse and overdose continues to increase in rural areas of the U.S. In response, access to naloxone hydrochloride ("naloxone"), an opioid antagonist used to reverse opioid overdose, has increased among both first responders and laypeople. While plenty of research has examined naloxone use among laypeople, little remains known about practices and concerns related to naloxone among emergency medical services (EMS) providers. This is particularly true among those serving rural areas that are disproportionately affected by opioid overdoses and the underutilization of naloxone. Accordingly, a mixed-method approach consisting of a quantitative Internet survey (N = 854) and qualitative focus groups (N = 20) was utilized to examine practices and concerns related to naloxone among EMS providers in a rural state. Participants represented a range of EMS licensure levels and years of experience. Findings from the focus groups can be summarized under two major themes: 1) variance in naloxone use and 2) concerns about naloxone use. In addition, meaningful information on practices of and concerns related to naloxone use, including rates of naloxone administration, knowledge about naloxone use/overdose, confidence in administering naloxone and providing follow-up care, and perceptions of rural impact, were obtained from rural EMS. Information obtained from this study can help inform policy and prevention efforts specific to EMS providers serving rural areas, including providing further evidence for permitting all EMS providers, regardless of licensure level, to administer naloxone and ensuring that education about naloxone use is effectively disseminated to these providers.