Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review.

BACKGROUND: Emergency medical services (EMS) often serve as the first medical contact for ill or injured patients, representing a critical access point to the health care delivery continuum. While a growing body of literature suggests inequities in care within hospitals and emergency departments, limited research has comprehensively explored disparities related to patient demographic characteristics in prehospital care. OBJECTIVE: We aimed to summarize the existing literature on disparities in prehospital care delivery for patients identifying as members of an underrepresented race, ethnicity, sex, gender, or sexual orientation group. METHODS: We conducted a scoping review of peer-reviewed and non-peer-reviewed (gray) literature. We searched PubMed, CINAHL, Web of Science, Proquest Dissertations, Scopus, Google, and professional websites for studies set in the U.S. between 1960 and 2021. Each abstract and full-text article was screened by two reviewers. Studies written in English that addressed the underrepresented groups of interest and investigated EMS-related encounters were included. Studies were excluded if a disparity was noted incidentally but was not a stated objective or discussed. Data extraction was conducted using a standardized electronic form. Results were summarized qualitatively using an inductive approach. RESULTS: One hundred forty-five full-text articles from the peer-reviewed literature and two articles from the gray literature met inclusion criteria: 25 studies investigated sex/gender, 61 studies investigated race/ethnicity, and 58 studies investigated both. One study investigated sexual orientation. The most common health conditions evaluated were out-of-hospital cardiac arrest (n = 50), acute coronary syndrome (n = 36), and stroke (n = 31). The phases of EMS care investigated included access (n = 55), pre-arrival care (n = 46), diagnosis/treatment (n = 42), and response/transport (n = 40), with several studies covering multiple phases. Disparities were identified related to all phases of EMS care for underrepresented groups, including symptom recognition, pain management, and stroke identification. The gray literature identified public perceptions of EMS clinicians' cultural competency and the ability to appropriately care for transgender patients in the prehospital setting. CONCLUSIONS: Existing research highlights health disparities in EMS care delivery throughout multiple health outcomes and phases of EMS care. Future research is needed to identify structured mechanisms to eliminate disparities, address clinician bias, and provide high-quality equitable care for all patient populations.

Implementation of a standardized pregnancy screening process to address gender disparities in radiology turn-around-time and ED length of stay.

OBJECTIVE: The objective of this initiative was to quantify and intervene upon suspected gender disparities in CT turn-around-time and emergency department (ED) length of stay. METHODS: This was a single-site before-after quality improvement initiative including patients aged 12-50 who underwent CT chest and/or abdomen/pelvis. The intervention included protocolization of the pregnancy screening process in triage. Primary outcomes included the difference between women of childbearing age and similarly aged men in regards to CT turn-around-time and ED length of stay. Pre- and post-intervention data were analyzed, including an "intensive intervention period" subanalysis. RESULTS: CT turn-around-time for women of childbearing age was 19 min longer than for similarly aged men at baseline and did not change significantly post-intervention. ED length of stay was 27 min longer for women of childbearing age compared to similarly aged men at baseline and 7 min longer post-intervention, although this was still a significant difference. During the intensive intervention period, CT turn-around-time for women of childbearing age was 15 min longer than similarly aged men but the difference in ED length of stay of 10 min was no longer significant. CONCLUSIONS: There is gender disparity in CT turn-around-time and ED length of stay in our ED, highlighting an important area for improvement to promote equitable care. A quality improvement initiative that aimed to protocolize pregnancy testing in triage did not show sustainable improvement in these outcomes but did result in increased pregnancy testing.

RéSUMé: OBJECTIF: L'objectif de cette initiative était de quantifier et d'intervenir sur les disparités présumées entre les sexes dans le délai d'exécution du scanner et la durée du séjour au service des urgences. MéTHODES: Il s'agissait d'une initiative d'amélioration de la qualité à un seul site avant-après, incluant les patients âgés de 12 à 50 ans qui ont subi une TDM thoracique et/ou abdominale/bassin. L'intervention comprenait la protocolisation du processus de dépistage de la grossesse lors du triage. Les résultats primaires comprenaient la différence entre les femmes en âge de procréer et les hommes du même âge en ce qui concerne le délai d'exécution du scanner et la durée du séjour aux urgences. Les données avant et après l'intervention ont été analysées, y compris une sous-analyse de la "période d'intervention intensive". RéSULTATS: Le temps d'exécution de la TDM chez les femmes en âge de procréer était 19 minutes de plus que chez les hommes de même âge au départ et n'a pas changé de façon significative après l'intervention. La durée de séjour aux urgences était de 27 minutes de plus pour les femmes en âge de procréer par rapport aux hommes du même âge au départ et de 7 minutes de plus après l'intervention, bien que cette différence reste significative. Au cours de la période d'intervention intensive, le temps de passage au scanner des femmes en âge de procréer était de 15 minutes plus long que celui des hommes du même âge, mais la différence de 10 minutes dans la durée de séjour aux urgences n'était plus significative. CONCLUSIONS: Il existe une disparité entre les sexes en ce qui concerne le délai d'exécution du scanner et la durée de séjour dans nos urgences, ce qui met en évidence un domaine important à améliorer pour promouvoir des soins équitables. Une initiative d'amélioration de la qualité visant à protocoliser le test de grossesse au triage n'a pas montré d'amélioration durable de ces résultats mais a entraîné une augmentation des tests de grossesse.

Implementing a Patient Tracking System in a Large EMS System.

Objective: Accurate tracking of patients poses a significant challenge to prehospital and hospital emergency medical providers in planned and unplanned events. Previous reports on patient tracking systems are limited primarily to descriptive reports of post incident reviews or simulated exercises. Our objective is to report our experience with implementing a patient barcode tracking system during various planned events within a large urban EMS system.Methods: In 2018, representatives from the Chicago Department of Public Health, Chicago Fire Department EMS, private EMS agencies, and 27 hospitals in the Chicago EMS System were trained on the use of a web-based patient tracking system using barcoded triage tags and wristbands to monitor triage category and hospital destination during an event. The tracking system was used on two planned operational days and three pre-planned mass gathering events. The primary outcome was the percent of patients initially scanned by EMS that were scanned by the hospital. Descriptive statistics were collected. Barriers to patient tracking system use were identified.Results: Each event was reviewed for the number of patients assigned a barcode identifier and scanned by EMS that were then scanned by the hospital. In the first planned operational day, 57% (359/622) of patients initially scanned by EMS were scanned by the hospital. In the second planned operational day, 88% (355/402) of EMS scanned patients were scanned by the hospital and 37% (133/355) were assigned a final disposition. At three city mass gathering events, there were 79% (50/63), 95% (190/199), and 82% (46/56) of EMS scanned patients also scanned by hospitals. Logistical and technological challenges were documented.Conclusions: Use of a web-based system with barcode identifiers successfully tracked patients from prehospital to hospital during planned operational days and mass gathering events. Percent of scanned patients increased after the first operational day and remained consistent in subsequent events. Limitations to the patient tracking system included logistical and technological barriers. Similar patient tracking systems may be implemented to assist with event management in other EMS systems.