Racial and gender disparities in violent trauma: Results from the NEMSIS database.

ABSTRACT

BACKGROUND: Barriers to EMS care can result in suboptimal outcomes and preventable morbidity and mortality. Large EMS databases such as the National Emergency Medical Services Information System (NEMSIS) dataset provide valuable data on the relative incidence of such barriers to care. METHODS: A retrospective cross-sectional analysis was performed using the NEMSIS database. Cases of violent trauma were collected based on gender and racial group. Each group was analyzed for the ratio of cases that involved an EMS barrier to care. Chi-square testing was used to assess associations, and the relative risk was used as the measure of strength of association. For all tests, statistical significance was set at the 0.05 level. RESULTS: 719,812 cases of violent trauma were analyzed using the NEMSIS dataset. EMS encountered barriers to care for white and non-white patients was found to be 4.9% and 4.0% respectively. The difference between groups was found to be 0.9% (95% CI [0.7%, 1.1%] p < 0.0001). RR was 1.23 for white patients (95% CI [1.19, 1.26]), and 0.82 (95% CI [0.79, 0.84]) for non-white. EMS barriers to care for male and female patients was found to be 6.03% and 3.34%, respectively. The difference between groups was found to be 2.7% (95% CI [2.6%, 2.8%] p < 0.0001). RR for male patients was 1.80 (95% Cl [1.76, 1.84]) while RR for female patients was 0.55 (95% CI [0.54, 0.57]). CONCLUSIONS: Racially white patients and male patients have a statistically significant higher risk of encountering an EMS barrier to care in cases of violent trauma.