Research commissioned by the Vancouver Fire Department found that racial minorities, women and the poor and elderly receive a lower quality of treatment for emergency medical services when compared with white male patients.
In response, the city announced Monday that steps are being pursued to improve equity in the delivery of those services regardless of person’s race.
The city, the fire department and AMR, the ambulance service contracted for the majority of the county, worked with Healthcare Equity Group in October to evaluate how those services are delivered to Vancouver’s diverse population. The city said in its announcement that the research was initiated by the fire department.
Fire officials and AMR provided data to the group. The first two treatments selected for analysis were pain management and cardiac arrest chest pain, according to the city. Treatment disparities were in both categories for some marginalized communities in Vancouver.
Data shows disparities
Based on that data, the group determined that Asian patients are 58 percent less likely to receive a pain assessment for cardiac chest pain when compared with white patients.
Black patients are 56 percent less likely to receive intravenous or intraosseous infusions (injections directly into bone marrow) for cardiac chest pain when compared with white patients.
Hispanic patients are 23 percent less likely and Asian patients are 29 percent less likely to receive a pain assessment for traumatic injuries and atraumatic pain when compared with white patients, the study found.
The study also found that Hispanic patients are 35 percent less likely to receive pain medication compared with white patients. Hispanic patients are less likely to get those medications overall when in moderate to severe pain.
Researchers also looked at treatment relative to gender and age. According to their findings, female patients are 21 to 29 percent less likely to undergo various treatments for cardiac chest pain when compared with male patients experiencing similar symptoms.
Poor and elderly patients were less likely to receive the same emergency medical treatments in all measures reviewed, including pain assessments, attempts at intravenous or intraosseous infusions, receipt of pain medications and reported reductions in pain levels, according to the findings.
Focus on systems
Healthcare Equity Group reached its determinations after assessing the agencies’ internal systems, policies and organizational practices to identify gaps and opportunities for improvement in their work environments, and to better understand the issue and how to address it.
Researchers handed over their findings in June, which city officials reviewed, in addition to a prepared presentation, in July.
The group reported that in medicine, “clinically irrelevant factors,” such as a patient’s race, can affect the quality of treatment received, independent of the medical provider’s awareness of this influence.
“Recent research in emergency medical services conducted by us and others has shown that racial minorities receive a lower quality of treatment when compared to white patients,” the report says.
In reviewing the agencies’ organizational workings, the group recommended that the fire department and AMR develop separate “process-of-care reports” to improve visibility of their overall performance, establish the ability to consistently report on the impact of training resources and increase the robustness of their reporting capabilities.
There are some challenges to making improvements, however. The group said that training topics are primarily chosen to help recertification needs of providers rather than train in areas where deficiencies exist, and there appears to be an inability to determine if training resources are making a difference.
All of the findings and the presentation can be found on the city’s website at www.cityofvancouver.us/fire.
‘Necessary first step’
Vancouver Fire Chief Joe Molina said the group’s analysis is a necessary first step in helping raise awareness within his department that inequities exist. It will also help to examine the effects that inequities have on patient care, and to gain an understanding of the disparities that exist in services, he said.
“I respect the professionalism and dedication of each and every one of our EMS providers, and I look forward to working together on eliminating treatment disparities for impacted communities in Vancouver,” Molina added.
“The research initiated by the city and VFD parallels the work being done by AMR Portland surrounding the identification of treatment disparities and development of health equity initiatives to better serve their community,” AMR Regional Director Rocco Roncarati said.
“The findings and recommendations from the research done in both Vancouver and Portland presents an opportunity for us to make a major change in how emergency medicine is delivered and potentially improve patient outcomes for future generations,” Roncarati said.
Molina said that the group’s recommendations are being reviewed and prioritized currently. The prioritization will require input from fire department employees and training staff, as well as AMR and the Medical Program Director.
“There will also be a need to engage the BIPOC community to get their perspective on how we can make the EMS system equitable. It will be critical to get that community involved as all too often institutions engage in solutions without ever asking those affected to be part of finding the solutions,” Molina said.
