Keywords
1. Pain Management Disparities
2. Emergency Medical Services
3. Paramedic Analgesia Administration
4. Healthcare Racial Bias
5. Prehospital Care Equality
New Study Shines Light on Racial Inequality in Pain Treatment by Student Paramedics
A recent study published in BMC Emergency Medicine has uncovered alarming racial disparities in the administration of analgesia by student paramedics. The research highlights substantial inequities in prehospital pain management, with patient race being a determining factor in the likelihood of receiving pain relief following trauma. This article, enriched with the study’s findings from the University of the Sunshine Coast and Santa Fe Community College, delves into the data and calls for urgent systemic changes to address this healthcare shortcoming.*DOI: 10.1186/s12873-019-0245-2
Introduction
The management of pain, an essential aspect of emergency care, has been under scrutiny due to emerging evidence suggesting that it is not meted out equitably across different populations. In a retrospective study observing the influence of patient race on analgesia provision by student paramedics, published on May 6, 2019, a clear disparity was observed, indicating that Caucasian patients were more likely to receive analgesics than non-Caucasian patients.
The Study and Its Methodology
Investigators at the University of the Sunshine Coast and Santa Fe Community College, led by researchers Lord Bill B and Khalsa Sahaj S, delved into the FISDAP Skill Tracker database, reviewing student paramedic records from January 1, 2014, to December 31, 2015. The study evaluated 59,915 cases of alert patients aged between 16 to 100 years with a primary or secondary impression of trauma. The key outcome examined was the association of patient race with the administration of any analgesia by student paramedics.
A stepped modelling approach in logistic regression was employed, adjusting for gender, age category, and injury cause. Even after these adjustments, the research found that African American patients had the lowest odds of receiving any analgesia when compared to Caucasian patients—with an odds ratio (OR) of 0.60, indicating a significant disparity.
The Results Unpacked
The data from this extensive analysis paints a troubling picture of inequity in emergency medical services (EMS). Specifically, African American patients under the care of student paramedics were significantly less likely to receive analgesics for trauma-related pain. This disparity cannot be simply attributed to clinical uncertainty, as it persisted even after controlling for variables like the cause of injury, age, and gender. Ethnicity, it appears, plays an influential role in prehospital treatment decisions.
Implications of the Study
These findings are consistent with previous research that has indicated racial and ethnic disparities in pain management. Past studies, such as the seminal work “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care,” have documented the pervasive nature of healthcare disparities across various levels of care, including emergency medicine. This latest study suggests that student paramedics, like many healthcare professionals before them, may be unknowingly perpetuating a pattern of uneven care affecting minority patients.
The Role of Implicit Bias
While the study does not explicitly delve into the underlying causes of these disparities, it does draw attention to potential implicit bias among the student paramedics. Implicit bias refers to the attitudes or stereotypes that affect our understanding, actions, and decisions unconsciously. In the context of emergency care, these biases can influence the likelihood of administering analgesia, leading to unequal treatment based on race.
Urgent Need for Educational Interventions
These revelations indicate a pressing need for targeted educational interventions aimed at reducing racial disparities in emergency care, particularly in the training of student paramedics and other healthcare providers. Education standards, as outlined by the National Highway Traffic Safety Administration’s National Emergency Medical Services Education Standards, emphasize the ethical obligation to provide high-quality care to all patients regardless of race or ethnicity.
Addressing the Issue: Recommendations
To combat the disparities highlighted by this study, several actions are needed:
1. Implement comprehensive bias training programs for paramedics and other healthcare providers to raise awareness of unconscious biases and their impact on patient care.
2. Standardize pain management protocols that account for individual patient needs but eliminate the influence of a provider’s racial bias.
3. Encourage healthcare institutions to engage in self-assessment and reformulate policies that ensure equitable treatment.
4. Foster a culture of empathy within EMS education, reinforcing the importance of understanding and addressing the needs of patients from diverse backgrounds.
5. Increase transparency in patient care practices, with regular audits and reporting on pain management to ensure accountability and improvement.
Conclusion
The disparity in analgesia administration among student paramedics based on patient race magnifies a systemic issue within healthcare that necessitates immediate and substantive action. The findings of this study [DOI: 10.1186/s12873-019-0245-2] not only contribute to a growing body of evidence but also serve as a call to action. They underscore the importance of cultural competence in the education and training of those who are on the front lines of emergency medicine.
As we grapple with racial inequalities in all facets of society, it is paramount that the healthcare community rises to the challenge of delivering equitable care. The moral imperative is clear: all patients deserve a healthcare system that serves them with impartiality and dignity. It is the collective responsibility of healthcare professionals, educators, and policymakers to ensure that this goal becomes a reality.
References
1. Smedley, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: confronting racial and ethnic disparities in health care. Washington DC: National Academies Press. DOI: 10.17226/12875.
2. Balsa, A. I., & McGuire, T. G. (2003). Prejudice, clinical uncertainty and stereotyping as sources of health disparities. Journal of Health Economics, 22(1), 89–116. DOI: 10.1016/S0167-6296(02)00098-X.
3. Pletcher, M. J., Kertesz, S. G., Kohn, M. A., & Gonzales, R. (2008). Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA, 299(1), 70–78. DOI: 10.1001/jama.2007.64.
4. Anderson, K. O., Green, K. R., & Payne, R. (2009). Racial and ethnic disparities in pain: causes and consequences of unequal care. Journal of Pain, 10(12), 1187–1204. DOI: 10.1016/j.jpain.2009.10.002.
5. Green, C. R. et al. (2003). The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Medicine, 4(3), 277–294. DOI: 10.1046/j.1526-4637.2003.03034.x.
With a concerted effort to address these disparities, the EMS community can play a critical role in bridging the gap and ensuring that all patients receive appropriate and unbiased pain management, regardless of race.