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To Combat Potential Implicit Bias in EMS, Diversify the Workforce

By Cedric Dark, MD, MPH, FACEP | on June 24, 2020 | 0 Comment
Policy Rx
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Chris Whissen & Shutterstock.com
Chris Whissen & Shutterstock.com

Unconscious bias, the subject Uché Blackstock, MD, wrote a November 2019 column on in ACEP Now, can be defined as “a person’s tendency to associate a group or category attribute, such as being black, with a negative evaluation (unconscious prejudice) or another category attribute, such as being violent (unconscious stereotype).”1 People in all walks of life throughout society, including physicians, possess these unconscious (or implicit) biases.

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ACEP Now: Vol 39 – No 06 – June 2020

These subtle subconscious feelings that we and other health care workers might harbor toward our patients have likely been present since the beginnings of the profession. However, it is only relatively recently that we have recognized these implicit biases, sought to better understand them, and devised strategies to ameliorate them.2 Racial and ethnic disparities in the emergency department delivery of analgesia for something as universally painful as a long-bone fracture have been known for several decades; a recent study extends the concern about a potential unconscious bias prevalent in prehospital care.3

Controlling for socioeconomic status and geography, researchers investigated if patients were transported to safety-net facilities based on their race. For black patients, transport to a safety-net facility by EMS occurred approximately 5 percent more often than for white patients; for Hispanic patients, transport to a safety-net facility occurred about 2.5 percent more often.4

These data reflect a snapshot in time, suggesting—but not proving—implicit biases may be at play in the prehospital setting. We should ask whether these are the results of individual decisions made by prehospital health care workers. Or are these results the effect of systemic issues involving medical direction protocols? Or perhaps they can be explained by less nefarious means, such as patient preference.

Regardless of the cause(s), the National Association of EMS Educators recommends the following as one possible solution: “A diverse EMS workforce, representative of the patients it serves, is crucial to promote understanding among EMTs and paramedics, patients and other providers in the health care system, and to eliminate disparities in care experienced by minority patients.”

As in business and in medicine, the time for greater workforce diversity in prehospital care is at hand.  


Dr. DarkDr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

  1. Blackstock U. Overcoming unconscious bias takes strategy and collective effort. ACEP Now. 2019;38(11):19.
  2. Brownstein M. Implicit bias. Stanford Encyclopedia of Philosophy website. Accessed May 11, 2020.
  3. Todd KH, Deaton C, D’Adamo AP, et al. Ethnicity and analgesic practice. Ann Emerg Med. 2000;35(1):11-16.
  4. Hanchate AD, Paasche-Orlow MK, Baker WE, et al. Association of race/ethnicity with emergency department destination of emergency medical services transport. JAMA Netw Open. 2019;2(9):e1910816.

Pages: 1 2 | Single Page

Topics: Black Health & WellnessDiversityEMSRacial Bias

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About the Author

Cedric Dark, MD, MPH, FACEP

A graduate of Morehouse College, Cedric Dark, MD, MPH, FACEP earned his medical degree from New York University School of Medicine. He holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University where he served as chief resident. Currently, Dr. Dark is an associate professor at the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine. Dr. Dark is the 2017 recipient of the Texas Medical Association’s C. Frank Webber Award, a 2019 American College of Emergency Physicians Choosing Wisely Champion, the Emergency Medicine Residents’ Association 2021 Joseph F. Waeckerle Alumni of the Year Award, one of emergency medicine’s Top 45 Under 45, and on Elemental’s List of 50 Experts to Trust in a Pandemic. He is currently on the Board of Directors for Doctors for America and the medical editor-in-chief for ACEP Now, the official voice of emergency medicine. .

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