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Study finds racial disparities in treatment by Oregon EMS agencies

Oct 16, 2018
The study, titled Inequity 911: Under Treatment of Racial Minority Patients by Oregon EMS Agencies, was completed by professor Jamie Kennel, who heads the Emergency Medical Services and Paramedic Education programs jointly offered by Oregon Institute of Technology and Oregon Health & Science University.
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Portland, OR. – New research has found evidence that racial minorities in Oregon are receiving a lower quality of Emergency Medical Services treatment compared to White Oregonians.

The study, titled Inequity 911: Under Treatment of Racial Minority Patients by Oregon EMS Agencies, was completed by professor Jamie Kennel, who heads the Emergency Medical Services and Paramedic Education programs jointly offered by Oregon Institute of Technology (Oregon Tech) and Oregon Health & Science University (OHSU). The study was co-sponsored by Oregon Health Authority’s Emergency Medical Services and Trauma Systems Program and the Oregon Office of Rural Health.

A first of its kind in Oregon, the Inequity 911 study assessed the racial equity of medical treatment by Emergency Medical Services (EMS) providers – emergency medical technicians and paramedics – when Oregonians called 911 for pain-related emergencies. Using the most comprehensive dataset of EMS medical charts available in the state, this investigation analyzed more than 104,000 EMS medical charts between 2015 and 2017. The study found evidence that EMS medical providers treated Black and Asian patients with significantly less pain medication than White patients for comparable levels of pain and injuries. Specifically, Black patients were 40% less likely, and Asian patients 36% less likely to receive pain medication from EMS providers compared to White patients in Oregon. Importantly, these treatment disparity results hold constant for other factors that may influence pain medication treatment, including differences in pain scores; patient gender, age, insurance status, and the anatomical location of the injury or complaint of pain.

“Racial treatment disparities in health care have been well documented for the past few decades, but for many reasons, racial treatment disparities by EMS providers have not been thoroughly investigated,” said professor Kennel, who is also a paramedic. “This study found evidence that when controlling for many of the clinically relevant factors that should affect the decision to administer pain medications to a patient, the non-medically relevant factor of race had significant impact on patients receiving pain medications or not.”

When looking at only patients with private health insurance, the racial treatment disparity is even larger compared to patients on Medicare, Medicaid, or without health insurance. For example, Black patients with private insurance were 56% less likely to receive pain medications compared to White patients with private insurance. This study provides evidence that these effects are not purely the result of racial minorities being overrepresented in lower socioeconomic status, but rather race itself having a negative impact on treatment.

“Providing racially disparate medical treatment goes directly against the ethics of all modern day medical providers’ training, education, desires, and beliefs,” said Rob McDonald, operations manager at American Medical Response (AMR). “This study further corroborated our own internal analysis, suggesting that EMS treatment inequity is real and is likely taking place beneath the conscious radar of most individual providers or the health care institutions that employ them. For almost a year now we’ve been proactively working with professor Kennel to better understand the mechanisms at work and further explore ways that our training, recruitment, and community outreach efforts can improve our already high quality of care to all Oregonians.”

For the last few decades, the EMS industry has dramatically increased its medical sophistication and can provide almost the full component of emergency medical care in the field that once took place only in hospital emergency departments. This includes emergency medical treatment for a variety of traumatic and medical emergencies, such as motor vehicle collisions, heart attacks, strokes, seizures, and other emergency medical events.

David Lehrfeld, MD, who is medical director of OHA Emergency Medical Services & Trauma Systems said, “When compared to many other medical specialties like oncology and cardiology for example, EMS and the emergency departments are considered a safety net provider, delivering treatment to vulnerable populations, and thus increasing the importance of providing care equitably across social categories of race, gender, and class. This study provides evidence that the inequity of the medical care they receive starts at the beginning of their interaction with health care when they call 911 for EMS treatment.”

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS), Medicare Rural Hospital Flexibility Program, supported the Inequity 911 study. The study received approval from the Institutional Research Boards of both the OHA Public Health Division/Multnomah County Health Department and the Oregon Institute of Technology.


About Oregon Institute of Technology
Founded in Klamath Falls in 1947, Oregon Institute of Technology (Oregon Tech) is the premier public polytechnic institution in the Pacific Northwest. Oregon Tech provides bachelor’s and master’s degree programs in engineering, health technologies, business, technology, communication, and applied sciences that prepare students to be effective participants in their professional, public, and international communities through applied, relevant learning and professional practice. Oregon Tech has a full-service, residential campus in Klamath Falls, an urban, industry-focused campus in Portland-Metro (Wilsonville), an Online Campus, and offers degrees at Boeing Seattle, Salem, and at other sites. Visit www.oit.edu to learn more about Oregon Tech.

About Oregon Health & Science University
OHSU is the only academic health center in Oregon and is nationally distinguished as a research university dedicated solely to advancing health sciences. This singular purpose allows us to focus on discoveries that prevent and cure disease, on education that prepares physicians, dentists, nurses and other health professionals for the evolving health care environment, and on patient care that incorporates the latest advances. Based in Portland, we are one of Oregon’s largest employers, operate the top-ranked adult and children’s hospitals in the state, and secure competitive research funding of more than $400 million. As a public organization, we also provide services for the most vulnerable Oregonians and outreach to improve health in communities across the state.

About Oregon Health Authority
The Oregon Health Authority’s mission is to ensure all people and communities can achieve optimum physical, mental and social well-being through partnerships, prevention and access to quality, affordable health care. It includes most of the state’s health programs, including the Oregon Health Plan, Public Health Division, Oregon State Hospital, the Public Employees’ Benefits Board and the Oregon Educators Benefit Board.
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