Paramedics Confronting Unconscious Bias & Discrimination 

By Robbie MacCue

"A retrospective study of prehospital care records in Oregon showed black patients were 40% less likely to get pain medications than their white peers, as well as disparities in the Asian and Hispanic populations."

Kennel J, Withers E, Parsons N, Woo H. Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies. Med Care. 2019 Dec;57(12):924-929. doi: 10.1097/MLR.0000000000001208. PMID: 31730566.

NPR news affiliate, Oregon Public Broadcasting, interviews paramedics and care providers about this study and the response.

The question many are asking, as an industry or, as an EMS agency:
"What are we doing about it beyond just studying racial disparity?"

Cell phones, live streaming, & body camera footage

Objective video recordings have revealed horrific deaths and racially motivated murders that make it hard to deny the realities of racial injustice and discrimination beyond a few "bad actors."

It becomes more and more apparent that there are systemic issues related to the training police officers or paramedics receive (or said more accurately the lack of training.)

The body camera footage of paramedics called to help Earl Moore Jr, December 18, 2022, show two EMS providers in Springfield, Illinois blatantly disregarding human life. 

Have We Seen Any Changes?

From how providers deliver patient care to how organizations treat their providers, there is a systemic history of discrimination based on race, gender, sexual orientation, and age.

The Oregon study above was published in 2019, and authors again in a 2023 study showing, "Among EMS patients with long bone fractures, Black, non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics compared with White, non-Hispanic patients. These disparities were not explained by differences in clinical presentations, patient preferences, or community socioeconomic conditions."

Crowe RP, Kennel J, Fernandez AR, Burton BA, Wang HE, Van Vleet L, Bourn SS, Myers JB. Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures. Ann Emerg Med. 2023 May 12:S0196-0644(23)00267-6. doi: 10.1016/j.annemergmed.2023.03.035. Epub ahead of print. PMID: 37178100.

The country's largest municipal EMS system, FDNY in New York City, has a long history of disparity between their City Fire Department, composed predominantly of white men, and their EMS department counterparts that employs mostly women and people of color. 

January of 2023, the country's largest municipal EMS department union filed a lawsuit with the EEOC over the pay gap between these two departments. This is despite the New York City council unanimously voting in favor of pay equity in June of 2020, the city's mayor Bill DeBlasio spent years stonewalling the EMS department citing 'the work is different' as a reason why they are paid so little.

DeBlasio was echoing over 30+ years of systemic inequities of prior city administrations dating back to mayor Ed Koch. In his infamous remarks after attending a graduation of EMS providers when asked when they could expect pay parity, the mayor responded "Never, I hope. Because you're not in a dangerous job." 

What Can We Do about it?

NASEMSO issued a Statement of Unity & Equity in 2020, calling on our industry leaders, "We must identify any biases within ourselves, and have the courage and empathy to fully commit our platform and resources to create an inclusive, diverse society with the cornerstone of equality for all."

June 28, 2020

Statement of Unity & Equity

In 2020, the EMS Leadership Academy hosted a series of conversations to address racism and unconscious bias, with over 900 participants to date enrolling in this training. 

In 2023, thanks to a grant provided to the Southern Tier Healthcare System (STEMS) of Olean, New York, the EMS Leadership Academy teamed up with renowned safety expert, Dr. I. David Daniels of ID2 Solutions, to take a different training approach to Diversity, Equity, Inclusion & Justice. 

Leading With Empathy: A Three Stepped Approach to Fostering More Diversity, Equity, Inclusion & Justice - Designed for Care Providers

Step 1. Understanding Mindset & How Our Brains Work

This introduction discusses how to help foster diversity, equity, inclusion, justice, and belonging in caregiver organizations. Strategies for problem-solving and success are highlighted, such as maintaining a learner's mindset, understanding internal systems and environments, and fostering non-judgmental conversations. Reticular activating systems and the amygdala are discussed in order to create conscious awareness and prevent blind spots. Additionally, the importance of leadership, transformational education, and understanding different psychological processes is discussed. Strategies for creating a meaningful and sustainable world are discussed to ensure all people are treated with respect and understanding.

Step 2. Creating a Sense of Safety: Exploring the Connection between Diversity, Equity, Inclusion, and Justice.

This section provides an overview of the importance of psychological safety for care providers. It explains the differences between safety as a condition and feeling safe as a subjective emotion. Research on employee engagement is discussed, with three levels of psychological safety identified (physical, cognitive, and emotional). The potential risks posed by systems and roles that are not well-defined or that may have an adverse impact on certain populations are examined. Finally, solutions are suggested for organizations to prioritize creating a shared belief system and encouraging diversity, equity, fairness, and justice in order to mitigate these risks.

Step 3. Designing The Future That Works For More

This last section emphasizes the importance of considering mental and psychosocial health when creating change. Five key takeaways are discussed in detail such as starting from scratch, following the clues, being mindful of structure, being creative, and striving for a safe and accepting environment. Additionally, communication, cooperation, appreciative inquiry, and creating sustainable outcomes are highlighted as tools to create the desired outcome and relationships. Additionally, creative problem-solving, honest feedback and building diverse and inclusive environments need to be addressed in order to be successful.

You can learn more about this DEIJ training, Leading With Empathy,  for your department and begin to influence the way people see themselves and others, both inside and outside your organization.

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Robbie MacCue

Robbie is the cofounder of the EMS Leadership Academy, host of the EMS Leadership Summit, and paramedic captain in Albany, NY where he serves in the Special Operations Division for ground rescue, flight, & tactical medicine. He performs international medical flights with North America's largest fixed wing Air Ambulance service. For more than 14 years, Robbie served as President of a non-profit EMS organization advocating for increased funding and raising the bar of excellence. In addition, Robbie is an American Heart Association advocate who is passionate about empowering others to save more lives. He has taught physicians, nurses, and other medical providers Advanced Cardiac Life Support at medical schools and hospitals throughout Manhattan. Robbie has undergraduate degree from Rensselaer Polytechnic Institute, and a MBA from Case Western Reserve University and provides business consulting that combines his love of technology with healthcare.

Robbie MacCue

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