209 - Emergency Medical Services Clinician Perspectives on Racial and Ethnic Disparities in Pediatric Prehospital Pain Management

Publication Number: 1198.209

Emily J. Dorosz, DC EMSC, Waldorf, MD, United States; Jessica M. Hippolyte, Children's National Medical Center, Washington, DC, United States; Gia M. Badolato, Children's National Health System, Washington, DC, United States; Meleah Boyle, Children's National Health System, Washington, DC, United States; Alix P. Mahon, Children's National Health System, Washington, DC, United States; Jessica Marshall, Children's National Health System, Washington DC, DC, United States; David A. Vitberg, District of Columbia Fire and EMS Department, WASHINGTON, DC, United States; Marshall Washick, DC Fire and EMS, Washington, DC, United States; Monika Goyal, Children's National Medical Center, Washington, DC, United States; Caleb E. Ward, Children's National Medical Center, Washington, DC, United States

Background: There are racial and ethnic disparities in the care provided by Emergency Medical Services (EMS). Injured Black and Hispanic children are less likely to have their pain assessed and receive analgesia compared to White children. Audit and feedback tools can improve the quality of clinical care and may help reduce disparities. Little is known about EMS clinicians' perspectives on healthcare disparities or how to mitigate them.

Objective: Our objective was to determine EMS clinicians' perspectives on disparities in pediatric pain management and assess knowledge and attitudes regarding equity-focused audit and feedback tools.

Design/Methods: We administered an electronic survey to an urban fire-based EMS agency that responds to 150,000 9-1-1 calls annually. The survey was conducted as a baseline assessment for a study analyzing the efficacy of an equity-focused audit and feedback intervention. Eligible respondents were paramedics and emergency medical technicians engaged in clinical care. Descriptive statistics were generated to summarize survey findings. We conducted a regression analysis to determine the impact of clinician race and ethnicity on responses.

Results: Of the 65 respondents, 51% identified as non-Hispanic White, 28% non-Hispanic Black, and 6% Hispanic. Most respondents were male (74%) and worked as Paramedics (63%) (Table 1). A majority (52%) agreed that the color of a patient's skin determined the quality of medical care patients received with 86% reporting that White patients received high-quality care compared to 66% and 55% for Black and Hispanic patients, respectively. A majority (54%) agreed that a patient's ethnicity or culture affects how they deal with pain. Only 31% of respondents had previously received an audit and feedback report. Almost all (80%) agreed this could be a useful tool to improve clinical practice, and 65% agreed this might help identify and mitigate disparities. We observed differences in beliefs based on the race and ethnicity of respondents (Table 2). Non-Hispanic Black respondents were less likely to agree that Black patients were likely to receive high-quality medical care (OR 0.21, 95% CI 0.05, 0.81). No differences were observed based on respondents' years of clinical experience.

Conclusion(s): EMS clinicians agreed there are disparities in the quality of prehospital care, with Black and Hispanic patients less likely to receive high-quality care. EMS clinicians had limited experience with audit and feedback tools. Further research is needed to assess whether audit and feedback tools can mitigate disparities in prehospital care,

Table 1
Demographics of Survey Respondents.

Table 2
Attitude and beliefs of EMS clinicians regarding disparities in pediatric prehospital pain management (page 1 of 2).

Table 2 continued
Attitude and beliefs of EMS clinicians regarding disparities in pediatric prehospital pain management (page 2 of 2).