By Jamie Kennel, PhD, NRP; Remle P. Crowe, PhD, NREMT; Soma de Bourbon, PhD; Miranda Worthen, PhD; Celeste Calderon; Michael Mason; Daniel Nazzareta; Joseph Graterol, MD
Completing an electronic health record may not always feel like a life-saving component of prehospital care, but EMS data is essential for improving patient outcomes, optimizing system performance and shaping public health policies.
Quality EMS data provides the foundation needed to confidently understand your local clinical performance, how effective your last training effort was; and also to engage in more persuasive discussions with your hospital and local regulators as you argue for increased funding. Importantly, EMS data is crucial in identifying and addressing inequities that impact the quality of care across different populations.
Highlights:
- EMS data is essential for improving patient outcomes, system performance and public health policies, especially in addressing care inequities across underrepresented populations, such as racial minorities and those of lower socioeconomic status
- Inequities in EMS roles include disparities in bystander CPR rates, pain management, 911 resource activation and workforce diversity
- Participants in the EMS Data Equity Summit learning community identified gaps in EMS data collection, representation and quality, with a focus on three steps: recognizing inequities, understanding root causes and addressing them
The term “inequity” can evoke strong negative emotions, yet we must become comfortable with exploring the uncomfortable, especially in situations like this where our desire to provide equitable care is not supported by our performance data. As EMS clinicians, we are committed to delivering the best possible care to all patients, but research increasingly shows that underrepresented populations are much more likely to receive a lower quality of EMS care for the same condition, regardless of clinical appropriateness or patient preference. The causes of these EMS treatment inequities are complex, requiring focused, collaborative efforts from multiple stakeholders to address them.
To better understand inequities in prehospital care and explore how data can be leveraged to improve both process and outcomes, the San Francisco Fire Department partnered with researchers at San José State University to host an EMS Data Equity Summit in January. This event was made possible through grant funding contributed by the CARESTAR Foundation, an organization that uses a racial equity lens to fund and advocate for improvements in prehospital care, and the National Science Foundation: Civic Innovation Challenge. This summit aimed to identify and address gaps in EMS data that hinder health equity in care delivery and outcomes. Discussions highlighted challenges such as inadequate data collection, representation, quality, literacy, ownership and accountability. Presentations from EMS agencies throughout the state, national EMS data experts, public health partners and community engagement specialists provided potential strategies for overcoming these challenges.
Building on the momentum from the EMS Data Equity Summit, a year-long learning community was established. Each month, participants gather virtually to discuss a topic related to health equity in EMS. The curriculum is divided into three modules:
- See it
- Understand it
- Address it
This three-part article series will summarize the findings of each module, beginning with the first module.
Module 1: See it – What inequities are happening in EMS?
Roles of EMS in the community and equity
In the first session of the learning community, participants explored the various roles of EMS within the community, focusing on areas where inequities might arise. Beyond providing assessment, treatment and transport for patients who are ill or injured, EMS also plays several additional vital roles, including:
- Responding to community-members in crisis
- Providing community education on lifesaving interventions
- Providing a critical safety net to access the broader healthcare system
- Providing quality skilled jobs as a local employer
- Purchasing goods and services in the local community
While these areas represent a growing area of equity research, there is sufficient evidence today to suggest inequities are present in each of these roles.
For example, communities with greater socioeconomic vulnerabilities are more likely to experience decreased bystander CPR rates, slower activation of 911 resources and lower rates of pain management. Additionally, EMS serves as an employer within the community, yet the workforce does not commonly reflect the diversity of the populations served.
|More: Becoming an agency of one: DEI among the ranks
Improving EMS data and quality management for equity
The second session focused on the current state of EMS data and quality management practices, with an emphasis on whether equity is embedded in these frameworks. Participants began by collectively identifying underserved populations within their communities. Populations highlighted included racial and ethnic minorities, women, transgender individuals, those of lower socioeconomic status, people with limited English proficiency, those who are obese, individuals with substance use disorders, people experiencing homelessness and older adults.
The group then discussed the types of data that are currently collected and those that should be collected to better “see” the quality of care being provided to these marginalized groups. Improvements in the national EMS data standard for collection of data for gender and housing status were noted, while gaps in other areas were noted. In particular, the lack of standardized data elements related to patients’ preferred languages was highlighted.
To round out the session, Paramedic Josh Worth from Pittsburgh, Pennsylvania, presented findings from a quality improvement project in which EMS data revealed disparities in pain management for the Bhutanese population in his community. By identifying these disparities, his team worked with frontline EMS clinicians and engaged the community to overcome barriers and enhance care.
Data linkage and interoperability for equity
In the third session, participants explored data linkage and interoperability in the context of promoting equity. Two key questions guided this discussion:
- What data sources are currently used to improve equity in care?
- What data sources outside of EMS could be leveraged to enhance equity in care?
Kelly Brown, community information officer at 211 Ventura County, presented on the services provided by her organization and the potential overlap with EMS patients. Naila Frances, from Alameda County EMS, shared experiences with regional linked hospital and EMS data to provide a more comprehensive view of prehospital care through hospital discharge.
With a solid foundation covering the EMS data ecosystem that provides visibility to more confidently see where and to what extent you have inequities within your system, you can be more informed to take the next steps exploring the mechanisms, or understand why the inequities are taking place.
The next installment in this series will cover the second module of the learning community, focusing on understanding the root causes of inequities in prehospital care so we can progress to the much-needed place of effectively addressing inequities within our systems.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.
ABOUT THE AUTHORS
Jamie Kennel, PhD, NRP, is with Washington State University.
Remle P. Crowe, PhD, NREMT, is with ESO.
Soma de Bourbon, PhD, is with San José State University.
Miranda Worthen, PhD, is with San José State University.
Celeste Calderon, is a MPH student, with San José State University.
Michael Mason is a paramedic with the San Francisco Fire Department.
Daniel Nazzareta is a paramedic with the San Francisco Fire Department.
Joseph Graterol, MD is with the San Francisco Fire Department.