Nationwide, the face of EMS providers is predominantly white and male. I’m not saying this is bad or wrong. However, it does present challenges when working in communities that are far more diverse, from communication issues to cultural comprehension.
Allow me to explain.
Most of us are not bilingual or even minimally aware of certain phrases that are commonly used when evaluating patients in the field. It’s a struggle to get a full understanding of the patient’s complaints and symptomology when our ability to obtain a patient’s history taking is limited. It can be helpful to have a translator nearby or over the phone, but it’s often awkward and sometimes unreliable, based on the translator’s own language abilities and their relationship to the patient.
Cultural context
Medical care doesn’t exist in a vacuum. How we view our health and mental well-being is grounded in cultural context.
A simple example is how Americans tend to believe in early use of prescription medications in treating certain conditions, whereas Asians may be more apt to use a combination of plant- and animal-based medications along with nonpharmacological approaches such as acupuncture to treat the same condition.
This cultural difference can create a bias on behalf of the EMS provider, who may underreport or dismiss the patient’s treatment plan. It’s also possible that a medication administered by the provider may interact negatively with the non-western medications.
Beyond the medicine are the psychosocial aspects of health care. In many cultures, the determination of care often rests on someone other than the patient; it may be a spouse (especially the husband) or a parent or even grandparent (even if the patient is an adult).
This difference in decision-making authority can present a challenge to the EMS provider who typically focuses attention on the patient. A stressful dynamic can be created, sometimes unknowingly to the crew.
How patients react to physical or emotional pain is also rooted in culture. It can be very easy to dismiss dramatic displays of grief as being theatrical. Or attribute a stoic silence as being uncaring or unfeeling.
These are but a few examples where the provision of health care by personnel not intimately aware of these issues can be hampered. Indeed, there are numerous studies that indicate non-dominant groups of people receive less health care overall.
Bridging cultural divides
It’s more productive to focus on how to bridge these divides rather than dwell on the root causes. Improving equity in public schools and raising awareness of EMS career opportunities for all students can help increase the number of women and ethnic minorities in the ranks of EMS.
Short-term EMT training programs, such as the offering from Southern Maine Community College to teach English language learners to be EMTs and translators can help fill in gaps. North East Mobile Health Services, a local EMS agency has committed to interviewing all course graduates for open positions.
EMT training is also an opportunity to match a community need for reliable employment with employers who need qualified and trained applicants. Allina Health EMS, Minn., makes a compelling business case for recruiting a diverse workforce and sees a clear return on investment from their efforts to recruit and train EMTs from diverse racial and ethnic groups.
Ultimately, ongoing awareness of the cultural challenges and actively working to reduce those barriers will help us perform our jobs more effectively.
