By Shannon L. Gollnick, DBA
The discussion surrounding diversity, equity and inclusion (DEI) policies has become increasingly polarized, with some arguing that these initiatives are unnecessary, arbitrary and even counterproductive. Regardless of the political debates about DEI in employment, government programs, education and other settings, the presence of healthcare disparities and their impact on clinical care in EMS is well documented and the necessity of equitable care is undeniable.
The Joint Commission defines equitable care as providing services that do not vary in quality due to personal characteristics like gender, ethnicity, geographic location and socioeconomic status. The American Medical Association has a similar definition and further emphasizes that its provision is not a zero-sum reality in which a set of winners and losers are created. Equitable healthcare ensures that all individuals have a fair and just opportunity to attain their highest level of health regardless of their socio-economic status, race, ethnicity, gender or sexual identity.
Whether DEI policies remain in place or are dismantled, the reality of bias and inequities in healthcare remains a persistent issue that must continue to be addressed. As EMS professionals, we have a duty to ensure that all patients receive high-quality care, regardless of their demographic background, socioeconomic status, religious beliefs, gender identity or citizenship status.
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The academic consensus on healthcare disparities
There are countless studies which have provided empirical evidence that disparities in healthcare quality and access are pervasive and detrimental to patient outcomes. A PubMed search of “healthcare disparities” yields nearly 175,000 published peer-reviewed articles. Healthcare disparity has also been highlighted in position papers by professional organizations including the American Hospital Association, the Joint Commission, the American Medical Association, and the American College of Physicians just name a few.
All of this research indicates that racial, ethnic, gender and socioeconomic factors contribute to differences in timeliness, effectiveness and quality of care that patients receive. Other studies indicate that implicit bias among healthcare practitioners — whether conscious or unconscious — can affect clinical decision-making, leading to significant disparities in pain management, diagnosis and treatment options. Socioeconomic factors, including a patient’s ability to pay, further compound these issues, often leaving marginalized populations with inferior care.
Given this body of evidence, the EMS industry cannot afford to ignore the structural and systemic barriers that create disparities in emergency medical care. The dissolution of DEI policies does not negate the existence of these inequities; it merely removes a formalized mechanism for addressing them.
The frontline of equitable healthcare
EMS professionals are uniquely positioned at the intersection of public health and emergency care. As an industry, we are the safety-net of entire communities and are the first — and sometimes only — healthcare touchpoint for many individuals in underserved communities. As such, EMS practitioners have a moral, ethical and professional responsibility to ensure care is delivered equitably.
As an industry, EMS has made significant strides over the past decade to improve equitable care delivery and bring awareness to implicit biases that serve as obstacles to this goal. To prevent the undoing of this progress, EMS training centers and individual agencies must continue to prioritize training, education and policy development that promote unbiased, culturally competent care. Regardless of the presence or absence of DEI policies at a governmental level, EMS professionals must counteract implicit biases in real-time to provide the highest standards of care to all of those we are privileged to serve.
Systemic barriers beyond policy
DEI policies have historically supported initiatives that train EMS personnel in cultural competency, implicit bias awareness and the specific healthcare needs of diverse populations. Programs that emphasize these disparities ultimately lead to better patient outcomes.
With the rollback of such policies, these critical training programs may be reduced or eliminated, leaving EMS providers without necessary tools to navigate the complexities of equitable healthcare delivery. Without proper training, EMS practitioners may unintentionally perpetuate these disparities.
While DEI policies play a role in promoting healthcare equity, they are not the sole factor influencing disparities in EMS. Social determinants of health such as income, education, housing stability, food security and access to healthcare significantly impact a patient’s ability to receive timely and effective emergency care. As we begin to see many of the social safety-net programs being rolled back as well, the EMS profession will not only be affected by these cuts, but will also be at the frontline of these communities in need.
EMS agencies must take proactive steps to mitigate these issues, regardless of policy changes. Community outreach programs, partnerships with local organizations and integrated healthcare collaboratives can help bridge the gaps in emergency healthcare access.
The role of EMS leadership
In the absence of formal DEI mandates, leadership within EMS organizations must take a proactive stance in fostering an inclusive and equitable work environment. This means committing to fair hiring practices, ensuring that recruitment efforts reach diverse communities, and providing professional development opportunities for underrepresented groups in EMS.
Diverse leadership within EMS agencies has been shown to positively impact decision-making and patient outcomes. A leadership team that reflects the communities they serve is better equipped to understand and address the unique challenges faced by these diverse populations. Even if governmental policies no longer emphasize diversity and inclusion, EMS leaders must recognize the tangible benefits of maintaining these priorities within their organizations.
MORE | EMS data to enhance equity: See where inequity occurs
A call to action
Regardless of political shifts or policy changes, the EMS industry has an ethical and professional obligation to ensure equitable healthcare delivery. The dismantling of DEI policies should not be used as an excuse to ignore the well-documented disparities that exist in prehospital care. Instead, it should serve as a call to action for EMS agencies to double down on efforts to eliminate bias, improve training and advocate for policies that promote healthcare equity.
Actionable steps EMS professionals can take include:
- Pursuing continuing education on implicit bias and cultural competency, even if not mandated
- Advocating for agency-let DEI initiatives, ensuring they remain a priority at the local level
- Implementing data-driven approaches to monitor and address disparities in healthcare, specifically including the disaggregation of clinical performance data to look at care by population and identify gaps in the care of population sub-groups
- Engaging in community outreach to better understand and meet the needs of diverse populations
- Encouraging diverse hiring practices to reflect the communities served
While DEI policies may come and go, the core mission of EMS remains unchanged: to provide lifesaving care to all individuals, regardless of background or circumstances. The academic consensus on healthcare disparities is clear — biases in medical treatment exist and contribute to negative outcomes for those in marginalized groups. Our commitment to take care of others is not a political undertaking; it represents the greatest of social contracts in helping our fellow humans in their time of need. The question is not whether DEI policies should be mandated, but rather how the EMS industry will continue to rise to the challenge of ensuring equitable care in the absence of such mandates.
ABOUT THE AUTHOR
Dr. Shannon L. Gollnick, DBA, is paramedic with Fort Mill EMS in South Carolina and an EMS/mobile health consultant for PWW | AG.
