Division of Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Prehosp Emerg Care. 2023;27(5):552-556. doi: 10.1080/10903127.2023.2187103. Epub 2023 Mar 24.
POSITION STATEMENTEmergency medical services (EMS), similar to all aspects of health care systems, can play a vital role in examining and reducing health disparities through educational, operational, and quality improvement interventions. Public health statistics and existing research highlight that patients of certain socioeconomic status, gender identity, sexual orientation, and race/ethnicity are disproportionately affected with respect to morbidity and mortality for acute medical conditions and multiple disease processes, leading to health disparities and inequities. With regard to care delivery by EMS, research demonstrates that the current attributes of EMS systems may further contribute to these inequities, such as documented health disparities existing in EMS patient care management, and access along with EMS workforce composition not being representative of the communities served influencing implicit bias. EMS clinicians need to understand the definitions, historical context, and circumstances surrounding health disparities, health care inequities, and social determinants of health in order to reduce health care disparities and promote care equity. This position statement focuses on systemic racism and health disparities in EMS patient care and systems by providing multifaceted next steps and priorities to address these disparities and workforce development. NAEMSP believes that EMS systems should:Adopt a multifactorial approach to workforce diversity implemented at all levels within EMS agencies.Hire more diverse workforce by intentionally recruiting from marginalized communitiesIncrease EMS career pathway and mentorship programs within underrepresented minorities (URM) communities and URM-predominant schools starting at a young age to promote EMS as an achievable profession.Examine policies that promote systemic racism and revise policies, procedures, and rules to promote a diverse, inclusive, and equitable environment.Involve EMS clinicians in community engagement and outreach activities to promote health literacy, trustworthiness, and education.Require EMS advisory boards whose composition reflects the communities they serve and regularly audit membership to ensure inclusion.Increase knowledge and self-awareness of implicit/unconscious bias and acts of microaggression through established educational and training programs (i.e., anti- racism, upstander, and allyship) such that individuals recognize and mitigate their own biases and can act as allies.Redesign structure, content, and classroom materials within EMS clinician training programs to enhance cultural sensitivity, humility, and competency and to meet career development, career planning, and mentoring needs, particularly of URM EMS clinicians and trainees.Discuss cultural views that affect health care and medical treatment and the effects of social determinants of health on care access and outcomes during all aspects of training.Design research and quality improvement initiatives related to health disparities in EMS that are focused on racial/ethnic and gender inequities and include URM community leaders as essential stakeholders involved in all stages of research development and implementation.
立场声明
紧急医疗服务(EMS)与医疗保健系统的各个方面类似,可以通过教育、运营和质量改进干预措施,在检查和减少健康差距方面发挥重要作用。公共卫生统计数据和现有研究强调,某些社会经济地位、性别认同、性取向和种族/族裔的患者在急性医疗状况和多种疾病过程的发病率和死亡率方面受到不成比例的影响,导致健康差距和不平等。就 EMS 提供的护理而言,研究表明,EMS 系统的现有特征可能进一步导致这些不平等,例如在 EMS 患者护理管理中存在已记录的健康差距,以及 EMS 劳动力构成与服务社区不相符,从而影响了隐性偏见。EMS 临床医生需要了解健康差距、医疗保健不平等和健康的社会决定因素的定义、历史背景和情况,以便减少医疗保健差距并促进护理公平。本立场声明侧重于 EMS 患者护理和系统中的系统性种族主义和健康差距,提供多方面的下一步措施和优先事项,以解决这些差距和劳动力发展问题。NAEMSP 认为,EMS 系统应:
在 EMS 机构的各个层面实施多元化劳动力的多因素方法。
通过从边缘化社区有针对性地招聘,雇佣更多多元化的劳动力。
在代表性不足的少数族裔(URM)社区和 URM 占主导地位的学校中,从年轻时开始增加 EMS 职业途径和指导计划,以促进 EMS 成为一个可行的职业。
审查促进系统性种族主义的政策,并修订政策、程序和规则,以促进多元化、包容和公平的环境。
让 EMS 临床医生参与社区参与和外展活动,以促进健康素养、可信度和教育。
要求 EMS 顾问委员会的组成反映他们所服务的社区,并定期审核成员资格,以确保包容性。
通过既定的教育和培训计划(即反种族主义、挺身而出和盟友关系)增加对隐性/无意识偏见和微侵犯行为的认识和自我意识,以便个人认识到并减轻自己的偏见,并能够充当盟友。
重新设计 EMS 临床医生培训计划中的结构、内容和课堂材料,以增强文化敏感性、谦逊和能力,并满足职业发展、职业规划和指导需求,特别是 URM EMS 临床医生和学员的需求。
在培训的各个方面讨论影响医疗保健和医疗的文化观念以及社会决定因素对护理获取和结果的影响。
设计与 EMS 中的健康差距相关的研究和质量改进计划,重点关注种族/族裔和性别不平等,并让 URM 社区领导作为参与研究制定和实施各个阶段的重要利益相关者。