DIVERSITY IN THE EMS WORKFORCE

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DIVERSITY IN THE EMS WORKFORCE

Nichole Bosson, MD, MPH, NRP, FAEMS

NAEMSP Medical Directors Course 2022

OBJECTIVES

1. Evaluate the current diversity in the EMS workforce

2. List the benefits of diversity for EMS systems

3. Define ways in which a Medical Director can promote diversity in EMS

Dr. Kamal Singh Kalsi

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CURRENT DIVERSITY IN THE EMS WORKFORCE

Nationally Registered

EMT

Nationally Registered Paramedic

US Population

Female Gender 50%

White 73%

Black 13%

Hispanic 18%

Crowe et al. PEC. 2020.



EMT


US Population

Female Gender 35% 50%

White 74% 73%

Black 5% 13%

Hispanic 13% 18%




EMT


US Population

Female Gender 35% 22% 50%

White 74% 81% 73%

Black 5% 3% 13%

Hispanic 13% 10% 18%


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WHILE SOME CHANGES WERE OBSERVED OVER THE LAST 10 YEARS, THE DIVERSITY OF EMS PROFESSIONALS EARNING INITIAL CERTIFICATION DOES NOT REFLECT THE DIVERSITY OF THE POPULATION SERVED.

Crowe et. al.

WHY DOES DIVERSITY MATTER?

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DISPARITIES IN HEALTHCARE

IOM. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Differences, disparities, and discrimination: Populations with equal access to healthcare. SOURCE: Gomes and McGuire, 2001.

IMPLICIT BIAS

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IMPLICIT BIAS IN HEALTHCARE▸Black patients, and black women in particular, are less likely to be referred for coronary angiography despite similar presentations to white males.

▸Minorities may be less likely to survive out‐of‐hospital cardiac arrest.

Green et al. J Gen Intern Med. 2007; LaViest et al. J Health Soc Behav. 2002; Schulman et al. NEJM. 1999.

BIAS IN EMS INTERVENTIONS▸Black patients are less likely to have pain score documented and less likely to have their pain treated by EMS.

Hewes et al. PEC. 2018; Meghani et al. Pain Med. 2012; Young et al. J Emerg Med. 2013.

BIAS IN EMS DESTINATION

▸ Black and Hispanic Medicare enrollees were:

▸ Less likely to be transported to the most frequent ED destination for white patients residing in the same zip code.

▸ More likely to be transported to a safety‐net ED compared with their white counterparts from the same zip code.

Hanchete et al. JAMA Open. 2019.

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BENEFITS TO DIVERSITY

CONCORDANCE IN RACE AND GENDER IMPROVES THE PATIENT EXPERIENCE

THE PEOPLE THAT WE SERVE, THEY NEED TO SEE IMAGES OF THEMSELVES REFLECTED BACK AT THEM.

Anaré Holmes –FFPM, LGBTQ LiaisonAtlanta Fire Rescue

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DIRECT RELATIONSHIPS AFFECT INTERETHNIC ATTITUDES

DIVERSITY ENHANCES LEARNING AND PROMOTES COMPLEXITY OF IDEAS

SURE, I HAD PHYSICAL LIMITATIONS BUT THAT GAVE ME THE OPPORTUNITY TO THINK ABOUT PROBLEMS MORE CREATIVELY.

Female FFPM

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FREEDOM HOUSE

Illustration by Marc Aspinall, with permission.https://magazine.atavist.com

FREEDOM HOUSE

▸ Black men from the Hill District of Pittsburg were recruited to train as paramedics.

▸ Brought life‐saving medical care to the streets; treating all patients regardless of race.

▸ Inspired the modern EMS system.

▸ Shut down abruptly in 1975 as the mayor of the city launched an ambulance service that was predominantly white.

Schlesinger Library, Harvard Radcliffe Institute.

BARRIERS TO WORKFORCE ENTRY

▸Insufficient exposure

▸Need for mentorship

▸Limited access

▸Inadequate support

▸Absence of positive reinforcement

▸Lack of opportunity

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CREATE AWARENESS

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Mission: "To create a greater awareness of the lesbian, gay, bisexual and transgender professionals working in the emergency medical and fire service fields and to support those coming out or pursuing a career.”

LOOK TO EXAMPLES

Lee LK, Platz E, Klig J, et al. Acad Emerg Med. 2021.

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COMPONENTS TO SUCCESS


▸ Have a champion

Peter Safar, MDSchlesinger Library, Harvard Radcliffe Institute.


▸ Have a champion

▸ Establish connections

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▸ Have a champion


▸ Recruit young


▸ Have a champion


▸ Recruit young

▸ Create identity


▸ Have a champion


▸ Recruit young

▸ Create identity

▸ Support basic needs

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▸ Have a champion


▸ Recruit young

▸ Create identity


▸ Provide mentorship


▸ Have a champion


▸ Recruit young

▸ Create identity


▸ Provide Mentorship

▸ Facilitate employment opportunities

-EMS -Fire -Police

TRANSFORMATIVE CHANGE

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GETTING INVOLVED

AdvocacyLeadershipMentorshipPolicyResearchRecruitment

GETTING INVOLVED

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ACKNOWLEDGEMENTS

▸David Page, MS, NRP – St Paul EMS Academy

▸Denise Whitfield, MD, MBA, NRP – LA County EMS Agency

▸ Jocelyn Garrick, MD – Alameda County EMS Agency

▸Michael Gibson, MPA, PCC – EMS Corps

▸ Lt Quention ‘Q’ Curtis – Black Fire Brigade

▸ Shira Schlesinger, MD, MPH – Harbor‐UCLA Medical Center

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Diversity in the EMS Workforce

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Additional Resources

1. Alameda EMS Corps: http://ems.acgov.org/CommtyResources/EMScorps.page

2. Bay Area Youth EMT Program: http://www.bayemt.org/About-Us.html

3. Chicago Black Fire Brigade: https://www.facebook.com/BlackFireBrigade

4. International EMS & Firefighters Pride Alliance: https://www.iefpa.org/

5. St Paul EMS Academy: https://www.stpaul.gov/departments/fire-

paramedics/parmedicsems/ems-academy

6. NAEMSP Diversity Task Force: https://naemsp.org/membership/committees/diversity-

in-ems-task-force/

7. Women in Fire: https://www.womeninfire.org/

DIVERSITY IN THE EMS WORKFORCE

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