Disparities in Student Paramedic Administration of Analgesia Based on Patient Race

Introduction—Disparities in healthcare are associated with factors such as social status, age, and race or ethnicity, with evidence showing African-Americans receive fewer procedures and poorer-quality medical care than Caucasians. Disparities in the management of pain have been shown to be associated with race. However, there are limited data regarding the influence of race on analgesia provided by paramedics. As such, this study aims to investigate associations between patient race and student paramedic management of pain.

Methods—This retrospective cohort study used a contiguous data set of all student paramedic records entered in the FISDAP Skills Tracker database, an online database for EMS students, between January 1, 2014 and December 31, 2015. Cases were extracted if aged 16 to 100 years, the patient was alert, and the primary or secondary impression was trauma (abdominal, chest, extremity, neck-back, multi) or burns. Head injury was excluded, as this is a contraindication to analgesia in some settings. The primary outcome of interest was the interaction between patient race and student paramedic administration of any analgesia for cases meeting inclusion criteria. Secondary outcomes of interest were associations between age and gender and analgesia administration. The adjusted logged odds of patients receiving any analgesic were tested with binomial logistic regression using a stepped modeling approach.

Results—In total, 59,962 cases were available for analysis; median age was 50 years (IQR 39 years), 50.2% were female (n=30,040). The most common cause of trauma was fall, representing 50% (n= 26,053) of cases. 14.1% of patients received any analgesia (n=8,431). Caucasian patients have significantly higher logged odds of receiving analgesia than non-Caucasian patients (p< 0.001). When analgesic administration is adjusted for age category, gender and cause of injury, African-Americans have the lowest logged odds of receiving any analgesia when compared to Caucasian patients (OR 0.60, 95% CI: 0.53–0.69, p<0.001).

Conclusion—The results indicate inequality in the provision of analgesia by student paramedics based on patient race. This suggests a need for education that addresses cognitive and affective biases that can affect clinical judgements, and EMS audit of cases to identify disparities in care based on race.