References

Alldredge BK, Wall DB, Ferriero DM. Effect of prehospital treatment on the outcome of status epilepticus in children. Pediatr Neurol. 1995; 12:(3)213-216 https://doi.org/10.1016/0887-8994(95)00044-G

Borelli MC, Bujanda M, Maier K. The Affordable Care Act insurance reforms: where are we now, and what's next?. Clin Diabetes. 2016; 34:(1)58-64 https://doi.org/10.2337/diaclin.34.1.58

EMS Data Cube. V3 Data Dictionary Supplemental Guide. 2019. https//tinyurl.com/bae7jadc (accessed 13 August 2021)

Genovesi AL, Hastings B, Edgerton EA, Olson LM. Pediatric emergency care capabilities of Indian Health Service emergency medical service agencies serving American Indians/Alaska Natives in rural and frontier areas. Rural Remote Health. 2014; 14:(2) https://doi.org/10.22605/RRH2688

Gold LS, Eisenberg MS. The effect of paramedic experience on survival from cardiac arrest. Prehosp Emerg Care. 2009; 13:(3)341-344 https://doi.org/10.1080/10903120902935389

Hanchate AD, Paasche-Orlow MK, Baker WE, Lin MY, Banerjee S, Feldman J. Association of race/ethnicity with emergency department destination of emergency medical services transport. JAMA Netw Open. 2019; 2:(9) https://doi.org/10.1001/jamanetworkopen.2019.10816

Hewes HA, Dai M, Mann NC, Baca T, Taillac P. Prehospital pain management: disparity by age and race. Prehosp Emerg Care. 2018; 22:(2)189-197 https://doi.org/10.1080/10903127.2017.1367444

Kapur J. Prehospital treatment of status epilepticus with benzodiazepines is effective and safe. Epilepsy Curr. 2002; 2:(4)121-124 https://doi.org/10.1046/j.1535-7597.2002.00045.x

Kennel J, Withers E, Parsons N, Woo H. Racial/ethnic disparities in pain treatment: evidence from Oregon emergency medical services agencies. Med Care. 2019; 57:(12)924-929 https://doi.org/10.1097/MLR.0000000000001208

Kurz MC, Schmicker RH, Leroux B Advanced vs basic life support in the treatment of out-of-hospital cardiopulmonary arrest in the Resuscitation Outcomes Consortium. Resuscitation. 2018; 128:132-137 https://doi.org/10.1016/j.resuscitation.2018.04.031

NEMSIS 2019 public-dataset now available. 2020. https//nemsis.org/2019-public-release-research-dataset-available/ (accessed 24 August 2021)

Michael GE, O'Connor RE. The diagnosis and management of seizures and status epilepticus in the prehospital setting. Emerg Med Clin North Am. 2011; 29:(1)29-39 https://doi.org/10.1016/j.emc.2010.08.003

Mochari-Greenberger H, Xian Y, Hellkamp AS Racial/ethnic and sex differences in emergency medical services transport among hospitalized US stroke patients: analysis of the national Get With the Guidelines-Stroke Registry. J Am Heart Assoc. 2015; 4:(8) https://doi.org/10.1161/JAHA.115.002099

National Association of State EMS Officials. National EMS scope of practice model 2019 (report no DOT HS 812–666). 2019. https//tinyurl.com/pas6wzts (accessed 13 August 2021)

National EMS Advisory Council. EMS funding and reimbursement. 2016. https//tinyurl.com/a43fkahf (accessed 13 August 2021)

National EMS Information System. NEMSIS data dictionary NHTSA v3.5.0. 2019. https//tinyurl.com/8mpewjx8 (accessed 13 August 2021)

National EMS Information System. NEMSIS data dictionary. NHTSA v3.4.0. 2020. https//nemsis.org/media/nemsis_v3/release-3.4.0/DataDictionary/PDFHTML/DEMEMS/NEMSISDataDictionary.pdf

National Institutes of Health. Racial and ethnic categories and definitions for NIH diversity programs and for other reporting purposes. 2015. https//grants.nih.gov/grants/guide/notice-files/not-od-15-089.html (accessed 25 August 2021)

Cost of providing EMS: a perspective of the first response fire district providing EMS. 2011. https//tinyurl.com/3t6k7e29 (accessed 13 August 2021)

Ryynänen OP, Iirola T, Reitala J, Pälve H, Malmivaara A. Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med. 2010; 18 https://doi.org/10.1186/1757-7241-18-62

Shah MN, Bishop P, Lerner EB, Czapranski T, Davis EA. Derivation of emergency medical services dispatch codes associated with low-acuity patients. Prehosp Emerg Care. 2003; 7:(4)434-439 https://doi.org/10.1080/312703002132

Silverman EC, Sporer KA, Lemieux JM Prehospital care for the adult and pediatric seizure patient: current evidence-based recommendations. West J Emerg Med. 2017; 18:(3)419-436 https://doi.org/10.5811/westjem.2016.12.32066

Sohn H. Racial and ethnic disparities in health insurance coverage: dynamics of gaining and losing coverage over the life-course. Popul Res Policy Rev. 2017; 36:(2)181-201 https://doi.org/10.1007/s11113-016-9416-y

Sporer KA, Youngblood GM, Rodriguez RM. The ability of emergency medical dispatch codes of medical complaints to predict ALS prehospital interventions. Prehosp Emerg Care. 2007; 11:(2)192-198 https://doi.org/10.1080/10903120701205984

A systems development guide for rural emergency medical services: a systematic approach to generate budgets for rural emergency medical services. 2014. https//tinyurl.com/k4uhtrsr (accessed 13 August 2021)

Wang HE, Balasubramani GK, Cook LJ, Lave JR, Yealy DM. Out-of-hospital endotracheal intubation experience and patient outcomes. Ann Emerg Med. 2010; 55:(6)527-537.e6 https://doi.org/10.1016/j.annemergmed.2009.12.020

Wang HE, Kupas DF. Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. JAMA Intern Med. 2015; 175:(8) https://doi.org/10.1001/jamainternmed.2015.2097

patient care
international
treatment
evidence

Racial disparities in emergency care for seizures in the United States

02 September 2021
Features
02 September 2021
Volume 13 · Issue 9

Abstract

Background:

Racial disparities exist regarding emergency medical services, and advanced life support (ALS) is superior to basic life support (BLS) for patients experiencing a seizure.

Aims:

This study aims to identify if there are racial disparities regarding access to ALS care for patients having a seizure.

Methods:

This study analysed 624 011 seizure cases regarding the provision of BLS rather than ALS care per racial group. Chi-square testing was used to check statistical significance and effect size was measured using relative risk.

Findings:

On average, non-white patients experiencing a seizure had a 21% higher relative risk of receiving BLS care than white patients. The highest disparity concerned American Indian patients, who had a 66% higher relative risk of receiving BLS care than white patients.

Conclusions:

Overall, non-white patients are less likely to receive ALS when experiencing a seizure than white patients, potentially leading to worse prehospital outcomes from less access to time-critical medications.

Emergency medical services (EMS) personnel form the foundation of care for patients in the prehospital setting. However, the level of care they can provide is not uniform. There are significant differences in education and training among EMS personnel and the US National Highway Traffic Safety Administration recognises four distinct levels of training for EMS personnel: emergency medical responder (EMR), emergency medical technician (EMT), advanced emergency medical technician (AEMT), and paramedic (EMS Data Cube, 2019; National Association of State EMS Officials (NEMSIS), 2019).

Traditionally, EMS units comprise two to three EMS personnel in a ground ambulance, which is classified as either advanced life support (ALS) or basic life support (BLS) depending on the level of training of the EMS personnel on board (Ryynänen et al, 2010). EMRs and EMTs provide BLS care, paramedics provide ALS care and AEMTs provide BLS or ALS care depending on local guidelines (NEMSIS, 2019).

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Advanced life support
Basic life support
Emergency medical services
Prehospital
Racial disparities
Ethnicity
Seizure