Diversity in EMS: Improving Equity and Confronting Bias at New Orleans EMS

Diversity in EMS is a new bimonthly column in which rotating authors will confront difficult questions of bias and discrimination in the emergency medical services and consider how agencies can lead change in their communities.

Why is diversity in EMS important? The quality of healthcare available to marginalized members of our communities has led to large disparities in health outcomes. These have been compounded by the effects of COVID, which has disproportionately affected people of color. 

When considering diversity we've often focused more on the demographic composition of our EMS workforce than that of the population we serve; in the United States EMS providers are predominantly white (75%) and men (65%).^1,2 

A diverse healthcare workforce can have many positive effects on patient care, including reducing communication and language barriers and increasing trust between providers and patients, which can result in more equitable care.³ Studies have shown that when physicians look like their minority patients, there is greater patient satisfaction, increased patient involvement in care, and better health outcomes.⁴ 

EMS providers may have limited or no information about a patient and must make split-second decisions in emergency situations. Implicit biases involving cultural stereotypes may cause providers to unknowingly perpetuate healthcare disparities.⁵ New Orleans EMS serves a diverse population that is 58% Black and 5% LGBTQ, but our EMS providers are, like the rest of the country, less diverse. We set out to make some changes to better bridge the culture gap and improve the care our patients receive. 

Advocates and More

Diversity and equity advocates—This year New Orleans EMS appointed our first diversity and equity advocates (DEAs), six paramedics and EMTs from different backgrounds. They are dedicated to improving equity and confronting bias to improve our care. The DEAs meet weekly with our director/medical director, Emily Nichols, MD, and me to discuss ways to make our organization more equitable and better serve our diverse community. 

Removing bias from hiring and promotions—Together we made changes to the hiring and promotions process to limit bias. The DEAs now participate in the hiring and promotions process. They review every application before they are filtered. They interview all new employees and those interviewing for promotions and ask questions to assess each provider’s ability to care for those with different backgrounds. We developed an objective, blinded grading system for our hiring and promotions process to remove bias. 

EMS programs in public high schools—New Orleans EMS is engaged in helping public high school EMT certification programs get more young people excited about careers in EMS. These groups visit our headquarters for tours and learn bystander CPR and Stop the Bleed. Hopefully over time these efforts will result in a pool of applicants that better represents the community we serve.

Pride and Black Lives Matter pins—Many members of the LGBTQ community are afraid to seek healthcare in the usual ways because of previous bad experiences. To better serve our transgender patients, we changed the fields in our electronic medical record to include preferred name, pronoun, and gender identity. We paired this change with education developed by the DEAs on these terms, how to use them, and best practices in caring for transgender patients. 

Studies show having a visual cue showing LGBTQ support can allow patients to know they are with a provider they can trust.⁶ Last year New Orleans EMS rolled out our Pride pins and badges as a way for our providers to show support for the LGBTQ community. Employees may choose to wear their Pride badge during specified times during the year, including June for Pride Month. Pins can be worn year-round to show our LGBTQ patients we are allies. 

Some people of color in our community are also reluctant to call for help from EMS. We also created New Orleans EMS Black Lives Matter pins to show support to our patients. The pins were developed by the DEAs and designed by New Orleans artist Christopher Marino. The image has a fleur-de-lis, the base of which turns into a fist.

Social media engagement—The DEAs also created a social media campaign aimed at engaging our diverse community. They made a video for Hispanic Heritage Month with our Spanish-speaking employees talking about why they love EMS. Two of our DEAs were interviewed for a local Hispanic culture Facebook Live broadcast. We featured our LGBTQ employees on our Facebook page during Pride month, and the DEAs have posted their Black Lives Matter statement as well. 

Looking Toward the Future

The DEA engagement has spurred many conversations about racism, xenophobia, and bias among our employees, and each day we learn more. We are using each instance to listen and reflect on where we are and how we can do better. We are working with other EMS leaders from around the country who are passionate about diversity to learn as much as we can. 

We know we still have a long way to go. We are arranging formal antibias training for all our employees to continue this momentum. Our employees are talking about these issues and pointing out bias in ways we haven’t seen before. When we look back on where we started, we have come a long way, but this is still just the beginning of this journey.  

References

1. Nelson A. Unequal treatment: confronting racial and ethnic disparities in health care. J Natl Med Assoc, 2002; 94: 666.

2. Data USA. Emergency Medical Technicians & Paramedics, https://datausa.io/profile/soc/emergency-medical-technicians-paramedics.

3. Institute of Medicine Committee on Institutional Policy-Level Strategies for Increasing the Diversity of the U. S. Healthcare Workforce. In the Nation’s Compelling Interest: Ensuring Diversity in the Health-Care Workforce. Washington, DC: National Academies Press, 2004.

4. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med, 2013; 28: 1,504–10.

5. Lesbian and Gay Foundation. Pride in Practice, www.lgf.org.uk/prideinpractice.

6. Crowe RP, Krebs W, Cash RE, et al. Females and Minority Racial/Ethnic Groups Remain Underrepresented in Emergency Medical Services: A Ten-Year Assessment, 2008–2017. Prehosp Emerg Care, 2020; 24(2): 180–7.

Meg Marino, MD, FAAP, is deputy medical director for New Orleans EMS, director of pediatric prehospital education for Ochsner Health, and a pediatric emergency medicine physician. She has a strong interest in provider wellness and is leading the Diversity and Equity Council at New Orleans EMS to improve access to care among marginalized communities and promote diversity in EMS.