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Racial Bias in EMS Textbooks
A research-based study titled “Black, Asian, and Female Individuals are More Likely to be Depicted as Patients in EMS Textbooks While White Men are Presented as EMS Providers” won the Best Educational Research of 2022 award at EMS World Expo in Orlando Oct. 27, 2022.
The study was conducted by five faculty and alumni from the Oregon Tech and Oregon Health & Science University (OHSU) EMS program. They were EMS program instructors Jamie Kennel, PhD, MAS, and Chris Hamper, paramedic program graduates Josh Michlitsch and Wilson Morris, and EMT course graduate Kendall Womack.
The study documented the racial and ethnic disparities in instructional imagery used in two nationally used primary EMS textbooks. “We found that if you're white and you're male, you are much more likely to be depicted as EMS providers in these books,” said Kennel. “If you belong to a non-white/non-male group, you're much more likely to be depicted as a patient.”
The only exception applied to Hispanics: “Even though they showed up much less frequently in the textbooks overall, when they did show up, they were much more likely to show up as EMS providers than patients,” he said.
Beyond the arbitrary assignment of roles, the study found that 79% of the total images in the two textbooks were of whites, even though the 2019 U.S. Census has whites making up 59% of the population. Meanwhile, though Hispanics make up 19% of the U.S. population, they only showed up in 2% of the images. Women make up 51%, and yet only 12% of images in the books showed females.
Such high levels of pictorial bias—even if unintentional—set up barriers to attracting and retaining a more diverse EMS workforce, said Kennel. “Primary EMS textbooks help to set and reinforce expectations about the learner’s feeling of acceptance and belonging in the career,” he said. “To put it plainly, if you can't see yourself in a job through the imagery of the people that do that job, you're much less likely to choose that as a career.”
Pictorial bias can also reinforce a sense of entitlement and superiority of groups who are overrepresented in educational textbooks; in this case, white male EMTs. “These textbooks reinforce an image to current EMS students and future leaders of the field as to who is acceptable in the profession and who is not,” Kennel said. “When you’re an EMS supervisor in charge of hiring, these unconscious prejudices could influence who gets the job, and who doesn’t.”
At this point, Kennel has not been in touch with the publishers of the two textbooks, so he doesn’t know what their intent was in choosing the images they used—or whether there was any conscious intent. He does hope that winning this award will catch their attention and that of other EMS textbook publishers, so that the pictures they use going forward accurately reflect the diversity of U.S. society, while steering away from reinforcing prejudices.
“We want to make sure that individuals of all walks of life show up in the textbooks in an equitably proportional way,” Kennel told EMS World.
In 2019, Kennel published a study in the journal Medical Care that documented racial minorities with traumatic injuries receiving substandard care from EMS agencies in Oregon. (The study was co-sponsored by the Oregon Health Authority’s Emergency Medical Services and Trauma Systems Program and funded by the Oregon Office of Rural Health at OHSU.) After this study was published, Oregon Tech partnered with the AMR Foundation for Research and Education to fund six scholarships in the Oregon Tech/OHSU program, in support of underrepresented communities.
James Careless is a freelance writer and frequent contributor to EMS World.
Comments
My question is why bring race in the teaching of EMS. EMS providers provide care for all, they don't follow the book on race. I spent 30 yrs in EMS. Race studies have no place in EMS. I hope that EMS does not go woke like the rest of the country.
—Jeff Kerry