The Impact of Race and Ethnicity on Prehospital Pain Management: Examining Disparities in a Hispanic Majority State

Introduction: Previous research has found significant differences in patient care associated with race/ethnicity. However, little research has been conducted in the prehospital environment. We examined prehospital patient care records in New Mexico, a state where Hispanic individuals represent more than half of the population and where provider demographics match the general population. Additionally this research compares care provided to patients with more objective indications for treatment (respiratory distress and hypoglycemia) versus more subjective indications for treatment (pain). 

Methods: We performed a retrospective cohort study using New Mexico EMS Tracking and Reporting System data from the New Mexico Department of Health Epidemiology and Response Division Emergency Medical Systems Bureau for patient care records entered between January 1, 2015 and December 31, 2017. We identified patients presenting with indicators of respiratory distress (n=2,722) (hypoxia, tachycardia and tachypnea), hypoglycemia (low blood glucose level, n=905), and (primary or secondary complaint of pain, n=52,220). We assessed whether patients had received appropriate treatment for those conditions based on state treatment guidelines. We then analyzed cases for all three complaints to identify differences in the rate of appropriate treatment associated with patient race/ethnicity.

Results: We found no significant difference in treatment rates for respiratory distress and hypoglycemia across races and ethnicities in this study population. In contrast, we found the rate of pain medication administration was significantly less in American Indian and black populations. White patients were 1.07 times more likely to receive pain medication compared to Hispanic patients (95% CI, 1.01–1.12), 1.28 times more likely than American Indian patients (95% CI, 1.20–1.38), and 1.66 times more likely than black patients (95% CI, 1.41–1.97).

Conclusion: This research suggests minority patients are less likely to receive prehospital pain medication compared to white patients. Additionally, we found disparities are reduced in Hispanic populations in the majority Hispanic state of New Mexico compared to Hispanics in the national population. This shows a need for services to systemically examine their patient care for such disparities and improve provider education.