Black Children Face Unequal Access to EMS Transportation During Asthma Episodes

This article was originally published by Pharmacy Times^®. It has been lightly edited.

Emergency medical services (EMS) are less likely to transport Black children to the hospital for an asthma episode compared wit White children, according to a study published in Prehospital Emergency Care.¹ The investigative team, comprising members from the University of Pittsburgh and researcher-physicians at the University of Pittsburgh medical center, also observed that Black children are more likely to experience a severe asthma episode, which may reflect differences in socioeconomic status or other external factors.

Boy using an asthma inhaler | Image Credit:WavebreakmediaMicro - stock.adobe.com

Asthma affects approximately 25 million people in the United States. Resulting in shortness of breath, chest tightness, and wheezing, it is the leading cause of death in children. According to 2020 data, Black children are 3 times more likely to die from asthma-related causes than White children. The investigators conducted a study to understand how EMS providers managed and treated children with asthma in the prehospital setting.

“We have a lot of data on hospital management of childhood asthma but very little information to show how well we are treating asthma in the prehospital environment or if there are disparities,” said first study author Sylvia Owusu-Ansah, MD, a pediatric emergency medicine physician and the medical director of EMS at UPMC Children’s Hospital of Pittsburgh, in a press release.²

Using a national database, the team analyzed 5266 EMS encounters with children aged 2 to 17 years. Of the patient population—which included 53% non-Hispanic Black children and 34% non-Hispanic White children—Black children were less likely to be transported to a hospital.

According to Owusu-Ansah, these patients may not recognize the severity of their illness, which may affect their decision to be driven to the hospital. Alternatively, these patients may have a general mistrust of health care or fear hospitalization, which can contribute to a reduced likelihood of being driven to the hospital.

“Patients may need to be transported to a hospital for further evaluation and care, and we don’t want people avoiding that follow-up care if it’s crucial to supporting their health and wellness,” said Owusu-Ansah in the press release.²

Conversely, Black children were more likely to be treated with a bronchodilator. This is significant because bronchodilators are used for more severe disease, which may indicate that a higher number of Black children have asthma compared with White children.

Having a baseline understanding of how social determinants of health (SDOH) can affect prehospital treatment and transport opens the door for future research opportunities. The medical director plans to further these studies in the prehospital setting because health care providers can interact with patients in a different way than they can in a hospital setting.

“As first responders, EMS has the first look at the patient and their home, so they can observe whether there is mold or other factors that contribute to a patient’s illness,” said Owusu-Ansah in the press release.² “A patient may not share that information with their doctor. But EMS can pick up on small details that may be important when treating a patient and have huge opportunity to make a difference.”

References

1. Owusu-Ansah S, Crowe RP, Ramgopal S. Racial, ethnic, and socioeconomic disparities in prehospital encounters for children with asthma. Prehospital Emergency Care. Prehosp Emerg Care. 2023:1-8. doi:10.1080/10903127.2023.2260471

2. New study finds disparities among management of pediatric chronic asthma. News release. University of Pittsburgh. September 26, 2023. Accessed October 9, 2023. https://www.eurekalert.org/news-releases/1002747