Your Skin Color May Decide Where Your Ambulance Ride Ends Up


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Latinos and blacks are more likely to be taken by ambulance to safety-net hospital emergency rooms, and not always the closest hospital, according to a new study.

National guidelines require EMS transportation to the nearest suitable hospital.

However, the study, led by researchers at Boston University School of Medicine, found large racial/ethnic differences for where emergency patients are taken.

Latinos and blacks were more likely than whites to be taken to a safety-net hospital—one with a legal obligation or mission to give health care regardless of insurance status. This suggests “ambulance diversion” bias, where ambulances don’t take certain patients to the nearest suitable hospital. 

“The cause for this observed pattern is unknown and needs to be further studied to really understand the impact on patient clinical outcomes and if such outcomes vary by race and ethnicity,” said study author Dr. Amresh Hanchate of Boston University, in a press release.

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‘Ambulance Diversion’ Bias based on Color

The study examined 864,750 Medicare enrollees from 4,175 particular zip codes who had 458,701 emergency visits via ambulance.

Researchers looked at which hospitals white, black, and Latino patients living in the same zip code were brought to.

Researchers also looked at how often the most frequently used destinations for white patients were also the destination for black and Latino patients.

The results of the research found there were substantial disparities by race and ethnicity.

In addition to finding that Latinos and blacks are more likely to be taken by ambulances to safety-net hospital emergency rooms, the study found this disparity occurred on an even larger scale in big urban areas with multiple emergency rooms and hospitals within the vicinity.

These findings are a hallmark of “ambulance diversion” bias, said study co-author Dr. James Feldman of Boston University and Boston Medical Center.

“Ambulance diversion is unfortunately a practice that remains common throughout the country,” Feldman said in a press release. “This research is a necessary first step in order to examine the effects ambulance diversion has on patient care and understanding the relationship between emergency utilization and health care disparities.”

How to Tackle ER Healthcare Disparities

Latinos are no strangers to inequities when needing live-saving emergency care.

Studies have shown that physicians and other healthcare professionals are regularly vulnerable to their unconscious bias. This is also known as implicit bias — automatic processing that is influenced by stereotypes, which then impact actions and judgments.

For example, Latinos and blacks who visit a U.S. emergency room are less likely to receive prescriptions for certain medications than Whites.

This can spell life-or-death consequences for Latinos and other people of color.

Still, there are many ways to overcome this problem. Options include teaching cultural competencies that can improve healthcare outcomes, decrease the cost of care, and building the field of Latino and black doctors and healthcare workers.

And, as Dr. Hanchate reminds, more research is needed, too.

“We need more research to understand the role that patient choice, usual source of care and clinical condition play in guiding EMS transportation decisions in diverse systems across the United States,” said Dr. Hanchate of Boston University.

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