美国国家公共电台 NPR Emergency Medical Responders Confront Racial Bias

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RACHEL MARTIN, HOST:

There's a recent study out of Oregon that shows that race comes into play, even when it means administering lifesaving care. Specifically, this study shows black patients are 40 percent less likely to get pain medication than white people. Kristian Foden-Vencil of Oregon Public Broadcasting reports.

KRISTIAN FODEN-VENCIL, BYLINE¹: Differences in how races are treated by doctors in the ER are well-documented. Whites tend to get better care and have healthier outcomes. But until this study, it was unclear if the same was happening in an emergency in the back of an ambulance. Leslie Gregory always wondered. Now a physician assistant, Gregory got her start as one of a very few black, female EMTs. She remembers one call. The patient was down and in pain. Driving up, she could see he was black. Then one of her colleagues groaned².

LESLIE GREGORY: It was something like, oh, God. Here we go again.

FODEN-VENCIL: She worried her colleague thought that because he was black, he was acting³ out to get pain meds.

GREGORY: At the time, I remember it increased my stress as we rode up on this person because I thought, now, am I going to have to fight my colleague for more pain medication, should that arise?

FODEN-VENCIL: A group of researchers at Oregon Health and Science University decided⁴ to try to see if there was a difference in the way patients were treated on emergency calls. They looked at 100,000 medical charts of ambulance patients over three years. Black patients were less likely to receive pain medications compared to white patients, regardless of socio-economic factors like health insurance.

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FODEN-VENCIL: At the end of a recent shift at American Medical Response in Portland, a row of ambulances files into the garage. Many emergency responders here bristle⁵ at the idea race plays a role in care. Jennifer Sanders has been a paramedic for 30 years.

JENNIFER SANDERS: I've never treated anybody different regardless.

FODEN-VENCIL: The very idea is distasteful, says paramedic Jason Dahlke.

JASON DAHLKE: No one I work with will explicitly⁶ and intentionally⁷ discriminate⁸ against somebody. It's not what we do. It's not the business that we're in.

FODEN-VENCIL: But Dahlke is willing to entertain the idea unconscious bias⁹ is at work in his field.

DAHLKE: Historically, it's the way this country has been. In the beginning, we had slavery and then Jim Crow and then redlining and all of this stuff that you can get lost in in, like, a large, macro scale. So yeah, it's there.

FODEN-VENCIL: So this study is given import. He mentions an older black patient he just treated. He was diabetic and complaining of extreme pain. Dahlke gave him glucose¹⁰ for low blood sugar but no pain meds. He says that's because by the time he'd stabilized¹¹ his blood sugar, they'd reached the hospital. And would he have done anything differently if the patient had been white?

DAHLKE: Consciously, absolutely not. Unconsciously, that's what studies are saying.

FODEN-VENCIL: Dahlke thinks another issue at play may be that white patients are more comfortable asking for medications than patients of color. Former EMT Leslie Gregory agrees. She says after years of discrimination, many African-Americans have their own biases¹² about the medical system. They just don't trust it.

GREGORY: How can a person of color not disrespect a system that is constantly studying and talking about these disparities but does nothing to fix it?

FODEN-VENCIL: The author of this new ambulance study, Jamie Kennel¹³, says another reason disparities loom¹⁴ so large may be that EMTs work in a stressful and time-pressured environment.

JAMIE KENNEL: In these situations, providers are much more likely to default to making decisions based on stereotypes¹⁵.

FODEN-VENCIL: So now ambulance agencies know unconscious bias may be at work. What are they doing about it? Robert McDonald with American Medical Response says he's looking at new training and a change in hiring practices.

ROBERT MCDONALD: We want to see more ethnicities represented in EMS that has historically been a white, male-dominated workforce¹⁶.

FODEN-VENCIL: The first step, though, is for emergency workers to just be aware of the role bias may play in care. For NPR News, I'm Kristian Foden-Vencil in Portland.

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MARTIN: This story is part of a partnership¹⁷ with NPR, Oregon Public Broadcasting and Kaiser Health News.