Disparities in Prehospital Non-Traumatic Pain Management

Aceves, Angie; Crowe, Remle P.; Zaïdi, Hanane; Gill, Joseph; Johnson, Renée; Vithalani, Veer; Fairbrother, Hilary; Huebinger, Ryan M.

doi:10.1080/10903127.2022.2107122

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…A study evaluating disparities in prehospital nontraumatic pain management found that Black patients were less likely than White patients to receive pain medications and receive pain medication within 20 min; however, Hispanic patients were more likely to receive pain medications. 27 This study identified significantly higher rates of EMS administration of bronchodilators for children with acute asthma exacerbations in a low or very low COI area compared to a moderate or high COI area. However, the study found no significant difference in systemic corticosteroid administration by COI.…”

Section: Discussionmentioning

confidence: 77%

“…However, those findings were not statistically significant due to smaller numbers and wide conference intervals. A study evaluating disparities in prehospital non‐traumatic pain management found that Black patients were less likely than White patients to receive pain medications and receive pain medication within 20 min; however, Hispanic patients were more likely to receive pain medications 27 …”

Section: Discussionmentioning

confidence: 99%

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Examination of disparities in prehospital encounters for pediatric asthma exacerbations

Riney,

Palmer,

Finlay

et al. 2023

JACEP Open

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IntroductionThere are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma.MethodsThis is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2–18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations’ neighborhood‐based conditions and resources relevant to children using the Child Opportunity Index (COI) 2.0, and analyzed associations between EMS scene address COI with medications administered by EMS.ResultsA total of 765 patients had available racial data and 825 had scene addresses that were geocoded to a COI. EMS administered at least 1 bronchodilator to 84.7% (n = 492) of non‐White patients and 83.2% of White patients (n = 153), P = 0.6. EMS administered a systemic corticosteroid to 19.4% (n = 113) of non‐White patients and 20.1% (n = 37) of White patients, P = 0.8. There was a significant difference in bronchodilator administration between COI categories of low/very low versus moderate/high/very high (85.0%, n = 485 vs. 75.9%, n = 192, respectively, P = 0.003).ConclusionsThere were no racial differences in EMS administration of medications to pediatric asthma patients. However, there were significantly higher rates of EMS bronchodilator administration for encounters in low/very low COIs. That latter finding may reflect inequities in asthma exacerbation severity for patients living in disadvantaged areas.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Examination of disparities in prehospital encounters for pediatric asthma exacerbations

Riney,

Palmer,

Finlay

et al. 2023

JACEP Open

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“…Additionally, subjective cues such as race and ethnicity have been found to affect prescribing opioids and potent painkillers, as people of color are more often labeled as drug-seeking ( 38 ). This and other factors, including racism, have led to the undertreatment of pain among minorities ( 39–45 ). This was evidenced in the above encounters.…”

Section: Discussionmentioning

confidence: 99%

Labeled as “drug-seeking”: nurses use harm reduction philosophy to reflect on mending mutual distrust between healthcare workers and people who use drugs

Febres-Cordero,

Shasanmi-Ellis,

Sherman

2023

Front. Public Health

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IntroductionOver 50 years of approaching drug use from the “War on Drugs” has led to ignoring the systemic structural and social determinants of health, enforced drug use stigma, and damaging stereotypes of people who use drugs or are labeled as “drug-seeking,” and sorely failed to support those needing assistance.On philosophy of harm reduction and powerPeople who use drugs are often disenfranchised and pathologized by being labeled as “a drug addict,” which then serves as a rationalization for mistreatment by healthcare providers. This is in opposition to a harm-reduction approach. Harm reduction philosophy is an epistemic valuation necessary for drug use stigma and our moral obligation to reduce harm from interlocking systems of power that perpetuate harm.On drug-seeking, mistrust, and human rightsWe have encountered many clients who use drugs that report harmful interactions with healthcare providers. Harm reduction is an issue of health equity, social justice, and fundamental human rights. This paper presents three vignettes, the author’s experiences of being labeled as—and advocating for family members labeled as “drug-seeking.”DiscussionTo better serve as healthcare providers, workers must be equipped to work with people who use drugs and reinforce the social justice commitment against medical stigma, neglect, racism, and inadequate pain coverage and withdrawal treatment. Nurses and our epistemic lens can meet the challenge of complex intersectional issues affecting our use of power to develop more just and equitable health systems and advance our rebuilding of a trusting relationship with the people we serve.

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“…Recent guidelines for pain management of traumatic injuries set forth by an expert panel enumerate 4 strong recommendations: (1) assess pain as part of general patient care, (2) consider all patients with acute traumatic pain to be candidates for analgesia, regardless of transport time, (3) use narcotic analgesia for moderate to severe pain, and (4) reassess patients and monitor for adverse effects . Despite the importance of prehospital pain management and known disparities by race and ethnicity in the hospital setting, most studies continue to demonstrate inequities in prehospital pain medication administration …”

Section: Introductionmentioning

confidence: 99%

“…20 Despite the importance of prehospital pain management and known disparities by race and ethnicity in the hospital setting, most studies continue to demonstrate inequities in prehospital pain medication administration. [21][22][23][24][25][26][27][28][29][30] Prior studies using NEMSIS data did not have the advantage of a pain score variable. To gain a snapshot of the entire US and how its agencies administer medications, we used the newly available pain score field and the robust size of the data set to expand on prior research previously limited to smaller cohorts or individual agencies.…”

Section: Introductionmentioning

confidence: 99%

Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury

Brunson,

Miller,

Matheson

et al. 2023

JAMA Netw Open

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ImportanceRacial and ethnic disparities in pain management have been characterized in many hospital-based settings. Painful traumatic injuries are a common reason for 911 activations of the EMS (emergency medical services) system.ObjectiveTo evaluate whether, among patients treated by EMS with traumatic injuries, race and ethnicity are associated with either disparate recording of pain scores or disparate administration of analgesia when a high pain score is recorded.Design, Settings, and ParticipantsThis cohort study included interactions from 2019 to 2021 for US patients ages 14 to 99 years who had experienced painful acute traumatic injuries and were treated and transported by an advanced life support unit following the activation of the 911 EMS system. The data were analyzed in January 2023.ExposuresAcute painful traumatic injuries including burns.Main Outcomes and MeasuresOutcomes were the recording of a pain score and the administration of a nonoral opioid or ketamine.ResultsThe study cohort included 4 781 396 EMS activations for acute traumatic injury, with a median (IQR) patient age of 59 (35-78) years (2 497 053 female [52.2%]; 31 266 American Indian or Alaskan Native [0.7%]; 59 713 Asian [1.2%]; 742 931 Black [15.5%], 411 934 Hispanic or Latino [8.6%], 10 747 Native Hawaiian or other Pacific Islander [0.2%]; 2 764 499 White [57.8%]; 16 161 multiple races [0.3%]). The analysis showed that race and ethnicity was associated with the likelihood of having a pain score recorded. Compared with White patients, American Indian and Alaskan Native patients had the lowest adjusted odds ratio (AOR) of having a pain score recorded (AOR, 0.74; 95% CI, 0.71-0.76). Among patients for whom a high pain score was recorded (between 7 and 10 out of 10), Black patients were about half as likely to receive opioid or ketamine analgesia as White patients (AOR, 0.53; 95% CI, 0.52-0.54) despite having a pain score recorded almost as frequently as White patients.Conclusions and RelevanceIn this nationwide study of patients treated by EMS for acute traumatic injuries, patients from racial or ethnic minority groups were less likely to have a pain score recorded, with Native American and Alaskan Natives the least likely to have a pain score recorded. Among patients with a high pain score, patients from racial and ethnic minority groups were also significantly less likely to receive opioid or ketamine analgesia treatment, with Black patients having the lowest adjusted odds of receiving these treatments.

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Disparities in Prehospital Non-Traumatic Pain Management

Cited by 9 publications

References 29 publications

Examination of disparities in prehospital encounters for pediatric asthma exacerbations

Examination of disparities in prehospital encounters for pediatric asthma exacerbations

Labeled as “drug-seeking”: nurses use harm reduction philosophy to reflect on mending mutual distrust between healthcare workers and people who use drugs

Race and Ethnicity and Prehospital Use of Opioid or Ketamine Analgesia in Acute Traumatic Injury

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