As a boy growing up in St. Louis, Larry Penton was fascinated by comedian Bill Cosby playing a wisecracking ambulance driver in the bawdy 1976 comedy “Mother, Jugs and Speed.” He often found himself thumbing through medical journals his mom, then in nursing school, brought home from time to time.
But young Larry couldn’t imagine himself, an African American kid, inside an ambulance, adrenaline surging, siren screaming, racing to help someone in an emergency. Back then, he thought that job was for white people, or for black actors playing fictional ones on screen.
“I didn’t think black people qualified for it – it was something that we didn’t do,” says Penton, 48, who grew up, finished school and went on to a career in information technology. “I thought it was an anomaly when I saw Bill doing the movie. But I thought, ‘Hey, he’s an actor – he’s playing a role.'”
A recent study, however, indicates Penton’s childhood analysis of the emergency medical services profession wasn’t off base. It indicates that, although more women and Hispanics are completing certification training in recent years, the profession is largely white and male, and struggles to put more minorities and women on the job – particularly African Americans.
That lack of diversity may perpetuate persistent health disparities between whites and minorities, according to the study, published this summer by the journal Prehospital Emergency Care.
More black and Hispanic paramedics and emergency medical technicians can lower language, cultural, and other communication barriers, “especially in settings where time pressure and incomplete information may exacerbate the effects of implicit biases” that can hinder delivery of needed treatment, according to a summary of the study and the analysis itself.
The study’s lead author, Remle P. Crowe, a research scientist at ESO – an emergency-medicine data company based in Austin, Texas – says she wasn’t particularly surprised by the results, which culled data on graduates of EMS training courses as a proxy for likely diversity in the upcoming workforce. A former emergency medical technician, Crowe says the profession has long struggled to attract minorities and women, and previous studies have shown similar outcomes.
However, “the surprising finding from the present study is that we’re seeing continued underrepresentation among this large, national group of recent graduates, which suggests that the overall diversity in the EMS workforce is not likely to improve right away,” she says.
Dr. David Tan, an emergency medicine specialist and associate professor at Washington University School of Medicine in St. Louis, says diversity in the field is important “because our patients come from all walks of life and ethnicities as well.”
Safest Communities in America
Removing cultural and language barriers between patient and first responder “may make it easier to communicate, which may facilitate a more accurate assessment of the medical emergency and enhance the delivery of quality care,” says Tan, who is also president of the National Association of EMS physicians. Still, “even if the (ambulance) crew is not exactly matched to every patient, a more diverse workforce overall naturally attracts a more diverse range of candidates which, over time, will help shape a more diverse cadre of EMS providers.”
In the study, Crowe and colleagues affiliated with Ohio State University and the National Registry of Emergency Medical Technicians assessed the composition of more than 588,300 EMTs and 105,350 paramedics awarded initial National EMS Certification from 2008 to 2017 by gender, race and ethnicity. An EMS certification provided by the National Registry of EMTs is required by 46 states in order to receive a license to practice, according to the registry.
Over that decade, the share of newly certified paramedics who were female never rose over 23%, while the share among EMTs rose from 28% in 2008 to 35% in 2017. Roughly half of the U.S. population is female, according to U.S. Census Bureau estimates.
Meanwhile, the share of initially certified blacks consistently languished around 5% among EMTs and 3% among paramedics. For Hispanics, there were signs of improvement: Their share rose from 10% to 13% among EMTs and from 6% to 10% among paramedics.
Still, “females and racial/ethnic minority groups remained underrepresented among newly-certified cohorts of EMTs and paramedics compared to the U.S. population in 2017,” according to the study. The U.S. population was about 18% Hispanic and about 12% non-Hispanic black in recent years, according to 2013-2017 census estimates.
The largest of what could be called a “diversity desert” was in the Northeast, where the study found 93% fewer newly certified EMTs identified as black compared to the population as a whole. Moreover, while “efforts to increase diversity among healthcare professionals are increasing on a national scale … few have specifically targeted EMS,” the study states.
Diversity among medical first responders matters because previous research among emergency department physicians “has shown implicit bias may impact treatment decisions such as thrombolysis for stroke and pain management,” Crowe says. In turn, she says, “some studies among EMS populations have shown disparities in administration of pain medications to patients belonging to racial/ethnic minority groups.”
In addition to being the first point of contact critically ill patients have with the medical system in an emergency, first responders are often primary caregivers, Crowe says: Poor people who are sick but don’t have health insurance often call 911 if they can’t afford a doctor.
Still, Tan and Crowe are optimistic, pointing to recruitment, training programs and scholarships aimed at high school students in the U.S. Crowe believes the EMS community should recruit even younger and wider, with “national efforts to promote this type of a career starting in middle or even elementary schools, particularly in schools with diverse student populations.”
Such an effort might have reached Penton, the IT worker in St. Louis who didn’t believe black people worked as paramedics.
Even though he loved learning from his mom’s medical journal as a child – and, when older, was inspired watching first responders on TV during the 9/11 terrorist attacks in 2001 – Penton never considered joining the emergency medical services profession.
That changed decades later when Penton, then a corporate information technology specialist, had a chance meeting with Monroe Yancie – a longtime African American paramedic in St. Louis and a real-life hero in the city’s black community. A close friend of Penton’s ex-wife, Yancie asked Penton: How’s work?
“I said I really wasn’t satisfied,” Penton recalls. Yancie then gave Penton a pitch: Take some classes, become a paramedic, ditch your IT job and change your life.
“He said, ‘It’s only a few months, it’s $600 at the community college’ – something like that – ‘and you can get started,'” says Penton, now a paramedic with multiple certifications to treat patients in Missouri. “And that’s exactly what I did.”