CDC Study Reveals Serious EMS Disparities Across U.S.

There are serious disparities in the quality and availability of EMS care across America. That’s the takeaway from “Emergency Medical Services (EMS): A Look at Disparities in Funding and Outcomes”, a study issued by the Centers for Disease Control (CDC) on October 9, 2024.

Among the CDC study’s conclusions:

• Rural areas experience lower levels of EMS care than do urban areas.
• Low-income neighborhoods experience lower levels of EMS care than do neighborhoods with high incomes. A case in point: “EMS response times for patients with cardiac arrest are 10% longer in low-income neighborhoods than in high-income neighborhoods,” stated the CDC study.
• “Studies find substantial disparities in the provision of EMS based on race and sex,” the CDC study said. “In a case study of eleven counties in California, local EMS agencies that served rural counties had lower per capita EMS funding and lower percentages of cases that met established quality standards.”

That’s not all. “There are widespread shortages in resources for emergency medical services,” said Sharada Shantharam, MPH, lead health scientist with the CDC’s Division for Heart Disease and Stroke Prevention. “Because EMS is provided primarily by local governments, available resources vary widely.”

With respect to the eleven California counties that the CDC examined for its study, “we identified large disparities in EMS revenue and spending between rural and urban LEMSAs [local EMS agencies],” Shantharam said. “Additionally, the urban LEMSAs in our study had more cardiovascular disease-related EMS quality indicators within the top quintile (20%) for the state of California, and the rural LEMSAs had more quality indicators in the bottom quintile. [But] because this is a limited case study, we cannot make any definitive statements about whether our findings are applicable more widely.”

Overall, the purpose of the research was to describe disparities in U.S. EMS provision nationwide, and to examine EMS funding levels and quality metrics that relate to cardiovascular disease outcomes. To reach its conclusions, “we used multiple sources for this study,” said Shantharam.

These sources included:

• Individual LEMSA plan submissions in California—EMS revenue and spending.
• California EMS Core Quality Measures Project—EMS metrics on cardiovascular disease for each LEMSA.
• Census Bureau population data.
• National EMS Assessment from the National Association of State EMS Officials.

“Some LEMSAs did not submit reports due to COVID-19, so we used pre-COVID data for consistency,” Shantharam told EMS World.

For the record, the CDC study’s selection criteria for LEMSAs included the following social and economic factors that were used to maximize diversity across localities:

• Industries, including one LEMSA with a sizable agricultural sector
• Urban and rural counties
• Average county incomes
• Racial and ethnic diversity
• Reasonable statewide geographic span
• A mix of single- and multi-county LEMSAs

Beyond the results noted above, the CDC study found that there was widespread popular support for additional EMS funding. However, the provision of better EMS care nationwide—beyond the disparities noted above—is being hampered by variable state funding and a shortage of qualified personnel.

When it comes to state funding, “Three states spend more than $10 per person on funding for EMS offices,” according to the CDC study. Three additional states spend more than $2 per capita; 20 states spend between $0.50 and $2 per capita; and 24 states and the District of Columbia spend less than $0.50 per capita on EMS funding or didn’t respond to the survey question.

As for recruitment issues? The CDC study found lots of reasons why people aren’t breaking down the doors to become EMTs. They include:

• Low salaries (national average: $34,320)
• Lack of racial equity among staff (in 2019, 86.6% of EMTs were White)
• Insufficient operations support
• Reports of ambulances held together with duct tape
• Reports of bake sales to raise money for fuel

These are just some of the issues leading to disparate EMS care across America. More can be found at the CDC study’s home page: www.cdc.gov/ems-community-paramedicine/php/us/disparities.html

As for the actions that Shantharam hopes will occur in response to this CDC study? “Improved data collection by local governments on EMS revenue, spending, and outcomes would benefit future studies on the connection between disparities in EMS funding,” she replied. “Additionally, LEMSAs could collaborate with other EMS providers to share best practices and improve EMS quality. These data can also serve to inform decision makers who are interested in addressing EMS disparities linked to resource shortages.”

James Careless is a Canadian-based freelance writer and frequent contributor to EMS World.