Project Description Narrative:
In 2019, Milwaukee County declared racism a public health crisis, altering the perspectives, practices, and vision of the county, to improve overall health through the achievement of racial equity. The Milwaukee County Emergency Medical Service system (MCEMS), which oversees EMS services (9-1-1 ambulance-based care) in the county under the medical direction team from the Medical College of Wisconsin (MCW), has been dedicated to addressing racial and ethnic health inequities in the EMS or "prehospital" environment through an increased focus on understanding, targeting, and ultimately improving equity in the provision of prehospital care.
While disparity research in the prehospital space has been limited, inequities in care have been demonstrated in relation to poor stroke recognition in Hispanic and Asian populations, less pain control among Black individuals, fewer cardiac arrest interventions in women, and prolonged trauma scene times in the elderly, among others. In MCEMS, MCW-based research has demonstrated that patients of color face disparities in stroke, heart attack, and cardiac arrest care.
Despite the existence of this relatively small body of prehospital disparity research, the studies performed have largely been limited by a combination of incomplete data and single center status. Most EMS systems in Wisconsin, and the U.S. more broadly, do not require patient demographics to be recorded, leading to a large portion of patient care records excluding critical information needed to evaluate and understand disparities. Moreover, of the more than 850 EMS agencies in Wisconsin, very few have the resources or data infrastructure to perform equity-based research on their own.
Research performed at MCEMS, the largest EMS agency in Wisconsin and one of the largest in the U.S. with 115,000 patient encounters annually, has broad reaching impact to improve the health of communities throughout the state and beyond. Examples include transformation of the methods and efficiency of cardiac event detection in the prehospital (EMS) space, increased survival from pre-hospital cardiac arrest and optimized treatment for patients with seizures.
Multicenter evaluations of data improve reliability of findings while enhancing external validity. Both characteristics would make the findings of multicenter prehospital equity research of particular interest to EMS agencies throughout Wisconsin who may not have comprehensive data sets, nor resources to perform internal, equity-based studies on prehospital care. While it may be desirable to complete this project with only Wisconsin-based agencies, these limitations pose major challenges; seeking out a diverse group of EMS agencies that already require demographic recording is critical to this endeavor. Through regional and national partnerships, this project's research team has identified nine EMS agencies, varied in size, with complete race data sets who are engaged in partnering in research collaboration. These include MCEMS as the lead research agency, Kenosha Fire Department, AMR Colorado Springs, Colorado Springs Fire Dept., Detroit East Medical Control Authority, Washington, DC, Fire/EMS, Indianapolis EMS, Little Rock Metro EMS and Salt Lake City Fire/EMS. In all, these systems have over 873,000 patient encounters per year and have comprehensive race and ethnicity on 7,431,560 encounters over as many as 33 years.
This project aims to develop other agency research approvals, data use agreements, and key contact relationships to facilitate sharing of over seven million EMS encounter patient care records from nine different EMS agencies. Further, it will create a data pipeline and centralized database infrastructure to support the HIPAA compliant transmission, storage, and accessibility of the EMS patient care records from up to nine contributing sites. It will clean, assess data variable agreement, and harmonize data from the electronic EMS patient care records in the central data repository for retrospective research purposes and develop scalable pathways and replicable procedures for the update and accessibility of data in the future to answer retrospective or prospective research questions for EMS agencies across Wisconsin.
Combining these EMS agencies into a single database will create significant power toward understanding, quantifying, and addressing racial, ethnic, gender, and other disparities in the prehospital care environment. A comprehensive multicenter database will help EMS agencies throughout Wisconsin recognize inequities in care that apply across all EMS systems and design measurable interventions to facilitate equitable care. Creating this unprecedented, first of its kind EMS data repository will not only benefit each participating agency-specifically Milwaukee County and Kenosha, which serve one out of six Wisconsinites-but would also provide an invaluable source of information to identify opportunities for system improvements to drive more equitable patient care in EMS agencies throughout Wisconsin, the nation, and the world.