ABSTRACTS
The Association Between Patient Race and Prehospital Drug-Assisted Airway Management Approach.Author: Sydney E. Jarvis | | Associate Authors: Jamie Kennel PhD MAS NRP, Jeffrey L. Jarvis MD MS EMT-P
Introduction: Evidence-based guidelines call for the use of rapid sequence intubation (RSI) during endotracheal intubation (ETI) to minimize adverse events. Black and Hispanic patients are less likely to receive guideline-recommended care across several conditions, however there has been no evaluation of racial disparities in prehospital drug assisted airway management (DAAM) approaches. We aim to determine the association between patient race and prehospital DAAM approach. Methods: We used the 2022 ESO Data Collaborative dataset to analyze patients without cardiac arrest intubated during a 911 activation. We excluded records with missing race or from agencies with fewer than ten RSI intubations. We analyzed four DAAM approaches using the following definitions based on medications administered prior to the initial ETI attempt: RSI (sedative and paralytic), SO (sedative only), PO (paralytic only), and NoMeds (received no medications prior to intubation). We characterized the dataset using descriptive statistics and calculated odds ratios (OR) and 95% confidence intervals, adjusting for age, gender, GCS<8, ETI indication, SpO2<90, SBP<80, and Social Vulnerability Index, to evaluate the association between race and DAAM approach. Results: Of the 11,140,341 911 responses in the dataset, there were 52,619 patients with at least one intubation attempt. There were 11,044 patients with documented race who were intubated outside of cardiac arrest. Among the 6,033 patients treated by an agency with at least ten RSI-intubations, 4,620 (76.6%) were White, 760 (12.6%) were Black, and 515 (8.5%) were Hispanic. DAAM approaches varied: RSI (71.1%), NoMeds (13.9%), SO (13.4%), and PO (1.3%). Black patients had 26% lower odds of receiving RSI than White patients (OR: 0.74, 95% CI: 0.58-0.95), and 65% higher odds of receiving SO (OR: 1.65, 95% CI: 1.24-2.18) than White patients. Conclusion: Black patients were less likely to receive guideline-recommended RSI than White patients. This provides additional data on clinically-important racial disparities in EMS.
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