Racial and Ethnic Differences in Emergency Medical Services Interventions for Out-of-Hospital Cardiac Arrest - Title: Racial and Ethnic Differences in Emergency Medical Services Interventions for Out-of-Hospital Cardiac Arrest Abstract: Out-of-hospital cardiac arrest (OHCA) represents a significant public health concern, affecting an estimated 347,000 individuals in the United States annually. Despite various efforts, the mortality rate after OHCA remains distressingly high, with a mere 9.0% of patients surviving to hospital discharge. Prior research has highlighted racial and ethnic disparities in patient outcomes following OHCA; notably, Black and Hispanic patients display lower rates of survival to hospital discharge compared to White patients. However, the underlying reasons for the disparities have yet to be fully explored. In particular, the influence of racial and ethnic differences on resuscitation practices employed by emergency medical services (EMS) personnel remains unclear despite the integral role of EMS in OHCA management. To address these crucial knowledge gaps, we aim to scrutinize racial and ethnic differences (Black or Hispanic as compared with White) in prehospital resuscitation interventions for OHCA, using the Resuscitation Outcomes Consortium (ROC) Epidemiologic Registry, a comprehensive prospective OHCA registry at 10 sites in North America. In this proposal, we will focus our investigation on racial and ethnic differences in three key EMS interventions: time to defibrillations, time to epinephrine administration, and time to termination of resuscitation (TOR). These practices are not only associated with patient outcomes after cardiac arrest but also modifiable through educational and clinical interventions. Additionally, it remains unclear whether racial and ethnic differences in EMS interventions diverge based on patients’ sex (intersectionality). We will evaluate the intersectionality, assessing whether sex is an effect modifier on racial and ethnic differences in time to the EMS interventions. Lastly, we will quantify the contribution of racial and ethnic differences in EMS interventions to racial and ethnic disparities in survival using mediation analyses. Our overall objective is to augment our comprehension of these potential disparities in prehospital practices and identify modifiable areas for enhancing OHCA care. We will leverage OHCA as a representative case for time-sensitive conditions, with the objective of evaluating racial and ethnic disparities in EMS practices as potential contributors to the prevailing health inequity. Our team is comprised of experts in cardiac arrest research, health disparities research, causal inference, and statistical modelling with extensive experience with the ROC dataset, ensuring the feasibility of the proposed project. We anticipate that our study will identify specific areas where interventions can be implemented to mitigate racial and ethnic disparities in patient outcomes after OHCA and serve as a pioneering step toward the further evaluation of health inequity in relation to other time-sensitive conditions within EMS systems.
