Common Health Disparities & How CPs Address Them

TL;DR

Some patients get worse care because of who they are and where they live. That’s a health disparity. It shows up on every CP shift.
EMS response times for cardiac arrest are 10% longer in low-income neighborhoods. Disparity starts before the hospital — sometimes before the call.
Black patients receive prehospital pain medication significantly less often than white patients for the same injuries. That’s a documented pattern, not an isolated incident.
Community paramedics address disparities through connections, not just clinical intervention:
- referrals
- care coordination
- resource navigation
Calling a patient non-compliant when the real issue is access is both inaccurate and a missed intervention. Label what you actually see.

Three visits this week. Same apartment complex. Different patients, same story.

Poorly controlled diabetes. No transportation to the clinic. Medications they stopped filling two months ago because they couldn’t afford them. A fridge with almost nothing in it. They keep calling 911 — not because of emergencies, but because nothing upstream has changed.

I’ve run that call. For a long time I documented it as non-compliance and moved on. That was wrong. What I was actually seeing was a health disparity — and as a community paramedic, it was sitting right in front of me waiting to be addressed.

Here’s what you need to know about health disparities in community EMS, what the research shows, and what you can actually do about it on shift.

Key Takeaways

Health disparities are preventable differences in health outcomes. They are not random and they are not inevitable.
Disparities in EMS start before the hospital — access, response time, pain assessment, and treatment decisions all show documented racial and socioeconomic gaps.
The CP’s job is connection: referrals, care coordination, and resource navigation — not just clinical intervention.
Cultural competence is an approach, not a checklist. Ask, listen, adjust — every patient, every visit.
Document what you find. Undocumented social needs don’t drive program decisions, resource allocation, or funding justification.
This is a core CP-C exam domain. Know the definitions, the contributing factors, and the CP’s role.

Why This Matters in EMS

Some patients get worse care because of who they are and where they live. We call that a health disparity. It’s preventable — which is what makes it worth talking about.

For traditional 911 EMS, disparities are background noise. You respond, treat, transport. However, for community paramedics, the upstream conditions are the job. If patients keep coming back to the ED, the question isn’t just clinical. It’s structural.

The CDC has confirmed it: EMS response times for cardiac arrest are 10% longer in low-income neighborhoods than in high-income ones. Substantial disparities in EMS care based on race and sex exist across all phases — access, treatment decisions, transport destination. Disparity doesn’t begin at the ED. It begins before the ambulance moves.

That means community paramedics are operating inside the very system that produces these disparities — and they have more leverage to address them than almost anyone else in healthcare.

What the Research Shows

The evidence is no longer thin. A 2022 scoping review in Prehospital Emergency Care analyzed 50 years of EMS literature and found disparities across all phases of prehospital care — symptom recognition, pain management, and stroke identification — disproportionately affecting racial and ethnic minorities and women.

Pain Management

Research from Oregon EMS data found that Black, Hispanic, and Asian patients were significantly less likely to receive pain medication for blunt traumatic injuries than white patients — 32%, 21%, and 24% less likely respectively, after controlling for age, gender, and insurance. Hispanic and Asian patients were also less likely to have a pain assessment documented at all. That’s not a transport problem. That’s a field problem.

Behavioral Health

A 2025 JAMA Network Open study of over 661,000 EMS encounters found that non-Hispanic Black patients had significantly greater odds of being physically restrained or chemically sedated during behavioral health emergencies compared to non-Hispanic white patients. Same call type. Different response.

Access and Geography

The CDC’s California case study found that rural counties serving lower-income populations had lower per capita EMS funding and lower rates of cases meeting quality standards. Geography and income create disparity before the call is even made.

These are not isolated incidents. They are patterns — and patterns can be changed with intentional practice.

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What This Looks Like on a Call

You’re on a post-discharge home visit. Mrs. Reyes, 58 years old, CHF, discharged three days ago from a hospital 45 minutes away — the only facility that accepted her Medicaid plan. Her daughter is translating. Discharge paperwork is in English only.

Vitals are stable. Medications are correct. She took them this morning. However, she’s unsure what her fluid restriction actually is. The paperwork says “limit fluids” with no specific amount. There’s no scale for daily weight monitoring. The nearest pharmacy is across town and she doesn’t drive.

Not non-compliant. Underserved.

Every gap you see — language, transportation, unclear instructions, no monitoring equipment — is a health disparity in action. Your job isn’t to check her vitals and close the visit. It’s to close as many of those gaps as you can and document the ones you can’t close today.

What You Should Do Differently

At the Patient Level

Screen for social needs on every visit — not just clinical status. Use a structured tool. Ask about food, transportation, housing stability, medication access, and social support. Document what you find. That data becomes your program’s value story.

Check your pain assessment documentation. Are you completing it on every patient who could have pain? Research shows disparities often start at the assessment level — not in treatment decisions. Make it automatic. Every patient, every visit, regardless of who they are.

Apply teach-back every time. Don’t ask “do you understand?” Ask the patient to explain back what they’re supposed to do. That single habit catches more health literacy gaps than any screening tool.

At the Program Level

Know your local resource map cold. The CP’s most powerful disparity tool is connection. Know your FQHCs, pharmacy assistance programs, food banks, transportation resources, and CHW partners. A referral that doesn’t work for this patient’s actual situation — their transportation, language, insurance — is worse than no referral. It erodes trust. Give specific names and phone numbers.

Flag patterns to your medical director. Three visits to the same complex with the same unmet needs? That’s a CHA finding. Document it, escalate it. CP programs that can demonstrate disparity reduction have a compelling argument for funding and sustainability.

Check your own practice patterns periodically. Am I spending the same time with every patient? Completing the same assessments? Making the same referrals? Implicit bias operates below conscious decision-making. Awareness and intentional protocol adherence are the evidence-based countermeasures.

Common Mistakes to Avoid

Calling it non-compliance when the real issue is access. A patient who can’t afford their medication is not refusing care. Label what you actually see: barrier to medication access.
Making a referral without confirming it’s actionable. Referring a patient without transportation to a clinic 40 minutes away is not a solution. Confirm it works for this patient’s actual circumstances before you document it as complete.
Skipping social screening when vitals look stable. Stable vitals and stable social situation are not the same thing. A clinically stable patient can still have food insecurity driving their next 911 call.
Assuming cultural competence means knowing facts about a culture. It’s an approach — ask, listen, adjust — not a checklist.
Not documenting social findings. What isn’t documented doesn’t exist in your program’s data. It won’t drive resource allocation. It won’t support funding. Write it down.

Quick Reference: Common Disparities CPs See in the Field

Disparity Type	What It Looks Like	CP Response
Geographic / Rural	Longer response times, no nearby pharmacy or specialist	Telehealth connection, transportation assistance, mobile pharmacy programs
Socioeconomic	Can’t afford medications, food insecurity, unstable housing	Medication assistance programs, food bank referral, housing navigation
Racial / Ethnic	Documented gaps in pain assessment, treatment, follow-up	Consistent assessment protocols, cultural humility, implicit bias awareness
Language / Literacy	Misunderstood discharge instructions, can’t read labels	Plain language, teach-back method, interpreter services
Insurance / Access	No PCP, ED used as primary care, delayed care	FQHC connection, Medicaid enrollment assistance, care coordination
Gender	Women wait longer to call EMS for cardiac symptoms	Patient education on atypical presentations, remove barriers to calling

Bottom Line

Health disparities are not happening somewhere else. They’re in the building you just drove to, the patient you just assessed, and the referral you almost didn’t make because you were short on time.

Community paramedics have something most of healthcare doesn’t — access to where people actually live, and time to look around. However, that access is only useful if you use it intentionally. Screen every visit. Make referrals that actually work. Document what you find. Check your own patterns.

The CP who does this consistently isn’t just providing good care. They’re building the case for a program that gets funded, sustained, and expanded. That’s worth doing.

References

Centers for Disease Control and Prevention. (2024). Emergency Medical Services (EMS): A Look at Disparities in Funding and Outcomes. https://www.cdc.gov/ems-community-paramedicine/php/us/disparities.html
Farcas A, et al. (2022). Disparities in Emergency Medical Services Care Delivery in the United States: A Scoping Review. Prehospital Emergency Care. https://www.tandfonline.com/doi/full/10.1080/10903127.2022.2142344
Bongiorno DM, et al. (2025). Racial and Ethnic Disparities in EMS Use of Restraints and Sedation for Patients With Behavioral Health Emergencies. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831746
Soares WE, et al. (2019). A Thousand Cuts: Racial and Ethnic Disparities in Emergency Medicine. Medical Care, 57(12), 921–923. https://pmc.ncbi.nlm.nih.gov/articles/PMC7069500/
Macias-Konstantopoulos WL, et al. (2023). Race, Healthcare, and Health Disparities: A Critical Review. Western Journal of Emergency Medicine, 24(5), 906–918. https://pmc.ncbi.nlm.nih.gov/articles/PMC10527840/
NAEMSP / University of Colorado. (2023). Study Explores Disparities in EMS Care in the U.S. https://news.cuanschutz.edu/emergency-medicine/study-explores-disparities-in-ems-care

Ready to Learn More?

Stay tuned for the next article in our Community Paramedicine Training Series: “Cultural Competence in Community EMS: Working with Diverse Populations.” 🚑

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