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EMS News in Focus
by Arthur Hsieh

Age and sex discrimination in EMS

By Arthur Hsieh

Editor's note: A report in the Toronto Star found that severely injured elderly patients are about 30 per cent less likely to get trauma centre care. Females, in general, are about 10 per cent less likely to receive trauma centre care.

The findings described in this article surprised me a bit initially. I mean, it shouldn't make a difference what the patient's sex and age are when it comes to trauma care, should it?

Thinking about it, though, perhaps there may be some unconscious processes in play that sets up the EMS provider to inadvertently choose the wrong destination. Perhaps some of the issues are inherent. Older patients tend to feel pain less, and have sensorium pertaining to tenderness and discomfort. Females may also have a different perception of pain — think cardiac, for example — and because of that, we might be led to believe that the seriousness of the injury might be less than it actually is.

There may be other, more social issues. For example, there is still the generation of seniors who believe that ambulances are designed to transport patients to hospitals (from which they never return) or to a nursing home. They may underestimate, or even mask, their symptoms in order to avoid being transported. Financial issues also affect the decision to be transported. Even with Medicare and third-carrier insurance, lengthy hospital stays still are very costly. Being on a fixed-income can make the decision much more difficult.

These are just a couple of ideas. What do you think? How else can we explain why women and elderly patients go to trauma centers proportionally less than the other population?

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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