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How EMS providers can manage bias in routine care

EMS providers can acknowledge their bias as they strive to deliver the best empathetic care to the patients they serve

Some time back, I joined several EMS providers in an online debate about the presence of bias in the way we treat our patients. Some of the participants thought bias was a major issue; others, less so. However, most of us generally agreed that bias was present in most situations we regularly encounter.

I say most, because there was one participant who insisted that he had no bias at all. He never once thought about the color of the patient’s skin when treating his patients.

Well, OK then. What about age? Sex? Sexual orientation? Religious belief? Socioeconomic status? The list can become very long, in very short order.

The fact is bias exists. It’s normal.

Bias is a byproduct of growing up. From our parents and childhood friends, to the media distortions and depictions of what is considered normal American life, our world views are shaped by what goes on around us from the day we were born.

The Internet and the digital age have accelerated that process. We can see what is happening around the world literally in an instant. All of that information and how it is interpreted by so-called experts continually assaults our minds, hammering our societal lens into a shape through which we see the world around us.

Influence of implicit bias
As this recent Yale study implies, bias likely influences how we see our patients. More likely, implicit bias which is the formation of opinions and mindset that occurs at the subconscious level influences how we react to a patient’s condition or presentation. Read the abstract for “Democratic and Republican physicians provide different care on politicized health issues” from the Proceedings of the National Academy of Sciences to learn more.

For example, it wasn’t too long ago that women with ischemic chest discomfort were not treated as quickly or as comprehensively as men experiencing the same thing. The dogma at the time was that chest pain in females was more likely to be diagnosed as non-cardiac in nature when compared to males. It wasn’t until studies showed that there was a disparity in how women were being treated for chest pain that there was a shift in the medical community toward treatment.

Having bias is normal. However, acting on that bias is where danger creeps in. Consider the seemingly homeless individual who appears altered and semi-responsive. What if he wasn’t homeless?

It’s very easy to state the obvious; of course it shouldn’t make a difference. But bias can and did in this infamous 2006 case, the brain injury death of journalist David Rosenbaum. Other research shows ongoing disparities in treatment among minorities and socioeconomic status.

Managing the influence of bias
How can EMS providers manage the pressure of bias in routine care? First, acknowledge that bias exists. Knowing who you are and accepting that you have one set of perspectives that may be very different than those of your patient goes a long way in defining the problem.

Second, work actively to not act upon your biases. Our initial reactions to unfamiliar situations are mostly instinctive and without thought. It takes effort to not react on impulse, since that is what feels “right.”

Third, strive for empathy. Being empathetic allows the practitioner to better understand where their patient may be coming from, especially when the background, upbringing and environment of the patient may be very different from the practitioner.

It’s easy to forget that EMS providers are human too. We are expected to be nonjudgmental and nonbiased when it comes to serving all members of our community. That’s never been true of course. But it’s an ideal that is worth striving toward.

Art Hsieh, MA, NRP teaches in Northern California at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. An EMS provider since 1982, Art has served as a line medic, supervisor 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 writer, author of “EMT Exam for Dummies,” has presented at conferences nationwide and continues to provide direct patient care regularly. Art is a member of the EMS1 Editorial Advisory Board. Contact Art at and connect with him on Facebook or Twitter.