Introduction
There exist several discrepancies in the U.S. healthcare system on the basis of race and colour. Hispanics and Blacks do not have adequate access to healthcare facilities and the whites receive better facilities and healthcare outcomes as compared with the Blacks and Hispanics. Emergency medical service or EMS is an essential part of healthcare. The United States is rapidly witnessing a change in the population which has individuals from diverse areas having diverse race, culture, value and ethnicity. The culture of an individual has a direct impact on the practices and values and beliefs pertaining to healthcare. The confidence of patients and their opinions about healthcare professionals and modern medicine is significantly impacted by the culture of an individual. The self-assessment of individuals with respect to the severity of their sufferings and the aspiration to take medicine, engage in exercise of a diet is impacted on their culture. Most people dialling the emergency care service contact are completely aware that they would be treated according to the regulations governing modern medicines. However, some individuals dial the emergency medical service only for dire circumstances. This reflects a conflict in their beliefs and values and also their contact with the mainstream healthcare system. Beliefs regarding ailments and healing are different among diverse cultures. This is one of the reasons for diversity and inclusiveness to be included in emergency medical care (Dees, 2007).
Need for diversity in Emergency Medical Services
A majority of the people in the United States of America abide to the values of preventive medical care like going to a medical practitioner in case of an ailment, taking the prescribed doses of medicines as and when required and contacting the emergency medical services only in case of extreme circumstances. However, there are other groups which first depend on the resources available in the community and the family to cure them and maintain their health. Especially among the Hispanics, or the Spanish people communities in the United States of America, engage in conducting traditional rites and cures and consult a healer, massage therapist, midwife and herbalist for ailments. Such individuals call the emergency medical services only when the patient is not cured by traditional rites. Such individuals also conduct alternative therapies like balancing therapy and hot cold therapy prior. In other cultures, individuals depend on offerings and prayer for healing. This is one of the main reasons for fostering diversity in the workforce in EMS. A diverse workforce will help in counselling such minority communities about the requirement for timely medical intervention instead of following traditional methods.
Language barrier
Another issue faced by individuals in accessing emergency healthcare service is that of language barrier. Most providers of emergency healthcare services engage individuals from the majority population and can converse in English only. This language barrier further acts as a hindrance for the Spanish speaking Hispanic minority. They face problems in explaining the condition of the patient to the EMS staff. Currently, the nation is striving to hire multicultural individuals who can converse in other languages including Spanish so that minority people are benefitted. Despite this, recent immigrants and minorities residing in tightly knit community are those experiencing barriers to languages while trying to call for emergency healthcare services. The EMS in the United States of America boasts of only 10 percent population from the minority communities. A majority of EMS workforce is white and speaks English as the main language for communication. Having a culture of inclusiveness and diversity in the EMS will help in mitigating the communication and language barriers. It has also been witnessed that communication barriers result in delay in explaining the condition of the patient including the sufferings and this further delays treatment. Hence, it is essential that the EMS workforce has individuals belonging to minority groups and communities.
Elements of time and space in communication
The communication of the patient with the paramedics and emergency medical service personnel is also impacted by time and space. Diverse cultures have diverse interpretations with respect to the time taken to impact their interaction with healthcare. Individuals hailing from a European or Chinese heritage are attuned to tradition and past. On the other hand, middle clas Anglo Indians display concern about their future and hene engage in using preventive medical care systems like routine checkups and immunizations. Other cultures like the African – Americans aer more concerned about the present rather than the future. The providers of emergency healthcare services become fed up with such people as they do not undertake prescribed treatments, do not engage in conducting checkups and do not consult the medical practitioner at an early stage of the ailment. Such patient may call the emergency healthcare services after several weeks have elapsed since the first signs of the ailment when they are unable to bear the pain. One of the challenging factors while caring for patients in response to pain. Pain responses may be different from individuals depending on cultural aspects. This discrepancy in pain responses may be difficult for the provider of emergency response services. The rating scale for pain may be beneficial for pain relief of an individual. However, this rating does not help in comparing the intensity of pain experienced by diverse individuals. (EMS4) One of the main challenges faced by EMS is the recruitment, selection and retention of diverse and multicultural workforce. It is essential therefore, that the education system of medical students and training for EMS workers should emphasize on the need for diversity and inclusion. This will further help in lessening disparities in healthcare especially if the EMS workers are proficient in subjects like inclusiveness, cultural competency and diversity (Bowman, Moreno-Walton & Heron, 2011).
Socio-cultural and demographic factors
The homeless and poor people are also attuned to the present rather than future and the main concern of survival also is a significant factor which impacts their calling for EMS. There are several others who may not conform to the follow – up treatment and prescribed medicines. Patients do not have the ability to foresee their future and may miss taking prescribed hypertension medicines because they feel to have already improved from their ailment. Those patients afflicted with tuberculosis may discontinue their antibiotic medications as they feel the signs of the ailment have lessened. Around twelve percent of the total population in the United States of America comprise of the poor and fifteen percent does not have medical insurance. EMS providers often meet challenging patients who live in conditions of poverty. It is essential that EMS providers treat the poor with the same dignity in which they treat other individuals. This is despite the fact that those who are living in poverty are undereducated, ignorant, incompetent and uncaring. One of the diverse elements complicating issues of health is poverty. Often, poor people contact EMS when the patient is in a state of crisis. In such instances, the complications in the health of the impacted individual may also not be resolved by EMS. It is essential that the issue of poverty is mitigated by societal transformations and governmental changes. Such measures should be aimed to provide long term solutions rather than short term measures. Those living in poverty experience the same ailments as other individuals. However those suffering from poverty contact EMS in advanced stages of their ailment. This may complicate their health as they may suffer from multiple ailments for not going through preventive care in the early stages of their ailments. Especially for those who are homeless and poor suffer severe complications due to ailment. This is mainly because for such people the priority lies in getting shelter and food rather than that of healthcare facilities. Hence, such individuals are those who dial the EMS when the ailment reaches a period of crisis.
Poverty and homelessness have also made some individuals to manipulate their own way into the healthcare system so that they may survive. Such people are those who often use EMS so as to get healthcare facilities. Such individuals are also not impacted by the education and counseling given to patients by EMS with respect to preventive care, acquiescence with the medicines prescribed and evading harmful things like alcohol. Several hindrances including an emphasis on poor coping skills towards life, presence and having a bleak outlook towards future also impact homeless and poor individuals. Patients lacking skills to effectively manage their problems and in most of the times not trying to address and resolve issues may often end up with drinking, substance use and smoking so as to counter their severe stress levels. Such kind of conduct permeates the culture of poverty and is frustrating to the providers of emergency medical service. This is because EMS providers view simple solutions to resolve such issues which often such patients do not want to follow or even acknowledge. For such individuals, the main objective of the EMS is to help them to cope up with their daily duties of maintaining their health to survive. The EMS should not strive to teach such individuals interpersonal skills that are often used by the middle class people. The barrier to language and the conflict in the culture may be heightened by incorrect interpersonal exchanges. This condition is rather accentuated if the patient uses EMS as the first and the only contact to gain access to American healthcare.
Another reason for having a diverse workforce in EMS is that of empathy. It is essential that EMS workers display empathy for individuals who are poor and homeless. This will further help them in understanding that such individuals may not enjoy the same accessibility to facilities and resources of healthcare. This may be one of the reasons for them to dial EMS only in case of dire circumstances. A diverse workforce in EMS will include people from all strata and this will further help in understanding the reasons for such poor people to contact emergency medical services for dire circumstances. A culture of inclusiveness will bring in people who effectively change the healthcare services to be not only culturally competent but also diverse. This will further help in empathizing for individuals belonging to minority communities and groups and having a wide range of cultures, customs and traditions.
Cultural competency and diversity in EMS
Having knowledge, respect and awareness of the culture and ethnicity for others is cultural competency. General opinions formed with respect to a particular group may include the awareness of values and culture of that particular group and helps in understanding the group better. Also such opinions should consider several aspects of acculturation, education, socioeconomic conditions, faith and nationality of that particular group (Vaughn, Jacques & Baker, 2009). Such general opinions are often based on stereotyping. In other words, people may assume that every individual belonging to a particular group or culture may think, act and believe in the same way. This can lead to having a negative opinion about poor caring for patients as well as the community in general. Education on cultural competency should include such biases and prejudices that EMS workers should abide thereby fostering a culture of multiculturalism and inclusiveness.
Finally, it is essential that EMS workers are provided training on diversity and cultural competency. This is mainly because most individuals have prejudices based on race, ethnicity and color. Such biases may contribute to the disparity in healthcare facilities. This may be a reason as to why the non – whites do not have similar treatment and care as compared with the majority population. Also while planning for training the EMS staff on diversity and cultural competency it is essential that individual prejudices and stereotypes with respect to implementation and planning for such program are evaded. It is also essential that those attending the diversity training is aware and address their own stereotypes so as to enhance and foster a culture of diversity in EMS. Such training programs should also determine the challenges faced by individuals in the implementation of such diverse and cultural inclusiveness training. One of the main hindrances may be faced if there is sparse population of patients from the minority communities. This is because having sparse patients from minority groups led to the development of certain negative stereotypes towards such patients.
Conclusion
Diversity and inclusiveness in EMS should strive to address the main challenge of maintaining and recruiting a workforce that is in sync with the population in the area of service. This means that if the EMS provider is serving an area having minority community and groups, it is essential that the EMS staff allocated for that particular area comes from the same minority community. Alternately, the EMS staff should be training to speak diverse language and have excellent communication skills so as to interact and develop a relationship of trust. Having an EMS workforce in sync with the same community helps in empathizing and understanding the issues faced by that community, their values, customs and traditions and fosters the development of favorable relationships and trust between patient and EMS worker.
Some EMS programs in this nation have started targeting students in high school and medical students so as to impart and equip them in diversity and cultural competency training. Such training helps in having future EMS workforce to be culturally sensitive and respect diversity in patient care. At the same time, these programs strive to identify issues which may arise in future due to a lack of diversity and include adequate training required to mitigate such problems.
References
Bowman, S. H., Moreno-Walton, L. & Heron, S.L. (2011). Diversity in emergency medicine education: expanding the horizon. Academic Emergency Medicine, 18, 2, 104 – 109.
Dees, L. (2007). Culturally competent care in the emergency medical services. Texas EMS Magazine, 34 – 39.
Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Neane, D. & Bindman, A. (1996). The role of Black and Hisptanic physicians in providing health care for underserved populations. The New England Journal of Medicine, 334, 1305 – 1310.
Vaughn, L.M., Jacquez, F. & Baker, R. C. (2009). Cultural health attributions, beliefs, and practices: effects on healthcare and medical education. The Open Medical Education Journal, 2, 64 – 74.
