Minorities More Likely to Have Their Ambulance Diverted

By Sheryl Nance-Nash on August 8, 2012 9:48 AM EDT

Ambulance
Hospitals in areas with large minority populations are more likely to be overcrowded and to divert ambulances, according to new research. (Photo: Wikimedia)

If you're a minority and in an ambulance, good luck. Hospitals in areas with large minority populations are more likely to be overcrowded and to divert ambulances, delaying timely emergency care, according to a multi-institutional study focused on Californiancaa.

The researchers examined ambulance diversion in more than 200 hospitals around the state to assess whether overcrowding in emergency rooms disproportionately affects racial and ethnic minorities. They found that minorities are more at risk of being impacted by ER crowding and by diversion than non-minorities.

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"Our findings show a fundamental mismatch in supply and demand of emergency services," said lead author Renee Hsia, MD, assistant professor of emergency medicine at UCSF, in a prepared statement.

Research shows that those at risk often rely on ambulances to get to the hospital.

"If you pass by a closer hospital that is on diversion for a hospital 15 minutes down the road, you are increasing the amount of time the patient is in a compromised situation," Hsia said. "It puts these patients at higher risk for bad health outcomes from conditions like heart attacks or stroke, where minutes could mean the difference between life and death."

When there is no room at the inn so to speak, it means a hospital's emergency department is too busy to accept new patients. Ambulances have to keep it moving and go the next best ER, even if it's miles away. This is not an uncommon practice in urban America, particularly in these tough times when many are turning to ER because they haven't had the money to pay for routine care and wait until a crisis to seek help.

This is the first study using hospital-level data to show how diversion affects minorities.

Researchers looked at ER departments at all of California's acute, non-federal hospitals operating in 2007, the majority of the 202 analyzed were not-for-profit facilities. In all, 92 percent of the hospitals were on diversion for a median of 374 hours over the course of the year. Those serving high numbers of minorities were on ambulance diversion for 306 hours, compared to 75 hours at hospitals with fewer minority patients.

Some limitations to the study were noted: Diversion is an imperfect measure of overcrowding, and even when an emergency department is on diversion status, certain patients - particularly trauma patients, still can be accepted.

"Emergency departments and trauma centers are closing more frequently in areas with vulnerable populations, including racial and ethnic minorities," Hsia said. "This is a systems-level health disparities issue that requires changing the 'upstream' determinants of access to emergency care. It's not just a problem at the level of the emergency department itself, but of the hospital and entire system."

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