Resuscitation Practices at Emergency Medical Service Agencies Working in Black and Hispanic Versus White Catchment Areas in the United States.

Chan, Girotra, Breathett, Dukes, Sperling, Pacheco, Kennedy, Sasson, McNally, Schacht Reisinger, Del Rios. Resuscitation Practices at Emergency Medical Service Agencies Working in Black and Hispanic Versus White Catchment Areas in the United States. Circulation. Cardiovascular quality and outcomes. 2025 Jun 1; 18(6):e011799, DOI: 10.1161/CIRCOUTCOMES.124.011799.

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Abstract:

BACKGROUND: Although survival for out-of-hospital cardiac arrest (OHCA) is lower at emergency medical service (EMS) agencies serving Black/Hispanic communities, it is unknown whether this is due to practice differences. METHODS: Within the Cardiac Arrest Registry to Enhance Survival (CARES) registry in the United States, we conducted a survey from 2022 to 2023 of resuscitation practices at EMS agencies with ≥10 OHCAs annually between 2015 and 2019. We examined differences in dispatch, first responder, and EMS practices between agencies with majority Black/Hispanic catchment areas ( > 50% residents Black or Hispanic) and majority White catchment areas using χ tests. We estimated each agency''s risk-standardized rate of survival to hospital admission for OHCA using multivariable hierarchical logistic regression and evaluated whether survival differences between the 2 agency groups were attenuated after adjusting for resuscitation practice differences. RESULTS: Among 470 EMS agencies (181 707 OHCAs), 47 (10.0%) served a majority Black/Hispanic catchment area. At EMS agencies with Black/Hispanic catchment areas, dispatchers and police first responders were less likely to always recognize a cardiac arrest (29.8% versus 43.0%); police first responders were less likely to respond to OHCA (46.8% versus 68.9%), initiate CPR (59.6% versus 83.2%), or apply an automated external defibrillator (29.8% versus 60.0%); and EMS staff were less likely to assess CPR competency annually (46.5% versus 65.0%) and use waveform capnography (91.5% versus 99.5%), as compared with agencies with White catchment areas. EMS agencies serving majority Black/Hispanic catchment areas had 2% (95% CI, 0.9-3.1%; < 0.001) lower risk-standardized rates of survival, as compared with agencies serving majority White catchment areas, and survival differences were partly attenuated after adjusting for practice differences between EMS groups. CONCLUSIONS: In the United States, we identified differences in dispatcher, first responder, and EMS practices for OHCA between agencies with majority Black/Hispanic and White catchment areas. These practice differences may partly account for disparities in OHCA survival between the 2 EMS agency groups.