healthcare disparities; pain management; emergency medical services (EMS); opioids; opioid analgesics; prehospital pain management


Emergency Medicine | Social Justice



Racial, ethnic, and gender disparities in effective pain management have been well-documented across healthcare settings. However, discrepancies in the treatment of patients in prehospital pain management settings have not been well researched. The objective of this study was to determine whether Wyoming emergency medical service (EMS) providers’ use of opioids to treat prehospital pain or injury varies by patient race/ethnicity or gender.


This cross-sectional study of EMS records examined 27 448 patient care reports (PCRs) generated during emergency medical responses to pain/injury emergencies in the state of Wyoming between January 2016 and March 2019. We included PCRs in the sample when 1) the primary impression was pain or injury, 2) the type of service was a 911 response, 3) the patient received treatment from and was transported by the EMS unit completing the PCR, and 4) the responding unit included one or more providers authorized to administer opioids.


The analysis identified a disparity in opioid administration by EMS providers during emergency transport (N = 27 448). Logistic regression reveals that EMS providers administered opioids to American Indian/Alaska Native patients (AI/AN) [n = 1610; 5.9%; P < .001; OR = 0.44] and those of Hispanic ethnicity (n = 1351; 4.9%; P = .001; OR = 0.74) at statistically significant lower rates (n = 14 769; 53.8%; P = .004; OR = 0.90) than they administer opioids to White patients. The analysis found EMS providers administer opioids to females at significantly lower rates (P = .004) compared to males.


Wyoming EMS providers administer opioids to White and male patients more often than non-White and female patients. Our results do not show a significant difference in the administration of opioids between White and Black patients. However, the data indicate a statistically significant difference between Hispanic, AI/AN, and White patients as well as between male and female patients.


Made minor text edit.