AGE DISCRIMINATION IN EMERGENCY TRANSPORT

This was posted online today. The source was HealthDay News (http://health.usnews.com/articles/health/healthday/2008/08/18/older-patients-less-likely-to-be-taken-to-trauma.html)

"Older trauma patients are less likely to be transported to an official trauma center for immediate care than younger patients, a new study found.

The finding was based on a review of a decade's worth of Maryland's statewide emergency medical services (EMS) records. And it suggests that the difference in care first comes into play as patients reach age 50 and worsens again at age 70...

More patients older than 65 were undertriaged, or not taken to a state-designated trauma center, than were younger patients (49.9 percent vs. 17.8 percent).

After adjusting for other related factors, the researchers found that being 65 years or older was associated with a 52 percent reduction in likelihood of being transported to a trauma center. This decrease in transports was found to start at age 50 years, with another decrease at age 70.

'I'm not sure I would call it a bias, because that word has negative connotations, but in general, people do seem to have unconscious blind spots when it comes to the elderly,' said study lead author David Chang. He is an assistant professor in the department of surgery at Johns Hopkins School of Medicine and in the department of health policy and management at Johns Hopkins Bloomberg School of Public Health.

'So not only EMS staff but also those receiving patients at trauma centers are operating on subjective assumptions as to what elderly patients need, how aggressively they should be treated, and what hospitals can do for them, rather than on clear and standard protocol, codes and trauma recommendations,' Chang added. 'And as a result, as patients get older, they are less likely to get into a trauma center.'

Chang and his team reported their findings in the August issue of the Archives of Surgery."

While the author of the study may be afraid to call this discrimination, I'M NOT! I see this same age-related discrimination happening every day in the business world. My job seeking clients over 40 (and even more obviously over 50) absolutely MUST hide any indication of their age in order to even get an interview. Once granted an interview, there is often a statement made about them being "over qualified" as a way of turning them down for the job.

In the workplace, this discrimination occurs typically due to three assumptions:

1. older workers are inflexible and cannot "be controlled:"
2. older workers cost more and we can get the same work done for less; and
3. older workers will have health-related issues that will increase their absenteeism, decrease their on-the-job performance and raise our medical insurance rates.

In the general community, the job of an Emergency Medical Technician or Paramedic is a very emotionally and physically demanding job. I know. I was certified as an EMT in the mid 1970's. In support of my contention that this is a physically rigorous job, in an article entitled, "Physician versus Paramedic in the Setting of Ground Forces Operations: Are They Interchangeable?" (http://findarticles.com/p/articles/mi_qa3912/is_200703/ai_n18755588/pg_4), the author made the following statement - "Paramedics are generally more available than physicians and since their average age... is younger, they are generally more fit."

The average age of a paramedic today is:

1. Oregon Office of Rural Health, 36 - 45 years old (http://www.ohsu.edu/ohsuedu/outreach/oregonruralhealth/providers/upload/2007-EMS-Poster.pdf);
   
2. University of North Dakota - 40.5 years old (http://ruralhealth.und.edu/pdf/remsifs2.pdf);
3. Canada, National Human Resource Review - 37.1 years old (http://www.jibc.ca/paramedic/forms/paraShortage_CallForAction.pdf);
4. University of Western Ontario - 36 years old (http://www.fims.uwo.ca/olr/Apr0407/paramedics.html);
5. A Comparison of Rural and Urban Emergency Medical System (EMS) Personnel: A Texas Study - "The urban EMP,more than rural subjects, was younger (mean = 36
   years)..." and "directors of EMS in urban settings can expect to manage a labor force comprised of married males (mean age = 37.0 years)" (http://pdm.medicine.wisc.edu/Volume14/Chng.pdf)
   

If you review the above averages, you see that they reflect an "average of averages" of about 38 years old, under the age at which discrimination is typically experienced but perilously close to becoming a recipient of that discrimination. My personal experience is that discrimination and change resistance increases at direct proportion to the approach of the discrimination in one's own life. Fear is a clear driver.

More from the article - "A follow-up survey of 127 EMS workers and 32 medical personnel (including doctors, nurses, and medical students) revealed that the top three reasons for not transporting an older patient to a trauma center were: a lack of sufficient training for handling such patients (more than 25 percent); not knowing trauma protocols (12 percent); and potential age bias (just over 13 percent)."

Give me a break! A lack of sufficient training for handling such patients???? Here are the statistics for emergency transport - "In 2003, patients arrived by ambulance for 16.2 million ED visits (14.2%)... Of ambulance-related visits, 39% were made by seniors..." (http://linkinghub.elsevier.com/retrieve/pii/S019606440501989X). That translates to 6,318,000 "senior" transports! Since seniors are the fastest growing age group in the US based on the influx of Baby Boomers, we are in trouble!

As for not knowing trauma protocols, if emergency tranport personnel do NOT know trauma protocols, they should not be emeregncy tranport personnel since that IS their job description!

In a second study published in the same issue of the journal, "a survey from the University of Connecticut School of Medicine found that trauma patients and caregivers alike seem to prefer palliative care, rather than aggressive critical care, if doctors believe that the latter is pointless."

In the seniorjournal.com website (http://www.seniorjournal.com/NEWS/Health/2008/20080818-SeniorsMuchLessLikely.htm), additional information NOT shared on the government web site from the original study includes the following statement, “'The problem of age bias raised in this study may negate efforts to improve clinical care for elderly trauma patients within trauma centers if the system as a whole does not function properly and deliver patients appropriately to needed resources,' the authors write. 'However, it may be difficult to change attitudes of age bias and may require a broad societal campaign.'"

I agree. This study result reveals another symptom of denial in the United States about which I have previously blogged. And, the very fact that the government website did NOT post the statement regarding the need for a "broad societal campaign" is also denial. If we don't address this as a society, not only is our own mortality at risk but so is that of our country.