Racial Disparities in Prehospital Interventions Among Injured Patients

Importance Recent studies suggest racial disparities exist in prehospital interventions among injured patients. Further evaluation is needed to understand how other social determinants of health may influence these findings and if these disparities translate to differences in outcomes. Objective To evaluate the association between race and ethnicity and receiving prehospital interventions, how these associations change based on neighborhood social determinants of health, and if these interventions are associated with patient outcomes. Design, Setting, and Participants This is a retrospective cohort study of the Linking Investigations in Trauma and Emergency Medical Services Task Order 1 database from 2017 through 2021. Patients included were 18 years or older with an injury severity score higher than 9 and had race and ethnicity data available. Data were linked to the Distressed Communities Index (DCI). These data were analyzed from January 2025 to June 2025. Main Outcomes and Measures Associations between race and prehospital interventions were evaluated, including prehospital blood products, prehospital needle decompression, prehospital airway, prehospital intubation, and prehospital tourniquet placement. The study team also evaluated if receiving prehospital interventions was associated with 24-hour and in-hospital mortality. Results A total of 18 280 patients meeting inclusion criteria were identified, of which 4327 self-identified as Black, 11 140 as White, and 2813 as other race. Patients of other race were more likely to receive prehospital blood products (492 [4.4%]) and prehospital intubation (882 [7.9%]) compared with Black patients (101 [2.3%] and 171 [4.0%], respectively). White patients were more likely to receive prehospital airway (1018 [9.1%]) and intubation (882 [7.9%]) compared with Black patients (250 [5.8%] and 171 [4.0%], respectively). Patients in socially disadvantaged neighborhoods were less likely to receive prehospital airway and intubation compared with more affluent communities. No significant interactions or significant mediation by the DCI was seen. Prehospital airway and prehospital intubation were associated with a 30% and 37% reduction in odds of in-hospital mortality (adjusted odds ratio [aOR], 0.70; 95% CI, 0.52-0.93 P = .05) and (aOR, 0.63; 95% CI, 0.46-0.86; P = .004). Conclusions and Relevance These results demonstrate that disparities in prehospital interventions among injured patients exist and these disparities are not significantly explained by neighborhood social determinants of health. Further studies are needed to better understand the underlying causes and employ targeted interventions.