Empowering Community Voices in Emergency Medical Services (EMS)

Authors: Alissa Leung, Senior Program Assistant and Ruben Cantu, Director, Prevention Institute

With contributions from: Courtney Davis, TabiMOMS ; Ryan McClinton, Public Health Advocates ; Toni McNeil, Concrete Development Inc ; Tasha Williamson, Exhaling Injustice ; and Dr. Miranda Worthen, San Jose State University ; and other CARESTAR Foundation grantees.

In an ideal world, communities would see their people, voices, and lived experiences represented in emergency medical services (EMS) and pre-hospital care. There would be trusting relationships between residents, EMS, and pre-hospital care workers. Trauma-informed, culturally-sensitive, and timely care would be standard practice. However, trauma-informed care (TIC) has yet to be systematically implemented in emergency departments . Patients with limited English proficiency experience communication barriers and distrust of EMS providers. In the U.S., Black and Hispanic people have been less likely to receive CPR at home or in public.?

And yet, while there is much room for improvement to reach full health equity in EMS (and many other components of the health care system), we are making progress listening to and lifting up community voices so that those most impacted by the inequities are being heard. Cross-sector partnerships have emerged to address the ongoing challenge of building equitable approaches.

Since 2022, Prevention Institute (PI) has partnered with the CARESTAR Foundation , a California-based philanthropic organization elevating community voice and power in EMS and pre-hospital care. The CARESTAR Foundation’s mission, its grantmaking, and operations all center racial equity. The Foundation’s support has allowed PI to explore ways that EMS and pre-hospital care can, in addition to saving lives, move upstream to focus on systems change.

PI engaged CARESTAR’s grantee network to hold several conversations exploring how centering community voices and experiences promote greater health equity and systems change. In October 2023, PI connected with several grantees—Courtney Davis of TabiMOMS , Ryan McClinton of Public Health Advocates , Toni McNeil of Concrete Development Inc , Tasha Williamson of Exhaling Injustice , and Dr. Miranda Worthen of San Jose State University —working to strengthen EMS and pre-hospital care. Their diverse professional experiences enriched our conversations. They shared guidance on centering community voices as a powerful way to affect systems change toward a more equitable EMS response and care.?

The grantees emphasized the importance of intentional relationship building towards centering community voices. It is a slow, deliberate process, ideally informed by historical and present-day trauma, stigma, and context. Toni McNeil, Concrete Development Inc. Founder and Executive Director, warned of quick and transactional relationship building. “Surveys can be an impersonal method of finding out what community members need and want; therefore, it’s crucial to build a relationship first. This approach differs significantly from starting with a survey.” EMS and pre-hospital care advocates and workers must rely on strong community relationships to identify and respond to resident priorities.

Centering community voice starts with identifying and prioritizing specific communities, those experiencing disproportionately poor health outcomes. Courtney Davis, TabiMOMS Founder and Executive Director, described community centeredness as “Acknowledging diversity [in experiences] exists in our vision and ensuring it’s lifted up; and counteracting a narrow lens on need by bringing in historically excluded groups.” EMS and pre-hospital care response should align their response with the highest needs, where there are the greatest health inequities.?

Besides informally identifying and prioritizing community needs via new and ongoing relationships, residents can contribute their ideas and actions to EMS reform by serving in a formal role. Ryan McClinton, Program Manager at Public Health Advocates, remarked, “Those closest to the pain are closest to the solutions.” Through their organization’s work, Ryan and his colleagues champion peer support specialists as an alternative or complementary response to an already overburdened 911 and hospital system. For example, peer support specialists are residents recruited to assist people in circumstances that mirror their own lived experiences (e.g., addiction and mental health crises). Formalizing resident roles not only improves the response and care provided, but it also lends credibility to the lived experiences of community members that are not automatically heard or respected.?

Lifting up community voices may also include listening to community members’ needs, ideas and decisions about their health and wellbeing. Such was the case when Toni McNeil supported Care Link Mobile Crisis Intervention to develop a community-based alternative to police in Stockton, California. With McNeil’s leadership, Care Link developed a three-year pilot program that deploys teams of licensed social workers, case managers, community health workers, and medical assistants to address mental health and social service needs. McNeil ensured community voice was at the forefront of this initiative by facilitating listening sessions and recruiting residents to draft an initial strategic request for funding of a community-based alternative to policing. Consequently, the city of Stockton allocated $5.76 million of its ARPA (American Rescue Plan Act) fund towards a community-identified need.

Our conversations with the CARESTAR Foundation’s grantees reinforced the importance of community centeredness and community voice in pre-hospital and EMS response and care. It is crucial for creating equitable health outcomes and systems change. CARESTAR grantees are building the foundation for deeper community trust, intentional relationship building, and a more comprehensive and responsive system, while demonstrating what a critical role EMS, pre-hospital care advocates, and providers can play in enhancing community safety and wellbeing.

References

Franco, V. (2022, November 4). City of Stockton Unveils Mobile Crisis Intervention Response Pilot Program. Stocktonia News. https://stocktonia.org/news/culture/2022/11/04/city-of-stockton-unveils-mobile-crisis-intervention-response-pilot-program/

Garcia, R. A., Spertus, J. A., Girotra, S., Nallamothu, B. K., Kennedy, K. F., McNally, B. F., Breathett, K., Del Rios, M., Sasson, C., & Chan, P. S. (2022). Racial and ethnic differences in bystander CPR for witnessed cardiac arrest. New England Journal of Medicine, 387(17), 1569–1578. https://doi.org/10.1056/nejmoa2200798

Greenwald, A., Kelly, A., Mathew, T., & Thomas, L. (2023). Trauma-informed care in the Emergency Department: Concepts and recommendations for integrating practices into emergency medicine. Medical Education Online, 28(1). https://doi.org/10.1080/10872981.2023.2178366

Stadeli, K. M., Sonett, D., Conrick, K. M., Moore, M., Riesenberg, M., Bulger, E. M., Meischke, H., & Vavilala, M. S. (2023). Perceptions of prehospital care for patients with limited English proficiency among emergency medical technicians and Paramedics. JAMA Network Open, 6(1). https://doi.org/10.1001/jamanetworkopen.2022.53364