Racial and Ethnic Disparities in Emergency Medical Transport: A Comparative Analysis of Trauma Admissions at a County Hospital and Academic Health Center in a Major U.S. City

Objectives: Trauma patients often cannot communicate a preferred hospital destination to emergency medical services (EMS) due to injuries or impaired consciousness. EMS teams, therefore, determine hospital destinations, potentially influencing access to care. This study examines differences in Level 1 trauma admissions between a county hospital (CH) and an academic health center (AHC) within two miles of each other, focusing on transport patterns and their association with patient demographics. Methods: We conducted a retrospective review of patient charts and EMS transport records, analyzing demographic data, hospital destinations, EMS pickup locations, and documented reasons for hospital selection. Results: Among 1520 patients transported to CH and 625 to AHC, significant differences in transport patterns were observed. White patients were more likely than minority patients to be taken to the nearest hospital (53.1% vs. 46.4%, p=0.003) and less likely to bypass it (21.2% vs. 33.0%, p< 0.001). Minority patients disproportionately bypassed AHC for CH (46.6% vs. 24.6%, p< 0.001), while only 3.8% bypassed CH for AHC. AHC admitted more Black patients (47.4% vs. 37.1%, p< 0.001), while CH admitted more Hispanic patients (10.1% vs. 5.6%, p< 0.001). AHC patients had higher Medicare and Medicaid coverage, whereas CH had more uninsured patients. Conclusion: EMS transport patterns reveal disparities in trauma care access linked to race, ethnicity, and insurance status, underscoring the need for equitable EMS protocols and resource allocation.