ESO Releases Groundbreaking Research on Disparities in Prehospital Pain Management for Long Bone Fractures

Research study highlights racial disparity after accounting for socioeconomic status and pain severity

May 31, 2023 – AUSTIN, Texas – ESO, the leading data and software company serving emergency medical services (EMS), fire departments, hospitals, and state EMS/Trauma offices, has revealed significant findings that shed light on racial disparities in prehospital pain medication administration for patients transported by EMS who were subsequently diagnosed with long bone fractures at the hospital. This groundbreaking research uses data from the ESO Data Collaborative, one of the nation’s largest integrated healthcare research databases, inclusive of EMS data and linked hospital outcomes. The findings are based on more than 35,000 patients with long bone fractures transported by 400 EMS agencies between January 1, 2019, and December 31, 2020.

“Inadequate pain management in prehospital emergency care persists, and this burden is experienced to a greater extent among Black patients,” said Dr. Remle Crowe, Director of Clinical and Operational Research at ESO. “For many patients experiencing severe acute pain, their first interaction with the healthcare system occurs in the out-of-hospital setting with EMS clinicians. EMS clinicians play an important role in reducing treatment disparities, which we can no longer ignore.”

Key Findings Include:

  • Objective Injuries through Linked Hospital Data: In this study, all patients were diagnosed with long bone fractures (humerus, radius/ulna, femur, or tibia/fibula) at the emergency department. This hospital outcome data was directly linked to the EMS records through ESO’s Health Data Exchange software.
  • EMS Pain Medication Administrations: Analgesic administration primarily rests within the control and discretion of attending EMS clinicians. According to the ESO Data Collaborative, EMS administered pain medication to 72% of White patients with severe pain compared to just 59% of Black patients with severe pain.
  • Analgesic Administration Disparities Were Not Explained by Clinical Factors or Patient Preferences: The ESO study found that Black, non-Hispanic patients were 35% less likely to receive pain medication in the prehospital setting compared to their White, non-Hispanic counterparts after controlling for potentially explanatory variables like pain severity, time to arrive at the emergency department, location of the fracture, age, gender, and socioeconomic status. The authors further read the free-text EMS notes to look for potential explanatory variables such as medical contraindications or patients declining analgesic medication; however, no differences were found to explain the racial disparity.
  • Socioeconomic Considerations: This study accounted for the complex relationship between race and ethnicity and socioeconomic status. The ESO dataset includes the socioeconomic status of the community where the EMS encounter took place as measured by the Centers for Disease Control and Prevention’s Social Vulnerability Index. Patients encountered in areas or lower socioeconomic status were less likely to receive pain medication; however, Black patients encountered in communities within the highest quartile of socioeconomic status remained less likely to receive prehospital pain medications.

“This study improves our understanding of the impact that racism and classism has on the quality of EMS treatment by making clear two key findings. First, Black patients, regardless of if they were injured in a rich or poor part of town had no evidence of refusing pain treatment any more or less than White patients yet received sub-standard treatment from EMS clinicians. This finding is based on a large national sample and aligns very closely with several other regional findings” said Dr. Jamie Kennel, PhD NRP Professor at Oregon Health and Science University and Oregon Institute of Technology. “Second, regardless of racial differences, individuals who live and work in poor areas of town received a lower quality of care when compared to individuals who live and work in wealthy areas of town. As a safety net provider, it is unacceptable to vary the quality of care based on a patients race or socioeconomic status. It’s time to rapidly move to understanding the underlying reasons this is taking place and swiftly test interventions so that all members of our communities receive the highest quality of EMS treatment possible.”

Visit the ESO Research page to view the peer-reviewed research in its entirety.

About the Research:
This research is based on 35,711 records for patients with diagnosed long bone fractures from the ESO Data Collaborative between January 1, 2019, and December 31, 2020.

About ESO
ESO is dedicated to improving community health and safety through the power of data. Since its founding in 2004, the company continues to pioneer innovative, user-friendly software to meet the changing needs of today’s EMS agencies, fire departments, hospitals, and state EMS offices. ESO currently serves thousands of customers throughout North America with a broad software portfolio, including the industry-leading ESO Electronic Health Record (EHR), the next generation ePCR; ESO Health Data Exchange (HDE), the first-of-its-kind healthcare interoperability platform; ESO Fire RMS, the modern fire Record Management System; trauma, burn and stroke registry software; and ESO State Repository. ESO is headquartered in Austin, Texas. For more information, visit


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