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Womens Health Issues. 2019 Mar - Apr;29(2):116-124. doi: 10.1016/j.whi.2018.10.007. Epub 2018 Dec 10.

Gender Differences in the Quality of EMS Care Nationwide for Chest Pain and Out-of-Hospital Cardiac Arrest.

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Division of Cardiology, Department of Internal Medicine, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Department of Emergency Medicine, Oregon Health & Science University Portland, Oregon Center for Policy and Research in Emergency Medicine, Portland, Oregon.
Department of Health and Human Services, Office on Women's Health, Washington, District of Columbia.
Department of Health Policy and Management, Milken Institute School of Public Health, Washington, District of Columbia.
Milken Institute School of Public Health, George Washington University, Washington, District of Columbia.
Milken Institute School of Public Health, George Washington University, Washington, District of Columbia. Electronic address:



We sought to determine whether gender disparities exist in the prehospital management of chest pain (CP) or out-of-hospital cardiac arrest (OHCA) among patients who accessed the emergency medical services (EMS) system.


We obtained 2010-2013 data from the National Emergency Medical Services Information System and identified all EMS activations for CP or OHCA by adults 40 years of age or older. We selected American Heart Association medications and procedures to manage cardiovascular events. We stratified women and men by age (<65 years vs. ≥65 years), race (White vs. Black), clinical condition (CP vs. OHCA), same EMS agency, and calendar year. We determined the gender-specific treatment proportions for each stratum and calculated the weighted percentage difference in treatment between women and men.


Approximately 2.4 million CP and 284,000 OHCA activations were analyzed. Women with CP received a lower percentage of recommended treatments than men. For every 100 EMS activations by women with CP, 2.8 fewer received aspirin (95% CI, -4.8 to -0.8). The greatest gap in CP care was that women were significantly less likely to be transported using lights and sirens than men (-4.6%; 95% CI, -8.7% to -0.5%). More than 90% of OHCA activations were resuscitated; however, women were significantly less likely to be resuscitated compared with men (-1.3%; 95% CI, -2.4% to -0.2%).


Small to modest disparities between otherwise similar women and men in the EMS treatment of CP and OHCA suggest the need for further evaluation and research with detailed contextual and outcome data.

[Indexed for MEDLINE]

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