I've been looking into emergency services for months now. What I found isn't pretty. When people call 911, they expect help to come fast, but that's not happening the same way for everyone.
A big study from 2019 in JAMA Network Open looked at over 63,000 heart attack cases all over the country. They discovered ambulances take way longer to get to Black neighborhoods - like 2 to 4 minutes more on average. You might think that's not much time, but the researchers say "each minute of delay to defibrillation decreases the odds of survival by 7%–10%". Then extra minutes can mean life or death.
In Houston, somebody analyzed almost 1.5 million ambulance calls between 2014 and 2019. Black neighborhoods waited about 6 minutes longer than white neighborhoods for ambulances to show up. And that's even after they adjusted for issues like traffic and distance from ambulance stations.
This isn't just numbers on a page. This is about real people facing life and death situations. I remember reading about Stephon Watts, he was this 15-year-old Black teen with autism in Chicago. When his family called for help during a mental health crisis, police got there before the medical personnel, and things went bad real quick. The boy ended up dead. Later on, ProPublica did this big investigation and found ambulances in Black neighborhoods on the South Side took 8.5 minutes on average, but in white North Side neighborhoods, they only took 6.1 minutes.
Dr. Uché Blackstock, who runs this organization called Advancing Health Equity, she told me something powerful. "These aren't just numbers. These are lives disproportionately Black and Brown lives—that could be saved with equitable emergency response systems."
I learned that the problems start right when somebody picks up the phone to call 911. Dr. Tarak Trivedi from UCLA studied how dispatchers decide which calls are most important. He found out calls from minority neighborhoods was more likely to get marked as less urgent than the exact same emergency described from white areas.
A lot of 911 centers now use these computer programs to help decide which calls need the fastest response. But there's a problem with that. A study in Science Advances by Emma Pierson showed that when these computer systems learn from old biased data, they just keep making the same unfair decisions, but now it looks all scientific and neutral.
Dr. Ziad Obermeyer a professor at UC Berkeley says: "The technology isn't inherently biased, but when it's trained on data that reflects existing societal prejudices, it automates those biases at scale."
Getting to the hospital isn't the end of the troubles neither. Once Black and Brown patients actually reach the emergency room, they still face unfair treatment. In 2021, the New England Journal of Medicine published this study that looked at more than 40,000 chest pain cases. They found Black patients having heart attacks waited 37% longer to get them important heart tests than white patients with the exact same symptoms.
Its not just Black patients neither. Another study in the Annals of Emergency Medicine showed Latino patients with broken bones was 66% less likely to get pain medication compared to white patients. And they had the same insurance and pain scores and everything!
Native Americans also face particularly severe healthcare disparities. According to the Urban Indian Health Institute, they wait an average of 90 minutes longer in emergency rooms before getting seen by a doctor.
Dr. Esther Choo an emergency doctor and professor at Oregon Health & Science University says, "These disparities aren't random. They reflect deeply ingrained stereotypes about who is deserving of prompt care and who is exaggerating their pain."
The money and resources for emergency services isn't distributed fair either. The Brookings Institution did this study in 2023 that found Black counties get 32% less funding per person for emergency medical services than white counties with similar populations.
What does that mean in real life? In Milwaukee, they did a city audit and found that Black neighborhoods had one ambulance for every 43,000 people, but white neighborhoods had one ambulance for every 27,000 people. That means when multiple emergencies happen at once, someone have to wait longer.
Dr. Leana Wen used to be the Baltimore Health Commissioner. She has seen this problem firsthand and she said, "Communities with the greatest health needs often have the fewest emergency resources. This inverted care law is particularly devastating during crises."
Most communities are no longer waiting around for the system to fix itself. They're creating their own solutions. In Oakland, this group called the Anti Police-Terror Project started a program called Mental Health First. They send trained community members to help with mental health emergencies instead of police, which has saved lives in communities of color.
Over in New York City, the Bronx Community Health Network trained more than 300 people from the community to be like "medical interpreters." They go with residents to the emergency room and help them get through all the barriers to good care. A study in Health Affairs found patients with these helpers got treated 37% faster than patients without them.
In some places people are starting to make changes that actually help. Cincinnati had this civil rights lawsuit in 2020, and after they settled it, they created what they call a "blind dispatch system." It removes neighborhood and demographic information when the call first comes in. Their early data shows its reduced response time disparities by 26%.
Seattle got this program called Health, One that pairs firefighters with social workers for certain kinds of emergency calls. It's been really successful at getting people the right kind of help instead of just taking everyone to the ER. They focused it especially on neighborhoods that historically had bad emergency outcomes.
Maryland passed this law called the Emergency Health Equity Act in 2022 that makes all ambulance services collect and publicly share their response times by neighborhood and demographic data. That creates accountability because everyone can see what's really happening.
This isn't just about what's right - it makes economic sense too. The Commonwealth Fund did an analysis in 2021 and estimated that these disparities in emergency care contribute to about $93 billion in extra healthcare costs every year. That's because when people don't get care quick enough, they end up with worse health problems that cost way more to treat.
Dr. Joseph Betancourt, who's the Chief Equity and Inclusion Officer at Massachusetts General Hospital, put it this way: "Investing in equitable emergency services isn't just the right thing to do—it's fiscally responsible. Preventing one stroke through timely response saves hundreds of thousands in long-term care costs."
I talked to a bunch of experts who all had ideas about how to fix these problems, and the give some solutions such as:
1. Data transparency: we need transparency about the data. Maryland already requires public reporting of response times by neighborhood, and other states thinking about doing the same thing.
2. Equity-focused resource allocation: we have to distribute ambulances and resources based on where emergencies is actually happening, not based on property values or just doing things the way they've always been done.
3. Community oversight: communities need a real say in how emergency services work in their neighborhoods. The American Public Health Association recommends independent review boards with actual representation from affected communities.
4. Bias training: Implementing comprehensive bias training for dispatchers, EMTs, and emergency department staff has shown to reduce disparities in several pilot programs
5. Technology audits: we need to regularly check the dispatch computer systems for bias, with input from the communities being affected.
Dr. Blackstock told me, "The technology to provide equitable emergency care exists. What's been missing is the political will to ensure that everyone—regardless of race, ethnicity, or zip code has equal access to life-saving emergency services."
Getting help fast in an emergency shouldn't depend on what neighborhood you live in or what you look like. Its a basic right that everybody should have.
Dr. Camara Jones who used to be the president of the American Public Health Association. She said something that really stuck with me: "When we tolerate different response times based on neighborhood, we are literally assigning different values to human lives based on race. This is the definition of structural racism, and its consequences are measured in preventable deaths."
We need changes at every level - from the federal policy all the way down to local ambulance services. We need both quick fixes for right now and long-term changes to the whole system.
The evidence is clear as day, emergency response systems isn't working the same for Black and Brown communities as they do for white ones.
The question now is whether we have the collective will to fix them.