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

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


Background: 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.

Methods: 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.

Results: 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%).

Conclusions: 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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiopulmonary Resuscitation / statistics & numerical data*
  • Chest Pain / therapy*
  • Emergency Medical Services / standards*
  • Emergency Medical Services / statistics & numerical data
  • Female
  • Healthcare Disparities*
  • Humans
  • Male
  • Middle Aged
  • Out-of-Hospital Cardiac Arrest / therapy*
  • Sex Factors
  • Women*