Thomas J. McAdam MPH , Seth J. Prins PhD, MPH , John R. Pamplin II PhD, MPH , Pia M. Mauro PhD, MPH , Sarah Gutkind PhD, MSPH , Megan E. Marziali MPH , Zachary L. Mannes PhD, MPH
{"title":"院前约束和镇静的种族和民族差异。","authors":"Thomas J. McAdam MPH , Seth J. Prins PhD, MPH , John R. Pamplin II PhD, MPH , Pia M. Mauro PhD, MPH , Sarah Gutkind PhD, MSPH , Megan E. Marziali MPH , Zachary L. Mannes PhD, MPH","doi":"10.1016/j.amepre.2025.108066","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Emergency medical service clinicians routinely encounter patients experiencing behavioral health emergencies, yet limited data describe the prehospital use of physical restraints or sedatives. Systemic racism and challenges in access to behavioral health care may contribute to disparities in restraint and sedation use among minoritized groups. This study examined whether race and ethnicity were associated with prehospital use of physical restraints and/or sedation among patients with behavioral health emergencies.</div></div><div><h3>Methods</h3><div>Using the 2022 ESO Data Collaborative consisting of ∼12,000,000 emergency medical service healthcare encounters, this study estimated the associations between race and ethnicity (non-Hispanic White, Black/African American, Hispanic any race, Asian, or American Indian/Alaskan Native) and physical restraint and/or sedation use (yes, no) among patients aged ≥15 years who had an emergency medical service encounter for a behavioral health emergency. AOR estimates with 95% CIs are presented.</div></div><div><h3>Results</h3><div>Approximately 7.1% (<em>n</em>=3,799) of behavioral health encounters involved any restraint or sedation use. All racial and ethnic minoritized groups were more likely to receive physical restraints (AOR range=1.62–2.72, <em>p</em><0.05) than non-Hispanic White patients, whereas Black/African American, Hispanic, and American Indian/Alaskan Native patients were more likely to be sedated with antipsychotics or benzodiazepines (AOR range=1.27–3.21, <em>p</em><0.05). Black/African American patients were also more likely than non-Hispanic White patients to be concurrently restrained and sedated (AOR=1.30, 95% CI=1.09, 1.55).</div></div><div><h3>Conclusions</h3><div>Disparities in restraint and sedation use may perpetuate poor psychiatric outcomes for racially and ethnically minoritized groups, particularly Black/African American patients, in a system that already hinders their access to mental health treatment.</div></div>","PeriodicalId":50805,"journal":{"name":"American Journal of Preventive Medicine","volume":"69 6","pages":"Article 108066"},"PeriodicalIF":4.5000,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Racial and Ethnic Disparities in Prehospital Restraint Use and Sedation\",\"authors\":\"Thomas J. McAdam MPH , Seth J. Prins PhD, MPH , John R. Pamplin II PhD, MPH , Pia M. Mauro PhD, MPH , Sarah Gutkind PhD, MSPH , Megan E. Marziali MPH , Zachary L. Mannes PhD, MPH\",\"doi\":\"10.1016/j.amepre.2025.108066\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Emergency medical service clinicians routinely encounter patients experiencing behavioral health emergencies, yet limited data describe the prehospital use of physical restraints or sedatives. Systemic racism and challenges in access to behavioral health care may contribute to disparities in restraint and sedation use among minoritized groups. This study examined whether race and ethnicity were associated with prehospital use of physical restraints and/or sedation among patients with behavioral health emergencies.</div></div><div><h3>Methods</h3><div>Using the 2022 ESO Data Collaborative consisting of ∼12,000,000 emergency medical service healthcare encounters, this study estimated the associations between race and ethnicity (non-Hispanic White, Black/African American, Hispanic any race, Asian, or American Indian/Alaskan Native) and physical restraint and/or sedation use (yes, no) among patients aged ≥15 years who had an emergency medical service encounter for a behavioral health emergency. AOR estimates with 95% CIs are presented.</div></div><div><h3>Results</h3><div>Approximately 7.1% (<em>n</em>=3,799) of behavioral health encounters involved any restraint or sedation use. All racial and ethnic minoritized groups were more likely to receive physical restraints (AOR range=1.62–2.72, <em>p</em><0.05) than non-Hispanic White patients, whereas Black/African American, Hispanic, and American Indian/Alaskan Native patients were more likely to be sedated with antipsychotics or benzodiazepines (AOR range=1.27–3.21, <em>p</em><0.05). Black/African American patients were also more likely than non-Hispanic White patients to be concurrently restrained and sedated (AOR=1.30, 95% CI=1.09, 1.55).</div></div><div><h3>Conclusions</h3><div>Disparities in restraint and sedation use may perpetuate poor psychiatric outcomes for racially and ethnically minoritized groups, particularly Black/African American patients, in a system that already hinders their access to mental health treatment.</div></div>\",\"PeriodicalId\":50805,\"journal\":{\"name\":\"American Journal of Preventive Medicine\",\"volume\":\"69 6\",\"pages\":\"Article 108066\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Preventive Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0749379725005343\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Preventive Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0749379725005343","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
Racial and Ethnic Disparities in Prehospital Restraint Use and Sedation
Introduction
Emergency medical service clinicians routinely encounter patients experiencing behavioral health emergencies, yet limited data describe the prehospital use of physical restraints or sedatives. Systemic racism and challenges in access to behavioral health care may contribute to disparities in restraint and sedation use among minoritized groups. This study examined whether race and ethnicity were associated with prehospital use of physical restraints and/or sedation among patients with behavioral health emergencies.
Methods
Using the 2022 ESO Data Collaborative consisting of ∼12,000,000 emergency medical service healthcare encounters, this study estimated the associations between race and ethnicity (non-Hispanic White, Black/African American, Hispanic any race, Asian, or American Indian/Alaskan Native) and physical restraint and/or sedation use (yes, no) among patients aged ≥15 years who had an emergency medical service encounter for a behavioral health emergency. AOR estimates with 95% CIs are presented.
Results
Approximately 7.1% (n=3,799) of behavioral health encounters involved any restraint or sedation use. All racial and ethnic minoritized groups were more likely to receive physical restraints (AOR range=1.62–2.72, p<0.05) than non-Hispanic White patients, whereas Black/African American, Hispanic, and American Indian/Alaskan Native patients were more likely to be sedated with antipsychotics or benzodiazepines (AOR range=1.27–3.21, p<0.05). Black/African American patients were also more likely than non-Hispanic White patients to be concurrently restrained and sedated (AOR=1.30, 95% CI=1.09, 1.55).
Conclusions
Disparities in restraint and sedation use may perpetuate poor psychiatric outcomes for racially and ethnically minoritized groups, particularly Black/African American patients, in a system that already hinders their access to mental health treatment.
期刊介绍:
The American Journal of Preventive Medicine is the official journal of the American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health.
Of particular emphasis are papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women''s health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and substance use disorders. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. Papers on health services research pertinent to prevention and public health are also published. The journal also publishes official policy statements from the two co-sponsoring organizations, review articles, media reviews, and editorials. Finally, the journal periodically publishes supplements and special theme issues devoted to areas of current interest to the prevention community.