Hennepin EMS seeks paramedic diversity to boost outcomes for minority patients

Infinity Beatty-Metcalfe’s graduation from Hennepin Healthcare’s paramedic trainee program on Friday may have been destiny, but it was a delayed one for the 31-year-old.

She pushed herself after growing up in foster care to become an emergency medical technician (EMT) at 19. But Beatty-Metcalfe burned out from the intensity and frequency of ambulance runs in St. Louis. She had been inspired after witnessing the heroism of paramedics who brought a baby born prematurely to a hospital by helicopter. But paramedic training seemed impossible while working to pay bills and starting a family.

“That’s a lot of balls to balance,” Beatty-Metcalfe said.

Her struggle is exactly why Hennepin Healthcare’s emergency medical services (EMS) division created its trainee program in 2020, paying EMTs to work part time while completing accelerated paramedic training.

Too few individuals who are Black, Indigenous or people of color (BIPOC) — like Beatty-Metcalfe — become entry-level EMTs in the first place, but fewer make the jump to paramedics, said Dr. Tim Kummer, assistant medical director of Hennepin Healthcare’s EMS division. The result has been a mismatch in the diversity of the EMS workforce and the community it serves, and that can have consequences.

“Patients who don’t look like their providers get different types of care,” Kummer said. “There’s delays in asthma treatment. There’s delays in pain medication. There’s things that exist that we have to just be honest about, and we have to go after with a multipronged approach, which includes evolving our workforce.”

Research had demonstrated the need for more diversity in the EMS workforce, even before the police killing of George Floyd in Minneapolis in 2020 sowed distrust in first responders, whether they be police officers or firefighters or medics. Oregon researchers in 2019 reported that Hispanic and Asian patients with traumatic injuries were less likely to be assessed by medics for pain and that Black patients were less likely to receive pain medications.

Hennepin Healthcare responded with a six-week paid internship called Talent Garden that exposes students of color to health care opportunities. Some of the first graduates now have jobs in the health system. A partnership with the Minneapolis Fire Department also expedites certification of minority students as EMTs. But Kummer said the paramedic program is key to addressing racial disparities in EMS care.

“It’s that gap from EMT to paramedic — right where there’s a big investment in money, there’s a huge investment in time — and that is where we see that drop off,” he said.

Fifteen paramedics graduated from the trainee program on Friday, including five women and three racial minorities.

Beatty-Metcalfe had been traveling from St. Louis to Minneapolis to work temporary EMT shifts when a breast cancer diagnosis last year motivated her to accelerate life plans, move her family to Minnesota and pursue paramedic training.

EMTs perform lifesaving functions and transport patients from emergency scenes. Paramedics have additional diagnostic and treatment responsibilities, including inserting breathing tubes in patients.

“It’s a totally different experience when you are the one giving medication, where you can take someone’s life” if you make a mistake, Beatty-Metcalfe said. “My interventions can have negative consequences if I don’t give them appropriately.”

She said she was grateful for the training and the medics who have mentored her on ride-along shifts and supervised her while she took charge of patient care at emergency scenes.

Passing the licensure exam is next. Then she’ll enter Hennepin Healthcare’s academy program and continue training until she is ready to be a lead paramedic on her own ambulance.

After a couple of years on the ground, she can pursue her goal of becoming a flight medic. Beatty-Metcalfe was flown by medical helicopter to a St. Louis hospital at 2 months old, when she had been physically abused and first entered foster care. The episode is a motivating influence, along with the desire to show others what they can achieve despite hardships.

“There is a pressure, there is an understanding that I am kind of that liaison,” she said, “who can show other BIPOC women and girls that you can do this, and despite how you started.”

The last statewide assessment of Minnesota’s EMS workforce, which includes EMTs and paramedics, showed in 2022 that fewer than 2% of certified first responders were Black. The precise rate was unclear because race data was missing for one-fifth of providers, but it was lower than the 7% of Minnesota residents who are Black. Only 28% of EMS workers are female.

Kummer said it’s impossible in emergencies to match patients and medics by their demographics, but he said a more diverse workforce will benefit the profession directly and indirectly. White paramedics can gain cultural sensitivity just by working more often with BIPOC colleagues.

Black patients make greater use of the EMS system, studies have shown, but take longer to call for help when dealing with strokes and heart attacks. A more approachable EMS system might make Black patients call for help sooner and improve their outcomes.