Examining Racial Disparities in Bystander Interventions During Out-of-Hospital Cardiac Arrest: A National Emergency Medical Services Information System 2023 Study

Out-of-hospital cardiac arrest (OHCA) remains a major public health concern in the United States, with survival outcomes heavily influenced by bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. Prior research has documented racial disparities in the administration of these life-saving interventions, but few studies have utilized nationally representative emergency medical services (EMS) data to explore these inequities across multiple racial groups. We hypothesize that minority racial groups are less likely to receive bystander CPR/AED. Our objective with this study is to encourage public health researchers to study this topic and for public health departments to expand CPR training and AED access.

This cross-sectional study used data from the 2023 National Emergency Medical Services Information System (NEMSIS) dataset to examine racial disparities in bystander CPR and AED use among 87,800 OHCA cases. Multivariable logistic regression models assessed the relationship between race and the likelihood of receiving bystander CPR and AED intervention, adjusting for age, gender, urbanicity, witnessed status, and cardiac arrest etiology.

Compared to White individuals, multiracial (aOR=0.67, 95% CI: 0.57–0.79), Asian (aOR=0.77, 95% CI: 0.71–0.84), Black (aOR=0.72, 95% CI: 0.69–0.74), and Hispanic (aOR=0.68, 95% CI: 0.64–0.72) individuals had significantly lower odds of receiving bystander CPR. Similarly, American Indian or Alaska Native (aOR=0.65, 95% CI: 0.55–0.78), Asian (aOR=0.75, 95% CI: 0.68–0.82), Black (aOR=0.88, 95% CI: 0.85–0.91), and Hispanic (aOR=0.65, 95% CI: 0.62–0.69) individuals had significantly lower odds of receiving bystander AED use.

Significant racial disparities persist in the receipt of bystander CPR and AED interventions during OHCA, even after controlling demographic and contextual variables. These findings show the need for targeted, equity-focused public health interventions to improve access to life-saving interventions in underserved communities and reduce preventable mortality.