UCLA

Emergency medical services (EMS) are an important entry point into the United States (U.S.) healthcare system for Hispanic older adults who often have challenges accessing preventive and diagnostic care (Melgoza et al., 2023). Between 2012 and 2050, the population of Hispanic older adults is projected to quintuple from 3.1 million to 15.4 million, although few studies assess the multi-level factors that impact provision of EMS to this population (Hummer & Hayward, 2015; Melgoza et al., 2023). The goal of this dissertation is to investigate the multi-level factors that impact provision of EMS for Hispanic older adults. The first study is a scoping literature review that provides an overview of the current state of the literature in assessing the multi-level factors that impact EMS provision for Hispanic older adults across each link in the out-of-hospital chain of survival. The second and third studies examine the multi-level factors that impact provision of EMS for two different types of emergencies: high acuity cardiac emergencies and low-acuity psychiatric emergencies. McLeroy’s (1988) Socio-Ecological Model and Link and Phelan’s (1995) Fundamental Cause Theory provide the theoretical foundation for all three studies. The Chain of Survival Framework also contributes to the theoretical foundation for the first and second studies that focus on EMS provision for cardiac emergencies. The first study used a scoping literature review methodology to identify studies across multiple databases that meet the inclusion criteria. The second and third studies use cross-sectional data from the San Francisco Department of Emergency Management (SF DEM) and the 2022 5-Year American Community (ACS). In addition to data from SF DEM and ACS, the third study also uses COVID-19 data from the San Francisco Public Health Department, eviction notices data from the San Francisco Open Data Portal, and homeless count data from the City and County of San Francisco’s Public Records Office. Key findings across all three studies suggest the importance of considering factors across multiple levels, and the interplay of these, on provision of EMS for Hispanic older adults. EMS provision for cardiac emergencies was higher among Hispanics, males, older age groups, and in geographic areas with a higher proportion of Hispanic residents, compared to Whites, females, younger persons, and geographic areas with a lower prorportion of Hispanic residents. On the contrary, EMS provision for psychiatric emergencies was higher among Whites, persons with suspected alcohol or drug use, younger age groups, and in neighborhoods with the highest number of eviction notices, but lower in neighborhoods with the highest concentration of persons who are homeless, compared to Hispanics, persons without suspected alcohol or drug use, older age groups, neighborhoods with fewer numbers of eviction notices, and neighborhoods with fewer persons who are homeless. Overall, this dissertation provides insights into provision of EMS for Hispanic older adults. The findings can inform the development, implementation, and evaluation of interventions and programs, as well as influence policies that address existing health disparities and work to achieve health equity in the prehospital setting.