Research & Speaking Engagements

Our work is designed to be applied directly and immediately to the work at hand and the communities served. To facilitate this, Equity Analytics Group is actively engaged in contributing to a broader community through publishing research in leading scientific and academic journals and presenting at industry-specific conferences, often with clients as our co-authors.

Browse by topic:

Racism | Sexism | Limited English Proficiency | Sizeism | Simulation Science | Other

Racism

  • Gerber, M., Kennel, J. (2024). Communities Must Address Racial Disparities in Emergency Medical Services. Opinion. Newsweek, Jan 19, 2024.

  • Yuengert, C., Aoun, J., Mattingly-App, A., Taghavi, S., Williams, T., Kennel, J. (2025). Abstract 4357278: Race and Socioeconomic Status Influence Prehospital Treatment and Diagnosis of Patients With ST-Elevation Myocardial Infarction, Circulation, Volume 152, S3

  • Farcas, A. M., Crowe, R. P., Kennel, J., Little, N., Haamid, A., Camacho, M. A., Pleasant, T., … Dorsett, M. (2024). Achieving Equity in EMS Care and Patient Outcomes Through Quality Management Systems: A Position Statement. Prehospital Emergency Care, 28(6), 871–881.

    Abstract

    Improving health and safety in communities requires a deliberate commitment to health equity. Inequities are defined as differences in access, treatment, and outcomes between individuals and populations that are systemic, avoidable, and unjust. Within health care generally, and Emergency Medical Services (EMS) specifically, evidence demonstrates inequities in the quality of care provided to patients based on characteristics associated with discrimination, exclusion, and bias. Given the critical role EMS plays within the health care system, EMS agencies and systems must work to reduce inequities by delivering evidence-based, high-quality care to all patients and communities.

    To achieve equity in EMS care delivery and patient outcomes, the National Association of EMS Physicians (NAEMSP) recommends that EMS systems and agencies:

    1. Make health equity a strategic priority and commit to improving equity at all organizational levels.

    2. Assess and monitor clinical and safety quality measures through the lens of inequities as an integrated component of quality management systems.

    3. Ensure that data elements are structured to support equity analyses and routinely evaluate data limitations that may hinder identification of inequities and quality improvement efforts.

    4. Involve patients and community stakeholders in decisions regarding data ownership and stewardship to ensure data remain appropriate and useful for measuring inequities in care.

    5. Address biases that influence the quality of care delivered and the standards of respect afforded to patients.

    6. Pursue equity using frameworks grounded in the principles of improvement science.

    The position statement emphasizes that achieving equitable EMS care requires intentional system-level action, robust quality management processes, meaningful community engagement, and ongoing evaluation of clinical and safety outcomes through an equity-focused framework.

    DOI: 10.1080/10903127.2024.2352582

    PMID: 38727731

  • Crowe, R., Kennel, J., Fernandez, A., Bourn, S., Burton, B., Van Vleet, L., Wang, H., Myers, B. (2023). Socioeconomic and Racial/Ethnic Disparities in Out-of-Hospital Pain Management for Patients with Long Bone Fractures. Annals of Emergency Medicine, 80(4), S96–S97.

    Abstract

    Study Objectives: Racial and ethnic minority patients are less likely to receive analgesia in the out-of-hospital setting than White patients. Whether these disparities persist among patients with objectively confirmed injuries while accounting for socioeconomic and encounter characteristics was unknown. The study aimed to evaluate socioeconomic and racial/ethnic disparities in out-of-hospital pain management among EMS-transported adults diagnosed with long bone fractures.

    Methods: This retrospective cohort study used the 2019–2020 ESO Data Collaborative public-use research datasets. Adult patients transported by EMS who were subsequently diagnosed in the emergency department with a long bone fracture were included. Primary outcomes were (1) administration of any analgesic by EMS and (2) pain relief, defined as a reduction of at least two points on a 0–10 pain scale. Race and ethnicity were categorized as White non-Hispanic, Black non-Hispanic, Hispanic, and Other. Socioeconomic status was assessed using the Centers for Disease Control and Prevention Social Vulnerability Index socioeconomic theme. For patients reporting severe pain (>6), multivariable generalized estimating equations were used to estimate adjusted odds ratios while accounting for clustering by EMS agency and adjusting for age, sex, fracture type, transport time, insurance status, and socioeconomic status.

    Results: Among 37,801 EMS patients with long bone fractures attended by 400 EMS agencies, 35,711 (94%) had race and ethnicity documented. Of these patients, 81% were White, 10% were Black, 7% were Hispanic, and 1% identified with other or multiple racial/ethnic groups. An out-of-hospital pain score was documented for 87% of patients. Subsequent analyses demonstrated that Black non-Hispanic patients with severe pain were less likely to receive analgesic medications than White non-Hispanic patients. These disparities persisted after adjustment for clinical, demographic, and socioeconomic factors.

    Conclusions: The study identified significant racial and ethnic disparities in prehospital pain management among patients with objectively diagnosed long bone fractures. Black non-Hispanic patients were substantially less likely to receive out-of-hospital analgesics than White non-Hispanic patients, and these differences were not explained by injury characteristics, patient preferences, clinical presentation, or socioeconomic conditions.

    Related Full Publication: The conference abstract was later expanded into a full peer-reviewed article, Racial, Ethnic, and Socioeconomic Disparities in Out-of-Hospital Pain Management for Patients With Long Bone Fractures, published in Annals of Emergency Medicine (2023).

    DOI (full article): 10.1016/j.annemergmed.2023.03.035

  • Kennel, J., Withers, E., Parsons, N., & Woo, H. (2019). Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies. Medical Care, 57(12), 924–929.

    Abstract

    Background: Despite the critical role Emergency Medical Services (EMS) play in the health care system, racial and ethnic treatment disparities within EMS have received relatively little attention. The study sought to examine whether disparities exist in pain assessment and pain medication administration among patients with traumatic injuries receiving EMS care in Oregon.

    Objective: To investigate racial and ethnic disparities in pain assessment procedures and pain medication administration within EMS.

    Research Design: Researchers conducted a retrospective analysis of 25,732 EMS encounters involving traumatic injuries recorded in the Oregon Emergency Medical Services Information System between 2015 and 2017. Multivariate logistic regression models were used to evaluate the relationship between patient race/ethnicity and the likelihood of receiving pain assessments and pain medications.

    Results: Hispanic and Asian patients were significantly less likely than White patients to receive a pain assessment. After adjustment for other factors, Hispanic patients were 21% less likely (95% CI, 10%–30%; P < 0.001) and Asian patients were 31% less likely (95% CI, 16%–43%; P < 0.001) to receive a pain assessment procedure. All racial and ethnic minority groups were less likely to receive pain medications than White patients. Specifically, Black patients were 32% less likely (95% CI, 21%–42%; P < 0.001), Hispanic patients were 21% less likely (95% CI, 7%–32%; P < 0.01), and Asian patients were 24% less likely (95% CI, 1%–41%; P < 0.05) to receive pain medication.

    Conclusions: Racial and ethnic minority patients experienced significant disadvantages in EMS pain treatment in Oregon. Hispanic and Asian patients with traumatic injuries were less likely to have their pain assessed, and Black, Hispanic, and Asian patients were less likely to receive pain medications compared with White patients. The findings provide evidence of racial and ethnic disparities in prehospital emergency care and highlight the need for strategies to improve equity in EMS treatment.

    DOI: 10.1097/MLR.0000000000001208

  • Kennel, J. (2018). IHI ID 08: Emergency Medical Services Treatment Disparities by Patient Race. BMJ Open Quality, 7 (Suppl 1).

    Abstract

    Background: In the United States, racial minority populations are at greater risk of receiving lower-quality medical care than White patients. Although extensive research has documented racial treatment disparities across many areas of medicine, Emergency Medical Services (EMS) has remained relatively understudied.

    Objectives: This study examined racial disparities in EMS pain management practices among adult patients receiving prehospital care for traumatic injuries or painful medical emergencies.

    Methods: A quantitative analysis was conducted using 104,210 EMS patient records from 63 EMS agencies in Oregon between 2015 and 2017. The primary outcome was receipt of pain medication. Patient race served as the primary predictor variable, while multiple clinical and socioeconomic status (SES) factors, including EMS provider impression, pain severity, and SES-related characteristics, were included as control variables.

    Results: After adjustment for clinical and socioeconomic confounders, significant racial disparities in pain treatment were identified. Compared with White patients:

    • African American patients were 40% less likely to receive any pain medication (adjusted OR 0.60; 95% CI 0.53–0.68).

    • Asian patients were 36% less likely to receive any pain medication (adjusted OR 0.64; 95% CI 0.50–0.83).

    • A secondary analysis found that African American patients with private insurance experienced an even greater disparity, being 55% less likely to receive pain medication than White patients with private insurance (adjusted OR 0.45; 95% CI 0.31–0.64).

    Conclusions: African American and Asian patients in Oregon who received EMS care for painful injuries or medical conditions were significantly less likely than White patients to receive pain medication. These findings demonstrate that racial disparities in treatment exist within prehospital emergency care and mirror disparities documented in hospital-based emergency medicine.

    Source: BMJ Open Quality, Institute for Healthcare Improvement (IHI) Scientific Symposium Abstracts, 2018.

    Related Note: This conference abstract represents an earlier, larger-scale analysis that preceded the subsequent peer-reviewed Medical Care publication on racial and ethnic disparities in EMS pain treatment in Oregon.

  • Kennel, J., & Copenagle, L. (2020). Healthcare Equity Analysis Report. Sponsored by the City of Vancouver, WA, American Medical Response Clark County, WA, and the City of Vancouver Fire Department.

    Abstract

    Background: In 2019, the City of Vancouver, Vancouver Fire Department (VFD), and American Medical Response Clark County (AMR) initiated a long-term effort to better understand equity within their emergency medical services system and identify opportunities to reduce inequities in patient care.

    Objectives: The project sought to evaluate equity in EMS service delivery through two complementary approaches: (1) an organizational review of internal systems, policies, and practices, and (2) benchmark analyses examining equity in selected EMS treatments. Initial treatment areas selected for evaluation were pain management and cardiac chest pain care.

    Methods: The report included an assessment of organizational processes related to quality reporting, training, community outreach, language and interpretation services, management practices, and data collection systems. In addition, EMS treatment data were analyzed to evaluate whether differences existed in the assessment and treatment of patients across demographic groups.

    Results: The treatment equity analyses identified disparities in EMS care affecting some marginalized patient populations in Vancouver. The report found differences in pain assessment, pain treatment, and aspects of chest-pain-related care across demographic groups. Organizational review findings highlighted opportunities for improvement in performance reporting, equity-focused quality monitoring, training priorities, community engagement, language-access practices, and data management systems.

    A contemporaneous news summary of the report stated that Asian and Hispanic patients were less likely than White patients to receive certain pain assessments and pain-management interventions, and that disparities were also identified in some chest pain assessment measures. The report additionally identified differences associated with insurance status.

    Conclusions: The report concluded that EMS systems should systematically evaluate treatment equity, improve data collection and reporting capabilities, strengthen community engagement, and implement organizational practices that support equitable care delivery. The findings were intended to serve as a foundation for ongoing quality improvement efforts focused on reducing disparities in EMS care within Vancouver, Washington.

  • Kennel, J. (2018). Investigating EMS Treatment Disparities by Patient Race/Ethnicity for Traumatic and Painful Emergencies in Oregon. Grant-funded report through the Health Resources and Services Administration (HRSA) and sponsored by the Oregon EMS and Trauma Systems Office and the Oregon Office of Rural Health.

    Report Summary

    Background: Racial and ethnic minority populations in the United States are at increased risk of receiving lower-quality health care. While racial disparities have been documented extensively in hospital-based medicine, Emergency Medical Services (EMS) had received comparatively little attention. Previous EMS studies identified disparities in pain treatment but did not adequately account for socioeconomic status (SES), a potential confounding factor.

    Objective: To investigate whether racial and ethnic disparities exist in EMS pain assessment and pain treatment practices among patients experiencing traumatic injuries and painful medical emergencies in Oregon while accounting for socioeconomic and clinical factors.

    Methods: The study analyzed EMS patient care records from Oregon EMS agencies between 2015 and 2017. The analysis focused on traumatic and painful emergencies and examined outcomes related to pain assessment and pain medication administration. Statistical models adjusted for relevant clinical variables and socioeconomic measures to better isolate the relationship between race/ethnicity and treatment practices.

    Results: The study found evidence of racial and ethnic disparities in EMS pain management. Hispanic and Asian patients were less likely than White patients to receive pain assessments, while racial and ethnic minority patients were generally less likely to receive pain medications. Related findings later presented at the Institute for Healthcare Improvement (IHI) Scientific Symposium reported that African American patients were 40% less likely and Asian patients 36% less likely to receive pain medication than White patients after controlling for clinical and socioeconomic factors.

    Conclusions: The report concluded that disparities in EMS pain treatment existed in Oregon and could not be fully explained by socioeconomic status alone. The findings suggested that racial and ethnic inequities may occur during prehospital care and highlighted the need for continued investigation, quality improvement efforts, and equity-focused EMS policies and training.

    Funding: Supported through the Health Resources and Services Administration (HRSA) Rural Hospital Flexibility Program and sponsored by the Oregon EMS and Trauma Systems Office and the Oregon Office of Rural Health.

    Related Output: Findings from this report were subsequently presented in BMJ Open Quality as “IHI ID 08: Emergency Medical Services Treatment Disparities by Patient Race” and later expanded into the peer-reviewed article “Racial/Ethnic Disparities in Pain Treatment: Evidence From Oregon Emergency Medical Services Agencies” published in Medical Care (2019).

  • Thorton, C., Hsieh, A., & Kennel, J. (2024). Educating Future EMS Leaders in a Racialized System; How to Change Your Educational Practices to Reduce Provider Bias (4-hour pre-conference). National Association of EMS Educators (NAEMSE) 2024 Annual Conference, Pittsburgh, PA.

  • Crowe, R., Kennel, J. (2024). Research and Improvement Science to Build Equity in EMS Care. EMS Equity Conference, CARESTAR Foundation and San Jose State University, San Jose, CA.

  • Kennel, J., Randall, D. (2023). Designing strategies to reduce racial treatment disparities in EMS Education, National Emergency Medical Services Educators (NAEMSE) 2023 Annual Conference, Reno, NV.

  • Kennel, J. (2023). Designing strategies to reduce racial treatment disparities in EMS, ESO Wave 2023 Conference, Austin, TX.

  • Crowe, R., Kennel, J., Fernandez, R., Bourn, S., Burton, B., Van Vleet, L., Wang, H., Myers, B. (2022). Disparities in Prehospital Analgesia Administration for Trauma Patients with Long Bone Fractures, National Association of EMS Physicians Annual Meeting, San Diego, CA.

  • Hamper, C., Kennel, J. (2022) Racial disparities in EMS textbook images. International Scientific Symposium, EMS World, Orlando, FL.

  • Kennel, J. (2022). Using PCR data to identify racial treatment disparities, ESO Wave 2022 Conference, Austin, TX.

  • Kennel, J. (2019). Racial treatment disparities in EMS. Invited speaker at Pinnacle EMS Leadership Conference, Orlando, FL.

    Kennel, J. (2019). Racial disparities in EMS treatment. Invited speaker at Statewide EMS webinar for the State of Oregon EMS and Trauma office. Portland, OR.

     Kennel, J. (2019). Racial disparities in emergency medical services treatment. Invited speaker at March meeting of the League of Oregon Counties, Salem, OR.

    Kennel, J. (2019). Racial treatment disparities in EMS. Invited speaker at Oregon EMS conference, Salem, OR.

  • Crowe, R., Kennel, J. (2023). Are EMS Treatment Disparities Related to Race or Class? Ensuring Equitable Treatment for all Communities Begins with Understanding How Unintentional Racism Can Produce Racist Outcomes in EMS. EMS1.com.

  • Kennel, J. (2018). Racial disparities in pain medication treatment in EMS. Invited talk at Institute for Healthcare Improvement (IHI) Scientific Symposium, Orlando, FL.

  • Kennel, J. (2019). Racial Disparities in EMS; Are we providing the same high-quality EMS treatments to all our patients? EMS1.com.

  • Kennel, J. (2017). Does patient race matter: Opioid administration disparities in the pre-hospital treatment of traumatic injuries. EMS Today, Salt Lake City, UT.

    Kennel, J. (2017). Does race matter? Opioid administration in the pre-hospital treatment of traumatic injuries. Portland State University, Sociology Department, Brown Bag Lecture Series, Portland, OR.

    Kennel, J. (2017). Does patient race matter: Opioid Administration disparities in the pre-hospital treatment of traumatic injuries. Invited speaker Portland State University Sociology Department Brown Bag Presentations, Portland, OR.

  • Hamper, C., Kennel, J. (2023). Are Some Patients Getting Our Best, While Others Are Not? Timberline EMS Conference 2023, Government Camp, OR.

    and

    Hamper, C., Kennel, J. (2023). Are Some Patients Getting Our Best, While Others Are Not? 2023 Eastern Oregon EMS Conference, Pendleton, OR.

  • Kennel, J. (2017). The influence of bias on medical treatment decisions. Invited speaker at annual Timberline EMS conference, Government Camp, OR.

  • Kennel, J. (2017). Threats to quality EMS care: Behavioral and cognitive bias. Invited speaker at first paramedic only TVFR recruit academy training. Tualatin, OR.

  • Kennel, J. (2017). Opioid treatment variability in traumatic injuries by patient race in emergency medical services. Invited speaker at 2017 Pacific Sociological Association Annual Conference, Portland, OR.

  • Kennel, J. (2016). Social Inequalities in EMS Pain Medication Practices. EMS Leadership Conference, OIT and TVF&R, Portland, OR.

  • Kennel, J. (2015). Social inequalities in EMS treatments. Portland Mountain Rescue EMS Re-certification Training. Portland, OR.

Sexism

  • Kimbrell, J., Villani, C., Rice, K., Wagner, A., Breyre, A., Bourn, S., Treichel, A., & Kennel, J. (2025/2026). Prehospital Pain Management for Injured Patients at the Intersection of Sex and Obesity: A Retrospective Observational Study. International Journal of Paramedicine, 13, 1–14.

    Objectives:

    The study investigated the association between obesity and the administration of analgesia and pain reduction among prehospital patients with traumatic injuries.

    Methods:

    Using the 2022 ESO Data Collaborative, the authors analyzed EMS records for 9-1-1 transports of adult patients with injuries. Patients were excluded if they had primary impressions related to behavioral, neurologic, respiratory, or cardiac emergencies, a Glasgow Coma Scale score below 15, were not alert on the AVPU scale, or lacked documented race or weight information. Weight status was categorized according to CDC BMI thresholds, with BMI estimated from documented weight, race/ethnicity, and gender using CDC height averages. Associations between BMI category, analgesia administration, and pain reduction were examined using bivariate and multivariable logistic regression.

    Results:

    Among 482,592 patients included in the analysis, 164,175 (34.0%) were classified as obese (BMI ≥ 30 kg/m²). Patients with obesity were more likely to receive analgesia and to experience pain reduction than patients without obesity (adjusted odds ratio [aOR] 1.13, 95% CI 1.10–1.17; and aOR 1.06, 95% CI 1.02–1.10, respectively). However, important sex-based differences were observed. Men with obesity were more likely than men without obesity to receive analgesia (aOR 1.21, 95% CI 1.17–1.24), whereas women with obesity were not more likely than women without obesity to receive analgesia (aOR 0.97, 95% CI 0.95–1.00).

    Conclusions:

    The findings suggest that obesity influences prehospital pain management, but the effect differs by sex. The results indicate a potential intersection of weight-related and gender-related disparities in EMS pain treatment, warranting further investigation into equity in prehospital care. This conclusion reflects the study's reported findings regarding differential analgesia administration across sex and obesity categories.

  • Thompson, K., Smith, J., Tanski, M., Neth, M. R., Sahni, R., Kennel, J., Jui, J., Newgard, C. D., Daya, M. R., & Lupton, J. R. (2025). Gender Differences in Defibrillator Practices in Out-of-Hospital Cardiac Arrest. Prehospital Emergency Care, 29(5), 586–592.

    Abstract

    Objectives: Disparities in survival after out-of-hospital cardiac arrest (OHCA) persist between women and men. This study evaluated differences in automated external defibrillator (AED) use before Emergency Medical Services (EMS) arrival and the time from EMS arrival to initial defibrillation according to EMS-assessed gender.

    Methods: This secondary analysis used adult, non-traumatic, EMS-treated OHCA cases from the Portland Cardiac Arrest Epidemiologic Registry (2018–2021). EMS-witnessed arrests were excluded. Primary outcomes included (1) AED application before EMS arrival and (2) time from EMS arrival to first defibrillation among patients presenting with a shockable rhythm and no pre-EMS AED application. Researchers evaluated overall pre-EMS AED application, as well as AED application by law enforcement and lay responders separately. Multivariable logistic and linear regression models adjusted for age, arrest location, witness status, bystander CPR, year, and dispatch-to-EMS-arrival time, with clustering by county accounted for through mixed-effects modeling.

    Results: Among 3,049 adult, non-traumatic OHCAs eligible for analysis, 1,011 (33.2%) occurred in women. Men had significantly higher adjusted odds of receiving any pre-EMS AED application compared with women (adjusted odds ratio [aOR] 1.40; 95% CI 1.05–1.86). This difference persisted for law enforcement AED application (aOR 1.89; 95% CI 1.16–3.07), but not for lay-responder AED application (aOR 1.19; 95% CI 0.83–1.71). Among patients still in cardiac arrest upon EMS arrival, with a shockable rhythm and no prior AED application, women experienced significantly longer times to initial EMS defibrillation than men (mean difference +0.81 minutes; 95% CI 0.22–1.41 minutes).

    Conclusions: Women experiencing out-of-hospital cardiac arrest received lower rates of AED application before EMS arrival and experienced delays in EMS defibrillation compared with men. These findings suggest important gender-based disparities in critical early resuscitation interventions that may contribute to differences in OHCA outcomes.

Limited English Proficiency

  • Kennel, J., Camacho, A., Wagstaff, H. Limited English Proficiency Treatment Disparities in EMS. Annals of Emergency Medicine.

    IN PRESS

  • Kennel, J., Wagner, A. (2022). What is the EMS Treatment Penalty for Not Speaking English? EMS World Expo 2022, Orlando, FL.  

Sizeism

  • Book Chapter - Kennel, J., Woo, H., Garcia, G. (2022). Chapter 14: Treatment and Outcome Disparities for Obese Patients in EMS, International Handbook of the Demography of Obesity. Switzerland AG: Springer Nature.

  • Kennel, J., Woo, H., Garcia, G. (2022). Treatment Disparities for Obese Patients in EMS, National Association of EMS Physicians Annual Meeting, San Diego, CA.

Simulation Science

  • Kennel, J., Ellingson, T. (2011). An audit of high-fidelity simulation utilization among a sample of five EMS education programs in the state of Oregon. Oregon Department of Community Colleges and Workforce Development funding administered though the Oregon Simulation Alliance. Portland, OR

  • Kennel, J., Ellingson, T. (2011). Development of 15 EMS simulation pre-hospital scenarios for statewide use. Oregon Department of Community Colleges and Workforce Development grant funding administered though the Oregon Simulation Alliance - Scenarios. Portland, OR.

  • Ellingson, T., Kennel, J., Olson, G., Newgard, C. (2010). Community college EMS program simulation curricular integration: An identification of barriers to incorporating and increasing utilization of high-fidelity simulation in community college EMS education programs. Oregon Department of Community Colleges and Workforce Development funding administered though the Oregon Simulation Alliance Grant, Community College EMS program SIM Curricular Integration. Portland, OR

  • Kennel, J. (2015). How to Effectively Debrief Medical Simulations. Oregon Simulation Alliance 2015 Simulation Conference. Portland, OR.

  • Kennel, J. (2012). In-situ EMS high-fidelity simulation training pilot program. Presented at Washington County Emergency Medical Services. Hillsboro, OR.

  • Kennel, J. (2012). Debriefing high-fidelity simulations. Invited presentation at Washington County EMS Mobile Simulation Vehicle Training Kickoff Event, Hillsboro Fire and Rescue, Hillsboro, OR

  • Gordon, M., Kennel, J. (2011). Conducting and debriefing a progressive inter-professional educational high-fidelity simulation. Oregon Health Sciences University School of Nursing, Portland, OR.

  • Kennel, J. (2011). Using simulation to assess and improve non-technical (CRMS) skill sets. Oregon Simulation Alliance, Sim Summit III, Portland, OR.

Other Topics

  • Torgerson, C., Taylor, N., Hughes, M., Chapman, K., & Kennel, J. (2025). Mental Health Symptoms, Stressors, and Coping: An Exploration of First Responder Experiences Working in Rural, Suburban, and Urban Areas. International Journal of Paramedicine, (11), 16–35.

    Abstract

    EMS first responders provide essential services to communities in rural, suburban, and urban locations across the United States. While the mental health experiences of first responders have often been generalized across geographic settings, less is known about differences among rural, suburban, and urban first responders. This study explored mental health symptom profiles, job stressors, coping mechanisms, and mental health resource availability among 118 first responders providing services throughout Oregon. First responder agencies across Oregon were contacted and asked to distribute an electronic survey. Participation was voluntary and anonymous.

    Findings revealed both common challenges and notable differences across geographic settings. Symptoms of depression, generalized anxiety, suicidal ideation, post-traumatic stress disorder (PTSD), and bipolar disorder were reported among participants. Depression, generalized anxiety, and PTSD were more evident among first responders working in urban and suburban areas, whereas suicide risk was more prevalent among rural first responders.

    Three primary categories of stressors were identified, along with a fourth “other” category: (1) broader societal stressors affecting first responders, (2) job-related stressors, and (3) financial stressors associated with first responder work. Subcategories included organizational, patient-related, and position-specific stressors, as well as financial, intrapersonal, and interpersonal stressors. Two overarching themes of stress management emerged: coping strategies with a clear function or purpose and coping strategies without an identified function or purpose. The authors provide recommendations for EMS agencies and outline directions for future research.

  • Jarvis, J. L., Jarvis, S. E., & Kennel, J. (2025). The Association Between Out-of-Hospital Drug-Assisted Airway Management Approach and Intubation First-Pass Success. Annals of Emergency Medicine, 86(5), 521–530.

    Abstract

    Study Objective: Achieving first-pass success during endotracheal intubation is a key target for emergency medical services (EMS) quality improvement efforts. Evidence regarding the effects of different out-of-hospital drug-assisted airway management strategies, including rapid sequence intubation (RSI), sedation-only intubation, and paralytic-only intubation, on first-pass success is limited. The study aimed to determine the association between airway management approach and intubation first-pass success, without evaluating procedural appropriateness or complications.

    Methods: Researchers conducted an observational analysis using a large national EMS dataset. The study included patients treated during 9-1-1 responses who underwent at least one intubation attempt and excluded all patients who experienced cardiac arrest at any point. Drug-assisted airway management approaches were categorized based on medications administered before the initial endotracheal intubation attempt. Descriptive statistics and adjusted odds ratios (aORs) with 95% confidence intervals were used to assess associations between airway management approach and first-pass success.

    Results: The analysis identified 12,713 intubated patients who were not in cardiac arrest. Of these, 7,396 (58.4%) were male, 3,081 (24.2%) were intubated for traumatic conditions, the median age was 60 years (IQR 40–73), and 42.6% underwent intubation using a video laryngoscope. Airway management approaches included rapid sequence intubation (51.2%), no medications (29.6%), sedation-only intubation (17.9%), and paralytic-only intubation (1.3%). Overall first-pass success was 75.1%. Compared with no-medication intubation, first-pass success was significantly more likely with rapid sequence intubation (aOR 2.23, 95% CI 2.00–2.50) and paralytic-only intubation (aOR 2.11, 95% CI 1.38–3.24), while sedation-only intubation showed similar odds of success (aOR 1.04, 95% CI 0.92–1.19). Rapid sequence intubation was also associated with higher odds of first-pass success compared with sedation-only intubation (aOR 2.14, 95% CI 1.88–2.43).

    Conclusions: Among patients undergoing endotracheal intubation outside of cardiac arrest, rapid sequence intubation was associated with significantly higher odds of first-pass success compared with both no-medication and sedation-only approaches. The authors conclude that further research is needed to evaluate how different airway management approaches affect peri-intubation adverse events and patient outcomes.

    DOI: 10.1016/j.annemergmed.2025.04.034

  • Rostykus, P., Kennel, J., Adair, K., Fillinger, M., Palmberg, R., Quinn, A., Ripley, J., & Daya, M. (2016). Variability in the Treatment of Prehospital Hypoglycemia: A Structured Review of EMS Protocols in the United States. Prehospital Emergency Care, 20(4), 524–530.

    Abstract

    Background: In many industries, reducing variability in processes has been associated with fewer errors and improved outcomes. Hypoglycemia is a common prehospital diabetic emergency, and most Emergency Medical Services (EMS) systems maintain treatment protocols for its management.

    Objective: To examine the degree of variability in EMS protocols used to treat prehospital hypoglycemia across the United States.

    Methods: Researchers conducted a structured review of EMS protocols obtained from two sources: the EMS Protocols website and manual collection from the 50 most populous U.S. cities. Trained investigators abstracted information regarding recommended glucose concentrations for parenteral treatment, blood glucose thresholds for intervention, dosing recommendations, follow-up assessment requirements, and patient non-transport policies. Additional protocol characteristics reviewed included effective dates, pediatric dextrose dilution guidance, glucagon administration recommendations, and requirements for follow-up blood glucose or neurologic assessment.

    Results: Protocols from 185 EMS agencies of varying sizes across the United States were analyzed. Among adult treatment protocols:

    • 70% specified only D50 (50% dextrose) for hypoglycemia treatment.

    • 8% specified only D10 (10% dextrose).

    • 22% permitted either D10 or D50.

    Among protocols using D50, 85% included dilution instructions for pediatric patients. The most commonly recommended initial dose was:

    • 25 g glucose for adults (73–78% of protocols),

    • 0.5 g/kg for pediatric patients (70%),

    • 0.5 g/kg for neonates (45%).

    The median treatment threshold was 60 mg/dL for all age groups, although mean treatment thresholds differed significantly among adults, pediatric patients, and neonates (p < 0.0001). Nearly all protocols (97%) allowed glucagon administration when vascular access was unavailable. Follow-up recommendations varied substantially: 32% required repeat blood glucose assessment, 31% required both repeat blood glucose and Glasgow Coma Scale (GCS) assessment, 4% required only GCS reassessment, and 33% specified no follow-up assessment. A specific policy allowing non-transport after successful treatment was identified in 49% of protocols.

    Conclusions: EMS protocols for the treatment of hypoglycemia in the United States demonstrated substantial variability in medication selection, treatment thresholds, dosing strategies, reassessment requirements, and non-transport policies. The authors concluded that additional research is needed to understand the causes of this variability and its impact on patient outcomes.

    DOI: 10.3109/10903127.2015.1128031

    PMID: 26930393

  • Kennel, J. (2017). Understanding quality improvement efforts at EMS agencies in Oregon. Grant funded report through Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) and sponsored through the Oregon EMS and Trauma Systems office and the Oregon Office of Rural Health, Portland, OR

  • Randall, D., Kennel, J. (2024). DOCUMENT: The Complete EMS Patient Care Report, EMS World Expo 2024 Annal Conference, Las Vegas, NV

  • Kennel, J. (2018). Getting more out of your EMS data. Invited speaker at Pinnacle EMS Leadership Conference, Phoenix, AZ.

  • Pace, M., Kennel, J., Radant, T., Anderson, C., Rosen, R., Widmeier, K. (2011). Paramedic Education Programs: An analysis of cognitive success based on educational institution type. The National Association of EMS Educators, Reno, NV.

  • Kennel, J. (2013). Leadership and outcomes management. Inter-professional panel presentation. Invited presentation at Oregon Health and Sciences University, School of Nursing, Portland, OR.

  • Kennel, J. (2012). Crew resource management: Communicating during a crisis. Metro West Ambulance In-Service Advanced Life Support Training, Hillsboro, OR.

  • Ellingson, T., Olson, G., Anderson, J., Kennel, J. (2011). Paramedic crisis resources management (PCRM): A curriculum and performance evaluation. Poster selected and presented at the International Meeting on Simulation in Healthcare (IMSH), New Orleans, LA.

  • Klein, C., Kuhn, T., Huxley, D., Kennel, J., Withers, E., & Lomonaco, C. G. (2017). Preliminary Findings of a Technology-Delivered Sexual Health Promotion Program for Black Men Who Have Sex With Men: Quasi-Experimental Outcome Study. JMIR Public Health and Surveillance, 3(4), e78.

    Abstract

    Background: Human immunodeficiency virus (HIV) disproportionately affects Black men who have sex with men (MSM), yet relatively few evidence-based interventions have been developed specifically for Black MSM communities. To address this gap, the authors created Real Talk, a technology-delivered sexual health promotion program designed for Black MSM.

    Objective: To determine whether participation in Real Talk positively influenced risk-reduction intentions, HIV-status disclosure practices, condom use, and overall sexual risk-reduction behaviors.

    Methods: The study used a quasi-experimental, two-arm design. During the initial session, participants completed a baseline assessment and were assigned either to the Real Talk intervention or to a standard-of-care control condition consisting of four sexual health brochures. Participants then completed a user-satisfaction survey. Six months later, both groups completed a follow-up assessment.

    Results: A total of 226 participants enrolled in the study, and 144 participants completed the six-month follow-up assessment. Compared with controls, participants who used Real Talk were significantly more likely to reject intentions to engage in several higher-risk sexual behaviors, including:

    • Having receptive anal sex without a condom with a partner of unknown HIV status (mean difference = −0.608, P = .02).

    • Relying on withdrawal during receptive anal sex with a partner of unknown HIV status (mean difference = −0.651, P = .03).

    • Relying on withdrawal during insertive anal sex with a partner of unknown HIV status (mean difference = −0.644, P = .03).

    Real Talk participants were also significantly more likely to disagree with the statement, “I will sometimes lie about my HIV status with people I am going to have sex with” (mean difference = −0.411, P = .04). Additionally, participants in the control group were more likely to report reduced concern about HIV acquisition because of the availability of antiretroviral medications and pre-exposure prophylaxis (PrEP).

    The study did not find significant differences between intervention and control participants in actual condom use or other reported risk-reduction strategies over the follow-up period.

    Conclusions: The findings suggest that Real Talk may support greater engagement with HIV prevention and sexual health decision-making among Black MSM by influencing intentions and attitudes related to sexual risk behaviors. The authors conclude that technology-delivered interventions may represent a promising strategy for promoting sexual health within Black MSM communities.

    DOI: 10.2196/publichealth.7933

    PMID: 29066422