Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review.



Emergency medical services (EMS) workforce demographics in the United States do not reflect the diversity of the population served. Despite some efforts by professional organizations to create a more representative workforce, little has changed in the last decade. This scoping review aims to summarize existing literature on the demographic composition, recruitment, retention, and workplace experience of underrepresented groups within EMS.


Peer-reviewed studies were obtained from a search of PubMed, CINAHL, Web of Science, ProQuest Thesis and Dissertations, and non-peer-reviewed ("gray") literature from 1960 to present. Abstracts and included full-text articles were screened by two independent reviewers trained on inclusion/exclusion criteria. Studies were included if they pertained to the demographics, training, hiring, retention, promotion, compensation, or workplace experience of underrepresented groups in United States EMS by race, ethnicity, sexual orientation, or gender. Studies of non-EMS fire department activities were excluded. Disputes were resolved by two authors. A single reviewer screened the gray literature. Data extraction was performed using a standardized electronic form. Results were summarized qualitatively.


We identified 87 relevant full-text articles from the peer-reviewed literature and 250 items of gray literature. Primary themes emerging from peer-reviewed literature included workplace experience (n = 48), demographics (n = 12), workforce entry and exit (n = 8), education and testing (n = 7), compensation and benefits (n = 5), and leadership, mentorship, and promotion (n = 4). Most articles focused on sex/gender comparisons (65/87, 75%), followed by race/ethnicity comparisons (42/87, 48%). Few articles examined sexual orientation (3/87, 3%). One study focused on telecommunicators and three included EMS physicians. Most studies (n = 60, 69%) were published in the last decade. In the gray literature, media articles (216/250, 86%) demonstrated significant industry discourse surrounding these primary themes.


Existing EMS workforce research demonstrates continued underrepresentation of women and nonwhite personnel. Additionally, these studies raise concerns for pervasive negative workplace experiences including sexual harassment and factors that negatively affect recruitment and retention, including bias in candidate testing, a gender pay gap, and unequal promotion opportunities. Additional research is needed to elucidate recruitment and retention program efficacy, the demographic composition of EMS leadership, and the prevalence of racial harassment and discrimination in this workforce.






Published Version (Please cite this version)


Publication Info

Rudman, Jordan S, Andra Farcas, Gilberto A Salazar, JJ Hoff, Remle P Crowe, Kimberly Whitten-Chung, Gilberto Torres, Carolina Pereira, et al. (2022). Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review. Prehospital emergency care. pp. 1–13. 10.1080/10903127.2022.2130485 Retrieved from https://hdl.handle.net/10161/26165.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.



JJ Hoff

Assistant Professor of Emergency Medicine

JJ Hoff, MD is an Assistant Professor in the Department of Emergency Medicine at Duke University School of Medicine. In addition, he serves as Assistant Medical Director for Duke Life Flight, as well as Medical Director for Duke Event Medicine. A Duke undergraduate alumnus, as well as a graduate of the Duke Emergency Medicine Residency Program, he is a Blue Devil through and through. Prior to attending medical school in his home state of New Jersey at Cooper Medical School, he was a high school biology teacher, and has continued to develop his passion for education throughout his medical career. After serving as Chief Resident at Duke, he pursued an EMS fellowship at East Carolina University prior to returning here as a faculty member.

Dr. Hoff's academic interests include EMS education, out-of-hospital medicine, critical care transport, event medicine, EMS quality improvement, and qualitative research.

Von Isenburg

Megan Von Isenburg

Prof Library Staff

Megan is Associate Dean for Library Services & Archives at the School of Medicine. Megan is responsible for planning and implementing high quality information services and resources to support the missions of Duke Health. She provides leadership for the Duke University Medical Center Library, which serves as a resource library for the state of North Carolina and the Mid-Atlantic region and is known for its innovations in health sciences librarianship and expertise in evidence-based practice. Von Isenburg also oversees the retention and preservation of institutional records through Medical Center Archives services. In addition to providing access to administrative records, the Archives capture the history of Duke Medicine through its record retention services.

Graduate Certificate in e-Learning, North Carolina State University (2011)
MSLS Library Science, University of North Carolina at Chapel Hill (2004)
BA, American Studies, University of North Carolina at Chapel Hill (1997)

Anjni Patel Joiner

Associate Professor of Emergency Medicine

Anjni Joiner, DO, MPH, FACEP, FAEMS is an Assistant Professor of Emergency Medicine at Duke University School of Medicine. Dr. Joiner serves as Medical Director of Prehospital Medicine at Duke University Hospital, overseeing the Emergency Medical Services section within the Department of Emergency Medicine. She also serves as the Medical Director for Durham County EMS, providing medical oversight to all county agencies, including EMS, first responders, and the Durham Emergency Call Center. In these roles, she strives to work collaboratively with community partners to provide care to underserved and underrepresented populations. These efforts include development of Community Paramedicine programs to address opioid use disorder in Durham Community through harm reduction techniques and partnering with organizations such as the City of Durham HEART team for unarmed police response.

Her research interests include injury prevention and trauma, development and strengthening of prehospital emergency care systems internationally, and improving access to care. Her current projects include a comprehensive assessment of the emergency care system in Moshi, Tanzania through a community needs and hospital capacity assessment and development of a prehospital emergency care system evaluation tool (PECSET) for underdeveloped EMS systems in South and Southeast Asia.

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