#So past Redline absolutely called it when she said that this was going to take a while

[fitnesshealthyoga-blog]

New Post has been published on https://fitnesshealthyoga.com/paramedics-and-emts-confront-unconscious-racial-bias-in-medical-care-shots/

Paramedics And EMTs Confront Unconscious Racial Bias In Medical Care : Shots

Talitha Saunders and AJ Ikamoto tidy their ambulance at the end of a recent shift. The two work as emergency medical responders in Oregon with American Medical Response in Portland. Leaders there are working to prevent any race-based disparities in treatment.

Kristian Foden-Vencil/Oregon Public Broadcasting

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Kristian Foden-Vencil/Oregon Public Broadcasting

Talitha Saunders and AJ Ikamoto tidy their ambulance at the end of a recent shift. The two work as emergency medical responders in Oregon with American Medical Response in Portland. Leaders there are working to prevent any race-based disparities in treatment.

Kristian Foden-Vencil/Oregon Public Broadcasting

A recent study out of Oregon suggests emergency medical responders — EMTs and paramedics — may be treating minority patients differently from the way they treat white patients.

Specifically, the scientists found that black patients in their study were 40 percent less likely to get pain medication than their white peers.

Jamie Kennel, head of emergency medical services programs at Oregon Health and Science University and the Oregon Institute of Technology, led the research, which was presented in December at the Institute for Healthcare Improvement Scientific Symposium in Orlando, Fla.

The researchers received a grant to produce the internal report for the Oregon Emergency Medical Services department and the Oregon Office of Rural Health.

Outright discrimination by paramedics is rare, the researchers say, and illegal; in this case unconscious bias may be at work.

A few years ago, Leslie Gregory was one of a very few black female emergency medical technicians working in Lenawee County, Mich. She says the study’s findings ring true to what she has seen.

She remembers one particular call — the patient was down and in pain. As the EMTs arrived at the scene, Gregory could see the patient was black. And that’s when one of her colleagues groaned.

“I think it was something like: ‘Oh, my God. Here we go again,’ ” Gregory says. She worried — then, as now — that because the patient was black, her colleague assumed he was acting out to get pain medication.

Leslie Gregory, a Portland physician assistant, asks, “How can a person of color not disrespect a system that is constantly studying and talking about these disparities, but does nothing to fix it?” She wants the CDC to declare racism a threat to public health.

Kristian Foden-Vencil/Oregon Public Broadcasting

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Leslie Gregory, a Portland physician assistant, asks, “How can a person of color not disrespect a system that is constantly studying and talking about these disparities, but does nothing to fix it?” She wants the CDC to declare racism a threat to public health.

Kristian Foden-Vencil/Oregon Public Broadcasting

“I am absolutely sure this was unconscious,” adds Gregory, who now lives and works in Portland, Ore. “At the time, I remember, it increased my stress as we rode up on this person. Because I thought, ‘Now am I going to have to fight my colleague for more pain medication, should that arise?’ “

Unconscious bias can be subtle — but, as this new report shows, it may be one of factors behind race-linked health disparities seen across the U.S.

The study looked at 104,000 medical charts of ambulance patients between 2015 and 2017. It found minority patients were less likely to receive morphine and other pain medication compared with white patients — regardless of socioeconomic factors, such as health insurance status.

Gregory is now a physician assistant, and one of her current patients, a black veteran, has cyclic vomiting syndrome. That means he periodically experiences bouts of vomiting he can’t stop without hydromorphone, a potent opioid.

If the man doesn’t get the medicine when he needs it, he could rupture his esophagus and die, Gregory says.

So he doesn’t call the ambulance anymore. Instead, he goes straight to a hospital emergency department for help. But, Gregory says, the same thing keeps happening — the health professionals in the ER won’t prescribe him the medicine he needs.

“I took his entire medical record and faxed it over to the emergency department director of a local hospital system, in anticipation of this very problem,” Gregory says. “And still, when he presented, it was the same exact thing.”

During a shift change at American Medical Response headquarters in Portland, I discuss the problem with EMTs and paramedics who are getting their rigs ready for the next shift.

Paramedic Jason Dahlke says he can see how unconscious bias could slip into an emergency responder’s decisions and taint health care. He has worked hard to be aware of it, in hopes of preventing those disparities in care.

Kristian Foden-Vencil/Oregon Public Broadcasting

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Kristian Foden-Vencil/Oregon Public Broadcasting

Paramedic Jason Dahlke says he can see how unconscious bias could slip into an emergency responder’s decisions and taint health care. He has worked hard to be aware of it, in hopes of preventing those disparities in care.

Kristian Foden-Vencil/Oregon Public Broadcasting

Jennifer Sanders, who has been a paramedic for 30 years, tells me she has heard about the new study. She is adamant that her work is not affected by race.

“I’ve never treated anybody different — regardless,” says Sanders.

Most of the emergency responders I speak with, including Jason Dahlke, say race doesn’t affect the treatment they give. But Dahlke also says he and some of his co-workers are thinking deeply about unconscious bias.

“Historically it’s the way this country has been,” Dahlke says. “In the beginning we had slavery and Jim Crow and redlining — and all of that stuff you can get lost in on a large, macro scale. Yeah. It’s there.”

Ask Dahlke where he thinks unconscious bias could slip in, and he talks about a patient he just treated.

The man was black and around 60 years old. Dahlke is white and in his 30s. The patient has diabetes and called 911 from home, complaining of extreme pain in his hands and feet.

When Dahlke arrived at the patient’s house, he followed standard procedure and gave the patient a blood glucose test. The results showed that the man’s blood sugar level was low.

“So it’s my decision to treat this blood sugar first. Make sure that number comes up,” Dahlke says.

He gave the patient glucose — but no pain medicine.

Dahlke says he did not address the man’s pain in this case because by the time he had stabilized the patient they had arrived at the hospital — where it was the responsibility of the emergency department staff to take over.

“When people are acutely sick or injured, pain medication is important,” Dahlke says. “But it’s not the first thing we’re going to worry about. We’re going to worry about life threats. You’re not necessarily going to die from pain, and we’re going to do what satisfies the need in the moment to get you into the ambulance and to the hospital and to a higher level of care.”

Dahlke says he is not sure whether, if the patient had been white, he would have administered pain medicine, though he doesn’t think so.

“Is it something that I think about when I come across a patient that does not look like me? I don’t know that it changes my treatment,” he says.

Asked whether treatment disparities might sometimes be a result of white people being more likely to ask for more medications, Dahlke smiles.

“I wonder that — if, in this study, if we’re talking about people of color being denied or not given narcotic medicines as much as white people, then maybe we’re overtreating white people with narcotic medicines.”

Research has also found African-Americans more likely to be deeply distrustful of the medical community, and that might play a role in diminished care, too. Such distrust is understandable and goes back generations, says Gregory.

“How can a person of color not disrespect a system that is constantly studying and talking about these disparities, but does nothing to fix it?” she asks.

Gregory wrote an open letter to the Centers for Disease Control and Prevention in 2015, asking it to declare racism a threat to public health.

Past declarations of crisis — such as those focusing attention on problems such as smoking or HIV — have had significant results, Gregory notes.

But the CDC told Gregory, in its emailed response, that while it supports government policies to combat racial discrimination and acknowledges the role of racism in health disparities, “racism and racial discrimination in health is a societal issue as well as a public health one, and one that requires a broad-based societal strategy to effectively dismantle racism and its negative impacts in the U.S.”

Kennel says false stereotypes about race-based differences in physiology that date to slavery also play a role in health care disparities. For example, despite a lack of any supporting science, some medical professionals still think the blood of African-Americans coagulates faster, Kennel says, citing a recent study of medical students at the University of Virginia.

Another question in the survey asked the students whether they thought African-Americans have fewer pain receptors than whites. “An uncomfortably large percentage of medical students said, ‘Yes, that’s true,’ ” says Kennel.

On top of that, he says, EMTs and paramedics often work in time-pressured situations, where they are limited to ambiguous clinical information and scarce resources. “In these situations, providers are much more likely to default to making decisions [based] on stereotypes,” he says.

Disparities in health care are well-documented. Whites tend to get better care and experience better outcomes, whether they’re in a doctor’s office or the ER. But before Kennel’s study, nobody knew whether the same was true in the back of an ambulance.

And they nearly didn’t get to know, because the research required ambulance companies to release highly sensitive data.

“We were prepared to maybe not look that great,” explains Robert McDonald, the operations manager at American Medical Response in Portland. AMR is one of the nation’s largest ambulance organizations, and it shared its data from more than 100,000 charts with Kennel.

Some people chalk up the disparities he found to differences in demography and health insurance status, but Kennel says he controlled for those variables.

So now that AMR knows about disparities in its care, what can the company do?

“My feeling is we’re probably going to put some education and training out to our folks in the field,” McDonald says.

In addition, he says, AMR is going to hire more people of color.

“We want to see more ethnicities represented in EMS — which has historically been a white, male-dominated workforce,” McDonald says.

AMR’s policies must change, too, he adds. The company has purchased software that will enable patients to read medical permission forms in any of 17 different languages. And the firm is planning an outreach effort to communities of color to explain the role of EMS workers.

This story is part of NPR’s reporting partnership with Oregon Public Broadcasting and Kaiser Health News, a nonprofit news service of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

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[petescycleco]

2020 Polaris Slingshot R First Drive

Everything about the Polaris Slingshot invites a reaction. What it is, what it looks like, who buys one, and how they accessorize it all produce hot takes made for a Twitter world. It's fitting, then, that I finally found the words to describe my feelings about the Slingshot on Twitter.

Author, journalist, and photographer Linda Tirado shared a piece of advice. She was talking about something much more important than a car review, but the great thing about wisdom is you can apply it to all sorts of situations. "Know who you want to be and then you never have to decide how to live," she wrote. That's the Slingshot. It defies categorization except unto itself. It knows exactly what it wants to be. Where some look at it and find confusion, driving it clarifies. It exists solely for people who want a Slingshot, specifically. There are a lot of them. We didn't review one when it first came out in 2015 because we didn't know what to make of it, either. It's not a car, but it's not a motorcycle, either. It's sort of a street-legal side-by-side or UTV, but with three wheels. Legally in most states it's considered an "autocycle," an old-timey categorization for bicycles with engines and mopeds that weren't really bicycles or motorcycles. My colleagues in the press who did drive it told me it was neat, a good first effort, but needed work. It was quick, they said, but not too quick. The brakes were soft and spongey. The steering was slow. The materials felt cheap, and the controls were clunky. Polaris listened. The 2020 Slingshot is what we'd call a major refresh if it were a car. The old GM-sourced 2.4-liter inline-four was never an inspiring or memorable engine when it was in a Chevy, and it wasn't doing the Slingshot any special favors, so it's been replaced by a Polaris-designed and built 2.0-liter I-4. It revs higher and makes peak power at redline rather than falling on its face at high rpm like the old engine. Plus, it makes more power: 178 hp in the standard SL trim and 203 hp in this top-end R trim, up from 173 before. It does make less torque, 120 and 144 lb-ft, respectively, but it doesn't matter that much in a vehicle with a claimed curb weight under 1,700 pounds. Polaris says it'll do zero to 60 in as little as 4.9 seconds now, sixth-tenths of a second quicker than before. That would also make it a tenth quicker than a Honda Civic Type R. That's downright quick, and it feels even faster on board. Losing the roof, the windscreen, and the doors will do that. Jeeps feel faster when you take the doors off, too. It's science. The even bigger story is the new Autodrive five-speed automated manual gearbox, aka an automatic transmission. Polaris figured out real quick it was leaving a ton of sales on the table with only a five-speed manual, and that's been corrected. You can still get the manual on this R model, but I guarantee you the vast majority of Slingshots sold from now on will be automatics. Most people can't drive stick and aren't going to learn. Don't let the automated manual thing put you off, either. I know, usually those suck. They shift slow and give you whiplash every time they change gears. This is the best automated manual I've driven, and that list includes Lamborghinis and Aston Martins. You still feel those gear changes, but it just gives you a little head bob. It still shifts slowly by modern automatic standards, but not slowly enough to really complain about. It's geared for performance with a single overdrive ratio, so you'll be turning 3,000 rpm at 65 mph, where cars these days are turning 1,800, but it means it pulls harder in higher gears as a result. Bombing around town couldn't be easier. Just push the D button and go. There's a small hesitation when you set off as the clutch engages, and pushing the gas harder just means it'll drop the clutch and chirp the rear tire. It'll also roll backward at a stop if you're on a hill because it won't engage the clutch until you hit the gas, so watch out for that. It even has a Sport mode. They call it Slingshot mode, and it works pretty well. Press the big red button on the steering wheel, and the transmission will hold gears out to redline regularly and downshift more aggressively. It's no Porsche PDK, but it's a hell of a first effort. It could use a little work, particularly in long, sweeping corners, where it gets confused. The computer sees the steady throttle and speed and assumes you backed off, so it upshifts. When you get to the end of the curve and deeper in the throttle, it panics and drops a gear hard. That could be a recipe for disaster with only one rear tire to handle the lateral g's and the shock from the powertrain, but it isn't. Revisions to the suspension have planted the Slingshot on the pavement. The staggered 18-inch front and 20-inch rear wheels with their 225-width front and massive 305-width rear Kenda tires on the R model hang on tight even when you're really thrashing this thing on a mountain road. Yeah, I had to Google Kenda, too. It's a Taiwanese company that custom-makes this tire for Polaris. You can only get it at Polaris dealers. Past reviews found the Slingshot would understeer slightly in hairpins and kick the tail out if you goosed the throttle. Not anymore. I whipped this thing as hard as I could on a mountain road, and it wouldn't let go. At most, the rear end shifted slightly if I absolutely threw it into a corner. With the automatic transmission it wouldn't overpower the rear wheel (I tried), though I'm sure a clutch kick or just a bad shift with the manual would do it. I might've gotten it to misbehave had I been more confident in the brakes. They seem to fall in with the 30 percent of parts carried over from before, and they need more bite if you're going to drive it hard. People love customizing these things, and I'd start with a more aggressive pad compound. They're fine tooling around town, if a bit spongey. When you stand on them, though, they just don't have the bite. Brake early. The good news is they don't really fade noticeably, either, so they don't get any worse.

Polaris fixed the steering. Lots of people complained it was just too slow for sporty driving; 3.5 turns lock to lock is like putting Camry steering on a Miata. Now, it's just 2.5 turns lock to lock and feels much sportier for it. The electric assist is nicely weighted and even gives you a little feedback through the thin-rimmed steering wheel. That steering wheel is now festooned with buttons controlling the in-house Ride Command infotainment system and cruise control. Right out of the box, it's got a 7.0-inch touchscreen and a 100-watt Rockford Fosgate stereo that's more than loud enough to be heard through a helmet. Please be courteous and turn it down when you're driving in traffic or neighborhoods. Don't be that guy. There's a pair of USB ports and Bluetooth connectivity, and you can even get navigation. Polaris has remounted the screen vertically so it doesn't get washed out by glare as easily and updated the processor so it works as quickly as any system in a car. While they were at it, the Polaris team reworked the rest of the interior, too. There are cupholders now and a spot to put your phone, plus storage under the armrest. The commodious glove box remains, as do the lockable storage compartments behind the seats, which are just big enough for a backpack, picnic basket, or a helmet each. The seats themselves have big, fat bolsters to keep you in place, though the seat was rather wide on me, so I slid from bolster to bolster. The seat bottom cushions are also a little short. I'm told the materials are better this time around, but they look to me like what you'd get on a side-by-side or UTV, so they must've really been something before. The seat belts are still mounted in the middle of the vehicle, so you'll be reaching in the wrong spot out of habit for a while until you force that into your brain. It's a good thing those seats are squishy, because this R model rides like a sports car. It's not harsh or teeth chattering, but it is stiff, and you're going to feel every bump. The adjustable Bilstein shocks previously available are gone for 2020, so you just have to deal. It may ride like a sports car, but it doesn't really sound like one. Granted, that old GM engine didn't sound good, either, but it sounded like a car. This Polaris engine sounds like, well, a Polaris engine. If you've ever driven one of their powersports toys, you know it, even if it's bigger and has more cylinders than any other Polaris has built. The exhaust being tucked up behind the front right wheel still eats into the passenger's legroom. With basically no body work to block it, the engine is a bit loud by car standards. A helmet blocks some of it out. We should talk about helmets because it's a sticky situation. Polaris has single-handedly revived "autocycle" as a classification of three-wheeled, street-legal vehicles that are neither bicycles nor motorcycles. Why go to the trouble? Because thanks to Polaris' lobbying, 48 states now recognize autocycles as street-legal vehicles that can be driven with a standard driver's license (rather than a motorcycle license) but don't have to meet the crash and emissions regulations of a car. (The federal government considers them motorcycles for regulatory purposes, but legislation has been introduced in Congress to change that.) This means if you live anywhere but New York or Massachusetts, you can do what I did: step over the side, buckle the center-mounted seat belt (after searching for it in the usual place), and hit the road. Whether you have to wear a helmet like I did depends entirely on your state's law, and they're all over the place. Many require helmets the same as riding a motorcycle, but several specifically exempt autocycles either entirely or with conditions. Even if it isn't the law where you live, I'd recommend you wear one. The standard windscreen does a remarkably good job of directing air up and over the seats even at highway speeds, but it won't stop rocks and larger bugs. I've taken both to the helmet while riding motorcycles and have been glad for the protection. You may want to invest in a Bluetooth helmet communication system, though, so you can talk to your passenger while moving. I get why you wouldn't if you didn't have to, though. You only really feel the wind on the top of your head, so it's not unlike driving a convertible in terms of hair restyling. It's a much more visceral and exposed feeling than driving a drop-top, though. Getting rid of the doors will do that. Windscreen or not (and I'm going to keep calling it that, not because I'm British but because it ain't a shield), it feels like driving a side-by-side or UTV capable of 125 mph. On the street. In traffic. On the interstate. Next to big rigs. Yes, you can drive the Slingshot on the freeway. I doubt many people do. It's loud, it's windy, and you can't help but feel vulnerable with a skeletal frame and a pair of roll hoops your only impact protection. People who buy Slingshots don't want a motorcycle, because they don't know how to ride one, because theydon't feel comfortable (read: safe) on one, or because of a physical limitation. They want the open-air experience, though. They want the outsider image. And man, do other people pay attention to this thing. It got far more looks and questions than the Ferrari I tested two days later. Here's the thing, though. You've seen me mention the Mazda Miata in this review already. It's just about the most fun per dollar you can buy when it comes to cars. It's also $27,525 to start and tops out in the mid-30s. It comes with things like air bags, heating and A/C, a trunk, doors, and a roof in case it rains. (Polaris will sell you a bolt-on roof) The 2020 Slingshot starts at $26,499, and this R model starts at $30,999. That's a lot of scratch for a third vehicle, a toy you only drive on the weekend and maybe the odd summer night. Then again, the folks who buy these love throwing thousands of dollars of accessories and modifications at them. Put it all together, and it's a narrow demographic. You wouldn't think there would be a lot of people with the money to spend 30 grand on a weekend toy who want the open-air experience and rebel image of a motorcycle but can't ride and don't want to learn and like the sense of security from seats and seat belts. Joke's on you. Polaris has sold somewhere north of 40,000 of these things already, and that's with a manual transmission. You think you see them everywhere now? Wait until people find out you can get 'em with an automatic. And this ain't the only three-wheeler on the market. There's the Harley trike, the Morgan 3-Wheeler, the Campagna T-Rex, Vanderhall Venice, Can-Am Spyder, and more. The 2020 Polaris Slingshot may not be for you, but don't make the mistake of thinking it's not for anyone. And for the people it's for, it's better than ever.

Shop Now: 2020 Slingshot SLINGSHOT R MANUAL

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