Published On: 30 May 2015Tags:

Current health policy emphasises prehospital care to avoid inappropriate emergency hospital admissions (Purdy, 2010) and minimise costs and risks (National Audit Office, 2011). Prehospital care refers to initial medical care given to an ill or injured patient, for example, by a paramedic or ‘first responder’ (Hanefield et al., 2004), or agencies such as NHS 111, other emergency services and possibly mental health services. Highly-skilled paramedics (National Audit Office, 2011) and a range of out-of-hours services (Turner et al., 2013) ensure that more patients are safely treated closer to home without having to be transported to hospital (Health and Social Care Information Centre, 2014).

The added complexity of services may increase the risk of under-use of the healthcare system, especially for those unfamiliar with how it works (Szczepura, 2005; Jayaweera, 2011; Chantkowski, 2014). There are strong links between ethnicity, deprivation, and ill-health (Psoinos et al., 2011) and a range of personal and organisational barriers prevent some people from ethnic minority groups with greater need from receiving the care they require (Tudor-Hart, 1971; Szczepura, 2005; Scheppers et al.,2006). Service providers have responded to increasing ethnic diversity through practical measures such as targeted interventions (Addo et al., 2012; Gardois et al., 2014); cultural competency training (Papadopoulos et al., 2004); and collection of patient ethnicity data. This briefing paper identifies barriers and facilitators to prehospital ambulance service care for minority ethnic groups; examines existing responses and identifies challenges for future practice.

Key messages

  • Prehospital ambulance care is becoming more important as an increasingly complex health system seeks to prevent avoidable admissions to hospital.
  • Inequalities in prehospital care for ethnic minority groups are underpinned by problems of cultural awareness in professionals; language and communication difficulties; and a limited understanding of how the healthcare system operates for some minority groups.
  • These inequalities in the face of increasing diversity have elicited a range of legislative and policy responses promoting equality.
  • Ambulance services can also employ a number of practical measures to improve prehospital care for minority ethnic patients, including the collection of patient ethnicity data; targeted interventions; improved cultural competency; and better interpreting services.
  • Challenges in delivering these strategies still exist and providers should strive to embed and improve measures to meet the needs of diverse communities.


  • Changing nature of ambulance services
  • Minority ethnic groups may suffer from poorer prehospital care
  • Legislative and policy responses to promote equality
  • Practical responses to promote equality
  • Challenges for future practice
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Author(s): Viet-Hai Phung; Professor A. Niroshan Siriwardena; Dr Karen Windle; Dr Zahid Asghar; Mukesh Barot; Professor Joe Kai; Professor Mark Johnson;
Briefing series: Better Health Briefing Paper 37
Publisher: Race Equality Foundation
Publication date: May 2015