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Recognized as a specialty by the American Board of Medical Specialties over 40 years ago, emergency medicine is unique since its inception – providing care to all patients in all times of unscheduled, time-sensitive need. Members of our specialty – whether working in an academic or a private practice setting – provide this care without regard to a patient's sex, sexual orientation, gender, creed, physical ability, ability to pay, or race/ethnicity. The last human determinant of health bears emphasis in our current climate of a race-based inequity crisis:

Of its many lessons, the COVID-19 pandemic has certainly taught us the integral importance of public health to the practice of emergency medicine. We, in emergency departments, are often first to detect a public health crisis. In other instances, we find ourselves with a “room with a view” of the scourges of public health crises on the lives of our often most vulnerable patients.

The high-profile, recent killings and assaults by police officers of fellow African-American citizens have highlighted yet another public health crisis – that of systemic racism and unchecked, race-based hatred. As an example of many health effects of systemic racism (to include stress-induced hypertension and its “downstream” effects, lower birth weights, lower rates of renal transplantation, historically unethical experimentation, etc.),^, African-American men are up to 3.5 times more likely than their White-American counterparts to be slain by police. According to Edwards et al. in a recent study, one in 1,000 African-American men will die at the hands of a law enforcement officer – twice the rate of men in general in the United States. Excessive police force – often disproportionately targeted toward African-Americans because of racism – is a public health crisis, too.

Battling the COVID-19 pandemic has afforded an almost unparalleled opportunity for the world to witness the life- and limb-saving care we provide to patients every day in emergency departments. The COVID-19 pandemic, a scourge again disproportionally impacting Black and Brown communities – has shown everyone that emergency departments are the place of heroes. Now, it is our time to show the world we are also heroes against systemic racism – a public health crisis literally killing our fellow citizens and our patients from Black and Brown communities.

To rise to the occasion, we in emergency medicine need to be actively antiracist. In doing so, we are being pro-patient – for each and every one of our patients regardless of the color of their skin (or any other social and moral determinant). And in being pro-all-patients, we are being pro–emergency medicine. It is our duty – regardless of our own backgrounds – to speak up and speak out for our patients and the communities in which they reside. We call on our colleagues in EM to commit to the following pledge to act against racism toward a solution for our patients and communities.

Toward a solution, for our patients and our communities:

• We pledge to continuously provide health care equity to the communities we serve regardless of race or ethnicity or any other human factor.
• We pledge to leave the bedside and meaningfully and genuinely engage our respective communities.
• We pledge to address the social and moral determinants of health that adversely affect our patients and their outcomes.^,
• We pledge to insist on diversity, inclusion, and belonging of all peoples in all matters.
• We pledge to speak up and speak out for our patients now and whenever we bear witness to racial injustices and inequities and health disparities.
• We pledge to become active antiviolence and procivility leaders.
• We pledge to become antiracists.
• We pledge not to be silent!

Our patients and the communities we serve are counting on it.

 

Authored by Dr. Ian B. K. Martin, MD, MBA, FACEP, FAAEM and Dr. Stephen Hargarten, MD, MPH