This blog post was written by Dalhousie Medical School students Tyler Agyekum and Ayman Ghanai, with editing by Dr. Antonia Sappong-Kumankumah, Dr. Claire Dawe, Kate Ash-McKesey, and Jenelle Gowie (Co-president of the Black Medical Students’ Association) & Eva-Brenda Bandyayera (Co-president of the Black Medical Students’ Association).

The death of Prashant Sreekumar, a racialized man who went into cardiac arrest after waiting eight hours in an Edmonton emergency department (ED) despite having chest pain, has renewed attention on how the healthcare system fails to prevent avoidable deaths. His case highlights how dangerous delays can be caused by an overstretched healthcare system.

Research shows that delays in emergency care don’t affect all patients equally.

Understanding triage and why inequities persist
In Nova Scotia, EDs triage patients using the five‑level Canadian Triage and Acuity Scale (CTAS). This scale ranges from CTAS 1 (resuscitation), which indicates a patient requires immediate attention, such as a cardiac arrest, to CTAS 5 (non-urgent), which indicates a patient has a non-urgent condition and can wait to be seen or can seek care in a lower acuity centre. Although the scale includes standardized criteria for symptoms and vital signs, the final score relies on the clinical judgment of individual providers to decide who needs care first.

Despite this system, emerging Canadian research shows that Black patients often don’t receive the same care as other patients in the ED. In Manitoba, studies have found that Black patients wait longer in the ED than white patients with similar clinical acuity; Black patients are also more likely to leave before being assessed.

Since triage decisions rely partly on judgment, implicit bias can influence how providers assess a patient’s pain, distress and level of risk in a busy ED. Canadian researchers warn that this means longer waits, fewer reassessments and delayed treatment for Black patients, further worsening their health. In an already strained healthcare system, delays can be the difference between timely care and preventable harm.

When bias becomes a barrier: Shirley Archibald’s story
Racism in the emergency department goes beyond triage and must be addressed through advocacy. One example of this is Shirley Archibald, a 72-year-old Black woman who was humiliated in an Ontario hospital.

While waiting for care in the ED, Archibald felt her heart condition symptoms worsen. She tried to explain to a nurse that her condition was deteriorating, but the nurse yelled at her to sit down. Things escalated when Archibald was called to triage. For emotional support, she kept her daughter, who is a nurse, on the phone. Despite other patients using their phones in the ED, the triage nurse yelled at Archibald to turn her phone off and threatened to call security. Driven to tears, Archibald felt scared, alone and vulnerable, and fled the hospital. She finally went back inside and received the care she needed only after her daughter, who had heard the yelling, intimidation and distress over the phone, advocated on her mother’s behalf and urged her to return. Archibald’s experience highlights both the presence of anti-Black racism in emergency care settings and the critical role of advocacy to confront and address the harm it causes.

How to advocate for yourself in the ED
Navigating the ED as a Black person can feel scary when you’re unsure if providers take your condition seriously. However, speaking up can help you get the healthcare you deserve. Here are tips to advocate for yourself in the ED:

• Triage captures only one moment; update staff if your symptoms change or worsen.
• Report red flags immediately: chest pain, shortness of breath, new weakness, slurred speech, sudden confusion.
• Bring a companion who can notice and communicate changes like increasing pain, declining alertness or new difficulty walking.
• Describe your symptoms in detail: location, duration, severity and quality (burning, sharp, crushing).
• If English isn’t your first language, request translation services or bring someone with you who can help communicate your medical history
• Request to be seen by a different provider if one is available

Report racism or poor care
If you experience racism or poor care in the ED, there are resources to help your voice be heard and to lead change. Patients can visit nshealth.ca or iwkhealth.ca and search “Feedback.” You can also report an incident to the Nova Scotia Human Rights Commission.

Helpful resources

• Nova Scotia Brotherhood
• Nova Scotia Sisterhood
• Newcomer Community Wellness Program
• Halifax Refugee Clinic
• African Nova Scotian Service (Under IWK Health)
• Health Association of African Canadians
• Black Lives Living Well Initiative

WANT MORE INFORMATION ON HEALTHY LIVING AND HEALTHCARE DELIVERY SENT DIRECTLY TO YOUR INBOX? SUBSCRIBE TO OUR NEWSLETTER TO GET ALL OF OUR CONTENT FIRST!