EMS World

AUG 2018

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44 AUGUST 2018 | EMSWORLD.com CONTINUING EDUCATION C reating a positive space for patients is difficult at the best of times. Having called 9-1-1, few patients would describe their day as going well. Developing rapport and building trust are essential abilities of today's healthcare practitioner. This may be especially punctuated in prehospital care, where the stakes are high and time is short. For paramedics, EMTs, and first responders, this is a tall order to fill; we serve a diverse popula- tion of adults and children, Catholics and Muslims, Africans and Asians, young and old, gay and straight. Recent case law, legislation, and con- stitutional challenges in the United States have highlighted rights for lesbian, gay, bisexual, and transgendered (LGBT) peo- ple in the context of healthcare delivery and discrimination by providers. 1–3 With 4%–12% of the population self- identif ying as LGBT, 4 you've certainly already cared for an LGBT person in the back of your ambulance. While some healthcare workers turn a blind eye to this population, they have unique health needs to consider, and there remain chal- lenges in ensuring LGBT patients feel comfortable, accepted, and safe. Defi nitions Words mean different things to differ- ent people. Here are some commonly accepted definitions relevant to LGBT populations: Sex—The anatomic distinction between male and female. Sex can be chromo- somal (XY for male, XX for female) or anatomical (testes for men, ovaries for women). Many developmental conditions result in being intersex, where external genitalia may not be congruent with internal sex organs, hormone function, or chromosomes. Gender—The social construct associ- ated with men (masculinity) and women (femininity). Social constructs, or "gender norms," that define what it means to be a man or a woman differ historically and culturally. Sexual orientation —How a per son thinks of him- or herself in terms of whom they are either emotionally or physically attracted to. Gender identity—An individual's own sense of their gender. It may or may not conform to the sex at birth and can be linked to a feeling of being male, female, both, or neither. Various nonbinary (male or female) descriptions are included in this category, including gender-fluid (moving between male and female), gender-queer (an intermediate bet ween male and female), agender (having no gender), or poly- or bigendered (being both or many genders). Heterosexism—The assumption made by institutions or individuals that everyone is heterosexual and/or that heterosexual- ity is inherently superior to homosexual- ity or bisexuality; any prejudiced attitude, action, or practice that subordinates people because of their nonheterosexual identity. Lesbian—A woman who is attracted to women in an emotional or physical sense. Not all women who engage in same-sex sexual intimacy identify as lesbian. Gay—A man who is attracted to men in an emotional or physical sense. Not all men who engage in same-sex sexual intimacy identify as gay. Bisexual—A person who is attracted to more than one gender in an emotional or physical sense. They may have a prefer- ence for one gender over others. Cisgender—A person whose gender iden- tity is congruent with their biological sex. Transgender—A person whose gender identity is not congruent with their bio- logical sex. Sexual orientation is separate from gender identity. This CE activity is approved by EMS World, an organization accredited by the Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE), for 1 CEU upon successful completion of the post-test available at EMSWorldCE.com . Test costs $6.95. Questions? E-mail editor@EMSWorld.com. • Understand and define the differences between sex, sexual orientation, gender, and gender identity. • Describe the disparities and health threats unique to LGBT patients. • Identify measures that can help create a positive environment in your ambulance or sphere of care. OBJECTIVES The ABCs of LGBT: Creating a Positive Space in the Ambulance What should you know to provide the best care for these vulnerable populations? By Michael Kruse, BSc, EMT-P, and Blair Bigham, MD, MSc, ACPf

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