EMS World

AUG 2018

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46 AUGUST 2018 | EMSWORLD.com CONTINUING EDUCATION and many states have antidiscrimina- tion laws for housing and employment, but there are also states attempting to make it legal to discriminate against LGBT people in some situations. Most pointedly, some have attempted to pass "religious freedom" laws that might allow a hypo- thetical EMT to refuse to care for some- one identified as LGBT. 12 It is hard to argue there are clear legal p ro hib itio n s a g ain s t dis cr im inatio n against LGBT people. We can argue, however, that there are strong moral and ethical ones. The NAEMT's Code of Ethics pledges to "encourage the quality and equal avail- ability of emergency medical care" and requires service with "compassion and respect for human dignity," while not judg- ing "the merits of the patient's request for service." 13 It is unfortunate that the 2013 update to the original 1978 code did not update the list of grounds upon which discrimination takes place, but the spirit of the code is to help everyone, regard- less of their background, circumstances, or culture. This code is much less detailed than those of other U.S. healthcare profes- sions. One has only to look at the code of ethics for the National Nursing Asso- ciation to see what a comprehensive code looks like. 14 In that code healthcare is taken as a fundamental right and the nurse is responsible for creating a "moral milieu that is sensitive to diverse cultural values and practices." From these documents one can argue that healthcare providers from all levels have a duty to reduce disparity and treat people equitably, regardless of differenc- es in cultural, religious, or moral norms. Surely LGBT patients should be afforded these same rights while the law catches up. Prehospital healthcare providers should be sensitive to their responsibili- ties to provide equitable care for all. However, despite this ethical impera- tive, many LGBT people are marginalized and stigmatized and do not seek health- care for fear of being judged or harassed by their providers. 15 Such patients often perceive they are not welcome. LGBT Q&A How can I create a positive space in my ambulance? When interviewing patients use phrases that do not assume heterosexuality. For example, if you see a wedding ring on a female, don't ask, "When did he propose?" but rather, "When did your partner propose?" Small cues signal to LGBT people that you are open to their existence. Treat spouses and partners of LGBT patients the same as you would any other spouse, including them as appropriate in information-gathering and decision- making. They will have the same pertinent information about a patient as any spouse. Other steps include asking your employer to post a positive-space symbol on your ambulance window or inside the patient compartment or incorporate it into the uniform. The upside-down rainbow triangle and rainbow flag are recognizable symbols. Advocating for positive-space training from your employer or acknowledgement of days of observance like World AIDS Day or the National Transgender Day of Remembrance are actionable steps. What if I hear a colleague use words like "gay" in a pejorative or derogatory way or make homophobic comments? It's easy for us to sit here in our offices and say, "Speak up and tell them that's not OK!" But doing so in practice is difficult. Use the situation as an opportunity for connection, education, and discussion. Keep in mind that change starts from a few people who stand up to the status quo. Remember that silence can be construed as agreement, by both the person making the comments and those subjected to them. LGBT employees spend a lot of emotional energy modulating their behavior to fit into homophobic workplace cultures; having a straight ally confront this behavior can go a long way to reducing the stress of LGBT coworkers. 19 It is important to be aware of workplace policies and codes of conduct (and, in some places outside the U.S., hate-speech legislation). If I am treating a transgendered person, how should I address them? The easiest thing to do is ask! Don't be embarrassed to ask a transgendered person their preferred pronoun. Use their preference in all conversation, being attentive to the use of words like "mister" or "she" or "his." If they have organs that do not correspond to their gender identity, it may sound odd, but in this case "her testicles" or "his ovaries" is correct. What if their chromosomal sex matters in my medical management or differential diagnosis? Explain to the patient that to best assess them, you would like to know what reproductive organs they were born with and what organs they have now. For example, "I'm trying to rule out some serious causes of abdominal pain. Do you have ovaries or a uterus?" How should I chart or report transgender people? A transgendered man refers to a person who was born female and identifies as male. This can be reported as a female-to-male (FTM) transgender person. A transgender female refers to a person who was born male and identifies as female. This can be reported as a male-to-female (MTF) transgender person. These individuals may or may not have undergone gender confirmation surgery. If your charting system has an "other" or "override" option, you can use it to describe the gender of your patient. Many new healthcare charts include a transgender option. If you cannot choose something other than male or female, the current gender identity is preferred. UC San Francisco's Center of Excellence for Transgender Health sets the standard as recording both the gender and sex on their birth certificates. For more information see http://transhealth. ucsf.edu/protocols. —Michael Kruse and Blair Bigham

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