LBGT (GAYS) in EMS

[Bieber]

Yes and yes. One of the folks I most enjoy working with at my service is a lesbian. We get along great and work well together.

actually, I don't believe the question is so simple. Having worked in Trinidad Colorado I've been exposed to many that were living as opposite genders prior to surgery, and very often their passability is far from ideal. Garish makeup, terrible, unstyled wigs, etc. much of what we do is provide comfort, yet being in a place where I was expected to pretend that a man dressed as a woman from a comedy or horror show as unnoticeable made me uncomfortable. Should patients be forced to perform the same mental and emotional gymnastics? I don't think so. My heart hurts for these people, but it hurts also for those too small, handicapped, or injured to do the job, so should they then too be allowed to work in EMS based on my wish that everyone would be allowed to make a living in any way that they choose?

I've worked with gay and lesbians, and currently work on a project populated by 37 nationalities, so it will be tough to make a sentence of bigot or repressive stick to me I think....

If one is passable, then I see no issues, if not, then I see no way to claim that they can truly do the job, as a patient advocate, based simply on their ability to lift as much, or push the same drugs as another....right?

Dwayne, I understand where you are coming from and see your point, but my question would be, how are you going to define what is an acceptable level of "passability" when it comes to transgender workers? I think that adhering to universal policies regarding makeup/jewelry/hair styles is appropriate, but otherwise, is there any other measure you can identify that would be appropriate in determining what is acceptable appearance standards? On another note, this time regarding your comment about how we're supposed to be a source of comfort for our patients, isn't there the possibility of conflict with that goal and other appearance abnormalities? What if someone is especially ugly? What if they have gruesome scars from a previous accident, have an eye patch, have lost fingers or have missing teeth? What if they look like Carrot Top? These things can also be distressing for a patient, and interfere with their ability to be comforted and comfortable, but can we really prevent people from working or dictate appearance standards beyond the typical uniform standards? And no, I don't think you're a bigot, I just want to know how you reconcile the notion that a transgender should be "passable" (and know by whose standard, as gender-specific beauty is subjective and has changed greatly over the years) with other conditions that may make people uncomfortable.

[ERDoc]

I hate to say it but after living in the area I live in for the last 6 years, I could see it being difficult for someone with any form of "alternate" lifestyle getting hired. I, personally, would have no problem with it. As others have said, if they can do the job, I don't care what color, orientation you are or what planet you are from. If you can move the meat, you are more than welcome here.

[DwayneEMTP]

Man Beibs, good points. I didn't consider a fair scale for hireability....and until I'm able to come up with such a thing then change my opinion to "of course they should be hired."

Often I've seen, and allowed my opinion to be colored by those that make me think, "God damn it...I'm sorry that you carry this extra burdon, but make some kind of effort!"

Thanks for the reality check.

[Just Plain Ruff]

So if we expect the patient to be accepting of these Transgendered providers and they end up not being accepting, does your service have a policy of sending another ambulance?

For example, someone who is so bigoted that they hate gays, or blacks, or transgendered that they get one of the listed and they refuse to go with you and request that another ambulance be sent. They are not refusing transport but they are refusing to be transported in "your" ambulance. Do you have a policy or some procedure to accomodate that patient?

I had an issue at one time when I had made a patient (prior ems call) so angry that they refused to go to the hospital in my ambulance. The patient wasn't refusing to go to the hospital by ambulance, he was just refusing to go with me, and therefore was refusing to go in my ambulance. There was no doubt that he needed to go but he wasn't going with me.

We called a neighboring service, they sent an ambulance to us with a 45 minute ETA and during that time the guy and I had a chance to talk and actually came to a gentleman's agreement that he would go with us and not wait. During the transport we got to talking even more and he actually came to a truce and saw why I made him so mad. There were no issues after that.

I know you can say that if the patient refuses to go with you due to some bias or racial nastiness then they can just sign the refusal but can you actually say you are providing the best possible patient care by falling back on that belief system. I know you can say "they get what they get when they call 911" and if they don't like what they get "just sign here" But I don't think that's being a good patient advocate. There should be remedies that can be made for this type of offensive belief system but there is a fine line between doing the right thing for the patient and enabling their offensive (to us) belief system.

Now if you are the only ambulance within a hundred miles, well then the patient is probably screwed but for large urban or even many rural services, there should be enough resources to provide a 2nd ambualnce for this person.

[ERDoc]

Ruff, the way I look at it is this. You are requesting an emergency service, you get what you get. The same thing happens in the ER. We get females of certain religions or persuasions who refuse to have a male do their pelvic exam. Sorry sweetie, I'm the only doc in house so you get what you get (I'm not calling in someone to do a pelvic exam. I can just imagine the laughing on the other end of the phone before it was abruptly slammed down). This isn't McDonald or the Sheraton. Now, I'm not that harsh with them face-to-face but I will try to explain the situation and why I feel the need to do xyz (much like you did). Sometimes it works, sometimes it doesn't. If not, here is your AMA paperwork.

[Just Plain Ruff]

I tend to agree with you Doc but couldn't it be argued that if the patient called for an ambulance and he was so adamantly against going with someone yet the patient definately needed to go that we should attempt to provide for that patient?

I'm simply playing devils advocate.

Let's take this to the next step, you are suing the ambulance service for the negilgent death of your family member. You have chest pain, you draw the short straw and you get "Bobby" who is the one you are suing. You refuse to go with Bobby but you do need ambulance transport. How would your service handle that?

Again, just playing devils advocate. LIke I said I don't think we should enable these people's behaviour but if there's another ambulance available, could that one not be sent which would solve the problem?

[ERDoc]

I agree to some degree. The path of least resistance is always the best, but like you said, don't give into their craziness. We see plenty of pts in the ER who are in the process of suing us. As for my pelvic example, if there is a female ER provider I have no problems asking her to do it. Same with EMS. If there is an ambulance that is in a reasonable distance, then it might not be a problem. When I was a volley, we could barely scrape up a first crew, let alone trying to find a second. I sure as hell wasn't going to mutual aid a neighboring district for something like this. Then again, it was a volley system and you get what you pay for.

[paramedicmike]

I tend to agree with you Doc but couldn't it be argued that if the patient called for an ambulance and he was so adamantly against going with someone yet the patient definately needed to go that we should attempt to provide for that patient?

How is this any different from the scenario Dwayne presented recently with the traumatic amputation patient refusing to go? (Aside from the fact that in Dwayne's example there was no other ambulance to fill the void. Not that it would've mattered anyway.)

If the patient refuses, no matter how badly s/he needs to go, the patient is allowed to refuse.

[Just Plain Ruff]

A second ambulance has to be available and close to make this thought process work.

But what sort of liability do our services place on them when they put a patient's belief system against the EMS Systems refusal to accomodate that patient.

It's all nice and easy to say if the patient doesn't like who they get and refuse to go with the ambluance crew that they can just sign the refusal form but does that really take the burden of patient care off the ambulance service?

The patient who we all know needs to go and refuses because of some personal belief or racism and we just say "you don't like who you get, tough shit buttercup" sign the refusal because if you don't go with us, you don't go. What kind of liability does that put our ambulance services and by extension what kind of liability does it put ME as a provider for following that line of thought.

The patient can sue of course, and more than likely will win.

I haven't heard of it happening lately but can you imagine the first Black EMT in Alabama or South Carolina? There are still people with that mindset out there.

You get a openly gay medic in a rough part of rural america and you can bet that they are going to have BIG issues.

I don't say it's right, I'm just looking at the other side of this. We all can say that we would have no problems with a gay partner or "transvestite" partner (I don't buy that part) but at one time I would have, when just getting out of high school I would have had a huge issue with it. Now, two of my best friends are gay and I've had countless gay partners and colleagues at my current line of work. (not an issue now but back then, it would have been)

How is this any different from the scenario Dwayne presented recently with the traumatic amputation patient refusing to go? (Aside from the fact that in Dwayne's example there was no other ambulance to fill the void. Not that it would've mattered anyway.)

If the patient refuses, no matter how badly s/he needs to go, the patient is allowed to refuse.

Mike, the patient isn't refusing to go to the hospital, he's just refusing to go the hospital with a gay medic or a black medic or whatever. He's just refusing to be taken care of by that medic in my example, he's not refusing to be transported, as a matter of fact, the guy who hated me, wanted to go to the hospital in our ems services ambulance but just not by me taking care of him. IN the end it all worked out but not until after we had some time to chat while waiting for the neighboring services ambulance to get to us.

[ERDoc]

If it comes down to a pt who really needs to go and you can accommodate them, then do so. In NY, the pt always had to go to the closest appropriate facility. We had a hospital that was not well liked and a large number of people preferred to go to one a little further away. Several times it came down to, "I'm going to Hospital B or I'm not going." It wasn't much of a burden on us and if it meant the pt got to the hospital and not left at home to die, then so be it.