Are paramedics comfortable and confident in their ability to provide emergency healthcare to transgender and gender diverse populations? A cross-sectional survey.

Introduction: Transgender and gender diverse people report high rates of healthcare avoidance, yet they also access emergency departments at higher rates than the general population. Our research explores the paramedic perspective of providing care to transgender and gender diverse populations. The objectives were to assess paramedic comfort, confidence, and knowledge in providing healthcare to transgender and gender diverse communities.

Methods: A descriptive, cross-sectional electronic survey was administered to paramedics licensed with the College of Paramedics of Nova Scotia (n = 1281) between April 9 and May 7, 2018. A 4-point Likert scale and open-ended questions about paramedic comfort, confidence, and knowledge were included. Descriptive statistics were used to describe respondent characteristics. Open-ended questions pertaining to paramedic knowledge needs were evaluated using constant comparative analyses employing open coding to identify themes.

Results: The response rate for the survey was 30%, with 387 licensed paramedics participating. Most respondents (66.2%) reported providing care to a patient who identified as transgender and gender diverse. A few respondents (4.9%) felt very confident in their knowledge regarding transgender and gender diverse identities and only 26.6% felt very comfortable in providing optimal care. Of those surveyed, 74.7% had no formal education on transgender and gender diverse health. Close to half (41.9%) reported observing transphobia in the workplace. Most respondents (70%) were interested in obtaining formal education and believed that it should be included in formative education curricula. Paramedics identified four distinct barriers to delivering equitable healthcare to transgender and gender diverse populations: (1) systemic, (2) personal, (3) socio-cultural, and (4) educational barriers.

Conclusion: Paramedics provide emergency healthcare to transgender and gender diverse patients. Comfort and confidence in providing this care were relatively low and identifiable barriers inhibit paramedic capacity to provide equitable healthcare. There was strong interest for education on transgender and gender diverse health and emergency presentations.