Veteran Idaho paramedic dies in off-duty rollover crash

Veteran Idaho paramedic dies in off-duty rollover crash

By EMS1 Staff

ONTARIO, Ore. — A paramedic died last week in an off-duty vehicle crash.

KTVB reported that paramedic Kevin Luby, 42, died at the scene of the crash after his SUV drifted off the road and overturned, rolling through lanes of the highway, according to police.

Luby had been a member of Ada County Paramedics since 2005 and also worked for the agency as a field training officer.

“Kevin was somebody that we’ve all worked closely with, one time or another,” ACP spokesperson Hadley Mayes said. “[He] would always tell it to you straight, like it was, even if you didn’t necessarily want to hear it. He would go out of his way to help his colleagues and his friends and family, without being asked.”

Mayes added that Luby’s death was an “absolute shock.”

“He was just not a coworker, a colleague, he was a friend, he was a family member to each of us,” she said.

ACP posted about the “profound sadness” Luby’s colleagues were experiencing after learning about his death.

“Luby, colleague, friend, husband, father, son, paramedic … you are, and will forever be, so incredibly missed,” the agency posted. “Ada County Paramedics will not be the same without your smiling face, witty humor and caring and loving disposition.”

A GoFundMe was set up to help raise money for a memorial honoring Kevin’s memory. Click here to donate.

 

Police, EMS union disputing after paramedic bitten by patient

Police, EMS union disputing after paramedic bitten by patient

By EMS1 Staff

DETROIT — A union is disputing with police over a response to a mentally ill girl after a paramedic was assaulted by the patient. 

The Detroit News reported that an EMS crew and police officers responded to a call about a 17-year-old girl who was being violent with her family and threatening to jump off of her roof.


A paramedic who was bitten by a patient is currently off the job recovering from the incident. (Photo/Detroit Fire Fighters Association)
A paramedic who was bitten by a patient is currently off the job recovering from the incident. (Photo/Detroit Fire Fighters Association)

“The first responding unit developed a rapport with the woman and was able to talk her off the roof,” Detroit Police Department Cmdr. DeShawne Sims said. “Medics were called … after the medics arrived, (the officers) assisted the medics with getting the individual onto a gurney. She became combative, and officers and medics tried to get her restrained.”

Police said the girl bit, kicked and spit on one paramedic, injured another and bit and spit on a police officer before she was restrained.

The paramedic who was bitten is currently off the job recovering from the incident, and he posted about it on Facebook under the pseudonym Daniel Joseph.

“So Monday night a ‘patient’ bit me to a point where I’m off duty until healed,” the Facebook post read. “Police on scene didn’t maintain control of her or the scene. As a result I got pinned between the stretcher and rig. Attempting to stop this individual from punching my partner, I got bit, spit in my face, and got a knee to the face … this is what happens when police runs continue to be pawned off on EMS.”

Detroit Fire Fighters Association President Mike Nevin said police response was not fast enough, but DPD Lt. Joseph Tucker said “at no time were the EMTs at the scene alone.”

“That’s not even the point,” Nevin said. “This is just more spin to try to make it sound like Detroit’s public safety isn’t broken. The issue is that the police didn’t control the scene properly. Sometimes you need more than two officers on a scene. People are being mentally polluted to think it’s OK to work these kinds of scenes with less people. It’s not normal. The police should’ve maintained that scene, and two officers weren’t enough.”

Tucker told WXYZ that he reviewed body camera footage and “the scene was controlled from beginning to end.”

“Backup, additional resources did respond. From what I could determine it was within a minute or so, not long at all. Several units responded. The scene was controlled from beginning to end. We actually take offense to the end of the statement that we pawned off runs on EMS. That’s not fair to us.”

Neb. first responder fights city over use of PTSD service dog

Neb. first responder fights city over use of PTSD service dog

By Riley Johnson
Lincoln Journal Star

LINCOLN, Neb. — Paramedic Rob Ravndal went on hundreds of emergency calls before the one response that ultimately ended his career at Lincoln Fire and Rescue.

The trauma of that call, a 3-year-old’s drowning in 2015, sent the father of young children into a spiral.


Rob Ravndal hopes sharing his experiences grappling with PTSD and trying to continue his career will help reduce the stigma of the disorder. (Photo/LFD)
Rob Ravndal hopes sharing his experiences grappling with PTSD and trying to continue his career will help reduce the stigma of the disorder. (Photo/LFD)

Nightmares. Breakdowns. A general sense of fear.

Even after his bosses pulled him off the ambulance, Ravndal struggled at work and at home as he grappled with post-traumatic stress disorder.

One of five firefighters or paramedics nationwide will suffer from PTSD during their career, according to the Journal for Occupational Health Psychology.

Ravndal sought treatment, eventually becoming the first Lincoln firefighter to use a service dog. But he never returned to full-duty and ended his nine-year tenure in October, walking away from the job the he said made him feel like a superhero.

Ravndal, 46, hopes sharing his experiences grappling with the disorder and trying to continue his career will help change the culture toward first responders experiencing PTSD.

“If the people don’t do something to change it, they can’t be upset if they call 911 and nobody comes,” he said.

The injury

Lisa Ravndal could tell her husband loved his job when he joined the force in Lincoln in 2009 after serving as a paramedic in Gillette, Wyoming.

Rob Ravndal, she said, was passionate about the work he did out of Station 8 in Irvingdale and “it showed.”

Ravndal was well-liked and well-respected among his peers, Lincoln Firefighters Association President Adam Schrunk said.

He was one of a few paramedics trusted by Lincoln Fire and Rescue to perform an emergency medical procedure, rapid sequence intubation, a high-risk technique to preserve an airway in patients with life-threatening injuries, Schrunk said.

“It’s a lot of fun being Superman,” Ravndal said of the paramedic job.

But in October 2015, Ravndal was called to a home where a 3-year-old child had drowned. His daughter had just turned 3.

Just how much that call changed him wasn’t immediately apparent to Ravndal or his family.

But two weeks later, he was crying for no reason, waking up in the middle of the night. His nightmares grew in intensity. So did his anger.

One day, he broke down while on-duty in the garage of his station.

“Every time that the tones (for emergency calls) went off, I had this feeling that the whole thing was going to happen again,” he said.

After talking to his captain, he went to see the Employee Assistance Program counselor. In those sessions, he felt anxious about his participation and worried notes would be shared with his superiors.

Still, he continued working on the rigs and continued the sessions for 18 months, until his symptoms got worse. Though he was seeing the counselor, he wasn’t receiving treatment, Ravndal said.

“After that (call), I literally lost my soul,” he said. “I was just a shell.”

Finally in May 2017, he connected with a therapist in Omaha who specializes in working with first responders. She told Ravndal to take time off because he needed to heal.

But ineligible for injury leave, he burned through sick time and vacation time until August, when he took family medical leave, Ravndal said.

Ravndal had already hired an attorney and filed a worker’s compensation claim that June, but he wasn’t treated the same as firefighters who suffer physical injuries in the line of duty, he said.

State lawmakers in 2010 extended workers compensation coverage to mental injuries suffered by first responders in the line of duty. But injury leave for a mental injury suffered in the line of duty wasn’t specifically mentioned in the city’s contract with the firefighter’s union.

Fire Chief Micheal Despain, who was hired in 2016, declined to comment on Ravndal’s case, citing the personnel issue.

The primary wage earner in his household, Ravndal had to return to work “because the city had not taken any ownership of my injury,” he said.

On Sept. 1, 2017, he returned to work on light duty.

And despite his sessions with therapists and the aid of a specialized six-day retreat in California, being at work made his life harder.

Doing paperwork and running errands for the fire department weren’t the difficult, grueling shifts he’d worked as a paramedic, but Ravndal said he continued to struggle at home and on-duty.

“It was hard; it was exhausting.”

‘Living one hour at a time’

By November 2017, Lisa worried about her husband every day she went in to work as a substitute teacher.

That summer, she’d noticed he’d been separating from his family, gaining weight, sleeping all the time or not at all.

While on light duty, he’d call in sick some days when his anxiety proved too much, and Lisa felt uneasy.

What would happen on the days she left him by himself, she thought: “We’re hunters. We have guns.”

That year, first-responder suicides in the U.S. exceeded all line-of-duty deaths for police officers and firefighters, according to a study released in April 2018.

One night around Thanksgiving, Ravndal had deteriorated to the point his friends at work intervened.

He had called out sick, and they went to his home asking him to get help.

“The day they came over, I was just living one hour at a time,” he said. “I would get to 12 o’clock, and I’d be like, ‘OK. I can hang on ’til 1.'”

Ravndal sought admission to Lasting Hope in Omaha Nov. 30 and received mental health treatment there for several days before he was accepted for treatment at the International Association of Fire Fighters Center for Excellence in Maryland.

In Lincoln, his coworkers rallied in support, working overtime to cover his shifts so the Ravndal family could continue to receive a paycheck while he was away. An online crowdfunding platform raised more than $8,000.

And in Texas, on the recommendation of Ravndal’s therapist, a trainer prepared a black and tan coonhound to be his service dog, capable of quelling anxiety attacks and managing his PTSD symptoms.

He arrived home Jan. 13, 2018, with new coping strategies, awaiting his service dog’s arrival.

He researched how paramedics like him in other states had brought their service dogs to work, offering hope that he could resume his life-saving career.

“Why should this be a big deal?” Ravndal recalled thinking. “It’s the law.”

Ravndal’s return

On Jan. 10, 2018, Ravndal emailed Despain and asked for accommodation for his service dog under the Americans with Disabilities Act. He explained the dog would remain kenneled at the station and would not go on any emergency calls. Ravndal would provide its kennel, feed and any necessary housekeeping.

The next day, Lincoln’s fire chief responded that he was exploring the issue and told Ravndal, “Hope to see you back here soon.”

City officials declined to answer specific questions, but emails Ravndal provided to the Journal Star offer insight on his request for accommodation.

After follow-up emails to Despain, the city’s human resources staff and City Attorney Jeff Kirkpatrick’s office, his request was acknowledged, but an answer didn’t come until Feb. 2.

In an email that day, Assistant City Attorney Don Taute told Ravndal the city needed more information from his doctor and therapist addressing his ability to return to full-duty.

“Leaving aside for the moment your question about a ‘service dog’ which you characterize as a request for a reasonable accommodation, the first matter to be addressed is your work status and whether you can return to work at this point in time,” Taute said.

Meanwhile, Ravndal found an instant connection with Pride, the coonhound that arrived on Feb. 1.

Pride would get between other people and Ravndal to give him a sense of anxiety-reducing protection. When he’d sense an attack coming, Pride would get up on Ravndal’s lap, applying a deep pressure therapy that calmed him, he said.

“He’s the perfect dog for me, and I’m the perfect person for him,” Ravndal said.

On Feb. 20, Ravndal again asked to discuss bringing Pride to work, but he was told that city officials were still talking it over and needed other information about his medications.

The next day, Ravndal faced a pivotal decision. He had to show up for work on light duty — without Pride — or be terminated because his time under the Family Medical Leave Act had expired.

So he went to work.

On Feb. 22, Taute told Ravndal his light duty was the accommodation being made for him, since he wasn’t able to return to full duty.

The debate continued, even as Ravndal completed simple tasks.

His therapist, Stephanie Levy, began pushing for Taute to allow Ravndal to bring Pride to work, stressing the service dog’s role in helping him to return to full duty. Taute asked whether Ravndal would be able to perform his paramedic duties on the scene without his service dog.

“I am saying (Ravndal) is not able to even try full duty at this point because his symptoms are too severe,” Levy responded. “I’m hoping with having (his) service dog on light duty his symptoms would stabilize and help (him) progress to full duty.”

A month later, Ravndal, a staff attorney from Disability Rights Nebraska and others met with city officials. And on Aug. 27, Taute sent an email approving Ravndal’s request to have his dog at work for up to six weeks.

“In summary, the City is willing to allow the requested accommodation, but there must be considerable progress exhibited during the time the dog is with Mr. Ravndal in the workplace,” Taute said. “The modified duty assignment cannot continue for an indeterminate amount of time.”

Ravndal rushed home to pick up Pride. They were a team for a month, until time ran out.

After a year on light duty and still not cleared to return to the ambulance, Ravndal needed to retire or be fired for exhausting his time on modified assignment.

Ravndal loves the department, but not the way he was treated.

“I may have gone back to the rigs,” said Ravndal. “What is clear is that I tried to go back, and City Hall would have no part of making an accommodation.”

‘Thank You, Rob’

Retiring wasn’t what Ravndal had in mind, but by September 2018 he was ready to move on.

Those who turned out for the retirement party organized by his wife and coworkers left him humbled.

The circumstances weren’t like other firefighter retirements he’d attended, but everyone from recruits to the fire chief stopped by, he said.

In the days after, he reflected on his fight with the city and what it all meant.

“I did not cower,” Ravndal said. “I recognized a just fight, and I did not cower.”

The city conceded in the worker’s compensation case that Ravndal’s PTSD was caused by his work duties and settled the case in September.

“It is the City’s position the handling of Mr. Ravndal’s case was done completely in compliance with the law taking into consideration the factual circumstances and medical information available throughout the pendency of Mr. Ravndal’s case,” Taute said in an email response to the Journal Star. “The matter has now been voluntarily settled by the parties, and Mr. Ravndal is currently receiving full duty disability benefits pursuant to the provisions of the City’s Police and Fire Pension Plan.”

Stephany Pleasant Maness, a staff attorney with Disability Rights Nebraska, said employers asked to provide accommodation to an employee with a disability often take six to eight weeks.

“It shouldn’t have taken 8 months,” she said.

The city’s reversal to allow the service dog at work in August, four days after a meeting, showed they didn’t handle his case as they should have, Pleasant Maness added.

Pleasant Maness said she believes there’s a public suspicion of service animals, and she hopes city staff will better educate themselves on how to accommodate these requests so workers with disabilities aren’t mistreated and left out of the workforce.

Despite his strong belief he was discriminated against, Ravndal doesn’t want to file a lawsuit against the city, he said.

Instead, Ravndal wants the city to treat mental injuries that first responders suffer on the job just like physical injuries sustained in the line of duty.

The work the city asks first responders to do every day, on every call, demands they be cared for if they’re injured in the line of duty, he said.

Schrunk, the union president, said the city’s lack of experience on this issue shows the need for ongoing consideration of the mental health of firefighters.

At Lincoln Fire and Rescue, Despain noted investment in professional counseling services, internal peer-counseling and debriefings. Assignments are rotated to help crews deal with mental health issues.

An initiative to increase staffing is reducing the net workload, Despain added.

Since his retirement, Ravndal has focused on rebuilding the relationships with his family and considering the next step in his career. He’s receiving a monthly disability pension from the city under the fire pension plan for permanently disabling line-of-duty injuries.

And wherever Ravndal goes, the store, the doctor’s office, the gym or church, Pride is often right beside him.

“I still have bad days,” Ravndal said. “(Pride) doesn’t cure it, but it definitely makes it far easier to go and do things … and just stay focused. Life itself is not simply survival.”

Copyright 2019 Lincoln Journal Star

1 dead, 4 in critical condition at mass overdose in Calif. house

1 dead, 4 in critical condition at mass overdose in Calif. house

Associated Press

CHICO, Calif. — One man has died and four are in critical condition following apparent drug overdoses at a house in Chico, the Enterprise-Record newspaper reports .

A dozen people were taken out of the house Saturday morning and brought to hospitals, police told the newspaper.


A mass overdose appears to have been largely caused by the dangerous opioid fentanyl. (Photo/AP)
A mass overdose appears to have been largely caused by the dangerous opioid fentanyl. (Photo/AP)

The mass overdose appears to have been largely caused by the dangerous opioid fentanyl, Chico police Chief Mike O’Brien said at a news conference.

“Every indication is that this mass overdose incident was caused from the ingestion of some form of fentanyl in combination with another substance. That is yet to be confirmed, but we do anticipate confirmation in the coming days,” O’Brien said.

All of the people hospitalized were over 18 and most appeared to be in their 20s, Chico police commander Mike Rodden said.

Cardiopulmonary resuscitation was performed on six people at the scene and a total of 12 were taken to the hospital, Steve Standridge, chief of Chico’s fire department, said.

Chico is a city of about 92,000 people about 160 miles north of San Francisco.

How helping patients get good care at home helps rural hospitals survive

How helping patients get good care at home helps rural hospitals survive

By Blake Farmer
Nashville Public Radio

NASHVILLE, Tenn. — Rural hospitals close when they don’t have enough paying patients to care for, but they’re also dinged when the same patients show up over and over again. That puts outlying medical facilities in the precarious position of needing to avoid repeat customers.

Charlotte Potts is the type of patient some hospitals try to avoid. She lives in Livingston, Tenn. — a town of 4,000, tucked between rolling hills of the Cumberland Plateau.

“I’ve only had five heart attacks,” Potts said recently with a laugh. “I’ve had carotid artery surgery. Shall we go on? Just a few minor things.” She joked that she’s “a walking stent.”

The heart trouble has affected the way Potts deals with her health problems. She spends much of her day in a recliner in her apartment, tethered to a pulsing oxygen machine, and listening to the radio.

Fortunately, her apartment sits within spitting distance of Livingston Regional Hospital — a 114-bed facility large enough to have a dedicated cardiac unit. But the hospital doesn’t want to see her every time her heart flutters.

So, the last time she landed in the ER, they helped her connect with a few companies that could provide care at home.

“If I’m going to have certain things going on here in my chest, I call for help, and they’re there,” Potts said of the home care team she chose.

There were days when the hospital might have viewed a home health agency as a competitor. Not anymore.

“When I started this almost 40 years ago, the mission was different,” said Tim McGill, CEO of Livingston Regional. “We wanted patients in the hospital. That was the incentive. We were paid for it. Now you’re not.”

Hospitals used to run on a so-called fee-for-service model with virtually no limit to how many times they could see a patient. But, under pressure from private and government insurance programs, that model is transitioning to one in which hospitals are rewarded for safety and efficiency — which often results in a patient spending less time in the hospital.

Under the Affordable Care Act, Medicare began to ding hospitals if too many patients are readmitted to any hospital within 30 days of discharge. The measure is broadly unpopular with the hospital industry, since so much falls outside a hospital’s control. Medicare has even walked back the rules for safety-net facilities, which tend to treat a sicker population.

The penalty is meant to encourage hospitals to get it right the first time. In Livingston, the hospital operates on the thinnest of margins — just 0.2 percent in the most recent figures. And “readmissions” have been a drag on the bottom line.

One in 5 patients with heart failure was back within the month. The hospital has paid the maximum penalty in some years — nearly $200,000. So leaders started asking a basic, unifying question of other providers in town, McGill said: “What can we do together so they’ll stay out of the hospital and stay healthier in their home setting? That’s where the work is.”

The work took the form of quarterly lunch meetings at the local library.

Mary Ann Stockton, a nurse at the hospital, invites all the home health agencies as well as hospice providers and the leaders of nursing homes.

At one meeting, she applauded the other providers for increasingly meeting patients inside the hospital before they’re discharged. She said it helps patients and families accept these home health workers.

“We know in our area people don’t like to have a total stranger come into their home,” she said.

The group brainstormed how to generate the same kind of acceptance for hospice care, which — as one doctor in the meeting put it — some families view as “assisted suicide.”

And on this day, the group spent much of its time reviewing the value of flu shots, especially for the staff in nursing homes. Stockton said elderly patients with bad lungs become a hospital emergency room’s “frequent flyers.”

“Flu starts off, goes into pneumonia, COPD exacerbation — and they are a revolving door in our hospital,” Stockton said. “They’re hitting that ER a couple of times a week.”

Advance directives are on the agenda for next time — another way to keep people near the end of life from becoming ER regulars.

Livingston’s parent company, LifePoint Health, is launching this community approach in many of its 80-or-so markets, which are primarily in the Southeast and almost all rural. Cindy Chamness, a LifePoint vice president, helps hospitals find willing partners.

“We were very frustrated for many years,” Chamness said, “because we weren’t able to impact readmissions just working on it by ourselves, as a hospital.”

The solution looks different from one town to another. In Lake Havasu, Ariz., paramedics now visit discharged patients to make sure they’re following doctors’ orders. The house calls also cut down on government-funded ambulance rides.

It’s not just rural hospitals — all hospitals can be penalized for readmissions now. And threatening the bottom line in that way does seem to be effective. Readmissions have been falling across the board, according to the latest research.

But rural hospitals, which already treat fewer patients than urban hospitals, wonder if they’ll have enough patients to survive, said Michael Topchik of the Chartis Center for Rural Health.

“(A) CEO from Montana said to me, ‘The problem is, when we do the right thing, are we saving ourselves right out of business?’” Topchik said.

The focus on cutting readmissions — by definition — cuts overall admissions too, he noted.

“So, this is the real inherent tension and challenge: Hospitals get reimbursed for doing ‘sick care,’” Topchik said. “But more and more they’re being asked to do population health, and really focus on ‘wellness.’”

To make up the volume, the Livingston hospital is expanding its maternity ward and general surgery offerings.

There is also some immediate financial upside to reducing readmissions: Livingston Regional has cut readmissions more than any other rural hospital in Tennessee and even the nation, according to data compiled by Chartis.

As a result, the hospital’s Medicare penalty in the coming year will be reduced to 0.3 percent of its reimbursements — down from the maximum of 3 percent, which was roughly $200,000 a year.

That’s all because patients like Charlotte Potts now can safely stay home.

“I got a real bad tightness in the chest,” Potts recalled about a recent episode. She’d questioned whether to call an ambulance. “I was very uncertain about what was going on.”

But she phoned her home health agency, took a nitroglycerin pill as the agency advised and, instead of going to the ER, was able to get back to sleep.

Introduction to affirming EMS care for transgender and gender diverse patients

Introduction to affirming EMS care for transgender and gender diverse patients

AUSTIN, Texas — Transgender and gender-diverse patients, which make up a vulnerable patient population in every service area, are often misunderstood and overlooked by healthcare providers. Eric Lowe, MD, FACEP, FAEMS, introduced NAEMSP Annual Meeting attendees to the terminology and significant healthcare issues this patient population faces.

Lowe delivered this education program to physicians, EMS providers and law enforcement officers because medical education has historically included little related to this population, and one third of self-identified transgender individuals report negative interactions with healthcare providers related to their gender status. He described what it means to be transgender, health-related vulnerabilities, and assessment tips to affirm and care for this population.

Memorable quotes on transgender patient assessment and care


(Photo/Courtesy of www.genderbread.org)
(Photo/Courtesy of www.genderbread.org)

Lowe began his presentation by relaying his personal experience as the parent of a transgender child. Here are three memorable quotes from Lowe’s NAEMSP presentation:

“In EMS, we work with some of the most vulnerable populations at the most vulnerable times in their lives. It is our job to be sensitive to our patients’ needs.”

“Always refer to somebody by the identity they know themselves to be.”

“EMS has the chance to set the tone for these individuals as they enter the healthcare system. We have a chance to make a difference.”

Top takeaways on transgender patient care

Transgender individuals exist in every community. An estimated 0.6 percent of the population identifies as transgender or gender diverse, and this population has many health vulnerabilities that may bring them in contact with EMS. As caregivers, EMS providers have a responsibility to understand this patient population. Here are my three top takeaways.

1. Understand the terminology

Lowe began his presentation by clarifying the importance of healthcare providers using a shared set of definitions for the terms sex, gender and sexuality.

  • Sex is the physical characteristics and biology of a person
  • Gender is one’s internal deeply held sense of who they are. Gender identity is a sense of who one is. Gender expression is how we demonstrate that identity to the outside world.
  • Sexuality is an expression through behaviors and emotions.

Two additional terms introduced during the presentation were cisgender and transgender.

  • Cisgender is the alignment of gender identity and biological sex.
  • Transgender is a contrast of biological sex and gender identity (biological sex and gender identity are different).

Lowe also reviewed the transition options some individuals undertake, including:

  • Social changes
  • Gender-affirming medications
  • Gender-affirming procedures

2. Transgender statistics and health risks

Many transgender or gender non-conforming individuals have suffered from harassment, physical assault and sexual assault while in primary education. “Forty percent of transgender adults reported having attempted suicide,” Lowe said.

Family support makes a significant difference to transgender individuals. The rate of suicide attempt increases to 60 percent for adolescents who report having an unsupportive family.

In the 2015 U.S. Transgender Survey, nearly one-third of respondents limited their food and water intake to limit their daily need for using school or public bathrooms. Those individuals are at increased risk of weak and dizzy spells, urinary tract infections and insufficient body weight; problems which may put them in contact with EMS providers, school nurses and emergency physicians.

One-third of transgender patients report having negative interactions with healthcare providers in the past year, primarily because of not being called by their preferred gender pronouns (being misgendered and misnamed), denial of their gender identity by healthcare providers, and having to explain their gender identity to skeptical or under-informed healthcare providers.

Tip: Name and pronouns are very important to gender identity. Use the patient’s preferred name and pronouns in verbal interactions with the patient, handoff report to emergency department staff and ePCR documentation.

3. Safe and affirming care environment

Lowe concluded the presentation by discussing what we can do better. “For all patients, we should create an environment that is safe and affirming,” Lowe said.

Tip: Ask the patient two simple questions:

  • What name would you like me to call you?
  • What pronouns do you prefer?

“If you can do any one thing, do this (asking the above questions). It makes an enormous difference,” Lowe said.

He acknowledged that at first, these questions might feel uncomfortable or awkward before explaining we use nicknames and variations (like Mike instead of Michael or Beth instead of Elizabeth). “This just takes practice and getting used to it,” Lowe said.

For patients with complaints that are dependent on understanding the patient’s anatomy, like abdominal pain, Lowe described how to conduct an organ inventory with three questions.

  • What sex were you assigned at birth?
  • Have you been on any gender-affirming medications?
  • Have you had any gender-affirming procedures or surgeries?

Finally, there are other actions EMS agencies and emergency departments can take to be inclusive and make patients feel welcome:

  • Inclusive signs, images
  • Awareness of how other providers interact with patients
  • Understanding organization policies

One of the images Lowe shared was the Montana #Open2All logo.


EMS1 image

Other opportunities for safe and affirming environment include:

  • Adding the patient’s preferred name, pronouns and gender identity to ePCR documentation
  • Adding patient’s preferred name field in the patient hand-off note, which can make a difference for all patients. 

Top Tweets

Learn more and get involved

Learning terminology and understanding the known health risks transgender patients experience is an important starting point for EMS providers, emergency physicians and all healthcare providers. One starting point is the Genderbread Person, a tool Lowe shared for understanding biological sex, gender expression and gender identity.


(Photo/Courtesy of Greg Friese)
(Photo/Courtesy of Greg Friese)

Additional resources: