LGBTQ+ EMS Clinicians Balance Professional Identity and Disclosure

The Human Element in Prehospital Emergency Care

Emergency medical services form the critical first link in the chain of survival for acute, life-threatening conditions. Clinical guidelines for managing acute ischemic stroke [1], severe sepsis [2], and acute coronary syndromes [3] all implicitly rely on the rapid, effective response of prehospital clinicians to initiate care and triage patients appropriately. While extensive research and standardized reporting protocols [4, 5] focus on optimizing these clinical interventions, the operational success of emergency medical services also depends heavily on the well-being and workplace dynamics of the clinicians themselves. An inclusive professional environment is increasingly recognized as a vital component for maintaining a resilient workforce and ensuring equitable patient care. A recent qualitative study offers fresh insights into the lived experiences of an underrepresented demographic within this critical workforce, exploring how personal identity intersects with the demanding role of a first responder.

Capturing the Lived Experience: Methodology

Despite increasing evidence that an inclusive health care environment promotes clinician well-being and patient health equity, little is known about the lived experience of lesbian, gay, bisexual, transgender, or queer (LGBTQ+) prehospital emergency medical services clinicians. To address this knowledge gap, the researchers established that the objective of this study was to explore the relationship between LGBTQ+ identity and the prehospital clinician role, offering insights into how these professionals navigate their daily clinical responsibilities. To gather these insights, this qualitative study used an interpretive phenomenological approach, a research method focused on understanding how individuals consciously experience and make meaning of their world, to capture the lived experiences of LGBTQ+ prehospital clinicians. Participants were recruited via social media and word-of-mouth. The researchers established specific parameters to ensure relevance to the current workforce, with inclusion criteria requiring a current role as a prehospital clinician, self-identity as LGBTQ+, residence in the United States, and age 18 years or older. For data collection, the researchers developed a semi-structured interview guide and completed interviews between February and May 2021. Once the interviews were transcribed, the research team analyzed the narratives to identify core patterns. Using a reflexive process, inductive coding and thematic analysis were performed, meaning the investigators drew themes directly from the clinicians' own words rather than applying a pre-existing framework. This analytical method ensured the findings accurately reflected the professional realities of the participants.

Demographic Breakdown of the EMS Cohort

Ultimately, eleven prehospital clinicians participated in the study. The researchers captured a diverse cross-section of gender identities within this qualitative cohort, noting that 45% of participants (n = 5) were cisgender males, 27% (n = 3) were cisgender females, and 27% (n = 3) were transgender. The cohort also represented a spectrum of sexual orientations. A plurality of participants identified as homosexual (45%, n = 5), while the remainder of the group included individuals who identified across multiple orientations. Specifically, 36% (n = 4) of participants identified as bisexual or pansexual, and 18% (n = 2) identified as queer. Regarding their clinical roles and geographic distribution, the respondents primarily represented foundational levels of prehospital care. The majority of participants were certified as Emergency Medicine Technician-Basic (55%; n = 6). Geographically, the majority of participants resided in the Southern region of the United States (55%; n = 6), providing a specific regional context to their lived experiences and workplace dynamics.

Navigating the Workplace: Three Core Themes

Following the thematic analysis of the interview transcripts, three themes emerged from the data. The first theme, identified as the strategic closet, proposes a case-use approach to self-disclosure in which clinicians weigh the benefits and risks of coming out on the job. For medical directors and physicians overseeing emergency medical services, this highlights that disclosure is not a single event but an ongoing, calculated risk assessment based on the immediate clinical environment, patient interactions, and team dynamics. The second theme, termed clinician-first identity, defines the desire of LGBTQ+ prehospital clinicians to be recognized for their skills as prehospital clinicians before any other identity within their professional space. Participants emphasized that their primary focus remains on patient care, such as managing acute trauma or stabilizing cardiac events. They want their clinical competence to be the defining metric of their professional value, ensuring that their technical abilities and medical knowledge overshadow personal demographics during high-stakes interventions. The third theme, the power of intersectionality, informs the necessity to bridge minority identity with first responder identity in the prehospital profession to improve health equity and workspace safety. Intersectionality refers to how different aspects of a person's social and political identities combine to create unique modes of discrimination or privilege. In this context, the concept underscores that acknowledging a clinician's diverse background can enhance cultural competence in the field. By integrating these dual identities, emergency medical services can foster a safer, more supportive working environment for staff while facilitating better, more equitable care for diverse patient populations.

Policy Implications for Prehospital Care Environments

The authors conclude that translating these qualitative insights into actionable administrative changes is essential for optimizing emergency medical services. Specifically, the researchers emphasize that to better serve prehospital patients and clinicians, the tolerance of minority identities must be prioritized. For medical directors and agency administrators, this means actively fostering an environment where diverse backgrounds are respected rather than merely accommodated. Furthermore, the study highlights that recognition of the informative nature of clinician personal experience must be prioritized. Acknowledging the unique perspectives that LGBTQ+ clinicians bring to the field can directly inform patient interactions, particularly when treating marginalized populations who may otherwise distrust the healthcare system. Moving beyond individual recognition, the authors call for systemic, structural changes within emergency medical service organizations. They conclude that incorporation of policies and education recognizing cultural and personal differences must be prioritized. For practicing physicians overseeing prehospital protocols, this requires developing formal training modules and anti-discrimination policies that explicitly address the realities of minority clinicians. By institutionalizing these educational initiatives, agencies can build a more resilient workforce, reduce the cognitive load associated with workplace concealment, and ultimately ensure that clinical focus remains entirely on delivering high-quality emergency care.

References

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2. Rhodes A, Evans L, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Critical Care Medicine. 2017. doi:10.1097/ccm.0000000000002255

3. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA Guidelines for the Management of Patients With Unstable Angina and Non–ST-Segment Elevation Myocardial Infarction: Executive Summary and Recommendations. Circulation. 2000. doi:10.1161/01.cir.102.10.1193

4. Moher D, Hopewell S, Schulz KF, et al. CONSORT 2010 Explanation and Elaboration: updated guidelines for reporting parallel group randomised trials. BMJ. 2010. doi:10.1136/bmj.c869

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