Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 19;26(3):458-464.
doi: 10.5811/westjem.39705.

Emergency Medical Service Responders' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany

Torben Brod  1 , Kambiz Afshar  2 , Christoph Schroeder  1 , Carsten Stoetzer  2 , Stephanie Stiel  2
Affiliations

Emergency Medical Service Responders' Perspectives on Transgender, Intersexual, and Non-Binary Patients in Germany

Torben Brod et al. West J Emerg Med. .

Abstract

Introduction: Gender minorities, including transgender, intersexual and non-binary (TIN) individuals, are at risk of receiving suboptimal care in emergency departments due to clinicians' limited knowledge and formal training in TIN-specific needs. Little evidence is available regarding emergency medical service (EMS) responders, including paramedics (EMT-P), emergency medical technicians (EMT) ,and prehospital emergency physicians (EP). Therefore, in this study we aimed to explore the experiences and knowledge, attitudes, and education/training needs of EMS professionals in Germany regarding the care of TIN patients.

Methods: In April 2023, we electronically surveyed EMTs, EMT-Ps and prehospital EPs from ambulance stations across Germany. Participants completed a questionnaire consisting of 15 closed-ended items assessing their experience and knowledge, attitudes, and education/training needs regarding the care of TIN patients. We used standard descriptive statistics and tested for group differences using the chi-square test.

Results: Of the 2,925 potential respondents, 906 completed the survey and were eligible for further analysis (response rate: 31%). Of these, 218 (24%) were prehospital EPs and 688 (76%) were EMTs and EMT-Ps, the latter two being significantly younger and less experienced. Almost half of the respondents reported having experience in caring for TIN patients as EMS responders (45% of EMTs/EMT-Ps vs 40% of prehospital EPs) but demonstrated significant gaps in non-medical and medical knowledge. Attitudes toward TIN patients were generally positive, but there were discrepancies between perceived comfort and actual communication behavior, with up to 25% of respondents overall avoiding questions they would ask non-TIN patients. Most respondents had no formal training in the appropriate management of TIN patients: only 7% of EMTs/EMT-Ps and 5% of prehospital EPs indicated having received such training during their professional or medical training. Our survey showed that 63% of EMTs/EMT-Ps and 62% of prehospital EPs agreed that there is an urgent need to increase awareness for TIN patients among EMS responders.

Conclusion: Despite generally positive attitudes toward transexual, intersexual and non-binary patients, EMS responders in Germany demonstrated deficits in knowledge and clinical preparedness to care for this vulnerable patient population, indicating that the care of TIN patients has not yet become routine in EMS and highlighting a strong need for improved education and training.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Experience and knowledge of pre-hospital emergency medical service providers in caring for transgender, intersexual and non-binary patients. ** = p <0.01 phEP, pre-hospital emergency physician; EMT/EMT-P, emergency medical technician or paramedic.
Figure 2
Figure 2
Attitudes of pre-hospital emergency medical service providers regarding transgender, intersexual, and non-binary patients. phEP, pre-hospital emergency physician; EMT/EMT-P, emergency medical technician or paramedic.
Figure 3
Figure 3
Education and training of pre-hospital emergency medical service providers regarding the care for transgender, intersexual and non-binary patients. phEP, pre-hospital emergency physician; EMT/EMT-P, emergency medical technician or paramedic.
Figure 4
Figure 4
Education and training needs of pre-hospital emergency medical service providers regarding the care for transgender, intersexual and non-binary patients. * P < 0.05, ** P <0.01, phEP, pre-hospital emergency physician; EMT/EMT-P, emergency medical technician or paramedic.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Wilson MH, Habig K, Wright C, et al. Pre-hospital emergency medicine. Lancet. 2015;386(10012):2526–34. - PubMed
    1. Kruse MI, Bigham BL, Voloshin D, et al. Care of sexual and gender minorities in the emergency department: a scoping review. Ann Emerg Med. 2022;79(2):196–212. - PubMed
    1. Reisner SL, Poteat T, Keatley J, et al. Global health burden and needs of transgender populations: a review. Lancet. 2016;388(10042):412–36. - PMC - PubMed
    1. Dennert G, Werner P, Kohls C, et al. Verbesserung des Zugangs zur Gesundheitsversorgung für inter und trans Menschen durch Abbau von Diskriminierung als versorgerseitiger Zugangsbarriere (InTraHealth) 2023. [Accessed October 10, 2024]. Available at: https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/5_Publikat....
    1. Bauer GR, Scheim AI, Deutsch MB, Massarella C. Reported emergency department avoidance, use, and experiences of transgender persons in Ontario, Canada: results from a respondent-driven sampling survey. Ann Emerg Med. 2014;63(6):713–20e1. - PubMed