Skip to main content

Emergency Medicine

  • Chapter
  • First Online:
The Equal Curriculum

Abstract

Over the last 70 years, the emergency department (ED) has developed into one of the key access points for medical care. The ED has three primary care functions (1) stabilization of critically ill patients, (2) acute diagnostic care, and (3) health care access and treatment linkage. It is often the main entry point of the hospital and provides a medical safety net for many under- or uninsured individuals in the fragmented American medical system. This chapter provides a basic overview of the correct approach to LGBTQ patients in the ED regardless of chief complaint. It then discusses conditions that disproportionately affect LGBTQ people or that require a highly intentional approach: acute sexual health complaints, trauma, psychiatric emergencies, intoxication, and withdrawal. Finally, special considerations for transgender people and homeless LGBTQ youth are discussed.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Sources

  • Addis S, Davies M, Greene G, Macbride-Stewart S, Shepard M. The health, social care and housing needs of lesbian, gay, bisexual and transgender older people: a review of the literature. Health Soc Care Community. 2009;17(6):647–58.

    Article  PubMed  Google Scholar 

  • American College of Surgeons Committee on Trauma. Initial assessment and management. In: Advanced trauma life support for doctors. Chicago: American College of Surgeons; 2008.

    Google Scholar 

  • Buchmueller T, Carpenter CS. Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000–2007. Am J Public Health. 2010;100(3):489–95.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention. HIV/AIDS among women who have sex with women. Atlanta: Centers for Disease Control and Prevention; 2006.

    Google Scholar 

  • Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2010 emergency department summary tables. Atlanta: Centers for Disease Control and Prevention; 2010. http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2010_ed_web_tables.pdf. Accessed 28 Aug 2014.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: HIV and AIDS among gay and bisexual men. Atlanta: Centers for Disease Control and Prevention; 2010.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: syphilis & MSM. Atlanta: Centers for Disease Control and Prevention; 2010.

    Google Scholar 

  • Centers for Disease Control and Prevention. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveill Suppl Rep. 2012;17(No. 3, part A).

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: HPV and men. Atlanta: Centers for Disease Control and Prevention; 2012.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: viral hepatitis and men who have sex with men. Atlanta: Centers for Disease Control and Prevention; 2012.

    Google Scholar 

  • Centers for Disease Control and Prevention. Incidence, prevalence, and cost of sexually transmitted infections in the United States. Washington, DC: Centers for Disease Control and Prevention; 2013.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: HIV among black/African American gay, bisexual, and other men who have sex with men. Atlanta: Centers for Disease Control and Prevention; 2013.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: HIV and gay, bisexual, and other men who have sex with men. Atlanta: Centers for Disease Control and Prevention; 2018.

    Google Scholar 

  • Centers for Disease Control and Prevention. CDC Fact Sheet: HIV and transgender people. Atlanta: Centers for Disease Control and Prevention; 2018.

    Google Scholar 

  • Cochran SD, Sullivan JG, Mays VM. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cohen MS. Reduction of concentration of HIV-A in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet. 1997;349:1868–73.

    Article  CAS  PubMed  Google Scholar 

  • Conron KJ, Mimiaga MJ, Landers SJ. A population-based study of sexual orientation identity and gender differences in adult health. Am J Public Health. 2010;100(10):1953–60.

    Article  PubMed  PubMed Central  Google Scholar 

  • Crandall ML, Nathens AB, Kernic MA, Holt VL, Rivara FP. Predicting future injury among women in abusive relationships. J Trauma. 2004;56:906–12.

    Article  PubMed  Google Scholar 

  • Cunningham RM, Bernstein SL, Walton M, Broderick K, Vaca FE, Woolard R, et al. Alcohol, tobacco, and other drugs: future directions for screening and intervention in the emergency department. Acad Emerg Med. 2009;16(11):1078–88.

    Article  PubMed  Google Scholar 

  • Custers EJ, Stuyt PM, DeVries RPF. Clinical problem analysis: a systematic approach to teaching complex medical problem solving. Acad Med. 2000;75(3):291–7.

    Article  CAS  PubMed  Google Scholar 

  • Denney JT, Gorman BK, Barrera CB. Families, resources, and adult health: where do sexual minorities fit? J Health Soc Behav. 2013;54(1):46–63.

    Article  PubMed  Google Scholar 

  • Deutsch MB. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco: University of California, San Francisco; 2016. http://transhealth.ucsf.edu/protocols. Accessed 25 Jan 2019.

    Google Scholar 

  • Diaz RM, Ayala G, Bein E, Henne J, Marin BV. The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from three US cities. Am J Public Health. 2001;91(6):141–6.

    Google Scholar 

  • Dilley JA, Simmons KW, Boysun MJ, Pizacani BA, Stark MJ. Demonstrating the importance and feasibility of including sexual orientation in public health surveys: health disparities in the Pacific Northwest. Am J Public Health. 2010;100(3):460–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Durso LE, Gates GJ. Serving our youth: findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund; 2012.

    Google Scholar 

  • East JA, El Rayess F. Pediatricians’ approach to the health care of lesbian, gay, and bisexual youth. J Adolesc Health. 1998;23(4):191–3.

    Article  CAS  PubMed  Google Scholar 

  • Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999;153(5):487–93.

    Article  CAS  PubMed  Google Scholar 

  • Gates GJ. In U.S. LGBT more likely than non-LGBT to be uninsured. Gallup-healthways well-being index. http://www.gallup.com/poll/175445/lgbt-likely-non-lgbt-uninsured.aspx. Accessed 29 Aug 2014.

  • Grant JM, Mottet LA, Tanis T, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey, executive summary. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

    Google Scholar 

  • Gryczynski J, Mitchell SG, Peterson TR, Gonzales A, Moseley A, Schwartz RP. The relationship between services delivered and substance use outcomes in New Mexico’s Screening, Brief Intervention, Referral and Treatment (SBIRT) Initiative. Drug Alcohol Depend. 2011;118(2–3):152–7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hack JB, Hoffman RS. General management of poisoned patients. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline D, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 7th ed. New York: McGraw-Hill; 2011. p. 1187–93.

    Google Scholar 

  • Herbst JH, Jacobs ED, Finlayson TJ, McKleroy VS, Neumann MS, Crepaz N, HIV/AIDS Prevention Research Synthesis Team. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. AIDS Behav. 2008;12(12):1–17.

    Article  PubMed  Google Scholar 

  • Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353–75.

    Article  PubMed  Google Scholar 

  • Ho GYF, Bierman R, Beardsley L, Chang CJ, Burk RD. Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med. 1998;338(7):423–8.

    Article  CAS  PubMed  Google Scholar 

  • Hughes TL. Chapter 9: Alcohol use and alcohol-related problems among lesbians and gay men. Annu Rev Nurs Res. 2005;23:283–325.

    Article  PubMed  Google Scholar 

  • Ibanez GE, Purcell DW, Stall R, Parsons JT, Gómez CA. Sexual risk, substance use, and psychological distress in HIV-positive gay and bisexual men who also inject drugs. AIDS. 2005;19(suppl 1):49–55.

    Article  Google Scholar 

  • Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19–26.

    Article  PubMed  Google Scholar 

  • King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I. A systemic review of mental disorder, suicide, and deliberate self harm in lesbian, gay, and bisexual people. BMC Psychiatry. 2008;8:70.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kruks G. Gay and lesbian homeless/street youth: special issues and concerns. J Adolesc Health. 2010;12(7):515–8.

    Article  Google Scholar 

  • Larkin GL, Beautrais AL. Behavior disorders: emergency assessment. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline D, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 7th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  • Larkin GL, Marco CA. Ethical issues in the use of patient restraints. ACEP News. January 2007. p. 20.

    Google Scholar 

  • Larkin GL, Claassen CA, Emond JA, Pelletier AJ, Camargo CA. Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv. 2005;56(6):671–7.

    Article  PubMed  Google Scholar 

  • Lee GL, Griffin GK, Melvin CL. Tobacco use among sexual minorities in the USA: 1987 to May 2007: a systematic review. Tob Control. 2009;18:275–82.

    Article  CAS  PubMed  Google Scholar 

  • Lurie S. Identifying training needs of health-care providers related to treatment and care of transgendered patients: a qualitative needs assessment conducted in New England. Int J Transgend. 2005;8(2–3):93–112.

    Article  Google Scholar 

  • Lyons T, Chandra G, Goldstein J. Stimulant use and HIV risk behavior: the influence of peer support. AIDS Educ Prev. 2006;18(5):461–73.

    Article  PubMed  Google Scholar 

  • MacKellar DA, Valleroy LA, Secura GM, et al. Two decades after vaccine license: hepatitis B immunization and infection among young men who have sex with men. Am J Public Health. 2001;91(6):965–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Mansergh G, Colfax GN, Marks G, Rader M, Guzman R, Buchbinder S. The circuit party men’s health survey: findings and implications for gay and bisexual men. Am J Public Health. 2001;91(6):953–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • McLaughlin KA, Hatzenbuehler ML, Keyes KM. Responses to discrimination and psychiatric disorders among black, Hispanic, female, and lesbian, gay, and bisexual individuals. Am J Public Health. 2010;100(8):1477–84.

    Article  PubMed  PubMed Central  Google Scholar 

  • Meckler GD, Elliott MN, Kanouse DE, Beals KP, Schuster MA. Nondisclosure of sexual orientation to a physician among a sample of gay, lesbian, and bisexual youth. Arch Pediatr Adolesc Med. 2006;160(12):1248–54.

    Article  PubMed  Google Scholar 

  • National Gay and Lesbian Taskforce. National Transgender Discrimination Survey: preliminary findings. Washington, DC: National Gay and Lesbian Taskforce; 2009. http://www.thetaskforce.org/downloads/reports/fact_sheets/transsurvey_prelim_findings.pdf.

    Google Scholar 

  • Nobay F, Promes SB. Sexually transmitted diseases. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline D, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 7th ed. New York: McGraw-Hill; 2011.

    Google Scholar 

  • O’Connell JJ. Premature mortality in homeless populations: a review of the literature. Nashville: National Health Care for the Homeless Council; 2005.

    Google Scholar 

  • Ostrow DG, Stall R. Alcohol, tobacco, and drug use among gay and bisexual men. In: Wolitski RJ, Stall R, Valdiserri RO, editors. Unequal opportunity: health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press; 2008.

    Google Scholar 

  • Palefsky J, Holly E, Ralston M. High incidence of anal high grade squamous intra-epithelial lesions among HIV-positive and HIV-negative homosexual and bisexual men. AIDS. 1998;12:495–503.

    Article  CAS  PubMed  Google Scholar 

  • Pitts SR, Pines JM, Handrigan MT, Kellermann AL. National trends in emergency department occupancy, 2001 to 2008: effect of inpatient admissions versus emergency department practice intensity. Ann Emerg Med. 2012;60(6):679–686.e3.

    Article  PubMed  Google Scholar 

  • Remafedi G, French S, Story M, Resnick MD, Blum R. The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health. 1998;88(1):57–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health. 2010;100(12):2433–41.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sanchez JP, Hailpern S, Lowe C, Calderon Y. Factors associated with emergency department utilization by urban lesbian, gay, and bisexual individuals. J Community Health. 2007;32(2):149–56.

    Article  PubMed  Google Scholar 

  • Sena AC, Miller WC, Hobbs MM, Schwebke JR, Leone PA, Swygard H, Atashili J, Cohen MS. Trichomonas vaginalis infection in male sexual partners: implications for diagnosis, treatment and prevention. Clin Infect Dis. 2007;44:13–22.

    Article  PubMed  Google Scholar 

  • Smith DM, Mathews WC. Physicians’ attitudes toward homosexuality and HIV: survey of a California medical society—revisited (PATHH-II). J Homosex. 2007;52(3–4):1–9.

    Article  PubMed  Google Scholar 

  • Su JR, Beltrami JF, Zaidi AA, Weinstock HS. Primary and secondary syphilis among black and Hispanic men who have sex with men: case report data from 27 states. Ann Intern Med. 2011;155(3):145–51.

    Article  PubMed  Google Scholar 

  • US Department of Health and Human Services. Healthy people 2010. Washington, DC: US Department of Health and Human Services; 2000. http://www.hhs.gov.

    Google Scholar 

  • US Preventive Services Task Force. Screening for cervical cancer. Rockville: US Preventive Services Task Force; 2018. https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2. Accessed 25 Jan 2019.

    Book  Google Scholar 

  • Van Leeuwen JM, Boyle S, Salomonsen-Sautel S, Baker DN, Garcia JT, Hoffman A, Hopfer CJ. Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective. Child Welfare. 2006;85(2):151–70.

    PubMed  Google Scholar 

  • Whitbeck LB, Chen X, Hoyt DR, Tyler KA, Johnson KD. Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents. J Sex Res. 2004;41(4):329–42.

    Article  PubMed  Google Scholar 

  • World Health Organization Global Health Observatory. HIV/AIDS. http://www.who.int/gho/hiv/en/. Accessed 1 July 2014.

  • Xavier J, Honnold J, Bradford J. The health, health-related needs, and lifecourse experiences of transgender Virginians: Virginia HIV Community Planning Committee and Virginia Department of Health. Richmond: Virginia Department of Health; 2007.

    Book  Google Scholar 

  • Zink BJ. Social justice, egalitarianism, and the history of emergency medicine. Virtual Mentor. 2010;12(6):492–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Carl G. Streed Jr. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Streed, C.G., Samuels, E.A., Rosenfeld, J. (2020). Emergency Medicine. In: Lehman, J., Diaz, K., Ng, H., Petty, E., Thatikunta, M., Eckstrand, K. (eds) The Equal Curriculum. Springer, Cham. https://doi.org/10.1007/978-3-030-24025-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-24025-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24024-0

  • Online ISBN: 978-3-030-24025-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics