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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
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.
American College of Surgeons Committee on Trauma. Initial assessment and management. In: Advanced trauma life support for doctors. Chicago: American College of Surgeons; 2008.
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.
Centers for Disease Control and Prevention. HIV/AIDS among women who have sex with women. Atlanta: Centers for Disease Control and Prevention; 2006.
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.
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.
Centers for Disease Control and Prevention. CDC Fact Sheet: syphilis & MSM. Atlanta: Centers for Disease Control and Prevention; 2010.
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).
Centers for Disease Control and Prevention. CDC Fact Sheet: HPV and men. Atlanta: Centers for Disease Control and Prevention; 2012.
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.
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.
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.
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.
Centers for Disease Control and Prevention. CDC Fact Sheet: HIV and transgender people. Atlanta: Centers for Disease Control and Prevention; 2018.
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.
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.
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.
Crandall ML, Nathens AB, Kernic MA, Holt VL, Rivara FP. Predicting future injury among women in abusive relationships. J Trauma. 2004;56:906–12.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Herek GM, Garnets LD. Sexual orientation and mental health. Annu Rev Clin Psychol. 2007;3:353–75.
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.
Hughes TL. Chapter 9: Alcohol use and alcohol-related problems among lesbians and gay men. Annu Rev Nurs Res. 2005;23:283–325.
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.
Kenagy GP. Transgender health: findings from two needs assessment studies in Philadelphia. Health Soc Work. 2005;30(1):19–26.
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.
Kruks G. Gay and lesbian homeless/street youth: special issues and concerns. J Adolesc Health. 2010;12(7):515–8.
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.
Larkin GL, Marco CA. Ethical issues in the use of patient restraints. ACEP News. January 2007. p. 20.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
O’Connell JJ. Premature mortality in homeless populations: a review of the literature. Nashville: National Health Care for the Homeless Council; 2005.
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.
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.
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.
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.
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.
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.
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.
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.
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.
US Department of Health and Human Services. Healthy people 2010. Washington, DC: US Department of Health and Human Services; 2000. http://www.hhs.gov.
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.
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.
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.
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.
Zink BJ. Social justice, egalitarianism, and the history of emergency medicine. Virtual Mentor. 2010;12(6):492–4.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
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)