 Understand and define the differ­ences between sex, sexual orient­ation, gender, and gender identity.
 Describe the dispar­ities and health threats unique to LGBT patients.
 Identify measures that can help create a positive enviro­nment in your ambulance or sphere of care.

Creating a positive space for patients is difficult at the best of times. Having called 9-1-1, few patients would describe their day as going well. Developing rapport and building trust are essential abilities of today’s healthcare practi­tioner.

Words mean different things to different people. Here are some commonly accepted defini­tions relevant to LGBT popula­tions:

Acce­ptance — Regarding something as proper, normal, or inevit­able.
Ally — A person who confronts homoph­obia, hetero­sexism, transp­hobia, and hetero­sexual privilege in themselves and others; respec­tfully shows concern for the well-being of people who identify as LGBTQ; and believes that hetero­sexism, homoph­obia, and transp­hobia are social justice issues.
Bisexual — A person who is attracted to more than one gender in an emotional or physical sense. They may have a preference for one gender over others.
Cisg­ender — A person whose gender identity is congruent with their biological sex.
Coming out — May refer to the process by which one recogn­izes, acknow­ledges, and/or embraces one’s own sexuality or gender identity (to “come out” to oneself). This term may also refer to the process by which one shares one’s sexuality or gender identity with others (to “come out” to friends, family, etc.).
Cros­s-d­ressing — In and of itself, this refers to a behavior that’s indepe­ndent of gender identity and not synonymous with a transg­ender identity.
Gay — A man who is attracted to men in an emotional or physical sense. Not all men who engage in same-sex sexual intimacy identify as gay.
Gender — The social construct associated with men (mascu­linity) and women (femin­inity). Social constr­ucts, or “gender norms,” that define what it means to be a man or a woman differ histor­ically and cultur­ally.
Gender identity — An indivi­dual’s own sense of their gender. It may or may not conform to the sex at birth and can be linked to a feeling of being male, female, both, or neither. Various nonbinary (male or female) descri­ptions are included in this category, including gender­-fluid (moving between male and female), gender­-queer (an interm­ediate between male and female), agender (having no gender), or poly- or bigendered (being both or many genders).

Hete­ros­exism — The assumption made by instit­utions or indivi­duals that everyone is hetero­sexual and/or that hetero­sex­uality is inherently superior to homose­xuality or bisexu­ality; any prejudiced attitude, action, or practice that subord­inates people because of their nonhet­ero­sexual identity.
Homo­phobia — The fear of, discri­min­ation against, or hatred of people who do not conform to rigid sex roles and sexuality stereo­types.
**Lesb­ian—A woman who is attracted to women in an emotional or physical sense. Not all women who engage in same-sex sexual intimacy identify as lesbian.
Queer — An umbrella term that embraces a variety of sexual orient­ations and gender identi­ties. The term “queer” may not be adopted by all people who self-i­dentify as LGBT.
Ques­tioning — A person who is in the process of questi­oning their gender identity and/or sexual orient­ation.
Sex — The anatomic distin­ction between male and female. Sex can be chromo­somal (XY for male, XX for female) or anatomical (testes for men, ovaries for women). Many develo­pmental conditions result in being intersex, where external genitalia may not be congruent with internal sex organs, hormone function, or chromo­somes.
Sexual orient­ation — How a person thinks of him- or herself in terms of whom they are either emotio­nally or physically attracted to.
Tole­rance — The act of putting up with something.
Tran­sgender — A person whose gender identity is not congruent with their biological sex. Sexual orient­ation is separate from gender identity.