Dignity in an emergency: Trans patients in A&E

You’ll be able to ask most patients in A&E for their name, pronouns and any relevant parts of their identities. However if a patient is unconscious or unable to understand and answer questions, they won’t be able to tell you. Additionally, you might not be able to tell a patient’s gender or if they’re trans just by looking at them.

If the person has come into hospital with a friend or family member, you could ask them the patient’s name, pronouns and any known medical history. You could, of course, ask their emergency contact the same things if you have access to their contact details. If they’ve been brought into hospital by ambulance, the paramedics will already have given you all the information they have about the person.

In many circumstances, you won’t need to know whether or not your patient is trans – you will just need to know their name and pronouns. You would only need to look for more information on a patient’s trans status if it’s relevant.

It might be relevant to know that a patient is trans if:

  • Their injury or condition is at or near a previous surgical site such as the chest or groin.
    In this instance you might want to know how the patient’s anatomy might differ from that of other patients, or if it might be more easily damaged. For example, some trans men and non-binary people who’ve had phalloplasty surgery have an erectile device within their penis – this is likely to be a malleable rod or a device with a saline reservoir in the abdomen, a pump in the scrotum and an inflatable cylinder (or two) in the penis.

  • The patient will need a catheter and has previously had phalloplasty or metoidioplasty surgery to create a penis.
    You are likely to be able to tell that a patient has had phalloplasty or metoidioplasty when you come to catheterise them. For patients who’ve had phalloplasty, there will be some scarring on the penis and scrotum and usually at another site such as the forearm, thigh or abdomen. People who’ve had metoidioplasty typically have a penis smaller than two inches long. If you think your patient has had phalloplasty or metoidioplasty, it is a good idea to err on the side of caution and use a paediatric catheter.

  • Their hormone replacement therapy is contraindicated with any medicines you plan to use.

  • Pregnancy could be relevant.
    It’s important to remember that trans men and non-binary people with uteruses can get pregnant. If you have a trans patient that could potentially be pregnant, follow the same process that you would for a woman who isn’t trans in those circumstances. If you need to catheterise a trans man or non-binary patient who was assigned female at birth, you will notice whether or not they’ve got a vagina. Obviously, if a patient hasn’t got a vagina there will be no possibility of them being pregnant.

If you don’t have any information about the person’s medical history, you’d use the same processes of risk balancing that you’d use when giving emergency care to any patient.

It might be that you come to discover that a patient is trans in the process of treating them during an emergency. If the information wasn’t in their medical records, they might have two scars on their chest in a position most commonly associated with masculinising mastectomy or you might have seen their genitals.

If a friend or colleague accompanied the patient to hospital or is their emergency contact, they might not know that the person is trans. That’s because some trans people keep their gender history a secret from most people in their life to protect themselves from discrimination and abuse. You should not mention that a patients is trans to their friends, colleagues or family unless you are certain that they already know. It is unlikely to be relevant and has the potential to place your trans patient at risk once they leave hospital.

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