"I'd Just Hope for the Best": Transgender and Nonbinary Marylander's Views on Contacting 911 in Emergency Situations

Background and purpose

Transgender and gender nonbinary (TNB) individuals face disproportionately higher rates of police victimization than cisgender individuals—reporting violence, misgendering, and assault. Thus, emergency support is even more critical. However, due to systematic/institutionalized and anti-trans bias, many do not feel safe utilizing 911 services in emergency situations, which results in exacerbated disparities and downstream consequences. The Trump administration attacks human rights of TNB populations as anti-trans legislation continues surfacing across the country. Especially when TNB status intersects with other marginalized identities, oppression of these gender-diverse groups is exacerbated, which has deleterious effects on a person’s mental/physical health and wellbeing. There is a paucity of evidence on how TNB individuals in the U.S. rely on, interact with, and perceive support of emergency services (i.e., calling 911). This study aims to assess perceptions of utilizing 911 emergency services among a population of TNB individuals living in Maryland.

Methods

From June to December 2023, qualitative data were collected (N=750) using the Maryland Trans Survey—a community-based research project examining the experiences of TNB people in Maryland. Respondents answered an online free-text question asking them to “Please elaborate on your views on calling 911 in emergency situations.” Researchers conducted a reflexive thematic analysis, and calculated interrater reliability using Cohen’s kappa. Two authors initially coded the first quarter and came to consensus with the final author (external auditor) on any items with disagreement. Next, two authors double-coded the remaining three-quarters of quotes.

Results

Researchers devised four main themes from the data: Individual (subthemes: Individual risk assessment, Positionality); Community (subthemes: Community consciousness, Mutual aid); Organizational (subthemes: Differentiation of police in general, Differentiation of police in contrast to other emergency services, Preference for community-based services, Mistrust in police, Police incompetence); and Policy (subthemes: Financial concerns, Lack of other options, Documentation and compliance). The interrater reliability was substantial (k=0.722) across the four themes. Participant responses are understood within the context of the social-ecological theory, where their concerns reflect multiple and intersecting levels of influence.

Conclusions and implications

The implications of these findings demonstrate the aversion of Maryland’s TNB population to contacting emergency services and express strong preferences for alternative forms of care and crisis support. Participants frequently assessed the risk to themselves/others associated with calling, often preferring fire/EMT, and noting a lack of alternatives. They signaled a partiality for community-based emergency services (e.g., social workers, mental health professionals, mutual aid). These findings propose a call to integrate a more community-based approach to emergency response services. Maryland has a reputation as a safer state for TNB people, yet these results highlight dramatic flaws in the current system and experiences of injustice from police and crisis intervention services. Thus, this may speak to broader TNB experiences across the U.S., including those potentially exacerbated by even greater stigma in different jurisdictions.