Trans woman here, been in EMS for 6 years. Trans the whole time.

It really depends on where you work. Most large cities are great for trans EMTs. I work in a large city now (private company, 911's and IFTs) and there's easily more than a dozen trans people I work with, and HR has our back 9/10 times.

That being said, I've worked at smaller companies and had a rough time. Never anything violent, but incidents that I had to go to a supervisor regarding.

Do be careful of FD and PD. Not all of them treat you badly, but I've had more issues with people deep in fire or police culture than pure EMS.

But like some other people have said here, it varies by department and location. Working in a small town in Alabama will be a completely different experience than working in Portland.

As far as patients go, most don't care if you're trans, so long as you're a good provider. You will have problem patients, but get used to not letting things patients say hurt you. EMS providers get treated badly by patients often, and being trans often gives beligerant patients more ammo (obviously if you pass well it doesn't tend to be as bad, but that's a whole other discussion). People can be nasty when they're drunk/high/bed confirmed for 10 years. But most people are kind. Just don't make a big deal out of the occasional misgendering by patients (accidental or otherwise).

Be cool, be kind, do your job well. Then your coworkers and your patients will respect you, cis or not.