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EMS: Courage and Compassion in Action: Language Barriers and EMS

By Shawn Godfrey
06:00AM / Monday, December 10, 2007
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Shawn Godfrey
After reading many (or hopefully all) of my columns thus far, you've come to learn that working day to day as an emergency medical provider can present myriad challenges. Yesterday morning was no exception. After checking our equipment and preparing the ambulance for our next run, my partner and I were dispatched to the scene of "an elderly woman with shortness of breath." We hastily put our equipment away, slammed the ambulance doors shut, and with siren blaring and red lights flashing, exited the garage. There are many thoughts that run through a paramedic's brain while responding to a call. The nature of this call could incite the following:   ● How short of breath is the woman?   ● Does she have a respiratory related medical history?   ● Will I have to place a breathing tube in her lungs? After arriving at the scene, we radioed our dispatcher and gathered some necessary equipment, including oxygen, breathing adjuncts and the stretcher. We wheeled the stretcher bouncily over the snow-covered walk, carried it up three stairs to the porch, and approached the front door. Bang! Bang! Bang! I rapped on the door. "It's the ambulance!" I shouted. No response. Bang! Bang! Bang! Still no response. "Is this the correct address?" I asked my partner. I attempted to turn the doorknob, but it was locked. "I think so," my partner replied as she peered through the window to see if anyone was clearly visible inside the apartment. A sign with a left-pointing arrow and written in what appeared to be Spanish ("Utilice puerta detras de la casa") was taped to the mailbox attached to the house. Following a few more knocks on the door, a neighbor finally showed up. "Don't you read Spanish?" he asked sarcastically. I cannot spell Spanish let alone read it, I lightheartedly thought to myself. "Umm ... no sir," I answered. "You need to go around the house to the back door. That what's the sign on the mailbox says," he added. After thanking the neighbor and trudging through the snow to the back of the house, we finally gained access through a dilapidated wooden door with a sign that read: El oxigeno en el Uso. "Hello, it's the ambulance," my partner shouted. "Estoy en la espalda," a nervous voice echoed from down a dimly lit hallway. As I entered the room, a man, who was the patient's husband, approached and informed me that his wife was Hispanic and did not speak English. In fact, he spoke with a thick, broken Latino accent, which made exchanging information difficult at best. "Me esposa ... you help?" he asked. "We will do our best," I responded. The overall assessment, treatment, and packaging process of the patient was difficult because of the language barrier, and despite using her husband as an interpreter and carrying emergency "cheat sheets" that include limited Spanish translations, both were of little or no help. While in route to the emergency department, there was very little conversation between the husband and I, and even less involving the patient. Using only the obvious physical signs presented to me, the patient was administered a series of breathing treatments, and made a vast improvement prior to hospital arrival. She ultimately was turned over to emergency department staff and an interpreter was called in for assistance. Just like when responding to a call, there are many things that run through a paramedic's brain following a call as well. A post run-through of this call could incite the following:   ● Did I make the patient any worse?   ● Did I perform to the best of my ability?   ● Did my interventions ultimately help the patient?   ● Will I sleep OK tonight? Despite feeling confident and secure in the treatment and outcome of the patient, I could not ignore how inadequate I felt while trying to communicate with her. Moreover, I could not help but think how helpless the patient must have felt when her pleas for assistance essentially landed on deaf ears. Granted, this particular patient improved in route to the emergency department, however, the language barrier notwithstanding, the time spent trying to locate her was delayed because of our inability to read, or have the resources to read, the sign posted on the mailbox. Communication Is Key Communication is the most fundamental element in the relationship between any emergency provider and their patient. When accurate communication is not possible, patient care may ultimately suffer. According to data from the 2000 U.S. Census, 17.9 percent of the population aged 5 and older spoke a language other than English in the home, an increase of 4 percent from the 1990 census. Although anecdotal reports exist, the frequency of encountered language barriers between emergency providers and patients/families in the prehospital setting remains unknown. Spanish: The Second Language? Across the United States, the use of the Spanish language is becoming more and more prevalent. Emergency personnel, such as dispatchers and emergency medical technicians, are oftentimes not fluent in Spanish or other languages. As a result, many services (especially emergency services) that are easily accessible to English-speaking persons, are not as easily obtained by non-English speaking persons. When those requiring emergency services are unable to communicate, once again we run the risk of total system failure. What Are We Doing About It? #9679; Learning the Language The surge in immigration over the past few years has made Hispanics the largest minority group in the country, and while debates about language and immigration issues continue to rage, many emergency providers have decided to take a proactive approach to facing the issue – learning the Spanish language. ● Bilingual Staff Hiring bilingual staff who do not require extensive language instruction and who can communicate directly with their patients is clearly the most efficient approach to dealing with language barriers. If providers speak the same language as their patients, and especially if they are of similar cultural backgrounds, many problems encountered by their monolingual colleagues are avoided. ● Interpreter Services When bilingual providers are not available to care for monolingual patients, well-trained interpreters can significantly help to bridge the language and cultural gaps. ● Written Materials Written materials, which place English alongside the target language, are occasionally used to communicate with non-English speaking patients. Emergency providers and patients then communicate by pointing to the appropriate phrase in their language. This method is obviously limited in usefulness and requires a patient to be literate in their native language. It is often useful in emergencies in the absence of a readily available interpreter, or for simple needs a hospital inpatient might have, such as indicating the need for a bedpan or a drink of water. ● Visual Language Translators Visual language translators (VLT) are colorful picture cards that allow an emergency provider to communicate with a patient, regardless of language, by simply pointing at pictures. The VLT facilitates fast communication and contains essential content for dealing with and treating medical needs and emergencies. The tool also helps exchange information with patients about symptoms and conditions, including critical pain and illness identification, as well as medication dosage and treatment options. ● Accepting Cultural Differences Overall, we emergency providers must expand our knowledge base to include areas other than everyday medical skills and treatment protocols. We have to become more diverse and strive to understand different cultures, which may include learning, in the very least, fundamental words, phrases, and dialects of another language. For this to work, a broadened level of patience and understanding between the emergency provider and the patient must be established. More importantly, this patience and understanding will help us effectively meet the needs of every patient and make our jobs much easier and far more rewarding in the end.
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