1. Overcoming Language Barriers in a Medical Emergency
Situation to Establish Safety and Compliance
Meredith Ghilardi, Luisanna V. Paulino
Dept. of Humanities and Arts, Worcester Polytechnic Institute, Worcester, MA 01609
FUTURE RESEARCH
ABSTRACT
THE ISSUE AT HAND
• Currently no universal Language of communication
• An estimated 6,700 recognized languages in the world
• The majority of individuals in this world are unilingual
• Most Emergency situations do not have a reliable translators
RESEARCH FINDINGS IMPLEMENTATION
• English & Spanish survey given in a teaching hospital:
• Case = patient with poor English skills or a translator, 68 total
• Control = good English skills and no translator, 193 total
• Both groups primarily of Hispanic origin, 96% completion rate
• Results:
• Both groups thought understanding of side effects correlates to
compliance (87% cases vs. 93% controls)
• More cases had a lower understanding of side effects than controls
(47% vs. 16%)
• More controls reported satisfaction with care than cases (84% vs.
93%)
• More controls reported better communication with doctor than cases
(72% vs. 87%)
• Conclusions:
• Understanding leads to better compliance
• Language barrier corresponds negatively to patient satisfaction and
compliance
• Cases reported more preventative testing
• Test ordering may be replacing dialogue
Physician Language Ability and Cultural Competence
• Questionnaire given to 116 Spanish-speaking patients with
diabetes and 48 primary care physicians (PCP) at a public
hospital with interpreter services:
• PCP’s rated Spanish and cultural competence
• Authors rated patient experiences using interpersonal process of care
(IPC)
• Results:
• Higher language ability was strongly linked to better IPC scores
• Better at eliciting and responding to questions/concerns
• Higher cultural competence associated strongly with responsiveness,
explanation of condition, & patient empowerment
• No strong association with two other more technical domains
• Conclusions:
• Physicians’ self-ratings are independently associated with patient reports
of interpersonal process of care in patient-centered domains
• Language and cultural competence is important for primary care
The Impact of Language as a Barrier to Effective
Health Care in an Underserved Urban
Hispanic Community
A. Establishing Trust and safety
• Hospitable gestures to make them feel comfortable
and same.
✧ Smiling
✧ Shaking hands
✧ Eye contact
• Not raising your voice around the patient
• Learn three or four common phrases of the language
you most run into
• Do not make side conversations but focus on the
patient
B. Communication Alternatives
• Vocal interaction is key in any emergency
• Ask a family/friend (if available) to act as a
temporary translator
• Attention to facial expressions and other body
language
✧ Similar to a patient without language barriers,
look for symptoms
✧ Pallor, breathing, etc.
• Gesturing or pantomiming
✧ Either patient or EMT
✧ Pointing to what area may be injured or in
pain
• Demonstrate
✧ Show on a partner or self
✧ If an IV or other sterile tool that may be
breaking the skin, demonstrate without
actually performing
• Use tools around you
✧ Driver’s license
✧ Packaging w/ printed translations
✧ Some places have made use of smartphones
o Translator apps or lists of common
phrases
o Can be unhelpful in some cases due to
dialects or spotty translating
• Implement provided solutions in Emergency Medical
Technician procedures at Worcester Polytechnic Institute
• Distribute surveys used in prior research to identify positive or
negative effects of provided solutions
Language Barriers and Resource Utilization in a
Pediatric Emergency Department
• Patients between 2 mo. and 10 yrs. of age with no chronic illness
and were complaining of vomiting, diarrhea, or decreased oral
intake
• Also determined was if there was a language barrier between physician
and family and if < 3yrs, the Yale Observation Score
• Data was obtained from about 2460 patients
• Results:
• 286 families (12%) didn’t speak English
• 209 cases had a language barrier (8.5%)
• LB patients were more likely to be Hispanic (88% vs. 49%) and less
likely to be commercially insured (19% vs. 30%)
• Patients with a LB saw higher testing charges and longer ED stays
• Analysis showed $38 increase in charges and 20 minute longer ED stay
with a LB
• Conclusions:
• Physician-family language barriers were associated with higher diagnostic
resource utilization and increased visit times
A study conducted by the U.S census bureau found that
about 11.9 million people in America live in what they refer to as
a “linguistically isolated home”, or in other words, homes were no
one above the age of 14 speaks English. This issue becomes a
greater problem in health care because their needs to be a way
to communicate with your patient, no matter what the
circumstances. Hospitals now provide interpreter services to
provide a mediator between doctor and patient; however, there is
currently no protocol for an emergency situation involving
patients who do not speak English. Further research in this issue
led us to provide several alternatives to communicating with a
patient in an emergency setting, in order to have compliance,
establish safety, and ultimately treat the patient without having
language being a deciding factor for patient health. The goal is to
then implement these suggestions at Worcester Polytechnic
Institute through the University’s EMT, services who receive
patients from other countries on a daily basis.
• 11.9 million people in America live in linguistically isolated homes
• There is currently no protocol for a medical emergency involving a
non-English speaking individual
• Communication during a medical emergency allows for the
patient to feel safe and more compliant towards the staff