Should EMS systems be expected to deliver full scope to non-English speakers?

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Disclosure right up front: I am a paramedic from Maryland and the co-creator of EMSpañol, a system for providers who don't speak Spanish to assess and manage patients who don't speak English.

As part of our research into the nature and breadth of the EMS language barrier, we have been asking our colleagues what your opinon is about this question: Should EMS systems be expected to render full scope of practice to non-English speaking patients?

Now please let me say up front that I

1) do not have an answer in mind. I want to know where the general consensus lies on this topic or what the range of opinion is.

2) do not intend this as a racially insensitive question. We started EMSpañol to help Hispanic patients and their EMS providers.

3) cannot be offended. Be polite please especially to each other, but let it rip. I am hoping to hear honest opinions from people with feelings on this topic.

I think we can all agree that whenever we are able, we are to render care to our full ability. No brainer.

But in reality, should we begin treating language barrier as a formal matter within EMS?

For example, we cannot give medications without exploring contraindications, but we can't explore contraindications without the ability to speak to the patient (for whatever cause, stroke, deafness, foreign language, etc.) So should we consider language barrier a contraindication or precaution to medication administration in and of itself?

Further, in a world with limited resources, should we even consider ourselves responsible for rendering a complete ALS scope for non-English speakers? Is it reasonable to expect full care for every language? And if not, which languages should we focus on and how should we do it?

Thank you.

Jeff Dean, NREMT-P, EMSpañol
 
I don't speak Spanish. I don't really wanna learn either. Right now if we have a spanish only speaker I call one of the PD officers or a deputy that speaks spanish to come and assist. Or ask my main question used on calls. "Does anyone here speak English?"
 
EMS, as well as all healthcare providers, always have an obligation to deliver the full scope of practice to every human being regardless of language. However, if the patient cannot communicate in the language of their health care providers than there may be some delay and ultimately a full scope of care may not be able to be delivered in the pre-hospital environment.

It is not the responsibility of EMS to learn other languages in order to carry out the job. If your gonna live, work, and play in the country that is the United States of America, than learn the English language as soon as possible. If a person does not learn the language than they assume the risks of living in a country where they cannot effectively communicate.

Where do you draw the line? Just learn Spanish? Or have to learn Spanish, German, and French? That's just crazy. The majority should not be made to accommodate the minority.

Just my opinion.
 
Cock gun before firing!

Considering your admission that you represent a product that is designed to bridge the language barrier between the medic and the Spanish-only speaker, I don't really see the point in your asking us if we think non-English speaking patients can get or are entitled to the full range of our services.

And your invitation to let it rip is premature. For what are you using this information? It appears to be information-gathering but how could I NOT catch a whiff of "to be used for advertising purposes"?
 
Render full scope? Yes. Speak their language? No.

We're taught how to handle unconscious people and treat them, obviously without speaking to us. Not much different with a non-English speaker.



Granted, I'm not thrilled with giving meds to someone I can't understand, but alas thats a problem they have to deal with.
 
Speakers of any language get full scope, excepting when the language barrier interacts where protocol (and good medicine) requires history before a procedure (questioning for viagra et al before giving nitro, reperfusion checklist before TPA, etc). Those are just a few possible examples (although we don't give any fibrinolytic treatments in the field here).
 
We call it Veterinary medicine here. I can get by with poor Spanish, however I see just as many Haitian and Cape Verde Creole and Vietnamese speaking folks. I can say "pain?" in several languages, but thats about where it stops.
 
boingo said:
We call it Veterinary medicine here. I can get by with poor Spanish, however I see just as many Haitian and Cape Verde Creole and Vietnamese speaking folks. I can say "pain?" in several languages, but thats about where it stops.
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You live in Florida?


Anyways...


Yes any human being gets treated I try improvised sign language I also have a little EMS English-to-Spanish guide in my pocket and I just kinda point to what I want to ask and they usually shake there head. I try to get BP to translate for us but they rarely know medical terms.

Ever try to get BP to ask "Did you take your diabetic medicine?"
 
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its difficult i'll admit but it can be done eventually, just takes a little while longer then normal on scene. i only speak english and a bit of irish. We have a huge polish population in ireland as well as many other nationalities who dont speak good english, im not going to learn them all so i just point and try to sign things.

Hopefully one of the things they say is giving consent for me to treat them
 
Like 18G said, it's unreasonable to selectively accomodate one foreign language instead of others. I used to work in NYC, and I now work in the suburbs near DC. We have more languages than I can count. We have Spanish speaking areas, Farsi, Hindi, Korean, Chinese, Vietnamese, Tagalog (Filipino), etc. etc. so on and so forth. It's unrealistic to expect me to learn a half dozen to a dozen or more languages, with various dialects and such. Unlike other regions that may be just English and Spanish, my county has sizeable populations of various ethnicities. That's why we have the Language Line phone service.

My ancestors immigrated to NYC in or around 1900. They moved to their respective ghettos at first, but they knew that they had better learn english quickly, or they would starve. There was none of this entitlement stuff back then. I frequently run into foreigners that have been here 10, 15, 20+ years and don't know more than a few English phrases. One the one hand, I try to communicate with them using any resources available. I'll use family, children, neighbors, phrases printed in their language, the Language Line, etc. The thing is, if we can't effective communicate with the pt due to their lack of command of the English language, I won't feel sorry for them if I need to withhold interventions that require effective communication to validate. If I can't get a good Hx and HPI, and I can't find anything overt on the physical exam (such as rales, wheezes, Levine's sign, 12 lead changes, low BGL for example), the pt only gets vitals, O2, monitor, IV (depending) and txp. They made the decision to come here, and they also chose not to learn English to the best of their ability. If they've only been here a month or so, then it's just bad luck on their part. The hsopitals use Language Line quite often in the ED as well, so it's not just EMS. Hsopitals, in general, are overburdened with the underinsured and uncomensated cases to begin with. As a result, we've seen an increasing trend in hospital closures, and/or reduction of services. It's likely not in the budget to hire language specialists to be at the ready 24/7/365.

I feel that we need to see additional compensation for learning other languages. This can be in the form of an annual stipend, or perhaps a precentage of your annual base salary. At the minimum, you should get hiring preference. What is wrong is to require certain additional languages as a condition of employment in EMS. It's discriminatory to be selectively accomodating for certain languages and not others.

Bottom line, if we're expected to learn additional languages, it needs to be compensated for.
 
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46Young said:
I feel that we need to see additional compensation for learning other languages. This can be in the form of an annual stipend, or perhaps a precentage of your annual base salary.
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Quite a few police departments do exactly that paying anywhere from 1 to 4 percent above a base for additional languages.

To answer the original question, we will use a language line in the field if there is absolutely no other way to effectively communicate with a patient. It's tedious and slow but better than nothing.
 
I don't think an EMT can be faulted for speaking only English. I won't go so far to say that all immigrants should learn English because that's the way it is, but I will say that if they don't, they're taking the risk of running into an emergency situation and facing a lot of difficulty with it.
I think EMT's should be expected to make every attempt to communicate and provide proper care, but full scope sometimes can't happen without communication.
We can't single out Spanish. Why is that different than all the other languages floating around the US? Oh, the great big melting pot...
 
just checked in my ambulance there, we have a phrase book english into 12 languages with simply phrases like where's the pain etc and then a little advice on how to deal with the situation.

i forgot we had that, i thought it was something about the mechanics of the vehicle
 
ems.amber911 said:
I don't think an EMT can be faulted for speaking only English. I won't go so far to say that all immigrants should learn English because that's the way it is, but I will say that if they don't, they're taking the risk of running into an emergency situation and facing a lot of difficulty with it.
I think EMT's should be expected to make every attempt to communicate and provide proper care, but full scope sometimes can't happen without communication.
We can't single out Spanish. Why is that different than all the other languages floating around the US? Oh, the great big melting pot...
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I will go so far as to say that if they want to live and work in the US, they need to learn English. Here in TX there are a few places (like our local DQ) that they only wanna speak Spanish. I have pissed off their manager more than once by telling them I won't order until they can give me someone who speaks english, as we do not live in mexico.
 
jtpaintball70 said:
I will go so far as to say that if they want to live and work in the US, they need to learn English. Here in TX there are a few places (like our local DQ) that they only wanna speak Spanish. I have pissed off their manager more than once by telling them I won't order until they can give me someone who speaks english, as we do not live in mexico.
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Yeah, but the US doesn't have an official language. That's part of the "we love everybody" thing we're supposed to have here. Though the DQ thing would be annoying, that's their choice.
 
ems.amber911 said:
Yeah, but the US doesn't have an official language. That's part of the "we love everybody" thing we're supposed to have here. Though the DQ thing would be annoying, that's their choice.
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Sorry, but the melting pot style of thinking doesn't work. There needs to be SOME level of assimilation to co-exist, period.

If I moved to another country to live for an extended period / forever, I'd learn their language ASAP. Why can the same not be expected, just because we don't have an official language?



It's not only common courtesy, it's common sense.
 
Linuss said:
Sorry, but the melting pot style of thinking doesn't work. There needs to be SOME level of assimilation to co-exist, period.

If I moved to another country to live for an extended period / forever, I'd learn their language ASAP. Why can the same not be expected, just because we don't have an official language?



It's not only common courtesy, it's common sense.
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So what happens when more Spanish-speakers move here and it becomes the majority? (Hypothetically) Are you going to learn Spanish then?
 
Trust me, there will be a push to have English the official language before people of European descent become the minority in the US.


Assimilate. Although the word brings up images of the Borg, it's not that bad of an idea and makes everyones lives so much easier.
 
Linuss said:
Trust me, there will be a push to have English the official language before people of European descent become the minority in the US.


Assimilate. Although the word brings up images of the Borg, it's not that bad of an idea and makes everyones lives so much easier.
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Lol. There already is a push. Something like 87% of the POP (I just looked this up) think English should be declared the official language, but it's been contested time and time again because of the freedom of speech crap.
And in one of my classes last week we discussed the fact/opinion(?) that caucasian will be the minority and most say just plain gone as interracial couplings are more and more accepted. I don't know about that, but it's food for thought.
I don't think an EMT can be held at fault and I definitely think it would be easier if everyone spoke one language, but welcome to America, I guess.
 
jtpaintball70 said:
I will go so far as to say that if they want to live and work in the US, they need to learn English. Here in TX there are a few places (like our local DQ) that they only wanna speak Spanish. I have pissed off their manager more than once by telling them I won't order until they can give me someone who speaks english, as we do not live in mexico.
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Well it would be nice but the reality is it will never happen, so we have to overcome it. We have a translation line available to us, we also have providers, police, and fire that do speak other languages so that can be helpful. I don't see it as a huge problem but it could escalate to one if you don't have the resources available.

I don't even wan't to know what happens to your food after your done arguing with the help.
 
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