What has been your experience with language barriers?

[Ensihoitaja]

So there you have it (and you can click on the HHS links above, so it's not just my opinion or the commercial vendor who created the blog). in an emergency, you can use minors (and I am going to assume adult friends and family members). And I will admit, since this change occurred in 2016, it was after I left the hospital's EMS systems, so my previous information might be outdated. I am also curious what a hospital-based EMS agency's procedure would be to have someone approved as a translator, and if EMS agency's (like the one @Tigger works for) that use the hospital for medical direction would need to follow the same rules to become an "approved" translator, as well as what the consequences would be if an unapproved translator used their language skills on an IFT to communicate with the patient. Doubt it's any legal liability, especially if no other options are available, but since I am not an attorney, I would refer you to your agency's legal counsel.

Interesting, I did not realize that was an internal standard vs a JCAHO standard. It’s probably worth pointing out that some of these standards likely affect us differently as a hospital-based agency vs a stand-alone/private/fire-based agency.

 

[hometownmedic5]

So you really think that a doctor will refuse to let a nurse, who is bilingual in both spanish and english,

That would be an employee of the hospital, not a random stranger off the street. Whether the joint commission would approves is another matter; regardless, a bilingual nurse isnt what we’re taking about here.

 

[Aprz]

I call language line. It is a recorded line, which I like since I got a verbal recording of most of my assrssment. Until I get language line on, I treat them like an unconscious, non verbal, unreliable patient. I sometimes use friends or family on scene, but I prefer not and feel like it tends to backfire since they will tell me what they think/know rather than what the patient is actually saying eg I'll tell them I am trying to assess the patient's mentation, have the patient say their name, and without asking the patient, will say the patient name. They might say "They know it" or say their complaint without asking the patient. Things go so much more smoothly when I have a translator who is going to ask everything and not assume for the patient. For me, they are always very literal and say exactly what I am asking.

On my trauma, I'll bring up language line after I've done everything else... like an unconscious or unreliable patient. Language line comes last or multi task putting them on speaker. It is doable even with my short transport times.

I learned some basic Chinese mandarin and Spanish. I don't know anything else. Even in those languages, I still call language line since I am not fluent.

 

[FiremanMike]

Wow, this got aggressive quick..

 

[Tigger]

So you really think that a doctor will refuse to let a nurse, who is bilingual in both spanish and english, act as a translator? or a tech? I mean, that's great if you have a stable patient and can wait until a qualified translator arrives. And as I said, the language line translators are awesome, but not every EMS system has access to them. And I have used the translation phone service... some of the translators are better than others.translation: you don't have any facts to back up your (likely false) claim. And when you were called out on it, you thought you could just refuse to back up your false statement. got it.that is your opinion... not based on any actual facts. and you know what they say about opinions...

No arguments from me on that one; if you have an "official" translator who is available, by all means use it. And if they (your medical direction) tells you "you shall only use 'approved' translators for all patient interactions" then follow your medical directors orders. HOWEVER, saying you are opening yourself up to liability if a family member translates, or that "an unqualified translation is legally indefensible," when your department doesn't have that written requirement, is false (unless you can show me caselaw otherwise)

so that blows a huge hole in the statement of "any decision/action based on an unqualified translation is legally indefensible if there was a qualified option available."

no, they do it because it makes their jobs easier and because the law requires that we accommodate everyone (which is why the DMV exam is available in multiple languages), but I digress.

The hospitals also have a lot more resources available to them, compared to an ambulance crew. If you can wait for a translator to arrive, then by all means do so. if not, you do what you can with the resources available to you.

And unless you can cite caselaw (which you have refused to do), I think it's fair to say that the unfounded claim of "any decision/action based on an unqualified translation is legally indefensible if there was a qualified option available" is an EMS urban legend spread by the ignorant. But if you have the resources readily available, definitely use them, if conditions permit.

If a service chooses to not have a plan to deal with language barriers, that's on them I suppose. Can't really call "we'll use however on scene" a plan, but oh well.

You can continue to tell us that we are wrong and using a stranger off the street is fine. Perhaps it is, but I am still not going to do that unless there are many mitigating circumstances. This is my career and livliehood, I choose to do better than that. You can choose to do whatever you wish to do.

 

[Peak]

Hospitals who have the luxury of easy access to phone or internet service will have a much higher requirement of translators as it is less costly to have a vetted medical translator than the potential legal costs of a lawsuit, fines, or unpaid insurance claims. Cost reduction strategies don’t necessarily have the same implications in the prehospital environment as in the ED.