What has been your experience with language barriers?

[Mikers]

Where I live it seems like we have a fair number of Spanish-only speaking patients but we also run into a wide range of folks that speak other languages like Russian, French, and Korean. Does anyone else run into non-english speaking patients on a regular basis? If so, what language would be useful to become proficient in?

 

[mgr22]

Unless you have a special interest in mastering a particular language, why not learn a few helpful phrases instead of going for proficiency? I did that with Spanish when I was working in an area with lots of native speakers. Just beware that dialects In some common languages -- e.g., Chinese, Arabic -- can vary a lot.

 

[CCCSD]

Key short phrases in each main language, combined with HOW to interact socially, is all you need.

 

[DrParasite]

It all depends on your coverage area. If you have a large spanish speaking population, then learning spanish can help you. same for russian, polish, and french. there is also language line, which can help in a pinch.

or ask a family member to translate. or my personal favorite, grab a kid from the area and ask if he or she can translate for you.

I speak pretty poor spanish. but i know a few key phrases. My former partner was Puerto Rican, so any Spanish speaking patient I always was the one asking questions, to the extent of my availability; and when that limit was reached, he would take over.

Realistically, do the best you can with the resources you have available.

 

[wtferick]

Either ask family to translate, or have the translation number on your phone. Will definitely help on avoiding missed strokes/chest pains. Which happens way to often.

 

[dutemplar]

I'm in a very crazy system. Qatar. There are an insane number of languages living here, particularly in the industrial/ laborer neighborhoods. The "majority" can speak arabic and/or english, but... the lower level workers? Nope. Good luck with that. That's what they have supervisors who can speak whatever for... But they aren't always available, particularly off duty or away from the dorms.

Most of the "basic" crews are a mix of Filipino, Indian, mixed "middle eastern" or "north african." Most of the CCPs are South African, American, British, with a scattering of Canucks and Kiwis. Between the basic ambulance, the CCP and their driving partner, they can handle a couple of languages.

But when we get into myriad of many many many languages, there are a lot lot lot of times we improvise, use friends/ family/ coworkers, call in other units or "phone a friend" to translate. It isn't rare to have a complete and total language barrier and no method of verbal communication at all. When I leave here, I might sit for a veterinarian exam and license from all the practice...

Thankfully their are also some decent phone apps to at least identify a language. Medical jargon doesnt always translate well using voice translate apps, but hey...

 

[hometownmedic5]

If you want to learn a language, learn the language you want to learn.

If you want to be able to get by on a call, download google translate. It’s not perfect. It’s not as convenient as actually knowing the language, but its free and will work with just about any language. Imagine spending a year or two learning not only conversational Spanish, but the medical words too, and then your next language barrier is with a Russian or German tourist. You can’t learn them all...

There is another angle to consider. Liability. If you don’t use a qualified translator, any decision/action based on an unqualified translation is legally indefensible if there was a qualified option available. Your dispatcher, assuming you have one, has(or should have) a number for a translation service(I believe that’s a PSAP requirement, but not all ambulance dispatch centers are PSAPs). If you go into business for yourself, you buy liability. If you use a proper translator and they screw up, its on them.

 

[Tigger]

We just have an access code for AT&T language line, I could also video conference with the hospital via Pulsara and use their translation services as well I suppose.

 

[DrParasite]

There is another angle to consider. Liability. If you don’t use a qualified translator, any decision/action based on an unqualified translation is legally indefensible if there was a qualified option available.

ehhh, this sounds like one of those EMS urban legends or fear-mongering "LIABILITY" situations that exist in theory, but in practice would never happen.

can you provide a legal case where an EMS professional, who was bilingual, was successfully sued for using an "unqualified translation" to treat a patient? Maybe even a case where an EMS provider failed to obtain a translator on a patient they treated objectively and transported to the hospital, and were sued and awarded damages because "there was a qualified option available"?

Oh, and please make sure you provide a verifiable source for where you got that info. thanks, that would be great.

 

[hometownmedic5]

ehhh, this sounds like one of those EMS urban legends or fear-mongering "LIABILITY" situations that exist in theory, but in practice would never happen.

can you provide a legal case where an EMS professional, who was bilingual, was successfully sued for using an "unqualified translation" to treat a patient? Maybe even a case where an EMS provider failed to obtain a translator on a patient they treated objectively and transported to the hospital, and were sued and awarded damages because "there was a qualified option available"?

Oh, and please make sure you provide a verifiable source for where you got that info. thanks, that would be great.

I guess thats why hospitals pay for IPOPs, and use them for languages somebody physically in the hospital likely speaks(like Spanish)...

I had a conversation once with a translator who’d been called in to translate for a patient who arrived with a bilingual escort. I was puzzled, so I asked. She said it was required because the doctor would otherwise have no way of being certain the escort was translating the risks etc accurately, and since there was a translator available, not to use it was increasing their liability.

I dont have, nor do I care to research case law. Do whatever you want in your practice, even if its stupid. Personally, I’ll call dispatch and have then connect in a translator. That’s what they’re being paid to do. That’s what the company/department is paying the service for. That’s the right thing to do because it can be done. You do you.

 

[Tigger]

ehhh, this sounds like one of those EMS urban legends or fear-mongering "LIABILITY" situations that exist in theory, but in practice would never happen.

can you provide a legal case where an EMS professional, who was bilingual, was successfully sued for using an "unqualified translation" to treat a patient? Maybe even a case where an EMS provider failed to obtain a translator on a patient they treated objectively and transported to the hospital, and were sued and awarded damages because "there was a qualified option available"?

Oh, and please make sure you provide a verifiable source for where you got that info. thanks, that would be great.

Perhaps there isn't case law (and I'm not going to look) but given the choice, I am going to follow the precedent that the hospitals (where I get medical direction from) have set regarding translators. As @hometownmedic5 points out, it is rare that the hospital will use a party not known to them to translate, especially if they are not family. They do it for liability reduction, that is not a myth. Will I refuse the help of someone that is not a vetted translator? Of course not. But it is something to consider when making "harder" decisions, like how aggressively to treat critically ill patients with significant comorbidities.

 

[meganq2]

I passed one semester at Paris, so I studied french.

 

[CCCSD]

Yeah... nothing like working a car wreck, and asking everyone to hold on because you want to wait for an interpreter to get on the phone...which may or may not work, when you can use the kid standing there who speaks English and Matabele perfectly.

Utter BS. You use what you have, and since you’re supposed to be such great medical providers, try looking at the patient and those things called S/S, V/S, skin color, physical findings...you know, those things you SHOULD be able to do with your hands and eyes, not rely on a machine.

Triple cross thread points.

 

[hometownmedic5]

We're having two different conversations, and you're being a **** about it.

I'm talking about the conversational part of the process. History, meds, allergies, symptomatology, etc. You know, the stuff you might consider investigating before making decisions like medication administration, destination etc. You're stick in blood and guts mode, and if I can't get you out of the car, I can't get your head out of your rectum.

Have it your way. The ignorance and insouciance has piled up beyond my capacity.

 

[CCCSD]

You actually made assumptions way beyond the OPs question, and beyond your ken.
Before you get all upset, perhaps you should reread it, insouciance and all...

ps. I’m betting I’ve got more time tending every kind of patient than most. I’m not stuck in a car, I was making a point, but yet again, you are so stuck on you, it flew right past you.
Next time, look around. It’s better for the patient and will keep you humble.

 

[Tigger]

Yeah... nothing like working a car wreck, and asking everyone to hold on because you want to wait for an interpreter to get on the phone...which may or may not work, when you can use the kid standing there who speaks English and Matabele perfectly.

Utter BS. You use what you have, and since you’re supposed to be such great medical providers, try looking at the patient and those things called S/S, V/S, skin color, physical findings...you know, those things you SHOULD be able to do with your hands and eyes, not rely on a machine.

Triple cross thread points.

Who said anything about needing a translator for a physical exam? Also this makes up less than 5% of calls (if that). Having a better plan for the other 95% of calls seems uh...professional?

 

[DrParasite]

I had a conversation once with a translator who’d been called in to translate for a patient who arrived with a bilingual escort. I was puzzled, so I asked. She said it was required because the doctor would otherwise have no way of being certain the escort was translating the risks etc accurately, and since there was a translator available, not to use it was increasing their liability.

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.

I dont have, nor do I care to research case law.

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.

Do whatever you want in your practice, even if its stupid.

that is your opinion... not based on any actual facts. and you know what they say about opinions...

Perhaps there isn't case law (and I'm not going to look) but given the choice, I am going to follow the precedent that the hospitals (where I get medical direction from) have set regarding translators.

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)

As @hometownmedic5 points out, it is rare that the hospital will use a party not known to them to translate, especially if they are not family.

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."

They do it for liability reduction, that is not a myth.

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.

 

[ffemt8978]

When I lived 100mi from the Canadian border, our community of about 3000 was over 90% Hispanic, and the vast majority of adults spoke little to no English. We had a couple of bilingual firefighters who would run on EMS calls as an interpreter, but if they weren't available we would use whoever was on scene. Usually it was the kids who were bilingual. Cell phone service sucked during transport, so we couldn't use the telephone interpreter service we had a contract with. We also used those bilingual cheat sheets to ask and get answers to some of the routine exam questions we would ask. In 10 years of doing EMS there, we never once had a legal issue with using non-official interpreters.

 

[Ensihoitaja]

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...

I obviously can’t speak for every hospital... that said the JCAHO annual training I have to do for my hospital-based service specifically says that any staff who wants to act as a translator needs to be approved by the hospital.

We have access to the Language Line and I make use of that. The only issue I’ve ever had was them not having a translator for the language I needed.

 

[DrParasite]

I obviously can’t speak for every hospital... that said the JCAHO annual training I have to do for my hospital-based service specifically says that any staff who wants to act as a translator needs to be approved by the hospital.

Finally, someone who is bringing up a actual source. So let's see what JCAHO says:

4. Qualifications for Language Interpreters and Translators

The Joint Commission requires accredited hospitals to hold language interpreters and translators working within their organization to a consistent set of qualifications and standards. These apply to staff interpreters, bilingual staff members who wish to serve as interpreters, and [private companies].

The Commission does not mandate a particular standard of interpreter qualifications; instead, surveyors focus on whether the hospital is adhering to its own standards as written.

So there is no particular standard for translators, only that the hospital adheres to its own standards, whatever they may be. And some more info:

In mid-2016, the US Department of Health and Human Services (HHS) issued a rule to help medical and insurance providers comply with Section 1557. A key change in HHS’s ruling modifies the standard for interpreters in healthcare, replacing “competent” with “qualified” as the expectation for anyone providing interpretation services.

In the wake of this ruling, many providers are looking for a workable definition of "qualified" interpreters. According to Section 1557 - and the subsequent clarifying HHS ruling - qualified interpreters should be:

TESTED AND TRAINED

By changing verbiage on interpreters from “competent” to “qualified,” HHS placed emphasis on interpreters needing some form of qualification. They drew a distinction between multilingual individuals and those who have undertaken specific training and had their proficiency tested.

PROFESSIONAL AND DESIGNATED

HHS's ruling specifically warned providers not to rely on bilingual staff unless their stated job duties include interpreting. Qualified interpreters must also be:

1. Proficient in speaking and understanding both spoken English and at least one other spoken language, including any necessary specialized vocabulary, terminology, and phraseology, and
2. Able to effectively, accurately, and impartially communicate directly with individuals with limited English proficiency in their primary languages.

The ruling also prohibited the use of minor family members (except in an emergency) and adult friends and family (unless the patient specifically requests it). Qualified interpretation must be done by professionals.

that's as per http://blog.cyracom.com/qualified-interpreters-what-does-section-1557-of-the-aca-require

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.