Emergency Communications with Limited-English-Proficiency Populations

Abstract

Objective. We investigated 9-1-1 telecommunicators’ perceptions of communication difficulties with callers who have limited English proficiency (LEP) and the frequency and outcomes of specific communication behaviors. Methods. A survey was administered to 150 telecommunicators from four 9-1-1 call centers of a metropolitan area in the Pacific Northwest to assess their experience working with LEP callers. In addition, 172 9-1-1 recordings (86 of which were labeled by telecommunicators as having a “language barrier”) were abstracted for telecommunicators’ communication behaviors and care delivery outcomes. All recordings were for patients who were in presumed cardiac arrest (patient unconscious and not breathing). Additionally, computer-assisted dispatch (CAD) reports were abstracted to assess dispatch practices with regard to timing of basic life support (BLS) and advanced life support (ALS) dispatch. Results. One hundred twenty-three of the telecommunicators (82%%) filled out the survey. The majority (70%%) reported that they encounter LEP callers almost daily and most (78%%) of them reported that communication difficulties affect the medical care these callers receive. Additionally, the telecommunicators reported that calls with LEP callers are often (36%%) stressful. The number one strategy for communication with LEP callers reported by telecommunicators was the use of a telephone interpreter line known as the Language Line. However, the Language Line was utilized in only 13%% of LEP calls abstracted for this study. The analysis of 9-1-1 recordings suggests that the LEP callers received more repetition, rephrasing, and slowing of speech than the non-LEP callers. Although there was no difference in time from onset of call to dispatching BLS, there was a significant difference in simultaneous dispatching of BLS and ALS between the LEP calls (20%%) and non-LEP calls (38%%, p < 0.05). Conclusion. Our study shows that 9-1-1 telecommunicators believe language barriers with LEP callers negatively impact communication and care outcomes. More research needs to be conducted on “best practices” for phone-based emergency communication with LEP callers. Additionally, LEP communities need to better understand the 9-1-1 system and how to effectively communicate during emergencies.

Key words: :

• dispatch
• literacy
• underserved populations
• EMS
• language proficiency
• English proficiency

The authors thank the operations managers and telecommunicators at the four participating call centers: Eastside Regional Communication Center, Valley Communication Center, Port of Seattle, and Enumclaw, for their assistance. In addition, we want to thank Cleo Subido, Megan Bloomingdale, and Linda Culley at Public Health Seattle King County, EMS Division, for their assistance in execution of the study protocols.