¡Socorro! Auxílio! Communicating with Vulnerable and Limited English Proficiency Populations during Emergencies

This month, CDC’s Vital Signs focuses on Hispanic Health. One in six people living in the United States are Hispanic, making Hispanics the largest racial/ethnic minority population in the U.S.

One-third of Hispanics living in the U.S. do not speak proficient English, self-reporting their English speaking ability as less than “very-well,” or not at all, according to the PEW Research Center.  This subgroup, Hispanics with limited English proficiency (LEP), face substantial barriers to receiving important healthcare and emergency health medical services.

When it comes to matters of health, language barriers can prevent people from accessing important health education material, regulatory medical care, and critical emergency medical attention.

Nearly 240 million 9-1-1 calls are made in the United States each year. In a situation where every second can mean the difference between life and death, effective communication is crucial. In the case of LEP populations, language barriers present obstacles that can affect the care they receive from emergency responders. To combat this, the Vulnerable Population Strategic Initiative (VPSI) of King County, Washington, is working to ensure that these populations receive the best possible emergency medical services (EMS).

Begun last year by Public Health—Seattle & King County (PHSKC), the 6-year Vulnerable Population Strategic Initiative applies and builds on findings from research at the Northwest Center for Public Health Practice (NWCPHP) at the University of Washington School of Public Health. Scientists found that LEP individuals perceive significant barriers to calling 9-1-1, and that, when 9-1-1 is called, they experience longer delays in cardiac arrest recognition and delivery of telephone-assisted CPR instructions.

The VPSI focuses on each of the three components of EMS: dispatch service, on-scene service, and after-care community service. Using NWCPHP research findings, the VPSI will design technological, training, and outreach interventions to improve 9-1-1 communication and use of interpreter services, and to reduce reliance on acute care services for non-medical situations by connecting patients with related social services.

For the dispatch services component, work focuses on improving 9-1-1 communications with LEP callers and educating LEP populations about using the 9-1-1 system.  Findings indicate that accessing interpreter services during 9-1-1 calls can be time consuming and challenging, and that LEP callers are less likely to understand and accept telephone CPR instructions and to perform bystander CPR, compared with native English speakers. This new program hopes to use technological and training interventions to improve three-way communication between the 9-1-1 operator, interpreter and caller.

The second component of the VPSI addresses the challenges of providing EMS to patients’ with who may be uncomfortable or unfamiliar with western medicine and have limited English communication skills. Here, the VPSI will investigate best practices in successful communication, including the potential development of after-care instructions in patients’ native languages.The aim of the third component of the VPSI is to increase follow-up care and community services offered to vulnerable populations, to reduce health disparities and unnecessary overuse of the 9-1-1 system. The VPSI will conduct needs assessments in fire departments across King County to identify ways to connect patients from vulnerable populations to appropriate social services and reduce reliance on acute care services for non-medical situations.

An additional priority of the VPSI is to increase the diversity and cultural competence of the EMS workforce. To do this the program will continue recruitment of individuals from targeted areas to help diversify trained EMS personnel, including partnering with some private ambulance companies to offer additional internships and help with special recruitment. Cultural competency training will also be provided to the EMS workforce.

The VPSI is a promising model for what can be accomplished on a systems level to improve services to vulnerable populations, like Hispanics with limited English proficiency, by building partnerships and applying research evidence to practice. “If the initiative works, it will be a beautiful example of a community relying on its own internal resources to do good,” observes Hendrika Meishchke, UW Health Services Department professor and health communications researcher.