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

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ambulance at night_sm

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.Hispanic Health Vital Signs_sm

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.

911 dispatcher fielding emergency calls.
911 dispatcher fielding emergency calls.

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.





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One comment on “¡Socorro! Auxílio! Communicating with Vulnerable and Limited English Proficiency Populations during Emergencies”

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    I think that it is very useful and important that the Vulnerable Population Strategic Initiative (VPSI) of King County, Washington is focusing specifically on how to better bridge the gap between people providing emergency medical services (EMS) and people with limited English proficiency (LEP). Since the United States is such a diverse place, I feel like cities across the United States should follow after this model in order to increase the quality of the EMS that people with LEP receive. In certain situations, I think that having language being the greatest barrier between life and death of an individual is something that definitely can be prevented. I also think that it is important that the VPSI is focusing on all aspects of EMS: dispatch service, on-scene service, and after care community service. In this manner, people with LEP can have improved EMS all around from the first point of contacting emergency services until they completely recover or their problem is fixed. I am really interested on how the increase (or possible decrease) on quality of care will be measured by the VPSI. If the results are good then I think this program should be adopted first in major cities across the United States with great diversity and become a nationwide program in which the US as a whole can seek to improve EMS for people with LEP.

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Page last reviewed: June 23, 2015
Page last updated: June 23, 2015