How to Break the 9-1-1 Language Barrier

As beautiful as America’s immigrant mosaic may be, the complexity language barriers cause when seconds count can be daunting for emergency dispatch centers, as was recently learned in New Mexico.

On the night of November 10, 2014, a woman in her early 20s staggered into a Mexican restaurant in the rough southwest valley section of Albuquerque, bleeding profusely from a gunshot wound to the head. Employees of Taqueria El Paisa rushed to render aid and call 9-1-1.

The problem that quickly surfaced was that nobody who was calling the Bernalillo County Dispatch Center spoke English, and nobody at dispatch at the time of the call understood Spanish. Confusion ensued as employees frantically searched for someone who spoke English. Seconds turned into minutes—bystanders said the confusion caused a 10-minute response delay. Officials with Bernalillo County said it was four minutes.

Larry Gallegos, Bernalillo County spokesman, says two calls came at the same time, one from an English speaker and one from a caller who spoke Spanish only. When the emergency communications operator (ECO) asked for the address of the emergency, Gallegos says, the Spanish speaker asked, “Spanish?” She was asked to hold on while the ECO called the county’s LanguageLine. While the ECO did that, the caller could be heard trying to find someone who spoke English. About 30 seconds later, the LanguageLine answered, but the caller hung up, Gallegos says. The English-language caller, whose call actually came four seconds earlier, was able to give that ECO the information needed, and a first responder was there in four minutes.

In this incident EMS was able to arrive and transport the woman to a local hospital, where she survived the attack. But even with the LanguageLine in place, there were still communication difficulties.

“The policy is to send the call to the LanguageLine for any language other than English,” Gallegos says.

According to Gallegos, the LanguageLine system is built into the CAD system, so the ECO just has to push a button to be connected. The LanguageLine is used in call centers statewide and falls under the New Mexico Department of Finance and Administration.

In a sparsely populated state such as New Mexico, it may be assumed that Spanish is the only foreign language dispatchers face. That’s incorrect. In fact, Gallegos says, in addition to Spanish, the LanguageLine is also prepared for Vietnamese and Native American languages such as Navajo, Tiwa and Tewa.

The U.S. Census Bureau lists 381 languages spoken in the U.S., with 21% of the U.S. population speaking a language other than English.¹ Nowhere in the United States would emergency dispatch translation be more challenging than New York City, where it has been estimated some 200 languages are spoken in nearly half the homes in the city.^2,3 Calls in Bantu, Swahili, Telugu, Tamil, Ibo and Amharic are not uncommon.

Much of this multiethnicity, according to Elisheva Zakheim of the Fire Department of New York, is already reflected throughout the city’s EMS system.

“EMTs and paramedics in the field speak many languages in addition to English,” Zakheim says, “including American Sign Language, Bengali, Cantonese, Creole, Ewe, Filipino, French, German, Greek, Hebrew, Hindi, Hungarian, Indonesian, Italian, Mandarin, Polish, Punjabi, Russian, Romanian, Spanish, Tamil, Turkish and Urdu.”

There is a paid New York City LanguageLine translation utilized by FDNY. Its emergency medical dispatch utilized it 339 times in one recent month, totaling 1,814 minutes of talk time. EMD does not formally utilize translators. FDNY had 23 different languages translated from the roughly 125 different types that LanguageLine offers, and averaged 17 seconds for interpreter connection time. Call processing takes longer when utilizing a translator. There is a specific streamlined process (auto-dial to a LanguageLine translator) EMD members are trained to use.

Ty Wooten, education and PSAP operations director for the National Emergency Number Association, says that while most dispatch centers utilize a LanguageLine, there is no universal state or federal mandate requiring they have one. “There is not a requirement, but it is a best practice,” Wooten says.

A Constant Battle

This best practice is put to the test daily around the country with the assumption that Spanish will be the primary non-English language confronting dispatchers. But as the U.S. Census statistics indicate, the task of translation services at dispatch centers and among first responders in the streets is a constant battle to stay ahead of the linguistic curve through education, technology and strategic staffing.

Jeff Clawson, MD, of the International Academies of Emergency Dispatch’s Division of Research, Standards and Academics, says some centers may staff for a particular language that’s commonly encountered—for example, by having Spanish-speaking call takers on duty.

“Since the IAED has a universal protocol for EMD interrogation, response coding and telephone instructions, it currently has this protocol translated into 21 languages and dialects,” Clawson says. “The IAED requires, for its Center of Excellence accreditation, that the center have a formal policy for an effective language translation process. In some of these centers, the call takers are not only foreign-language speakers, but also follow very closely the fully translated protocol in that language. This is the gold standard, in my opinion.”

The IAED has, in its “unknown problems” protocol, a fail-safe mechanism for these situations: A dispatch determinant code, 32-B-4, exists for a caller’s language not understood (no interpreter in center), which gets an immediate response while then allowing the dispatcher to contact LanguageLine while responders are en route. This avoids significantly delaying the initial response.

“If the EMD does not understand the caller’s language well enough to determine a chief complaint and no one on duty is able to assist, the EMD should send 32-B-4, immediately contact a LanguageLine service, if available, and reconfigure as appropriate,” Clawson says.

Mike Chavez, EMS division chief for the Bernalillo County Fire Department, says for the most part the LanguageLine has been successful. It is on scene where translation issues arise.

“We have people who don’t speak Spanish, but we do have enough crew members who could put a translation together if necessary,” Chavez says.

He says crews often rely on patient’s children, who are in American schools and have better bilingual skills, for translation.

There is no doubt the questions asked in the patient history can be difficult for a child trying to translate in an emergency situation, resulting in an inaccurate examination and potentially wrong care.

New Technology

In the field first responders are taking advantage of new technology to breach the language barrier. As smartphone technology and creativity advance, so does the ability to serve as an on-site translator when human resources are not available or time is of the essence.

There are no less than eight conversational apps on the market today that can be downloaded into a first responder’s smartphone.⁴ According to Simon Hill’s report on www.digitaltrends.com, the following programs can be downloaded onto smartphones with capabilities to translate between 10–70 languages: Google Translate, iTranslate, SayHi Translate, Navita Translator, Bing Translator, Jibbigo, VerbalizeIt and Lexifone.

Programs that specifically address medical symptoms and examinations include Universal Doctor Speaker: Medical Translator with Audios, which has 13 languages and costs $6.99 to download. The Medical Translator for iPad costs $2.99 but translates 60 languages. Canopy Medical Translator is free.

Chavez couldn’t say how many times this technology has been used in the field, but he cautions that translation apps rely on proper spelling and enunciation of words.

“Regarding EMTs using an app, sounds like a good idea at scene, given the level of detail needed from the patient and family,” Clawson says. “I know some paramedic agencies have a booklet with some standard inquiries already translated into a bunch of languages.”

Summary

America’s multiethnic composition can create havoc in answering emergency calls and translating patient information on scene. It is incumbent upon EMS services to have a translation strategy and protocol in place to mitigate delays in providing emergency care. While digital translation programs may be of assistance, exercise caution in ensuring information is accurately downloaded to obtain an accurate translation.

References

1. Ryan C. Language Use in the United States: 2011. U.S. Census Bureau, https://www.census.gov/prod/2013pubs/acs-22.pdf.

2. City of New York, Department of City Planning. Population Facts, https://www.nyc.gov/html/dcp/html/census/pop_facts.shtml.

3. Venugopal A. The Many Languages of New York City. WNYC, https://www.wnyc.org/story/255668-blog-census-languages-new-yorkers-speak/.

4. Hill S. Is It Bonjour or Hola? These Apps Will Help You Translate Languages Wherever You Are. Digital Trends, https://www.digitaltrends.com/mobile/best-language-translation-apps/#ixzz3K0dPrqHJ.

Joseph J. Kolb, MA, has a 20-year history as an EMT and currently serves with the New Mexico Task Force 1 urban search and rescue team. He designed and teaches a self-defense curriculum for EMS workers through Global One Defense Solutions in Albuquerque. Reach him at kolbjoseph69@yahoo.com.