by Danielle Allen
You’ve heard the saying:
"A little bit goes a long way."
This is nearly "gospel" for toothpaste, nutmeg, and speaking Spanish on EMS (Emergency Medical Service) calls.
When I started out as a firefighter, I’d ask my Spanish-speaking patients one-word questions, or give simple commands like:
“¿Cinturón de seguridad?”
“¿Dolor?”
“Cálmete”
“Respírete”
As time passed and I accumulated experience, I found I could use more complete sentences like,
“¿Estás tomando medicaciones?” (Are you taking any medications?)
“¿Puede abrirse los ojos?” (Can you open your eyes?)
“Cuéntame, lentamente, lo que pasó.” (Tell me slowly what happened.)
So, it’s true, a little bit of Spanish can go a long way. You can properly assess the mental situation of your patient. You can gain patient rapport, calm them down, get the real story of what happened, earn their trust and cooperation.
In EMS, there’s the continuum of care spectrum from an EMT (Emergency Medical Technician) making first patient contact in the field, all the way to transferring your patient to the ER (Emergency Room) and possibly even to the ICU (Intensive Care Unit), both with round the clock doctors.
The continuum of communication
What happens, though, when that continuum of care doesn’t take into consideration a continuum of communication? Every time the patient’s story is translated, the story changes— details get left out, and the quality of short and long term patient care declines. It becomes like the children’s game of "telephone", the last one in line hears a very different story from the first.
On scene
I have a patient on the ground. Standing nearby are his mother, his wife, and the two police officers who were first on scene. There is a sense of panic in the air. The patient has just been shot twice in the leg.
The guy on the ground, clearly in pain, only speaks Spanish. The wife and mother are way too upset to use their basic English. The police officers speak zero Spanish.
When I arrive on scene, I usually begin my work by asking all of my patients the same question: “Hi, I’m Danielle, what’s your name?” This familiar question often puts patients at ease, it's friendly territory in an otherwise difficult situation.
Introducing myself and asking their name helps me to assess how well my patient will be able to follow commands, follow what I’m saying. it also indicates how in touch with reality they are.
This patient speaks Spanish, so I start with “Hola, me llamo Daniel, ¿cómo se llama?”. Speaking to him in a language he understands easily lets him know that he is free to speak to me in Spanish. He tells me his name "Carlos", and that he's in a lot of pain.
In the ambulance
I continue, telling Carlos exactly what I am doing at each moment, and why. I let his wife and mother know where we are going, how to get there. On the way, I reassure Carlos that we are going to the hospital as fast as possible. I ask him to keep his eyes open, to take slow and deep breaths, to tell me his last name, his birthday, any medical history, any allergies he has. I ask him what else hurts and where, if he’s having any trouble breathing, how he’s feeling.
Most of this is to make sure my patient still has the ability and blood pressure to be able to talk to me. On the other hand, though, by being able to communicate with him in his own language, I can comfort a person who may be experiencing the most traumatic event in his life.
I tell Carlos that we are approaching the ambulance bay— that we’re almost at the hospital and the staff is going to take excellent care of him.
The hand over
We roll the patient out of the ambulance and into the ER room. The resident on call begins her assessment of the patient as we carefully transfer him over to the hospital bed.
“Hi sir, can you look at me?” she asks.
“The patient is Spanish-speaking only.” I inform her. “His name is Carlos. He’s been AOx4; appropriate responses to questions, able to follow commands, but says he feels dizzy and weak. Two gunshot wounds to the lower leg here and here.” I point to Carlos' leg and knee.
The student resident flushed red. “I can’t ask him anything. I don’t speak Spanish. I don’t know what to do!”
The chief resident steps in and kindly, but firmly grips her arm.
“Figure it out. Do you have anyone in here who speaks Spanish?” The chief resident points to me, then herself. “Use your resources.”
The resident takes a deep breath and asks the chief resident to translate for her. I step out of the ER bay back into the hallway.
Meet your neighbors
Nearly 30% of my city’s population speaks Spanish. Nearly 70% are Spanish speaking in the 10 mile radius where this hospital is located. 24,000 people work in this hospital system.
It's pretty easy for a patient to go from being understood and properly assessed and cared for to “veterinarian medicine” — pointing, gesturing, and lots of superfluous testing or lack of, simply because someone in the continuum doesn't speak the language, not even a little bit.
As a first responder myself, I’ve been on countless calls where this continuum of patient communication was broken. To make up for this break, I’ve seen police officers stay and translate for a doctor. Hospital janitorial staff will pop their heads into a room and translate for a nurse. Sometimes even security guards end up translating for the patient they are actively restraining.
A little bit of Spanish goes a long way. Shouldn’t we consider training EMTs, paramedics, nurses, and doctors in the language many of their neighbors speak so that they can provide the level of care the patient needs? Do we care enough about patients with language barriers to provide them with equal care as those without?