title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Health Services, University of Washington, Seattle, Washington 98195, USA. hendrika@u.washington.edu
authors.forename: Hendrika
authors.initials: H
authors.lastname: Meischke
authors.forename: Devora
authors.initials: D
authors.lastname: Chavez
authors.forename: Steve
authors.initials: S
authors.lastname: Bradley
authors.forename: Tom
authors.initials: T
authors.lastname: Rea
authors.forename: Mickey
authors.initials: M
authors.lastname: Eisenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003144:Communication Barriers; D032882:Comprehension; D004631:Emergency Medical Service Communication Systems; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D014861:Washington; D055815:Young Adult