title: Awareness and utilization of emergency medical services by limited English proficient caregivers of pediatric patients.
abstract: BACKGROUND
  Previous studies have shown that limited-English-proficient (LEP) patients are less likely to utilize health care services. Objective. To assess the knowledge and perceived barriers to utilization of emergency medical services (EMS) by LEP caregivers of children served by an urban EMS system.
  
  
  METHODS
  We prospectively surveyed a convenience sample of caregivers of children presenting to the emergency department (ED) from January to December 2008. Caregivers were identified as LEP using their response to the U.S. Census question ;;How well do you speak English?'' Caregivers were assigned to one of three cohorts: 1) LEP Spanish- and Arabic-speaking caregivers (n = 50), 2) proficient-in-English (PE) Spanish- and Arabic-speaking caregivers (n = 50), and (3) native English-speaking (NES) caregivers (n = 100). We collected data on EMS awareness and perceived barriers to EMS utilization using a written survey administered in the caregivers' preferred language (English, Spanish, or Arabic). We used descriptive methods to summarize sample characteristics and comparative methods (chi-square test, analysis of variance [ANOVA], and t-test) to compare group differences.
  
  
  RESULTS
  There were no differences in the patient age groups, triage categories, caregiver age, and payer status among the three groups. The LEP caregivers were less aware of EMS (93% NES vs. 94% PE vs. 60% LEP; p < 0.01) and had called EMS significantly fewer times when compared with the NES and PE groups (16% LEP vs. 58% NES vs. 48% PE; p < 0.01). Fourteen percent of the LEP caregivers were unaware of the telephone number to call for EMS. Concerns about inability to communicate with the operator and cost were cited by the LEP caregivers as the main barriers to EMS utilization.
  
  
  CONCLUSIONS
  Caregivers with limited English proficiency are less aware of and are less likely to utilize EMS for their children. Barriers to utilization include concerns of cost and communication with the operator.
authors.affiliation: The Division of Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, MI 48201, USA. mydili@gmail.com
authors.forename: Mydili R
authors.initials: MR
authors.lastname: Subramaniam
authors.forename: Prashant V
authors.initials: PV
authors.lastname: Mahajan
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Knazik
authors.forename: Paul T
authors.initials: PT
authors.lastname: Giblin
authors.forename: Ronald
authors.initials: R
authors.lastname: Thomas
authors.forename: Nirupama
authors.initials: N
authors.lastname: Kannikeswaran
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers; D002654:Child Care; D002675:Child, Preschool; D003144:Communication Barriers; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006786:Hospitals, Urban; D006801:Humans; D007802:Language; D008297:Male; D008824:Michigan; D011446:Prospective Studies; D055815:Young Adult