Download kbehnke101respap1.1

Kevin Behnke
English 101 HO1 Composition 1
Professor Mark McBeth
December 3, 2015
Language Barriers and Emergency Response in New York City
Ever since its inception in the late 1700’s, The United States has been a melting pot for
various cultures from nearly every corner of the globe, with each of these groups bringing its
own language to the table. WARRANT It is estimated that 310 different Languages are spoken
in America, and in many households, English is not the primary language. EVIDENCEIn a
recent study conducted by the center for immigrant studies, it was determined that
“approximately 45 million people over the age of 5 living in The United States currently speak a
language other than English at home. . . Of these, 20 million people are classified as Limited
English Proficient (LEP), whereas another 11.9 million are classified as linguistically isolated.”
(). In broader terms, this equates to approximately one sixth of the U.S. population speaking only
limited English and one twelfth of the U.S. population being inept with the English language.
WARRANTThis brings up the question of how governments, especially urban centers with high
immigrant populations, deal with these language barriers in order to communicate with the
people within their jurisdiction, especially in the field of emergency response where
communication and information gathering in a timely manner could mean the difference between
life and death.
EVIDENCE There is no city with a bigger challenge on its hands when it comes to
dealing with language than New York City, where 23% of the population identifies itself as LEP
(FDNY access). In addition, a 2013 study done by the Center for an Urban Future determined
Behnke 2
that 1.7 million New Yorkers speak English “not very well”, with that number expected to
increase approximately 14% annually. WARRANT This means that for every 911 call and
emergency response handled by the FDNY and NYPD, there is about a one in four chance of an
LEP individual being involved. In a field where timely communication and information
gathering is vital, language barriers encountered in the diverse response area of New York’s
emergency units are bound to present some degree of delays and challenges that negatively effect
the outcome of the emergency. CLAIM This paper will analyze how three areas of New York’s
emergency services, EMS, fire, and police, currently deal with these language barriers as well as
discuss policies and programs initiated by other municipalities that New York could potentially
learn from to improve its response to such emergencies.
CLAIM Language presents a challenge for emergency personnel from the very first step
of the emergency response procedure: 911 call receipt. Just imagine the sheer panic and chaos
one would feel if their home was on fire or child on the floor seizing and they dialed 911 only to
have a person speaking another language answer the phone. This is exactly the problem
encountered by LEP populations within the United States, prompting many to panic and hang up
after hearing English and still others to not even call 911. Those who do stick it out find
themselves in a complex situation of trying t convey information to someone who doesn’t
understand their language, which usually results in delays that ultimately impact the care of the
individual who needs assistance. In order to even begin an emergency response, dispatcher need
to know the address of the caller. Luckily, this information appears on a screen when the call is
form a landline phone, but when the caller utilizes a cell phone just figuring out where to send
units can be a challenge in and of itself.
Behnke 3
CLAIM The next key step is to determine the nature of the situation in order to determine
if more units, such as Advanced Life Support (ALS), are needed, which would be in the case of
life threatening conditions such as cardiac arrest, severe trauma, and seizures. The problem,
however, is that dispatchers often have problems determining what exactly the situation is when
a language barrier exists, and often have to revert to utilizing strategies such as repetition and
speaking slowly. EVIDENCE In a recent study in which analyst compared 911 recordings of
LEP callers with those of English callers, it was determined that “LEP callers received more
repetition, rephrasing, and slowing of speech than the non LEP callers” (Meischke, H 2010). The
study found that “There was a significant difference in simultaneous dispatching of ALS and
BLS between the LEP calls, which occurred 20% of the time, and the non- LEP calls, which
occurred 38% of the time, resulting in delays of dispatching ALS on average 40 seconds.”
(Meischke, H 2010). WARRANT Since ALS responds to serious instances where seconds
matter, this delay is huge and could meant he difference between life and death.
CLAIM Although it may seem that this is not a common issue, it is. EVIDENCE In a
recent study done on nationwide Emergency medical responses marked in the national register
for reporting responses as a delayed response, it was determined that language barriers were the
second most common cause for a delayed response at 13.1%, following only inclement weather
at 45% (Grow, R 2008). This is an issue not only in New York City, where approximately one
quarter of 911 calls or from the LEP populations, but also across the nation in places like
Washington state, where a recent survey of123 tellecommunicators revealed that 70% reported
encountering calls with LEP speakers almost daily. Of those who reported speaking almost daily
with LEP callers, 78% reported that communication difficulties with these individuals “affects
the medical care callers receive” (Mieschke, H 2010).
Behnke 4
CLAIM Communication barriers and subsequent delays have also scared many LEP
individuals from using the 9-11 system all together. EVIDENCE For example, one LEP caller
states ‘‘There was a fire! So we called 9-1-1. But [the operator] was speaking English and I was
very scared…At the other end [of the line] was an English speaker, but I don’t understand any
English, so I hung up.’’ (Ong, B. 2012). In another similar scenario, an LEP husband called his
bilingual wife and told her to call 9-11 after witnessing a woman collapse outside a bus stop
because he didn’t know how to speak English. (Ong, B. 2012). Others go directly too the hospital
“without calling 9-11 because [they don’t] want to wait. If [they] just go [themselves] it will be
much quicker.” (Ong, B. 2012). WARRANT Thus, this explains at least part of the reason why
surveys show that LEP populations have a much lower utilization of healthcare and emergency
services (Ong, B. 2012)
CLAIM Currently, the solution in New York City and many other municipalities across
the globe is to utilize the Language Line, a phone interpreting service provided by AT&T that
connects 911 callers and dispatchers to translators from over 143 languages and dialects in a
three-way conversation. EVIDENCE According to the 2015 FDNY Language Access Plan, this
service was utilized 1,700 times in the year 2014 with requests predominantly for Spanish,
Russian, Mandarin, Cantonese, Bengal, and Haitian Creole. The Language line was also ranked
the number one strategy for dealing with LEP individuals during a recent survey of
tellecommunicators (Meischke, H 2010).
Despite the popularity of the Language Line strategy, it too has its flaws. Time delays
connecting to the service, for example, present a major problem and cause of delay, especially
when in severe medical emergencies seconds can mean the difference between life and death. A
review of MNSTAR EMS response reports from Minnesota revealed that “the average time from
Behnke 5
connection to the service and connection to the actual interpreter was 49 seconds” (Meischke, H
2013). 49 seconds is a long time no matter what the emergency is. Still, other dispatchers
reported difficulties using the service due to “interpreter behaviors”. For example, the
interpreters had heavy accents that were difficult to understand, could not translate clearly and
concisely, or couldn’t keep the caller calm due to a lack of emergency dispatch training. The
service is also expensive, costing as much as $7 a minute depending on the package utilized by
the municipality.
The problems, however, don’t stop there. Once emergency crews are finally dispatched,
the on scene EMT’s and Paramedics encounter difficulties in assessing the patient. Common
questions vital to assessing patients such as “where is the pain?” or “on a scale of 1-10 how
severe is the pain?” could become impossible to answer due to language barriers. This can have
huge effects on first responders who often rely on the answers to such questions to asses the
conditions of patients suffering say from internal pain, especially when there are no visible
external injuries and their vitals are normal. Thus, many first responders rely upon children or by
standers to provide interpretation. This is problematic, however, as there is no way of knowing
whether or not the information these people are providing is accurate or changed in any way. For
example, a recent lawsuit was filed and won against a California state paramedic for $71 million
who misinterpreted the relatives of a collapsed 18-year-old. They stated that he was feeling
“intoxicado” prior to the collapse. The paramedic took this as intoxicated, rather than its meaning
of nauseated, resulting in the individual to undergo three days of drug treatment prior to the
hospital realizing that he had suffered from a brain aneurysm. As a result of the delay in care, the
individual became quadriplegic (Harsham, P. 1984)
Behnke 6
Still, many EMT’s and paramedics opt to just pick up the individuals and transport them
to the hospital, which typically have better resources for LEP patients, as quickly as possible
rather than waste time on scene trying to figure out what exactly the problem is. According to
data collected in a 2008 study, “time on scene in runs complicated by language barriers was
actually shorter than in runs identified as not having delays suggesting that prehospital providers
may be more inclined to spend less time on scene given the inability to effectively communicate
and instead take a so-called ‘scoop and run’ approach.” (Grow, R 2008).
While this may seem like a good thing, as LEP patients are arriving at hospitals in a
timelier fashion, it actually is quite problematic. When compared to their English speaking
counterparts, LEP patients have much greater rates of hospitalization, mainly due to the fact that
EMT’s don’t even try to see if hospital care can be avoided. Instead, since they can’t understand
the patient, they just take them to the hospital in a sort of “rather be safe than sorry” ideology,
regardless of whether hospital care is necessary or not. This results in an increased rate of
unnecessary hospitalizations amongst LEP populations when compared to English speakers,
resulting in high healthcare costs and time spent away from work for those linguistically
impaired people. Consequently, this results in a negative economic impact on these populations.
Problems, too, exist even at the hospitals. As stated in The Prehospital Emergency Care
Journal article “Language Barriers as a Reported Cause of Prehospital Care Delay”, LEP
patients admitted in hospitals had an increased likelihood for laboratory testing, intravenous fluid
administration, and intubation for both medical and traumatic conditions. This suggests that even
hospitals do not truly understand the conditions of their patients due to language barriers, and
thus, like EMT’s utilize the “rather safe than sorry” method of caution, testing patients and
giving them medication even when unnecessary just to “play it safe”. This lack of
Behnke 7
communication also results in “decreased quality of follow up care as well as a decreased
understanding of diagnosis and prescribed medications which ultimately results in decreased
patient satisfaction among non-English speaking hospital patients.” (Grow, R, 2008).
And despite such high numbers of LEP speakers across the country as well as the fact
that article VI of the Civil Rights Act requires healthcare facilities to provide a means of
communication for limited and non- English speakers, hospitals seem to be doing nothing to
resolve the issue. In a recent survey of patients at a New York area hospital, only 57% of those
labeled LEP reported having any type of interpreter with the physician during admission with
those numbers dropping down to 37% having an interpreter with their nurses during the
hospitalization process (Schenker, Y 2011). Those interpreters, however, were more often than
not individuals with limited or no prior medical knowledge. In the same study, only 19% of the
initial 57% reporting that they received an interpreter stated that the physician himself spoke the
language and only 6% reporting that their nurses spoke their language (Schenker, Y 2011). In
the majority of cases, the interpreter was a family member or outside individual, not the doctor,
nurse, or another healthcare provider. This is problematic, as studies have shown that “untrained
interpreters are more likely to make errors that have clinical consequences, have higher risk of
not mentioning side effects, and may be more incline to ignore ‘embarrassing’ medical issues,
especially when children are used as the interpreter” (Walker, P).
Thus, it is evident that the FDNY, as well as municipalities across the country, are
dealing with a broken system when it comes to dealing with LEP individuals. LEP and language
barrier programs are underfunded and in all honesty not given the time or attention that they
should given the fact that they comprise such a large number of the population. Fortunately,
however, it seems as if things may be changing and more significance is to be laced on
Behnke 8
improving dispatch, response, and hospital procedures for the language impaired. According to
the FDNY foundation’s 2013-2014 annual report, “visual language translator cards were issued
to 3,000 EMS paramedics and emergency medical technicians to help them better communicate
with non-English speaking patients about symptoms and treatment during EMS emergency field
calls.” These cards provide visual queues that can be universally understood by all cultures and
nationalities to at least provide first responders with some means of communicating with victims
and bystanders when on scene
Similarly, the FDNY Language Access Plan for 2015 outlines numerous forward looking
policies that hope to bring the FDNY a few steps closer to adequately being able to deal with the
Language problem found in the city. According to the report, the FDNY was to begin initiating a
“pilot project to educate FDNY members (Firefighters, paramedics, and EMT’s) in Mandarin
and Cantonese to better engage and communicate with the NYC Chinese population. This
project’s intent is to educate members on key phrases to emergency response such as “where is
the pain?” as well as basic anatomy phrases. The report also states that the FDNY plans to survey
its staff to uncover bilingual employees who are able to assist in interpretation services. This is
huge, as the report states that the FDNY employs firefighters, EMT’s, paramedics, and
dispatchers who are bilingual in “Spanish, Filipino, Russian, Mandarin, Cantonese, Arabic, and
Ukrainian”, yet has done nothing up until this point to identify and label who those individuals
are so that they can be placed in strategic neighborhoods or called upon for assistance when
necessary. Similarly, the report states that the FDNY plans to “include language access in
training of newly hired staff” as well as provide “annual language access to front line staff
interacting with the public”. The FDNY also plans on updating its website to “allow users to read
[the site] in over 90 languages”, as well as print information brochures and emergency action
Behnke 9
plans (EAP’s) in the six major languages of Spanish, Russian, Arabic, Chinese Italian, and
Korean. Ultimately, the FDNY has set out to develop “an internal emergency preparedness plan
for how [the] FDNY will serve LEP customers during a citywide emergency”.
While these improvements are much needed and will certainly help the FDY in fulfilling
its mission of protecting and treating ALL of the cities 8.5 million citizens, there is still much
more that could and should be done. Other agencies, such as the Anaheim Police Department, are
being much more proactive on the issue. The Anaheim Police, for example, recently just
completed an interagency investigation in order to compile an extensive roster of the bilingual
members already on its payroll. The Anaheim Police Department also began to offer pay
incentives for bilingual employees at a 2.5%, 5%, or 7% increase in salary based on their level of
bilingual capability. These bilingual personnel are then kept in a database with their contact
information so that their translation services can be called upon during set shifts if the need arises
(Shah, S). Finally, the Anaheim Police Department is also actively trying to recruit bilingual
individuals to join the force through increased starting pay and priority “points” added on to their
test scores during the hiring process. Other communities, such as Bellingham, Washington, are
making strategic use out of their bilingual personnel by placing their bilingual EMT’s within
certain ethnic neighborhoods that fit their communication skills, further increasing the odds that
a bilingual member will arrive on scene. Indianapolis, too, is taking steps towards acquiring
more bilingual personnel and has begun offering language classes to its employees with the goal
of “having at least one bilingual person on any rig at any time, anywhere in the city” (Khashu, A.
2005). Man other communities, such as Delray Beach Florida, have gone as far as creating
volunteer ethnic interpreter groups that can assist local police and EMS when called upon, and
have eve made their own bilingual Haitian and Hispanic police academies (Khashu, A. 2005).
Behnke 10
These are all strategies which the FDNY, NYPD, and other emergency response agencies
across New York could employ with little to no cost to the city and its taxpayers. First, they
should start out by following the lead of Anaheim and taking a survey to find out the bilingual
capabilities of their current staff. Next, certain target neighborhoods should be identified, and
these bilingual personnel should be reassigned to stations or units within the response zone of the
neighborhoods which meet their bilingual skills. This way, these employees can have their
capabilities put to maximum use and actually be utilized, rather than the current system, of
having an EMT who is fluent placed in some random district, say Spanish Harlem, when in
actuality he should be placed in Little Italy. The FDNY, other agencies, as well as New York
City hospitals should also look into the possibility of establishing volunteer translator groups,
similar to Del Ray Beach, to ride along with emergencies crews, stand by at hospitals, or be on
call when necessary in order to assist with the language barrier issues commonly seen within the
city. This is a cheap, yet effective solution that could greatly improve response times and the
ability to communicate with LEP populations. The FDNY and related agencies should also
actively try to encourage their members to learn another language by following the lead of
Anaheim and offering pay incentives for bilingual employees as well as ready access to
Language classes and training for those employees who seek to further themselves.
In addition, New York State should pass the recently drafted bill by State Assemblyman
Richard Gottfried, chairman of the Assembly Health Committee, to reimburse New York
hospitals for language services. This would further motivate hospitals to provide such service
and it is only right that all taxpayers are taken care of in a quality manner. Thus, while it may not
be the easiest task at hand, New York Cities emergency services really needs to step up its game
when it comes to dealing with Language barriers. New York is the most linguistically diverse
Behnke 11
city in the country and one of the most in the world, thus there is no reason it should be as ill
prepared as it is now. While some improvements are currently being made, the city needs to add
in more financial incentives for bilingual personnel and learn to utilize the staff it already has
more effectively. In addition, New York needs to follow what other cities are doing in order to
craft its own response plans. All taxpayers have the right to equal protection and equal access t
services, thus bilingual emergency personnel are a necessity so that all New Yorkers in all
neighborhoods, regardless of the language they speak, can receive quality care without the risk of
time delay, miscommunication, or headaches. Hopefully, with time, New York can stop
following the lead of other cities, and in turn take the initiative to find new and innovative ways
to deal with a problem more prevalent in New York than anywhere else in the country so that the
city itself turns into an example for other municipalities to follow.
Behnke 12
References
“FDNY 2015 Language Access Implementation Plan.” nyc.gov. 26 May 2015. Web. 6 Nov 2015
"FDNY Foundation 2013-2014 Annual Report." FDNYFoundation.org. 2014. Web. 6 Nov.
2015.
Grow, R., Sztajnkrycer, M., & Moore, B. (2008). Language Barriers as a Reported Cause of
Prehospital Care Delay in Minnesota. Prehospital Emergency Care Prehosp Emerg Care,
12(1), 76-79.
Harsham P. A misinterpreted word worth $71 million. Med Econ. 1984; June:289–292
Khashu, A., Busch, R., & Latif, Z. (2005, August 1). Building Strong Police-Immigrant
Community Relations: Lessons from a New York City Project
McCabe, B., Carpenter, C., & Blair, D. (2003). The Worker Component at the World Trade
Center Cleanup: Addressing Cultural and Language Differences in Emergency
Operations. WM Symposia, 13(3).
Meischke, H., Calhoun, R., Yip, M., Tu, S., & Painter, I. (2013). The Effect of Language
Barriers on Dispatching EMS Response. Prehospital Emergency Care Prehosp Emerg
Care, 13(4), 475-480.
Meischke, H., Chavez, D., Bradley, S., Rea, T., & Eisenberg, M. (2010). Emergency
Communications with Limited-English-Proficiency Populations. Prehospital Emergency
Care Prehosp Emerg Care, 265-271.
Schenker, Y., Pérez-Stable, E. J., Nickleach, D., & Karliner, L. S. (2011). Patterns of Interpreter
Use for Hospitalized Patients with Limited English Proficiency. Journal of General
Internal Medicine, 26(7), 712–717. http://doi.org/10.1007/s11606-010-1619-z
Behnke 13
Shah, S. (n.d.). Breaking Through the Language Barrier: Promising Practices from the Field.
CALEA.