After reading many (or hopefully all) of my columns thus far, you've come to learn that working day to day as an emergency medical provider can present myriad challenges. Yesterday morning was no exception.
After checking our equipment and preparing the ambulance for our next run, my partner and I were dispatched to the scene of "an elderly woman with shortness of breath."
We hastily put our equipment away, slammed the ambulance doors shut, and with siren blaring and red lights flashing, exited the garage.
There are many thoughts that run through a paramedic's brain while responding to a call. The nature of this call could incite the following:
● How short of breath is the woman?
● Does she have a respiratory related medical history?
● Will I have to place a breathing tube in her lungs?
After arriving at the scene, we radioed our dispatcher and gathered some necessary equipment, including oxygen, breathing adjuncts and the stretcher.
We wheeled the stretcher bouncily over the snow-covered walk, carried it up three stairs to the porch, and approached the front door.
Bang! Bang! Bang! I rapped on the door.
"It's the ambulance!" I shouted.
No response.
Bang! Bang! Bang!
Still no response.
"Is this the correct address?" I asked my partner.
I attempted to turn the doorknob, but it was locked.
"I think so," my partner replied as she peered through the window to see if anyone was clearly visible inside the apartment.
A sign with a left-pointing arrow and written in what appeared to be Spanish ("Utilice puerta detras de la casa") was taped to the mailbox attached to the house.
Following a few more knocks on the door, a neighbor finally showed up.
"Don't you read Spanish?" he asked sarcastically.
I cannot spell Spanish let alone read it, I lightheartedly thought to myself.
"Umm ... no sir," I answered.
"You need to go around the house to the back door. That what's the sign on the mailbox says," he added.
After thanking the neighbor and trudging through the snow to the back of the house, we finally gained access through a dilapidated wooden door with a sign that read: El oxigeno en el Uso.
"Hello, it's the ambulance," my partner shouted.
"Estoy en la espalda," a nervous voice echoed from down a dimly lit hallway.
As I entered the room, a man, who was the patient's husband, approached and informed me that his wife was Hispanic and did not speak English. In fact, he spoke with a thick, broken Latino accent, which made exchanging information difficult at best.
"Me esposa ... you help?" he asked.
"We will do our best," I responded.
The overall assessment, treatment, and packaging process of the patient was difficult because of the language barrier, and despite using her husband as an interpreter and carrying emergency "cheat sheets" that include limited Spanish translations, both were of little or no help.
While in route to the emergency department, there was very little conversation between the husband and I, and even less involving the patient.
Using only the obvious physical signs presented to me, the patient was administered a series of breathing treatments, and made a vast improvement prior to hospital arrival.
She ultimately was turned over to emergency department staff and an interpreter was called in for assistance.
Just like when responding to a call, there are many things that run through a paramedic's brain following a call as well. A post run-through of this call could incite the following:
● Did I make the patient any worse?
● Did I perform to the best of my ability?
● Did my interventions ultimately help the patient?
● Will I sleep OK tonight?
Despite feeling confident and secure in the treatment and outcome of the patient, I could not ignore how inadequate I felt while trying to communicate with her. Moreover, I could not help but think how helpless the patient must have felt when her pleas for assistance essentially landed on deaf ears.
Granted, this particular patient improved in route to the emergency department, however, the language barrier notwithstanding, the time spent trying to locate her was delayed because of our inability to read, or have the resources to read, the sign posted on the mailbox.
Communication Is Key
Communication is the most fundamental element in the relationship between any emergency provider and their patient. When accurate communication is not possible, patient care may ultimately suffer.
According to data from the 2000 U.S. Census, 17.9 percent of the population aged 5 and older spoke a language other than English in the home, an increase of 4 percent from the 1990 census. Although anecdotal reports exist, the frequency of encountered language barriers between emergency providers and patients/families in the prehospital setting remains unknown.
Spanish: The Second Language?
Across the United States, the use of the Spanish language is becoming more and more prevalent.
Emergency personnel, such as dispatchers and emergency medical technicians, are oftentimes not fluent in Spanish or other languages. As a result, many services (especially emergency services) that are easily accessible to English-speaking persons, are not as easily obtained by non-English speaking persons. When those requiring emergency services are unable to communicate, once again we run the risk of total system failure.
What Are We Doing About It?
#9679; Learning the Language
The surge in immigration over the past few years has made Hispanics the largest minority group in the country, and while debates about language and immigration issues continue to rage, many emergency providers have decided to take a proactive approach to facing the issue – learning the Spanish language.
● Bilingual Staff
Hiring bilingual staff who do not require extensive language instruction and who can communicate directly with their patients is clearly the most efficient approach to dealing with language barriers. If providers speak the same language as their patients, and especially if they are of similar cultural backgrounds, many problems encountered by their monolingual colleagues are avoided.
● Interpreter Services
When bilingual providers are not available to care for monolingual patients, well-trained interpreters can significantly help to bridge the language and cultural gaps.
● Written Materials
Written materials, which place English alongside the target language, are occasionally used to communicate with non-English speaking patients. Emergency providers and patients then communicate by pointing to the appropriate phrase in their language. This method is obviously limited in usefulness and requires a patient to be literate in their native language. It is often useful in emergencies in the absence of a readily available interpreter, or for simple needs a hospital inpatient might have, such as indicating the need for a bedpan or a drink of water.
● Visual Language Translators
Visual language translators (VLT) are colorful picture cards that allow an emergency provider to communicate with a patient, regardless of language, by simply pointing at pictures. The VLT facilitates fast communication and contains essential content for dealing with and treating medical needs and emergencies. The tool also helps exchange information with patients about symptoms and conditions, including critical pain and illness identification, as well as medication dosage and treatment options.
● Accepting Cultural Differences
Overall, we emergency providers must expand our knowledge base to include areas other than everyday medical skills and treatment protocols.
We have to become more diverse and strive to understand different cultures, which may include learning, in the very least, fundamental words, phrases, and dialects of another language.
For this to work, a broadened level of patience and understanding between the emergency provider and the patient must be established.
More importantly, this patience and understanding will help us effectively meet the needs of every patient and make our jobs much easier and far more rewarding in the end.
If you would like to contribute information on this article, contact us at info@iberkshires.com.
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Una columna muy intuitiva y pertinente. Gozo la lectura sus historias cada semana. Usted esta tan caliente como usted es inteligente. guino. ;)
State Fire Marshal Offers Cold Snap Heating Safety Tips
STOW, Mass. —With temperatures expected to dip into the teens overnight this week, Massachusetts State Fire Marshal Jon M. Davine is reminding residents to stay warm safely and protect their loved ones from some of the most common home heating fires.
"We're expecting very cold weather in the nights ahead, and home heating appliances will be working overtime," said State Fire Marshal Jon M. Davine. "Heating equipment is the leading cause of carbon monoxide at home and the second leading cause of residential fires. Whether you're using gas, oil, solid fuel, or space heaters to keep warm, be sure you keep safe, too."
State Fire Marshal Davine said there were nearly 6,000 heating fires in Massachusetts from 2019 to 2023. These fires claimed eight lives, caused 139 injuries to firefighters and residents, and contributed to over $42 million in damage. And in 2023 alone, Massachusetts fire departments reported finding carbon monoxide at nearly 5,000 non-fire incidents.
Smoke and Carbon Monoxide Alarms
Every household needs working smoke and carbon monoxide alarms on every level of their home. Check the manufacturing date on the back of your alarms so you know when to replace them: smoke alarms should be replaced after 10 years, and carbon monoxide alarms should be replaced after 5 to 10 years depending on the model. If your alarms take alkaline batteries, put in fresh batteries twice a year when you change your clocks. If it's time to replace your alarms, choose new ones from a well-known, national brand. Select smoke alarms with a sealed, long-life battery and a hush feature.
Natural Gas and Oil Heat
If you have a furnace, water heater, or oil burner, have it professionally checked and serviced each year. This will help it run more efficiently, which will save you money and could save your life. Always keep a three-foot "circle of safety" around the appliance clear of anything that could catch fire. Never store painting supplies, aerosol cans, or other flammable items near these appliances. If you smell gas, don't use any electrical switches or devices: get out, stay out, and call 9-1-1 right away.
Residents struggling to pay for heating bills or maintenance may be eligible for assistance through the Massachusetts home energy assistance program (HEAP). No matter what type of heating equipment you use, HEAP may be able to help you pay your winter heating bills or maintain your heating system. All Massachusetts residents are encouraged to explore eligibility for this free program and apply for assistance.
Solid Fuel Heating
If you use a fireplace or a stove that burns wood, pellets, or coal, always keep the area around it clear for three feet in all directions. This circle of safety should be free of furniture, drapery, rugs, books and papers, fuel, and any other flammable items. To prevent sparks and embers from escaping, use a fireplace screen or keep the stove door closed while burning. Use only dry, seasoned hardwood and don't use flammable liquids to start the fire. To dispose of ashes, wait until they are cool and shovel them into a metal bucket with a lid and place it outside at least 10 feet away from the building.
Have your chimney and flue professionally inspected and cleaned each year. Most chimney fires are caused by burning creosote, a tarry substance that builds up as the fireplace, wood stove, or pellet stove is used. If burning creosote, sparks, embers, or hot gases escape through cracks in the flue or chimney, they can cause a fire that spreads to the rest of the structure. Annual cleaning and inspection can minimize this risk. Contact the Massachusetts Chimney Sweep Guild or Chimney Safety Institute of America to identify reputable local companies.
Space Heaters
Keep space heaters at least three feet from curtains, bedding, and anything else that can burn. Plug them directly into a wall socket, not an extension cord or a power strip, and remember that they're for temporary use. Always turn a space heater off when you leave the room or go to sleep.
When purchasing a space heater, select one that's been tested and labeled by a nationally recognized testing company, such as Underwriters Laboratories (UL) or Intertek (ETL). Newer space heaters should have an automatic shut-off switch that turns the device off if it tips over. Unvented kerosene space heaters and portable propane space heaters are not permitted for residential use in Massachusetts, State Fire Marshal Davine said: the risk of fire and carbon monoxide poisoning that they pose is too great.
Monument Mountain's Everett Pacheco took control of the race in the final mile and went on to a convincing Division 3 State Championship on Saturday at Fort Devens. click for more
Mila Marcisz ripped a shot from the top of the 18 that slipped just under the swing of teammate Adele Low and past the Mustangs keeper in the fourth minute of the second overtime to give Mount Greylock a 1-0 win. click for more
Mount Greylock dominated for much of the game, compiling a 17-4 advantage in shots on goal, not to mention numerous Mountie chances that went just wide or high of frame. click for more
Nora Schoeny, Gianna Love and Elyssa Scrimo Sunday led the Lenox girls cross country team to a narrow victory in the Division 2 race at the Western Massachusetts Championships at Stanley Park. click for more
Wahconah High senior Tim Kaley Sunday earned his second Berkshire Classic Championship by shooting a 77 at the Country Club of Pittsfield. click for more
