ILLUSTRATIVE CASE
Triage in the Tower of Babel Interpreter Services for Children in the Prehospital Setting Ramsey C. Tate, MD* and Maureen C. Kelley, PhDÞþ
Abstract: Minority pediatric populations have higher rates of emergency medical services use than the general pediatric population, and prior studies have documented that limited-English proficiency patients are more likely to undergo invasive procedures, require more resources, and be admitted once they arrive in the emergency department. Furthermore, limited-English proficiency patients may be particularly vulnerable because of immigration or political concerns. In this case report, we describe an infant with breath-holding spells for whom a language barrier in the prehospital setting resulted in an escalation of care to the highest level of trauma team activation. This infant underwent unnecessary, costly, and harmful interventions because of a lack of interpreter services. In a discussion of the legal, ethical, and medical implications of this case, we conclude that further investigation into prehospital strategies for overcoming language barriers is required to provide optimal prehospital care for pediatric patients. Key Words: prehospital emergency care, communication barriers, clinical ethics, civil rights (Pediatr Emer Care 2013;29: 1280Y1282)
S
ick and injured children in the prehospital setting are an especially vulnerable population. Rapid response and accurate assessment of a child’s medical status in the field can mean the difference between life and death. Minority populations have higher utilization rates of emergency medical services (EMS) in the United States and often have a greater proportion of household members younger than age 18 years.1 Of the 20.9 million people with limited-English proficiency in the 2000 census, 3.4 million or 16% were school-age children.2 For children with limited-English proficiency families, particularly recent immigrants, an EMS response may be their first interaction with health care services in the United States. Care delivered in the prehospital setting occurs in a unique environment, often in the family’s home or other informal setting. For immigrant families newly arrived as refugees from repressive countries or countries without emergency response systems, EMS providers may not be clearly distinguishable from police or other government agencies and their presence in the home can be intimidating. This may be especially true for families without visas or legal citizenship. Any parent of a sick or injured child is in a frightened and vulnerable state. In the absence of professional interpreter services, these families may From the *Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; †Department of Pediatrics, Bioethics Division, University of Washington School of Medicine, Seattle, WA; and ‡Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, Seattle, WA. Disclosure: The authors declare no conflict of interest. The authors alone are responsible for the content and writing of the article. Reprints: Ramsey Tate, MD, Department of Emergency Medicine, MSC11 6025, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131-0001 (e
Triage in the Tower of Babel Interpreter Services for Children in the Prehospital Setting Ramsey C. Tate, MD* and Maureen C. Kelley, PhDÞþ
Abstract: Minority pediatric populations have higher rates of emergency medical services use than the general pediatric population, and prior studies have documented that limited-English proficiency patients are more likely to undergo invasive procedures, require more resources, and be admitted once they arrive in the emergency department. Furthermore, limited-English proficiency patients may be particularly vulnerable because of immigration or political concerns. In this case report, we describe an infant with breath-holding spells for whom a language barrier in the prehospital setting resulted in an escalation of care to the highest level of trauma team activation. This infant underwent unnecessary, costly, and harmful interventions because of a lack of interpreter services. In a discussion of the legal, ethical, and medical implications of this case, we conclude that further investigation into prehospital strategies for overcoming language barriers is required to provide optimal prehospital care for pediatric patients. Key Words: prehospital emergency care, communication barriers, clinical ethics, civil rights (Pediatr Emer Care 2013;29: 1280Y1282)
S
ick and injured children in the prehospital setting are an especially vulnerable population. Rapid response and accurate assessment of a child’s medical status in the field can mean the difference between life and death. Minority populations have higher utilization rates of emergency medical services (EMS) in the United States and often have a greater proportion of household members younger than age 18 years.1 Of the 20.9 million people with limited-English proficiency in the 2000 census, 3.4 million or 16% were school-age children.2 For children with limited-English proficiency families, particularly recent immigrants, an EMS response may be their first interaction with health care services in the United States. Care delivered in the prehospital setting occurs in a unique environment, often in the family’s home or other informal setting. For immigrant families newly arrived as refugees from repressive countries or countries without emergency response systems, EMS providers may not be clearly distinguishable from police or other government agencies and their presence in the home can be intimidating. This may be especially true for families without visas or legal citizenship. Any parent of a sick or injured child is in a frightened and vulnerable state. In the absence of professional interpreter services, these families may From the *Division of Pediatric Emergency Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM; †Department of Pediatrics, Bioethics Division, University of Washington School of Medicine, Seattle, WA; and ‡Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Hospital, Seattle, WA. Disclosure: The authors declare no conflict of interest. The authors alone are responsible for the content and writing of the article. Reprints: Ramsey Tate, MD, Department of Emergency Medicine, MSC11 6025, University of New Mexico, 1 University of New Mexico, Albuquerque, NM 87131-0001 (e
