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Triage in the Tower of Babel: interpreter services for children in the prehospital setting
Ramsey C Tate1, Maureen C Kelley
1From 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.
Insights
Limited English proficiency in pediatric emergency care leads to unnecessary interventions. Improved prehospital communication strategies are crucial for equitable and safe pediatric emergency medical services.
Area of Science:
- Emergency Medicine
- Pediatric Care
- Health Equity
Background:
- Minority pediatric populations exhibit higher emergency medical services utilization.
- Limited-English proficiency (LEP) patients face disparities in emergency care, including increased procedures and admissions.
Observation:
- A case report details an infant with breath-holding spells experiencing escalated prehospital care due to a language barrier.
- Lack of interpreter services resulted in unnecessary, high-level trauma team activation and interventions.
Findings:
- Language barriers in prehospital settings can lead to inappropriate escalation of care for pediatric patients.
- Unnecessary, costly, and potentially harmful interventions occurred due to inadequate communication.
Implications:
- This case highlights critical legal, ethical, and medical implications of language barriers in pediatric emergency medical services.
- Further research into prehospital communication strategies is essential to ensure optimal care for all pediatric patients, irrespective of language proficiency.
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.
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