Protocol for an observational prospective study on the use and impact of over-the-phone interpretation in 911 calls...

There are more than 25.9 million people in the U.S. who experience limited English proficiency (LEP). Compared with English-speaking callers, LEP individuals contacting 911 are less likely to receive and perform prearrival instructions and are more likely to experience delays and adverse health outcomes. While we know that using interpreters in clinics improves care delivery, patient satisfaction, and health outcomes, no similar gold standard has been established for overcoming language barriers in emergency 911 calls. The objective of this study is to examine the relationships between the use of over-the-phone interpretation (OPI) and various call characteristics, communication strategies, and dispatch outcomes to better inform public safety telecommunicator (PST) decision making on when and when not to connect to OPI.

This is an observational prospective study based on the Feldman-Stewart Framework of Patient-Provider communication. Through meticulous coding, we will transform linguistic data from a sample of 660 real-life LEP 911 calls collected from four Emergency Communication Centers (ECCs) into quantitative data which will be used to examine the relationships between caller characteristics, OPI use, and associated communication and dispatch outcomes. Primary outcome measures are the time to first dispatch, the time to delivering medically relevant prearrival instructions, and triage errors. Primary analyses will use multilevel linear and logistic regression models to examine the relationships between the outcome variables and various predictors, including the use of and time to accessing OPI, in addition to alternative strategies for establishing language concordance (e.g., asking for a lay interpreter). Secondary analyses will explore possible mediators and effect modifiers including but not limited to caller emotionality, the severity and complexity of the primary complaint, and other caller- and context-specific characteristics.

The results of this study will shed light on the call characteristics that are associated with the use of OPI and better dispatch outcomes for LEP callers. Our findings will inform future training and policy for 911 PSTs and LEP language communities, with the goal of reducing delays and disparities that result from language barriers in the context of emergency dispatch.