Equitable and inclusive care
Blending technology and human-driven care to navigate language barriers and make the scene safer
Imagine this: paramedics in a busy metropolitan area respond to a call – a toddler is hurt. The paramedics assess the scene and begin to ask the child’s frantic mother questions, only to realize that the mother doesn’t speak English; she’s speaking a dialect of Arabic that no one on the scene knows. They do their best to communicate back and forth with gestures and pen and paper while they ask dispatch to try connecting with a translator who knows the language, which they know may take upwards of several minutes at best. Luckily, another family member soon arrives and helps translate, but the mother is now more distraught than ever after these long minutes of struggling to communicate.
For many EMS organizations around the country, serving a diverse community as inclusively as possible and at the highest standards of quality is a top priority. Yet the scene above is all too common, especially as communities become increasingly diverse with dozens of different languages and dialects in use. And in cases where patients use American Sign Language, phone-based translation services are of no help.
How can EMS organizations continue to deliver the best and most inclusive care possible while navigating these language barriers?
In my experience as Deputy Chief of Operations for Hennepin EMS (HEMS), which serves Minneapolis and 13 surrounding communities with a staff of over 300 medical professionals, we have found new uses for technology invaluable in bridging the gap. HEMS began piloting Jeenie, a translation app that connects to translators in seconds via video, in 2021. We quickly moved the program out of pilot and into widespread operationalization in the spring of 2023. To our knowledge, HEMS is the first EMS agency to use Jeenie in the prehospital setting.
The pilot and ensuing rollout across our crews has been nothing short of game-changing, and it’s an experience we’d like to share with other EMS organizations across the country that may benefit from what we’ve learned.
A growing need for translation services in diverse communities
Many EMS organizations – HEMS included – are recognizing the need to build a more diverse workforce that better reflects the diversity of the communities they serve. While this can help reduce language barriers, the sheer number of languages spoken in some communities means that personnel may still encounter languages they are unfamiliar with, let alone fluent in. In our primary service area’s 14 urban and suburban communities, for example, there’s not only prominent Hispanic, Somali and Hmong communities, but also smaller pockets of groups that speak Russian, Swahili, Pashto, Indonesian, Korean and dozens more languages.
To date, HEMS has used Jeenie’s translators to help administer care in all of these (in total, 33) languages, including American Sign Language, as well as five different dialects of Arabic. That has added up to 9,560 minutes of interpreter time (over 159 hours).
Operationalizing and training EMS departments in translation technology
As any EMS leader knows, trying out a new technology and process is one thing; operationalizing them across an organization is a whole other conversation. As our pilot of Jeenie quickly proved its value, we leveraged existing technology and trainings to help us operationalize it across HEMS as quickly as possible.
On the technology side, we looked at how to marry the app with hardware already on-board HEMS ambulances to be as efficient and streamlined as possible. Each of our vehicles was already equipped with an iPad used for ultrasound. We were able to simply add the Jeenie app to each of these existing iPads, which was both resourceful and didn’t add another piece of equipment for crews to manage. A separate Jeenie account and log-in was set up for each of these iPads so that paramedics and EMTs could immediately use Jeenie as needed – no need to call back to dispatch first to facilitate a translator connection.
On the training side, HEMS integrated the Jeenie app into spring practicals, which are required for all personnel. In addition to the nuts-and-bolts training of how to use the app, we also made sure to train everyone on best practices to maintain the human element of the care we deliver. For example, we included a focus on how to maintain eye contact with the patient and family members while the app’s translator speaks (instead of turning one’s back to the patient and speaking only to the translator on the iPad).
A later phase of the operationalization occurred recently, with HEMS dispatch also integrating Jeenie into its phone- and web-based systems – a bigger technological code to crack, but one that now allows dispatch to patch together 911 calls and Jeenie translators as quickly as our EMT and paramedics can.
Increasing efficacy and quality of care – as well as paramedic safety
Aside from the obvious benefits of understanding a situation and symptoms much faster than, say, relying on a patient’s family member to translate, there’s also something to be said for patients being able to see someone on video speak to them in their own language, especially in a time of distress.
My colleague, Dr. Nick Simpson, HEMS chief medical director, can speak to this firsthand. “I’ve used Jeenie with a patient who needed ASL, and it went from them attempting to type out notes as fast as they could on their phone to actually being able to interact and fully describe what was going on,” he said. “The change and relaxation you could see in the patient and her family was marked. This is a huge step toward improved health equity and better patient outcomes.”
Good communication has many benefits, not just for patient care but also for potential threats or scene safety concerns for paramedics and EMTs. During a translation session, the patient or family members could volunteer information about scene safety or a threat that those responding may not otherwise know about due to the language barrier.
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Whether an EMS service is located in a growing metropolitan area with dozens of languages in use or it serves a smaller population that may have one or two immigrant communities, language barriers of any kind can hamper the speed of care and the quality of the experience. Blending newer technologies, such as Jeenie with the human-centered care core to paramedics’ and EMTs’ training can help bridge these gaps.