Text-to-9-1-1: Testing CPR Instructions for the Deaf and Hard of Hearing Population in King County, WA

Abstract

There are nearly a quarter of a million individuals who are deaf and hard of hearing in Washington State as of 2015 (Raff, 2013). Members of this community face several challenges when communicating with others, particularly with 9-1-1 and emergency services. Despite the size of this population, patterns in communication with EMS within this group remains poorly understood. Though many counties are now rolling out text-to-9-1-1, the efficacy of text-to-9-1-1 has not been comprehensively reviewed. This paper aims to address ways to optimize the delivery of text-to-9-1-1 for the deaf and hard of hearing population in King County, Washington, primarily with critical time-sensitive emergencies, such as cardiac arrest. A simulation pilot was completed to understand the barriers and facilitators of text-to-9-1-1 for the deaf and hard of hearing population with the goal of optimizing delivery of CPR instructions via text messages. The simulations were a crossover observational evaluation design, testing two formats for the delivery of CPR text instructions. The formats differed by the time between each CPR instruction – format A sends all three text message CPR instructions at once, whereas format B asks for a response from the texter in between instructions. Ten participants were recruited from the deaf and hard of hearing population in King County. Both a King County call taker and American Sign Language interpreters were provided for the completion of the simulations. Semi-structured survey questions were administered verbally prior to the simulations and once the simulations were completed. After the pre-survey was administered, participants were asked to read a scenario describing an adult man, represented by a CPR manikin, who was found unresponsive in a building. Using their own phones, the participants were asked to text 9-1-1 using a test number. During the simulations, the participant and call taker exchanged text messages. The call taker provided CPR instructions using the predetermined formats. All ten participants completed the full simulations and tested both canned message formats. While one format was not heavily preferred over the other, we found that both formats had no obvious problems in delivering CPR instructions for the participants. These simulations helped identify ways King County can best optimize the delivery of CPR instructions by including simplified language and asking texters about their CPR knowledge. Additionally, these simulations point to the need of effective text-to-9-1-1 campaigning within this population to educate members on the application of text-to-9-1-1. The deaf and hard of hearing population face unique barriers when communicating with 9-1-1, such as language differences. There is a need for additional explanatory studies using larger and more representative samples of members from the deaf and hard of hearing population. These simulations indicate the significant opportunity to standardize and improve the delivery of text-to-9-1-1 CPR instructions.