Factors Impacting Pre-Hospital Response for Patients with Limited English Proficiency: A Qualitative Study with Emergency Medical Services Providers

Abstract

Background and Objective: Patients with limited-English proficiency (LEP) experience disparities in pre-hospital care, including time to dispatch, time to cardiopulmonary resuscitation (CPR), and quality of CPR. On-scene interactions between patients with LEP and providers of emergency medical services (EMS) are critical to optimal response and have been minimally explored. We aimed to identify EMS-perceived barriers and facilitators to providing optimal pre-hospital response for patients with LEP. Methods: Eight semi-structured focus groups with 26 firefighters and 13 paramedics were conducted, recorded, and transcribed verbatim. Data were analyzed independently by two researchers using thematic content analysis. Results: EMS providers identified ineffective interpretation, cultural differences, and perceived delay in patients activating EMS due to distrust as barriers to optimal response for patients with LEP. Strategies to facilitate optimal response included using an on-scene interpreter, relying on objective clinical findings, remaining adaptable in different situations and conservative medical decision-making. Providers reported transporting most patients with LEP to hospitals regardless of illness severity due to concern for miscommunication or unrecognized problems. Education for communities and EMS providers, better speed/technology for interpretation, and community-EMS interactions outside of emergent situations were commonly cited as potential strategies for improvement. Conclusions: EMS providers describe many challenges during pre-hospital emergency response for patients with LEP, including ineffective interpretation and cultural differences which may contribute to overutilization of resources through high rates of hospital transport. Future work should focus on development of targeted interventions to improve modifiable barriers to care such as distrust and interpretation.