Neil Spencer
Control Training and AMPDS Manager,
East Midlands Ambulance Service NHS Trust
Tel: 0115 9193481
Email: neil.spencer@emas.nhs.uk
Summary:
EMAS is committed to promoting an inclusive culture for all service users so they receive equality of care regardless of language barriers, hearing or speech impairment.
The objectives of the ‘Language/Speech is not a barrier’ project were to give non-English speaking service users 24/7 access to interpreters and to create a SMS Text service for the deaf and hard of hearing.
All 999 callers now have access to interpreters both at the time the call is made and when the crew arrives on scene. The deaf community has access to all 999 services through EMAS’ 999 SMS Text service.
Abstract:
The aim of the project was to give equal and fair access to all users contacting EMAS regardless of language or speech barriers. We aimed to reduce health inequalities by removing barriers and sought to ensure people with language and speech barriers had the same options available to them for appropriate care pathway as others.
The first objective was to give all 999 callers access to Language Line telephone interpreter service. This was achieved January 2004.
The second objective was to give front line crews access to Language Line for on-scene interpretation. This is scheduled for January 2006.
The final objective, to create one number for people to use to contact any emergency service (via a SMS Text message from a mobile phone) was requested by the Nottinghamshire Deaf Society. Previously these people couldn’t make contact unless accompanied by a hearing and speaking person or they had access to a type talk ‘Minicom’ machine.
Service users register to use the SMS Text service and their EMAS will hold their details on a database. When we receive a text message, information about the patient is immediately available to the Control Operator. Furthermore, registered users can be kept up to date with news about developments of the service. The SMS facility is scheduled to go live in February 2006.
This initiative links to EMAS’ Strategic Direction which focuses on developing a range of responses to diversify our resource profile thus ensuring we provide an appropriate level of care and a positive patient experience.
The change has been supported by communication, consultation and training for staff. Funding was obtained from networking with Nottinghamshire Police and Fire services. The project has been coordinated through EMAS’ IWL Equality Working Group and was supported through presentations at EMAS’ Patient and Public Involvement forums.
Before we introduced Language Line, callers for whom English isn’t their first language were often over or under triaged. For example, calls would typically be coded ‘unknown’ and responded to by a vehicle on ‘blues and twos’. We gave no telephone advice before the ambulance arrived and information on how to perform, for example, Cardio Pulmonary Resuscitation (CPR) couldn’t be passed. Furthermore, patients with more serious illnesses were ‘at risk’ because resources were not available to them.
Since the introduction of Language Line, all patients are correctly prioritised, the correct advice is given and EMAS responds appropriately based on the patient’s medical need.
The Nottinghamshire Deaf Society requested the SMS Text service as they identified that members couldn’t access emergency services. So, a deaf person on their own with a mobile phone would have extreme difficulty and would probably be unable to do call for help. Furthermore, if they did make contact, they couldn’t relay key details such as location and nature of emergency. With the SMS Text service, these people have assurance they can make contact and receive appropriate help.
EMAS has developed Control Centre staff’s roles to utilise new technologies. Staff can conference call emergencies with interpreters and use a SMS Text service from a PC. This new, innovative way of working has given staff the opportunity to widen their skills base and feel positive about making a real difference with groups which would previously have been partially, if not totally alienated from receiving the full range of patient care and benefits. The project also dovetails with the rollout of Equality and Diversity Awareness training for all EMAS staff.The number of calls processed through Language Line is increasing month by month and the currently monthly volume is just over 50 calls. The system has been used to translate languages as diverse as Tigrinian and Zulu.
It is estimated 10 calls per month will be received via the SMS Text service, 8 of these requests being for assistance with medical emergencies.
Of the 50 monthly calls received through Language Line, an average of 10 are classed as Category C (non life-threatening) calls which are passed to the EMAS’ Nurse Triage team. This ensures patients receive the appropriate care pathway. Prior to Language Line, patients would have presented with an unknown problem and calls categorised as immediately life threatening. In most cases the patient would have been transported to the nearest casualty department. Now, patients receive a response appropriate to their condition. Our “Call Compliance” audits demonstrate that 97.8% of patients are satisfied with the service provided.
This project relates directly to people whose main language is not English and those who are deaf or hard of hearing. Coordinated through EMAS’ Equality and Diversity Working Group, the project assists resident and visitors to EMAS’ area. Through the use of interpreters, it supports an understanding of cultural differences and how to address and support these. Also, it informs EMAS on the future training needs for staff.
The project has been run in conjunction with the Nottinghamshire Deaf Society, Nottinghamshire Police and Nottinghamshire Fire and Rescue.
Emergency Medical Dispatchers and responders have access to Language Line ensuring the service change is integrated into the whole care pathway and delivered to a consistently high standard.
By registering users for the SMS Text Service we ensure the service is not open to abuse. We are able to store information about service users such as home address, previous medical history, name and date of birth which is useful if they text an emergency call. We can also keep registered users up to date with developments.
