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4 ways fire chiefs can communicate with foreign-language public

The growing number of limited English speakers raises the urgency for fire chiefs to have a solid plan for communicating with them in times of need

By Christopher Divver

On Aug. 11, 2000 President Clinton signed Executive Order 13166, "Improving Access to Services for Persons with Limited English Proficiency." The order coupled with the growing number of non-English-speaking residents has a very real impact for fire and EMS service delivery.

Clinton's order requires federal agencies to examine the services they provide, identify any need for services to those with limited English proficiency, and develop and implement a system to provide those services so LEP persons can have meaningful access to them.

Limited English proficiency is defined as any individual who does not speak English as their primary language and who has a limited ability to read, speak, write or understand English.

Consequently, the fire service has needed to alter the delivery of services to those individuals who identify as LEP in order to be compliant with federal laws pertaining to Executive Order 13166. These laws include Title VI of the Civil Rights Act of 1964, and the Title VI regulations, prohibiting discrimination based on national origin.

These laws prohibit any agency that receives federal financial assistance from discriminating against LEP individuals. Federal financial assistance includes grants, training, use of equipment, donations of surplus property and other assistance. Sub-recipients are also covered, when federal funds are passed from one recipient to a sub-recipient.

In short, any department that receives federal grant funding, such as SAFER and AFG grants, needs to be compliant with the stipulation of addressing the language barrier with their LEP community.

Scope of the problem
In the same year Executive Order 13166 was signed, the U.S. Census Bureau reported that "nearly 47 million persons spoke a language other than English as a first language, with approximately one-forth of this group reporting that they spoke English 'not well' or 'not at all' (Meischke, et al. 2009)."

Research has also shown that use of a professional interpreters is associated with improved clinical care more than the use of ad-hoc interpreters; this includes using bilingual firefighters and police officers as interpreters (Karliner, et al, 2007).

There is also research showing that having non-certified interpreters readily available brings about a host of moral, ethical and potential legal considerations.

While no case law could be found regarding a fire department or EMS agency being held liable for documentation or patient care issues resulting from language barriers, "The High Cost of Language Barriers in Medical Malpractice" white paper emphasizes the need for strict policies regarding LEP and language discordance in order to prevent such liability for fire and EMS agencies.

A 2008 study found that “family members, friends, and especially minor children are often not competent interpreters because they do not interpret accurately and are prone to omissions, additions, substitutions and volunteered answers (Flores et al., 2008, p. 13)."

Four tools
As customer service agents, it is imperative that we research ways to adequately address and overcome the emerging issue language barriers present in our communities.

One such avenue is a subscription service that can provide services such as over-the-phone, on-demand video remote interpreting, or on-site interpretation and translation services that may be used by field personnel either via an ePCR or other handheld device.

Another adjunct to use are iSpeak cards. These flashcards can be used to help identify the language of a non-English speaker by using short phrases written in over 30 languages.

A similar tool uses pictures to communicate with the customer. Designed with young children, non-verbal children, and ESL children in mind, these cards use a variety of symbols and simple pictures to depict the child's mood and medical condition.

The Community Interpreter is a website operated by Cross-Cultural Communications, the only training agency in the U.S. offering nation-wide programs for community interpreting and cultural competence. This organization offers training programs designed for on-site language interpreter and translator services during a 40- to 60-hour course culminating in a professional interpreter certification.

By establishing sound policies and procedures directed to field personnel outlining specific steps to be taken when encountering an individual with limited English proficiency you will not only limit your agency's liability but show those in the LEP community that you care enough about them to hurdle the obstacle of language discordance.

Flores, G., Laws, M., Mayo, S., Zuckerman, B., Abreu, M., Medina, L., & Hardt, E. (2008, January). Errors in Medical Interpretation and Their Potential Clinical Consequences in Pediatric Encounters. Pediatrics, 111, 6-14. http://dx.doi.org/10.1542/peds.111.1.6

Karliner, L., Jacobs, E., Hm Chen, A., & Mutha, S. (2007, April). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of literature. Health Services Research Trust, 42, 727-754

Meischke, H., Chavez, D., Bradley, S., Rea, T., & Eisenberg, M. (2010). Emergency Communications with Limited-English-proficiency populations [Entire issue]. Prehospital Emergency Care, 14(2).

Quan, K., & Lynch, J. (2011). The high cost of language barriers in medical malpractice [White Paper]. Retrieved from National Health Law Program: www.healthlaw.org

About the author

Christopher M. Divver, MPA, NRP, is a lieutenant with the Clifton (N.J.) Fire Department. He is enrolled in the Executive Fire Officer Program at the National Fire Academy and is an at-large board member for the Company Officers Section of the International Association of Fire Chiefs

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