An innovative EMS program – in any language
When Rick Knowlton was a practicing paramedic with the Hyannis Fire Department, he encountered a number of patients who did not speak English.
“Family members—often kids—acted as interpreters,” he recalled. “That’s not good. You shouldn’t put a family member in such a stressful situation.”
In November 2015, Knowlton, who is co-director of Cape & Islands EMS System (CIEMSS) heard Cecilia Phelan-Stiles, senior manager of interpreter services for Cape Cod Healthcare, give a presentation on interpreter services.
“When I heard her presentation and learned how often interpreters are used at the hospital, I put two and two together,” he said.
Phelan-Stiles was moved by Knowlton’s concern for responders and patients struggling to understand each other in critical health situations.
“The faster and more accurately they can identify the nature of the ailment or injury, the better for the patient,” she said.
While interpreter services are readily available—and legally mandated—at medical facilities, emergency medical technicians (EMT) and paramedics delivering pre-hospital care in the field do not have access to that resource. But, thanks to a pilot project developed by Knowlton, Phelan-Stiles and others, that may soon change.
Earlier this year, through a $5,000 Cape Cod Healthcare Community Benefits grant the first teleinterpretation demonstration project was launched, focusing on the two busiest fire departments on Cape Cod—Hyannis with 5,643 ambulance runs in 2015 and Yarmouth with 4,294.
The project features first responders using their own cell phone to call a toll-free number to unlock access to interpreter services in 200 languages.
At the outset of the program, Knowlton and Phelan-Stiles created a two-hour training program and delivered it to all four shifts at each department. A key goal of the training was to teach the firefighters how to interact with the patient and medical interpreter for the best possible outcome.
The service is easy to use. When an interpreter is needed, the first responder dials a toll-free number, enters a PIN and then a 3-digit code for the language. To speed up the process, Phelan-Stiles put together a flash card with the most commonly used languages among the 200 available.
Lieutenant Ron Napolitan has been a firefighter and EMT for 16 years with the Yarmouth Fire Department. Shortly after the initial training he had a patient who spoke only Spanish.
“The patient’s teenage daughter interpreted for a while but you could tell the patient was uncomfortable with it,” Napolitan recalled.
Once in the ambulance, the crew dialed up the interpreter services.
“We were able to ask the patient questions on the pain scale,” said Napolitan. “We talked to him about setting an IV and he agreed to the procedure. It worked out very well for the patient and for us.”
Lieutenant Napolitan offers this advice to first responders about the interpreter services program: “Don’t be afraid to use it. It made the whole situation a lot easier for everyone. The patient relaxed when he was able to talk in his own language.”
The Origins of the Pilot Program
The CIEMSS and CCHC team built the pilot program from the ground up. Excited by the concept and wanting to avoid “reinventing the wheel,” Phelan-Stiles emailed her colleagues in Massachusetts to find out who was providing first responder tele-interpretation services. The answer was virtually no one. A nationwide sampling revealed essentially the same result. There was nothing to borrow from or copy.
From the outset they knew that funding would be necessary, so Phelan-Stiles contacted the Office of Community Benefits at Cape Cod Healthcare and they were impressed with such an innovative solution that addresses gaps in care.
Initially the group was thinking they would need to buy cell phones for all the fire department ambulances—around 65 across Cape Cod. In the midst of the planning, Knowlton attended a conference on the modernization of the medical field and the power of information technology. He came away with the notion of “use what you know and know how to use.”
He thought, why can’t first responders use their own cell phones?
“Why put an unfamiliar phone in an ambulance when everyone already has a phone and is comfortable using it?” asked Knowlton.
Over the course of the summer, the two departments used the teleinterpretation service 20 times. Phelan-Stiles is pleased with that number.
“When the hospital started with interpreter services it moved very slowly in the beginning but then took off,” she said. She expects the same to be true with teleinterpretation in the field.
With the demonstration project behind them, the team is preparing to explore the next step: the possible incremental rollout to more departments on the Cape.