Abstract
BackgroundIn the United States, language barriers pose challenges to communication in emergency response and impact emergency care delivery and quality for individuals who are limited English proficient (LEP). There is a growing interest among Emergency Medical Services (EMS) personnel in using automated translation tools to improve communications with LEP individuals in the field. However, little is known about whether automated translation software can be used successfully in EMS settings to improve communication with LEP individuals.ObjectiveThe objective of this work is to use scenario-based methods with EMS providers and nonnative English-speaking users who identified themselves as LEP (henceforth referred to as LEP participants) to evaluate the potential of two automated translation technologies in improving emergency communication.MethodsWe developed mock emergency scenarios and enacted them in simulation sessions with EMS personnel and Spanish-speaking and Chinese-speaking (Mandarin) LEP participants using two automated language translation tools: an EMS domain-specific fixed-sentence translation tool (QuickSpeak) and a statistical machine translation tool (Google Translate). At the end of the sessions, we gathered feedback from both groups through a postsession questionnaire. EMS participants also completed the System Usability Scale (SUS).ResultsWe conducted a total of 5 group sessions (3 Chinese and 2 Spanish) with 12 Chinese-speaking LEP participants, 14 Spanish-speaking LEP participants, and 17 EMS personnel. Overall, communications between EMS and LEP participants remained limited, even with the use of the two translation tools. QuickSpeak had higher mean SUS scores than Google Translate (65.3 vs 48.4; P=.04). Although both tools were deemed less than satisfactory, LEP participants showed preference toward the domain-specific system with fixed questions (QuickSpeak) over the free-text translation tool (Google Translate) in terms of understanding the EMS personnel’s questions (Chinese 11/12, 92% vs 3/12, 25%; Spanish 12/14, 86% vs 4/14, 29%). While both EMS and LEP participants appreciated the flexibility of the free-text tool, multiple translation errors and difficulty responding to questions limited its usefulness.ConclusionsTechnologies are emerging that have the potential to assist with language translation in emergency response; however, improvements in accuracy and usability are needed before these technologies can be used safely in the field.
Highlights
The United States is linguistically diverse, with over 350 spoken languages [1]
We conducted a total of 5 group sessions (3 Chinese and 2 Spanish) with 12 Chinese-speaking limited English proficient (LEP) participants, 14 Spanish-speaking LEP participants, and 17 Emergency Medical Services (EMS) personnel
QuickSpeak had higher mean System Usability Scale (SUS) scores than Google Translate (65.3 vs 48.4; P=.04). Both tools were deemed less than satisfactory, LEP participants showed preference toward the domain-specific system with fixed questions (QuickSpeak) over the free-text translation tool (Google Translate) in terms of understanding the EMS personnel’s questions (Chinese 11/12, 92% vs 3/12, 25%; Spanish 12/14, 86% vs 4/14, 29%)
Summary
In 2016, approximately 63.2 million US residents spoke a language other than English [2], and approximately 40% of these individuals (25.4 million people) are considered limited English proficient (LEP) [3]. With growth of the foreign-born population in the United States, the number of LEP individuals is growing [5]. In the emergency response setting, lack of clear communication between LEP individuals and Emergency Medical Services (EMS) personnel can interfere with prompt and accurate dispatching of aid [8]. In the United States, language barriers pose challenges to communication in emergency response and impact emergency care delivery and quality for individuals who are limited English proficient (LEP). There is a growing interest among Emergency Medical Services (EMS) personnel in using automated translation tools to improve communications with LEP individuals in the field. Little is known about whether automated translation software can be used successfully in EMS settings to improve communication with LEP individuals
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