Administration and Leadership, Columns, Mass Casualty Incidents

Be Able to Communicate with All Patients During an MCI

Issue 9 and Volume 39.

When teaching mass casualty incident (MCI) management, I frequently ask participants what the No. 1 problem is at MCIs. Invariably, the overwhelming response is “communications.” They often cite the overcrowding or limited availability of channels and the verbal diarrhea that occurs when personnel overtalk instead of condensing their messages.

There are protocol and equipment solutions for most of these issues but there are a few communications issues that seem to slip under the radar when agencies are developing their MCI plans.

An area that needs attention is how you communicate with the deaf/partially deaf patient, which we address in this month’s feature “Nonverbal Rescue: Hearing-impaired patients require special consideration during a disaster,” by Aly Lim, EMT-D, BFA; Andrew Mazurek, EMT-D; Amy Updike, AN, BSN, CEN and Gavin Macgregor-Skinner, on pp. 44–50.

The authors point out that 7.6 million people experience difficulty hearing in the United States, and dispel a lot of myths surrounding these patients, like the assumption all deaf people can read lips.

The authors also provide lots of tips you should incorporate into your MCI and emergency response plans. A few I like most are:

  • Speak clearly and slowly. Don’t shout, cover your mouth or chew gum because this renders lip reading useless;
  • Make sure the person speaking doesn’t have a mustache, as that makes lip reading extremely difficult;
  • Eye contact, facial expressions and gestures are extremely beneficial, as well as trying different approaches with fewer words to convey a message; and
  • If possible, talk with family or relatives who communicate with the individual on a daily basis.

The other key area that needs to be incorporated into disaster plans is how to bridge language barrier gaps. I was involved in the management of a bus accident once that involved two buses full of French-speaking Haitians. In that case, we were fortunate to find an ED physician who spoke French and could communicate with a group of walking wounded/minor-injury patients.

But what about those who are nonambulatory and need assessment communications immediately at the scene? Do you have policies and procedures to tackle this important task?

Use uninjured or minor-injury patients as language interpreters at MCIs to assess and reassure the injured.

Use uninjured or minor-injury patients as language interpreters at MCIs to assess and reassure the injured. Photo Rick Sforza

In my September 2013 JEMS article on a horrible bus rollover accident in San Bernardino County, Calif. (“Bus Rollovers: Knowing & overcoming the challenges of MCIs involving passenger coaches,” pp. 40–45), I noted what a great job the crews did in breaking the language barrier with the passengers, most of which only spoke Spanish, by identifying and utilizing uninjured or minor-injury patients to serve as interpreters.

They told their “language recruits” to “Stay with this person; stay with your friend. Talk to them and, if something changes, come find us.” Often, this simple solution is all it takes to solve language barrier problems with victims.

But what if no one is around who can translate a language for you? Would you know what “Estou grávida de sete meses, tem dor de barriga terrível e estou sangrando” means in Portuguese?

It means, “I am seven months pregnant, have terrible belly pain and am bleeding.” Your ability to learn this fast can mean the difference between successful management of a red priority patient or allowing them to become a black tag.

There are free apps like Google Translate that should be on your crews’ phones and agency laptops to allow rapid communication with patients in a multitude of languages. All you or the patient has to do is type in questions or answers and it immediately translates it for you.

There are also free apps like Voice Translator Free and Deaf Helper that translate a patient’s spoken words immediately, displaying the translation on the screen. If a patient is unable to read the display, the app also verbally translates your message very clearly in the language you need.

This app can also be a godsend when dealing with the blind, particularly the blind patient who speaks a different language.

Think ahead, prepare for these communications issues before they occur at a critical scene, and arm your crews with the methods (and apps) they need to assess patients with all languages and hearing (or seeing) disabilities.