In 1985, I had my first encounter with EMS and the health care system in New York City. My mother was in a motor vehicle collision, and she was taken to the local emergency department.
At the time, I was in high school and had a general interest in health care. After spending a few hours in the emergency department, it was very frustrating to see how non-Spanish-speaking health care providers were struggling to obtain medical histories and additional information from their Spanish-speaking patients.
During my time with my mother, I volunteered to help some of the staff to interpret. It felt rewarding. I then signed up to volunteer at the emergency department and spent most of my time interpreting. In 1985, there was no requirement for mandatory interpreting services in hospitals.
I then became an emergency medical technician and paramedic and have served the citizens of New York City for over thirty years. I became a New York State EMS instructor and pursued higher education while working in hospital administration.
I later earned my Master of Public Health and Master of Science in Health Services Administration. In 2023, I completed my education and training and became a registered nurse (RN).
Now in 2024, I had an experience which made me revisit some of the same issues affecting certain populations. While working in a psychiatric area of a busy urban emergency department, I was assigned a 35-year-old non- English-speaking woman who was brought in by EMS at 1 a.m. for “acting erratic.”
Upon evaluation in the triage area, it was documented that the woman had suicidal ideations and had a plan, so she was transferred for additional evaluation by psychiatric services and a 72-hour hold.
I approached the woman, introduced myself and conducted my interview and assessment in Spanish. I asked her what was going on that evening. She explained to me that she was under a lot of stress because 1) she was near the deadline of an eviction notice, 2) had two young children and 3) was currently unemployed.
When I inquired if she had any thoughts of hurting herself and if she had a plan, she replied in Spanish, “of course not, I have my children and I am just very stressed. I just need to speak to someone to help me.”
She was additionally stressed because she wanted to return to her children and get them ready for school the next day. I quickly discovered that no one had used the mandatory interpretive services and just decided based on an inappropriate assessment.
She mentioned that just kept saying “Yes” to whatever she was asked by her English-speaking physician. She said that she thought she was just saying yes to seeing someone to speak about getting some assistance and guidance because of her imminent eviction.
I then took actions to get her properly evaluated and after being re-evaluated, she was discharged with referrals to appropriate services for assistance.
Nearly forty years later, the same inequalities are still present. This woman’s life and her children could have been deeply impacted by the current gaps that still exist.
Inaction could have resulted in long term devasting consequences. This recent experience was particularly jarring as it occurred during Hispanic Heritage Month.
Although quite frustrating to see these conditions still exist, it serves as motivation to continue serving as a patient advocate as a paramedic and nurse.
George W. Contreras, DrPH(c), MEP, MPH, MS, CEM, RN, EMT-P, serves as dean of the School of Health Sciences and Wellness at SUNY Westchester Community College. He is an active paramedic in New York City and a registered nurse in a trauma center. He is also a member of the JEMS Advisory Board.
