Rebekah Honeycutt

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Innovative Report: Emergency Medical Providers, Sign Language, and the Future of Communication within Haywood County Emergency Medical Services


Emergency Medical Services are utilized by various persons in numerous situations, some of which contain language barriers.  One such group of persons that have been presented with language barriers and have also been the subject of discrimination is deaf and hard of hearing individuals (HOH) across America. In order to prevent such discrimination the Americans with Disabilities Act (ADA) was put into effect. The ADA explains the legal requirements of communication with deaf and HOH individuals that is mandatory within all public businesses. In an effort to avoid discrimination lawsuits, it is necessary for Haywood County Emergency Medical Service (EMS) to incorporate a solution that fits adequately within the frame of the legal requirements. The possible solutions include qualified interpreters, Video-Remote Interpretations (VRI) and ad hoc interpreters. Each of these solutions has unique advantages and disadvantages within the emergency medical field that are briefly explained within this document.  Communication is inevitably required when providing medical services and in the case of deaf and HOH patients utilizing the aid of EMS, there are legal guidelines that the service must adhere to.



Americans with Disabilities Act, Emergency Medical Services, Patients, Sign Language Interpreter, Communication, Deaf, Hard-of-Hearing



The use of Emergency Medical Services (EMS) has become a way of life for Haywood County residents.  The ability of an individual to call 9-1-1 and have a fully qualified Emergency Medical Technician (EMT) arrive to assist him or her in a time of need is not only expected but is necessary.  When a medic arrives to the patient’s location and finds a deaf or hard-of-hearing (HOH) individual with a language barrier, how do the patient and the provider continue?  If the medic has been trained in basic medical Sign Language, the communication barrier would not be as significant.  However, if the medic has never received this knowledge basis, multiple problems could ensue.  In the article, “Communication Access within Healthcare Environments” the authors explain, “In health care settings, communication breakdowns between patient and caregiver can have dire consequences: increased pain, misdiagnoses, drug treatment errors, unnecessary extensions in length of hospital stay, even death.” (Pressman, Newman & Pearson, 2009).  These consequences can be easily avoided by increasing the education of EMTs to include the course, “Sign Language for Emergency Medical Providers”.  Legally, to insure the ability of deaf or HOH individuals to obtain interpreters, the ADA mandates all public businesses must supply effective means of communication.  A business that does not provide interpreters for deaf or HOH persons may become the subject of a discrimination lawsuit.  The necessity to provide all Haywood County emergency medical providers with a course that enables effective and accurate communication through Sign Language is vital.  The course provided should adhere with the legal requirements given by the ADA for all public entities and in doing so reduce the possibility of future discrimination lawsuits.  More importantly, by providing this course, EMS will be better acclimated with Deaf Culture and can offer more outstanding care for all patients.


Americans with Disabilities Act (ADA)

The Americans with Disabilities Act of 1990 is “a comprehensive civil rights law prohibiting discrimination on the basis of disability”(“Nondiscrimination on the,” 2010).  According to the final rule which became effective on March 15, 2011, “A public entity shall take appropriate steps to ensure that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with others”(Section 35.160, 2010).  With the unique situation of EMS being a quick response system, the ADA has not provided guidelines for EMS as of the year 2011.  In spite of this, there are available documents that provide insight for regulations and helpful communication tips for Law Enforcement agencies and hospitals which can be utilized as a reference by EMS.  The ADA provides the article, “Communicating with People Who Are Deaf or Hard of Hearing in Hospital Settings.”  Within this document is a comprehensive list explaining circumstances when there is a need for an interpreter.  The portions of the list that coincide with EMS are as follows:

Situations when an interpreter may be required for effective communication…

  • Discussing a patient’s symptoms and medical condition, medications, and medical history
  • Explaining a patient’s symptoms and medical conditions, tests, treatment options, medications, surgeries, and other procedures
  • Providing a diagnosis, prognosis, and recommendation for treatment
  • Obtaining informed consent for treatment
  • Communicating with a patient during treatment, testing procedures, and during physician’s rounds;…(“Communicating with people,” 2003)

Providing an interpreter in these situations correlates precisely with the assistance EMS provides to all patients.  Instructing EMT’s by providing the course, “Sign Language for Emergency Medical Providers” will ensure that when these settings are presented, the patient will obtain sufficient communication and satisfactory care.

The number of Deaf/ HOH individuals

The statistics for individuals who use American Sign Language (ASL) as their first language are unavailable as of 2011. According to Ross Mitchell, author of “How Many Deaf People Are There in The United States?” this is entirely due to issues with documentation within the United States Census Bureau. Mitchell explains, “…U.S. Census practice is to code ASL to English when it appears on its forms, so an analysis of ASL use is not possible”(Mitchell, 2005).  This means that when an individual checks the ‘other’ box on the primary language area and writes ASL in the open space provided, the personnel at the US Census Bureau change the language to English.

In 2008, using chart data from the National Health Interview Survey, Haywood County contained a total population of 7,999 people that are ages 18 and above with documented hearing loss.  This number is shown as 17.40% of county’s population.  Residents ages 18-64 with hearing loss were documented as 4,005.  Hearing loss residents ages 65-74 show 1,666 while ages 75 and above conclude at 2,329 persons. (“Prevalence [sic] of hearing,” 2009)  These statistics show a direct need for making a basic medical Sign Language course available for all medics within Haywood County EMS.  Preparing for the future of communication within EMS will reduce the likeliness of EMT’s appearing in discrimination lawsuits. Essentially, the course will provide more adequate care for all individuals that come in contact with Haywood County EMS.


Possible Solutions for Haywood County’s Emergency Services

There are many solutions listed within the ADA’s final rule that express different ways of reducing communication barriers with deaf or hard-of-hearing individuals.  A few of these solutions are: Qualified Sign Language Interpreters, Video-Remote Interpreters, and ad hoc Interpreters.  Each of these solutions has the benefit of lowering language barriers and providing communication between deaf or hard-of-hearing patients.   Ultimately the decision lies on Haywood County’s Emergency Services to choose the best solution for an emergency situation.  The advantages and disadvantages of each solution as it pertains to EMS are explained within this document.


Qualified Sign Language Interpreters

The term ‘qualified’ is defined as “an interpreter who…is able to interpret effectively, accurately and impartially, both receptively and expressively, using any necessary specialized vocabulary” (“Sec 35.104,” 2010).  This definition is meant to include not only certified interpreters and a professional interpreter with a degree, but also any person that can meet the requirements outlined.  This means that EMTs that are specially trained to use Sign Language in the medical field would be considered a ‘qualified’ interpreter.  During communications with an ADA Specialist by telephone, the specialist agreed that the course, “Sign Language Emergency Medical Providers” would coincide with the ADA regulations as long as the students were able to interpret effectively, accurately and impartially (ADA Specialist, 2012).  The telephone interview was conducted in a completely informational and informal application and for the sole purpose of this report.

On the discussion website,, a person with the username “Anij” made an accurate assessment of a todays EMS and deaf/HOH communication. “Anij” observed, “It’s impractical to request an interpreter to arrive at the scene, doing so would cost more lives than it would save due to extreme time delays unless they were a certified interpreter that also happened to be an EMT and were riding in the emergency response vehicle in range… something that’s just not going to happen on a regular or reliable basis” (“Anij”, 2012).  Nevertheless, Haywood County EMS should prepare the medics employed within the service for overcoming language barriers through the course, “Sign Language for Emergency Medical Providers”. In doing so, having an EMT who is a qualified interpreter would become a consistent occurrence.  By making this course available, Haywood County EMS would be reducing the potential of a discrimination lawsuit from occurring in the future while ensuring improved quality of care for deaf or HOH parties.


Video-Remote Interpreters (VRI)

Video-Remote Interpreters encompass the use of web cameras or other video devices that enable the user to connect directly with a Sign Language interpreter.  An advantage of VRI’s does include the ability to have an interpreter communicate with deaf or HOH patients to receive medical information and explain medical procedures.  Another advantage is the ability of the patient to communicate his or her signs, symptoms and concerns.  A large disadvantage is the need for wireless internet cards so that VRI interpreters can be reached while en route to the hospital which results in an excessive expense for EMS.  Another disadvantage is the possibility of the device causing frequency issues with the cardiac monitor which could, in turn, cause the medical provider to misinterpret the rhythm strip or be unable to obtain a readable rhythm all together.

The National Association of the Deaf (NAD) in the article, “Position Statement: VRI Services in Hospitals”, approved this statement,

“VRI is a technological tool that may be used by hospitals and other medical entities to ensure immediate communication with deaf individuals who communicate in sign language. It is the position of the NAD that the use of on-site interpreters should always be paramount, and when VRI is used in the absence of any available on-site interpreter, it must be used properly in terms of policy, procedure, and technology” (National Association of the Deaf, 2008, ¶10).

In summary, the NAD approves the use of VRI’s only when the device is operating properly and when on-site interpreters are unavailable for communication with patients.  For EMS purposes, use of VRI’s would be effective, but marks an increase in expenses and more importantly, could cause a decline in patient care.


ad hoc Interpreters

The use of family members and bystanders is available in emergency situations per ADA regulations. The final rule document addresses this situation by explaining:

(1) A public entity shall not require an individual with a disability to bring another individual to interpret for him or her.

(2) A public entity shall not rely on an adult accompanying an individual with a disability to interpret or facilitate communication except-

(i) In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available; or

(ii) Where the individual with a disability specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances.

(3) A public entity shall not rely on a minor child to interpret or facilitate communication, except in an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available. (“Sec 35.160,” 2010)

The ADA, through this document, shows understanding that in the case of an emergency, the use of any means necessary will be utilized to communicate with deaf/HOH persons.  Two advantages of using ad hoc interpreters are the familiarity of the interpreter with the patient and direct availability of information for medics.  The two drawbacks that can be presented in an emergency situation are that a family member or bystander may not be present to assist with translation and/or the situation may be of a private nature that the patient does not wish to share with the interpreter.  In short, the use of ad hoc interpreters, if available, would be beneficial to EMT’s during patient care.  Conversely, if an ad hoc interpreter is unavailable, basic medical Sign Language knowledge would be available tool.



Human lives are at stake when communication is indistinct and unclear especially in the case of language barriers.  Even with the lacking statistics on the number of American Sign Language users who are located in America as a whole, the evidence of individuals with hearing loss that are located in Haywood County provides that there is a need for basic medical Sign Language instruction within Emergency Medical Services.  The Americans with Disabilities Act requires public businesses to provide interpreters for deaf and hard-of-hearing persons so the patient receives the same quality of care as a hearing individual. The ADA also prepares services with the knowledge foundation so the company may not become a defendant during a discrimination grievance.  To adequately oblige the regulations provided by the ADA, the solution to provide all Emergency Medical Technicians with a course that enables effective and accurate communication with patients through basic Sign Language is essential.  It is the responsibility of Haywood County Emergency Service departments, and its personnel, to increase patient care during a language barrier situation with deaf and HOH persons. In turn, providing increased patient care will also decrease the potential of legal discrimination issues as a result of inadequate communication.




ADA Specialist. (2012, February 28). Personal telephone interview.


“Anij”. (2012, February 27). Question 911 emergency situations [Online forum comment]. Retrieved from


Mitchell, R. (2005). How many deaf people are there in the united states? estimates from the survey of income and program participation. Oxford Journal11(1), 112-119.


National Association of the Deaf. (2008, April). Position statement: Vri services in hospitals. Retrieved from


NC Department of Health and Human Services, Division of Services for the Deaf and the Hard of Hearing. (2009). Prevalence [sic] of hearing loss in nc. Retrieved from website:


Pressman, H., Newman, E., & Pearson, J. (2009, August 24). Communication access within healthcare environments a call for action. Retrieved from


US Department of Justice, Civil Rights Division. (2003).Communicating with people who are deaf or hard of hearing in hospital settings. Retrieved from U.S. Government Printing website:


US Department of Justice, Civil Rights Division. (2010).Nondiscrimination on the basis of disability in state and local government services; final rules(Federal Register Part II 28 CFR Parts 35 and 36). Retrieved from U.S. Government Printing website:


One response to “Innovative Report: Emergency Medical Providers, Sign Language, and the Future of Communication within Haywood County Emergency Medical Services

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