Saturday, January 21, 2012

What Was That Again?

I had a very interesting conversation today with the mother of a student. Turns out that part of her job is captioning lectures for hearing impaired students. She is working on a project funded by the National Science Foundation because they have found that deaf students were dropping out of certain kinds of classes largely because the method of captioning video material sucked, and was not accurate enough. As is often the case when things aren't working well, it was a communication problem.

This got me thinking about the variety of situations we come across where there is a communication gap of some sort.

There are several totally different kinds of situations that cause communication problems.

Possibly the most obvious one is a language barrier. If you and your patient don't speak the same language, it can be hard to ask and answer questions. One possible resource is a translator- perhaps a child, or a friend on the phone, or  professional translation service. You might also have a phrase book, or, if there is a particular language that is common where you are, learn some of that language, particularly phrases that would be useful during an emergency.  Sometimes, rudimentary signing can help, or drawing pictures.

Another situation is one where your patient has dementia, or an altered level of consciousness. Perhaps they could normally communicate with you just fine, but not at the moment. This one is tougher because you can't just translate. They may not be able to understand you at all, and vice versa. Try very simple questions or commands. Assist them physically, if necessary. Demonstrate what you want them to do, or help them do it. If there is simply a delayed response, give them time to answer or move.

Because of the conversation I had earlier, I spent a little time looking for resources for EMS for hearing impaired people. The usual places yielded excellent results. has a good article on Patients With Hearing Impairment.
Greg Friese, from Everyday EMS Tips, also has an article on Assessment Tips for Deaf and Hard of Hearing Patients.  One suggestions I found was to carry a small white board and dry erase pens, since they are easier to write on while on your back. That would be useful for a wide variety of patients.

Yet another situation that involves a communication barrier is when your patient is on the autism spectrum. Because the symptoms vary so widely, it is not possible to simply have a specific plan for how to best communicate with such a person. You'll need to wing it a little, and figure out what works for that particular patient. An understanding of what that means is, of course, a good idea. I've been to three different training courses so far, and learned different things from each one.

A good starting place online is an excellent video from the First Responders Network, one of their "Seat at the Table" videos, Communicating with the Autism Spectrum.  It's about 18 minutes long, and has a couple of guests discussing the issue. It also references a blog (Spirit of Autism) written by a woman who is an EMT, and has an autistic child. She has a page of resources for emergency responders.

Communication is such an important part of what we do that it is well worth the time to consider these types of patient contact situations, and be as prepared as possible.

I'm planning to go out and get a small whiteboard that will fit right into the PCR clipboard. I'm sure it will be useful.

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