Do you think Healthcare professionals should learn basic ASL ....

[Dixie]

... to help better communicate with their Deaf patients and to provide quality care?

I ask this as a former EMT myself. From my experience as a former EMT, we have little time to write on pen and paper back and forth to the patient especially in truama situations or urgent medical emergency. (Yes there is a classification between medical emergency and urgent medical emergency). 9 out of 10 times, we are going to do a rapid patient assesment where the vitals and condition of the patient are checked and often this is done in less than 4 minutes. This is where we our baseline vitals from and know what has to be done en route to the ER.

Due to my deafness, I had to leave EMS, but the more I think about it the more this gnaws at me.

Outside the ambulance, do you think ER nurses and doctors should know some basic ASL to get some much needed info across such as "Where does it hurt?" "How bad does it hurt?" and in some cases, being able to describe the pain. And other stuff such as Name, age, and who to contact? Other info that would be useful is the SAMPLE assesment:
Signs/symptoms,
allergies,
medications,
pain (if any)
Last oral intake
Events leading up to injury/illness (what happened to cause this?)

I think this would be very beneficial for healthcare providers and patients in areas where there is a large deaf community such as Gally, RIT or in cities where there are schools and colleges for the Deaf.

If there is any miscommunication or information that is omitted can cause the Medics, Doctors, and nurses to treat the wrong problem and cause potential harm.

Am I on a warmongering campaign? Absolutely not, but I do want your honest opinion.

 

[jillio]

I think that there should always be terp available anytime that information is being given in a non-emergency situation, but for emergency situations where the terp is not available at the time, I think all health care providers, or at least someone that is on the staff at all times, should have ASL training.

 

[Reba]

... to help better communicate with their Deaf patients and to provide quality care?

I ask this as a former EMT myself. From my experience as a former EMT, we have little time to write on pen and paper back and forth to the patient especially in truama situations or urgent medical emergency. (Yes there is a classification between medical emergency and urgent medical emergency). 9 out of 10 times, we are going to do a rapid patient assesment where the vitals and condition of the patient are checked and often this is done in less than 4 minutes. This is where we our baseline vitals from and know what has to be done en route to the ER.

Due to my deafness, I had to leave EMS, but the more I think about it the more this gnaws at me.

Outside the ambulance, do you think ER nurses and doctors should know some basic ASL to get some much needed info across such as "Where does it hurt?" "How bad does it hurt?" and in some cases, being able to describe the pain. And other stuff such as Name, age, and who to contact? Other info that would be useful is the SAMPLE assesment:
Signs/symptoms,
allergies,
medications,
pain (if any)
Last oral intake
Events leading up to injury/illness (what happened to cause this?)...

Hmm. If they learn how to sign, they also need to learn how to "read" signs so they can understand the Deaf patients' responses. If the EMT or nurse or MD asks about symptoms, will they understand the response? Also, they will have think conception, not medicalese. "Last oral intake"? "Events leading up to injury/illness"? With Deaf culture, be prepared for a looooong response, going way back in time, sometimes including what we hearies consider to be irrelevant details. "Who to contact"? You'd think that's a straight-forward, simple question. If you get a reply of a sign name only, good luck. Hopefully, the patient will pull out a wallet with a name and phone number written on a piece of paper.

Also, don't expect to see text-book signs, especially from someone in pain, with an IV in the dominant signing hand, shaking from shock, etc. A Deaf patient whose glasses were smashed in a car accident has trouble seeing the signs or written notes. A Deaf patient with a crushed or burnt hand can't sign back to the EMT.

That's going to require more than a few signs to be accurate.

Sometimes, more important than knowing the signs is just awareness of the language and cultural aspects of Deaf patients, and expediting their access to qualified terps.

As a terp, I've ridden in ambulances, rushed to ER's, sat in waiting rooms, viewed invasive medical procedures, and struggled to clarify communication for patients who were scared, in pain, crying, puking, tied down, bleeding, screaming, and eyes closed. I know that you've experience a lot worse in your EMS work; I'm just giving you examples of how those things can effect the quality and accuracy of communication. It's risky.

Somewhat off topic: I would love to see more of the follow-up staff knowing basic signs. It would be nice if the ward nurses who have daily contact with the inpatients knew some signs.

Just food for thought.

 

[Dixie]

Thanks for the input, it really is beneficial. I will say this - as an EMT student I was puked on, peed on, attacked, bitten and what not in my short 3 months riding with the local EMS. When I got my certs, I was happy. But because I was unable to pick up the BPs in some cases, I could not work on an ambulance. It is very hard for a hearie as it is to pick up BPs when you have a diesel engine, sirens blaring, and radios going off in a truama case. I did however get to put my skills to use for a short time in a nursing home setting, but due to the others on staff not really willing to communicate to me in better ways, it didn't last for long. The NH manager felt bad for me in a way so she let me part on good terms. Do I regret the fact that I am no longer an official EMT? No, but I do realize that I can put my knowledge and skills to good use. I have thought about finding ways to help the Deaf learn basic first aid to help their friends until the Medics arrive to take over for them, and to also help the communication gap between healthcare providers and Deaf patients.

As EMT-students we lightly touched on the subject of patients who may be hard of hearing, but you want to know where they had that section?? In the Geriatrics Unit. We were basically told to speak to them like a child and I personally felt that was a bit demeaning, but as hearies, they usually don't understand.

Now as for IVs and what not, most of the time the IV is going to be set near the wrist if possible, but I've seen (and had some myself) stuck in odd places. One IV I had was stuck right on my knuckle, I couldnt bend my hand for crap, so I can absolutely see what you are saying by seeing unusual signs or lop-sided signs in those situations.

But you absolutely did bring up a good point about what as a provider I might think is a straightforward question, but to a Deaf patient they may go into alot of detail and use signs the Medics, Nurses, or Docs may not understand.

For that I may try to find a way to rephrase it or ask mostly yes/no questions.

For Last Oral Intake I may sign WHAT YOU EAT LAST? They may sign back something simple as DINNER AT MOM HOUSE, or go into alot of detail such as DRANK KOO-LAID ATE POTATO BEAN CHICKEN CORNBREAD. Most EMTs and Medics are not going understand the second response.

Perhaps for this the first thing the medic should attempt after checking the level of responsiveness in the Deaf patient is to sign YOU HAVE ID YOU? Then hopefully the Deafie can reach into his/her pocket and pull out Driver's license or contact card, then they would have something to go with as far as contacting family members, friends, or possibly a 'terp. If not then the medics would have to wait until they rolled the patient to the spine board to check the back pockets for ID as well as looking for injuries to the posterior.

But here is the kicker, you cant tell a Deaf person from a hearing person just by looks, especially if the Deaf patient does not wear HA or CI. So we may say they are in shock, when the reality is that they simply cannot hear what the medics are saying, so that is another thought that has come into play.

How could we positively identify that the patient is Deaf??

And as for Floor nurses knowing basic signs, that would be great. I have heard of hospitals that hire nurses who are fluent in ASL to work in hospitals that are in areas where there is a large Deaf population. I think these hospitals are taking a step in the right direction in bridging that communication gap.

 

[ASLGAL]

I'm reviving an older topic here but one that is a very important struggle.

A firefighter and I are trying to get this very thing implemented in our city right now. The PD and FD officers need this type of training badly.
The bottom line seems to be money and legal liability to the city.
We have a certified interpreter on board and will do the classes for an extremely reasonable fee but everytime we bring it to the city we get the same reaction.
What a great idea and then nothing.

Any ideas?

We have thought about sending out a call to our deaf community and having them all show up at a council meeting and demand that their communication needs be addressed.
(of course, living in a small city, it would take about a second for them to figure out who orchestrated it - and would we have he-- to pay)

 

[Aleser]

I don't. Personally, I think this would DISCOURAGE hospitals from providing effective trained interpreters. Knowing every alternative format a patient might communicate in is just asking too much of doctors. Would you make them all also learn spanish or whatever a commonly used language in that area is?

 

[Interpretrator]

I don't. Personally, I think this would DISCOURAGE hospitals from providing effective trained interpreters.

Very interesting point. Also this:

If they learn how to sign, they also need to learn how to "read" signs so they can understand the Deaf patients' responses.

Receptive proficiency comes way after expressive proficiency so that is a very valid concern. Perhaps a better idea is to instruct medical professionals in very basic communication with deaf people, largely yes-no questions or ones that incorporate gestures like "point to where it hurts," "do you want an interpreter?" "can you wait?" and so forth. (Not to mention "I only understand a little sign!") That way responses from patients will not be misunderstood, which is the worst case in an emergency medical situation. Also deaf patients can then be assured that the professionals are sensitive to their situation and an interpreter is on the way.

I also have to agree with the comment, mentioned before in other threads as well, about making doctors, nurses, EMTs and other staff learn every language they might encounter. As I mentioned elsewhere, here in California that would entail at the very least a dozen languages. It's just not realistic.

 

[Dixie]

they dont have to learn every language they encounter but they do need to have some basic phrases down such as "Do you understand English?" "Do you need an interpreter?" Most hospitals have interpreters hired just for this specific purpose. If an interpreter is asked for, 99% of the time it will be provided. In larger hospitals such as those in NYC and in LA you may have 10 Interpreters that all are fluent in a different language all on a single shift.

Here at the local hospital there are 4 spanish-english interpreters because there is a large hispanic population here.

And as for foreign languages - most colleges REQUIRE a foreign language instruction for at least 4 semesters before graduation, but the downside is they are usually taken during the Freshman and Sophmore years and used very little outside the classroom. Sometimes some basic phrases will stay with the person but 9 out of 10 times they never see a need for the language again until they have entered the workforce and encounter a person that does not know English but knows Spanish.

 

[BearBeauty]

Remember.. not all hospitals will have an interpreter on site.. so having a doctor, nurse or whatever that speaks the language while waiting for interpreters, would work. so the doctor can tell which language the patient speaks and be able to contact the correct interpreter for that patient. so having someone who works at the hospital who knows some of the language and can verify that the patient speaks whatever langauge, can be a big advantage, plus if it's life or death.. that would be a big help to have someone be there who can help communication between doctor and patient, even if it's not the doctor himself.

 

[Interpretrator]

so the doctor can tell which language the patient speaks and be able to contact the correct interpreter for that patient.

I think it's way too much to ask personnel already in an emergency situation to be able to determine exactly what language a person is speaking, especially a person in pain or not communicating properly.
Seriously, you'd have to choose from a *minimum* of 15-20 languages around here. Maybe it's more feasible in smaller and less linguistically diverse cities.

Without making professionals go to a zillion language classes, I think it's more likely that specialized phrase books could be made with lots of common phrases and questions in various languages (with phonetic spellings) for medical personnel to use. There could be responses for the patients to point to if they are capable and if not the doctors or nurses will have to make do with what they can, which is the case a lot of the time with English-speaking patients anyway.

Sign being a special case I could see where medical personnel should be able to use at least a little since in the case of someone who can't write or point to words or pictures, unlike with the hearing people who speak another language, it's a lot harder to do "phonetic" quick-phrase books in sign!

It's just one of the unfortunate situations of being in a language minority in this country that in emergency situations more time may be needed to best accommodate your linguistic situation. Yes, more education would be great for overworked medical staff when possible, and in a perfect world yes, everyone would know basic sign and other languages, but this is an English and hearing majority country so that's where the resources tend to go.

I don't mean to sound bitter or pessimistic, just realistic. I'm not saying it doesn't suck though.

 

[Tousi]

I do know, though, that the renowned Mayo Clinic in Rochester, MN has a language board. They provide interpreters for many of the world's languages and this is for hearing people. I am almost sure they would have terps there for the American deaf population and probably not for the deaf of the world outside this country.

 

[ASLGAL]

A lot of good response on this topic.

If they learn how to sign, they also need to learn how to "read" signs so they can understand the Deaf patients' responses. If the EMT or nurse or MD asks about symptoms, will they understand the response?

Agreed, the PD, FD, and Medical personel would have to get a basic grasp of ASL. The concern in my area is that if the one or two of us that know ASL and can be SSP until we can get an interpreter there are not around then how can a Deaf/DeafBlind person communicate what emergency they have.

Originally Posted by Aleser View Post
I don't. Personally, I think this would DISCOURAGE hospitals from providing effective trained interpreters.

Good point, but wouldn't that be covered under ADA requirements?

Interpretater, I am going to pick you brain if you will allow it.

A firefighter and I are trying to get this very thing implemented in our city right now. The PD and FD officers need this type of training badly.
The bottom line seems to be money and legal liability to the city.
We have a certified interpreter on board and will do the classes for an extremely reasonable fee but everytime we bring it to the city we get the same reaction.
What a great idea and then nothing.

Any ideas?

Are there any ways you can think of that this idea could be presented that would facilitate a more active response instead of - "Great idea" and then nothing coming of it?
This is one of my biggest frustrations right now.

 

[Schermy]

Here is a problem I had when I brought my daughter to the ER. My daughter and I are hearing and my husband is deaf. When checking in at the desk in the ER I asked right away for an intp. cause being that I was sooooooooo focused on my daughter (she as not 3yrs old yet and we went to ER cause she spiked temp of 105) I didn't feel I could acuratly intp. for my husband. The lady behind the desk thought is was funny and said that I was there and I could do it. I demamded to see a supervisor and said I wanted an intp. They said they would call one. My daughter was admited to the hospital for 3 days and the only person the hospital had come to "help my husband" was the chaplin who "knew some sign." That is what I see as a problem. The minute the hospital has someone on staff who even remotley has a bit of sign knowledge, they find everyway possible to not spend the money on an intp. So, should the staff know basic sign. Yes. However, I think it will cause more problems later trying to get a real intp. when needed. The chaplin at the hospital had my husband thinking that my daughter was going to die and needed to have major surgery and possibly replace a kidney. It turns out she only had a bad urinary track infection.

 

[Interpretrator]

Good point, but wouldn't that be covered under ADA requirements?

Evidently not, according to Schermy's story. I'm positive many places that are required to provide accommodations according to the ADA simply aren't aware of it. Having said that...

The lady behind the desk thought is was funny and said that I was there and I could do it.

I think far easier than teaching everyone in the hospital sign is educating them about their responsibilities under the ADA. This is a lot more feasible and could be done with a meeting of some kind and booklets (which I'm sure must already exist) detailing responsibilities if, for example, a deaf person comes in and requests an interpreter. I don't see any reason this can't take place; seems like a job for HR or something.

Interpretater, I am going to pick you brain if you will allow it.

Well, there's not much left, but you can try.

Are there any ways you can think of that this idea could be presented that would facilitate a more active response instead of - "Great idea" and then nothing coming of it?

I will be very honest with you. As I said before, in a perfect world this is a really nice idea but I think the practicalities are limited. There are several reasons as I see it, and if you want you can take this as a "devil's advocate" post.

1. Learning ASL well enough to communicate under normal circumstances takes a pretty good amount of time and effort.

I'm not even talking about proficiency and fluency, but just wrapping your mind around a visual-spatial language. Adults are not as good as children at learning languages and it takes a pretty concerted effort to get beyond ASL 1. Also there is the "use it or lose it factor" which means everyone could take this class and then not encounter a deaf person for four months and forget everything. Yes, they SHOULD be out practicing but these are busy professionals in stressful jobs and again, I'm being realistic.

2. Learning ASL well enough to communicate with sick, scared, injured, etc. people in an emergency takes a great deal MORE time and effort.

Your response about personnel needing receptive proficiency is that "...the PD, FD, and Medical personel would have to get a basic grasp of ASL." But a basic grasp of ASL does not cover the kinds of things these personnel are going to encounter. They're going to encounter medical terms, classifiers, slang, low-language proficiency, all in the context of emergency situations. That is extremely difficult for someone who just learned the alphabet and "where does it hurt?" And I'm not being condescending; I don't do emergency medical interpreting myself because I'm not confident in my ability to work under those conditions (linguistic, not emergency).

3. You mention legal liability. This is pretty important. Imagine if an injured or sick deaf person comes in and a doctor completely misunderstands what the patient is telling him. You know the expression "A little knowledge is a dangerous thing?"

If you want to get this going I would suggest first making out your curriculum. Don't focus on teaching people basic ASL, but focus more on a sort of medical phrasebook, short phrases that can mostly be answered by pointing or yes/no. Teach them "Do you want an interpreter," "We will call an interpreter," "Can you write who else to call" and so forth. Work with the interpreter on this (I assume she has medical interpreting experience; if not, find someone who does.) Once you've designed the curriculum you can present it to the powers that be with the specific and realistic results you hope to achieve. People who fund projects generally don't do it based on a "great idea," but require plans and objectives so they can see exactly where the benefits are.

I hope this was some help, sorry it was so long and probably way more than you needed to hear.

 

[shel90]

very interesting thread and a lot of good points..hmmmm

 

[Gobae]

Dixie - I though you were a medical professional of some sort. I was paying attention to how you were using terminology in some of your other posts.

Anyway, I was an EMT (NYS EMT-D, OH EMT-B, & NR EMT-A) for 10 years and one of the MAIN reasons I took sign language classes was so I could communicate with Deaf patients; because I found the basic instruction in the EMT manual incredibly stupid.

Our EMT book suggested we carry a card with us that said "Are you deaf?". That was it! No suggestions about how to actually communicate with the patient! As if it was just enough to know they were deaf; that was good enough.

Reba said:

As a terp, I've ridden in ambulances, rushed to ER's, sat in waiting rooms, viewed invasive medical procedures, and struggled to clarify communication for patients who were scared, in pain, crying, puking, tied down, bleeding, screaming, and eyes closed. I know that you've experience a lot worse in your EMS work; I'm just giving you examples of how those things can effect the quality and accuracy of communication. It's risky.

Yes, all those things are very true and your point is well taken. But 80% of EMT calls are actually non-life threatening and don't qualify as "True Emergencies". That would leave lots of opportunity to successfully use sign with patients.

ASLGal Said:

Are there any ways you can think of that this idea could be presented that would facilitate a more active response instead of - "Great idea" and then nothing coming of it?

Outline what specifically you want to do and what things would be needed. Then pester them. "How's the ASL program coming?", "When will this be implemented?", "What issues are stopping this from happening?", "What's the process used for this to go forward?". Then tackle some of the issues and roadblocks they come up with, and go back to them and show them you've solved some of their problems, and once again ask those same questions OVER and OVER. (BTW notice the questions don't ask why "they" aren't doing something. It's a subtle change that makes the questions less confrontational.)

 

[ASLGAL]

I guess I did not state the intention well, I have no desire to make all PD/FD units complete and highly literate in ASL. That would be an impossibility.

Yes. This is exactly what I feel the other FD/PD first responers and EMT's need....

Interpretater said~

I would suggest first making out your curriculum. Don't focus on teaching people basic ASL, but focus more on a sort of medical phrasebook, short phrases that can mostly be answered by pointing or yes/no. Teach them "Do you want an interpreter," "We will call an interpreter," "Can you write who else to call" and so forth. Work with the interpreter on this (I assume she has medical interpreting experience; if not, find someone who does.) Once you've designed the curriculum you can present it to the powers that be with the specific and realistic results you hope to achieve. People who fund projects generally don't do it based on a "great idea," but require plans and objectives so they can see exactly where the benefits are.

... good suggestions, perhaps having a hard copy of something like a phrasebook would ease their minds about liability issues and show exactly what we wish to accomplish....a basic way of communication between the emergency scene personel and what ever comes next so there are less stresses and misunderstandings.

Gobae said~

Outline what specifically you want to do and what things would be needed. Then pester them. "How's the ASL program coming?", "When will this be implemented?", "What issues are stopping this from happening?", "What's the process used for this to go forward?". Then tackle some of the issues and roadblocks they come up with, and go back to them and show them you've solved some of their problems, and once again ask those same questions OVER and OVER. (BTW notice the questions don't ask why "they" aren't doing something. It's a subtle change that makes the questions less confrontational.)

...more great suggestions on approach. I think I perhaps have not fully explained what, where, why, and how as well as I should because I already am ASL, work with the Deaf/DeafBlind and know what we need.

Good points and thanks

 

[Interpretrator]

But 80% of EMT calls are actually non-life threatening and don't qualify as "True Emergencies". That would leave lots of opportunity to successfully use sign with patients.

What about the 20% of calls that are life-threatening?

Outline what specifically you want to do and what things would be needed. Then pester them.

I disagree. If you want to get this off the ground then asking other people "how's it going?" is going to accomplish exactly squat. You're going to have to do it all yourself (well, and with your firefighter and interpreter compadres), and present your objectives, goals, and accomplishments to whoever's paying for it. If you bring up the topic and leave it to other people, whether or not you pester them, it's going to be another "Great idea!" where nothing happens.

 

[Reba]

Maybe all terps should learn basic nursing and doctoring skills. In a medical emergency, they can "carry on" until the professionals show up. Or maybe it won't even be necessary to call an ambulance. Those ambulance runs are pretty expensive. The terp took a first aid/CPR course; that should be adequate.

No?

Why not?

OIC

 

[Gobae]

What about the 20% of calls that are life-threatening?

They cause communication problems regardless if the person is deaf or hearing.

Facial trauma, pain, oxygen masks, C-collars cause communication issues for speakers; while eyes closed in pain, IV sticks, and splinted arms cause communication issues for signers.

Just different issues for the different modes of communication. <shrug>

In a medical emergency, they can "carry on" until the professionals show up..... The terp took a first aid/CPR course; that should be adequate.

Absolutely! That's what we recommend for EVERYONE! Decent bystander First Aid saves lives.