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Overcoming Communication Barriers in Emergency Situations: Some Basic Tools

by Harvey Pressman

In emergency situations, communication breakdowns between victims and caregivers can have dire consequences including unnecessary pain, misdiagnoses, drug treatment errors, unnecessarily long hospital stays, and even death. They can, and often do, create huge barriers between patients and caregivers. These communication breakdowns can be attributed to new and/or chronic speech and/ or comprehension difficulties, medical interventions, or language barriers with non-native speakers, etc. People in these situations regularly report instances in which communication barriers result in feelings of anxiety, fear, frustration, unrecognized pain, and overall loss of control.

First responders face an especially critical need for communication. As the first to reach people in trouble, often under emergency conditions, first responders must be able to accurately assess a patient’s need in order to administer the proper care in the field. With little access to interpreters, these heroes must rely on simple, low-tech products to enable them to give the best possible care to their patients.


Language boards are among the most helpful tools for communicating in the field.

Whether a patient does not have a clear command of English, is too ill or traumatized to speak clearly, or has a chronic speech problem, language boards enable patients and first responders to communicate through words and pictures. Products such as the Kwik Point Medical Translator have boards aimed specifically at emergency situations. These boards include pain scales as well as picture sets to express nausea, dizziness, and other common symptoms.

Although language boards are simple devices, they quickly provide paramedics and EMTs with the communication skills necessary to assess a patient’s condition.

Although communication boards can be invaluable, nothing replaces the ability to speak directly to a patient. As the number of persons of limited-English proficiency rises in the United States, first responders have found it increasingly necessary to speak other languages, especially Spanish. Several organizations have risen to this challenge by developing language programs geared specifically toward first responder needs. SpanishOnPatrol offers online Spanish classes that focus on the phrases and vocabulary first responders are most likely to encounter while on duty. Spanish 4 Emergencies also offers a variety of products that serve as an easy reference while in the field. In addition, materials originally developed for health care settings (such as Vidatak boards, see below) can also prove useful in emergency settings.

Listed below is a selection of some of the more common communication tools that first responder personnel can use to facilitate communication while in the field:

Kwikpoint Medical Translators

Kwikpoint Medical Translators (https://www.kwikpoint.com/disaster-recovery/) are laminated booklets that facilitate communication between first responders and non-English speaking patients. The cards includes pictures for basic emergency-related topics and assistance phrases that patients can point at to express their needs. Translators are available in Spanish and French as well as for health care situations (Spanish, Tagalog, Vietnamese, etc..

Emergencia! Emergency Translation Manual

by Lisa Maitland de Hernandez (https://www.amazon.com/Emergencia-Translation-Lisa- Maitland-Hernandez/dp/0766836266html)

EMERGENCIA! Emergency Translation Manual is a language reference for English speaking medical caregivers who need to communicate effectively with Spanish speakers in emergency situations. Translations of a wide array of medical emergencies include phonetic pronunciations of words and phrases and relevant questions that require only "yes" or "no" answers. Diagrams of the human body labeled in Spanish and pages of commonly used words and phrases further facilitate communication and ultimately quicken response time.


Spanish on Patrol


SpanishOnPatrol offers complete Spanish courses in public safety to help officials gain the language skills they need to respond in a safe and effective way. Online classes are offered for law enforcement, fire/EMS, 911 dispatch, park rangers, and corrections officials.

Critical Communicators/Pocket Communicators

https://www.alimed.com/the-critical-communicator.html These communication boards assist staff in interacting with patients who cannot speak or who have limited English proficiency through the use of pictures. Content includes pain scale, pictures for immediate needs, and comfort among others. The Critical Communicator is available in over 20 languages.

I Speak Card

The Department of Justice’s Civil Rights Division publishes an I Speak Card containing 38 languages to help first responder personnel identify the language their patients speak. The card can be downloaded for free here.

Vidatak Communication Boards


The EZ Board enables health care providers to communicate with patients with impaired communication. The board is intended for use with patients who cannot speak and with non- English patients. Boards are 17 x 11, two-sided, dry-erase boards with new research-based content and are available in 17 languages.

Communication Picture Board


The Communication Picture Board was designed initially to help bridge the communication gap between emergency first responders and people who are deaf. The picture board has proven also to effectively enhance the communications needs between first responders and non-English speaking populations, children, people with developmental disabilities, as well as those impacted by a traumatic event. It has also been used extensively in hospital settings The Communication Boards contain pictures with a word describing the picture underneath in both English and Spanish. On the back of the board, a number of other languages are listed, so that (literate) non-English speakers can identify their language, if other than English or Spanish. learn more or to order these boards, contact office at mail@eadassociates.com

Tips for First Responders (http://cdd.unm.edu/products/tipsforfirstresponders.htm)

Tips for First Responders is a 14-page, color-coded, laminated 4.5 x 5.5-inch field guide, incorporating “tip sheets” that provide information that first responders can use during emergencies as well as routine encounters. They are not meant to be comprehensive, but contain specific information that can be read quickly either before or while responding to an incident, and can be downloaded free or purchased in laminated field guide form. Tips are included for persons with a wide range of disabilities, as well as Seniors, People with Service Animals, People with Mobility Challenges, People with Mental Illness, Blind or Visually Impaired People, Deaf or Hard of Hearing People, People with Autism, People with Multiple Chemical Sensitivities, People with Cognitive Disabilities, and Childbearing Women and Newborns.

Health Care Communications Board http://www.greenhousepub.com/hecacobo.html

Designed originally for use in hospitals, rehab units, acute care, emergency rooms, assisted living facilities, nursing homes, clinics, hospice care and in the home, the Health Care Communications Board can provide an inexpensive alternative for communication in emergency situations (200 boards for $39.00). It includes (1) pain scale for determining where and scale for determining where and how bad one hurts (2) 68-clear, 4-color pictures depicting wants, needs, ailments, comforts, questions, emotions, etc., (3) easy to understand instructions for patient response alternatives, (4). Alphabet for spelling out words, and (5) numbers for numerical information.


Speak Unlimited


Speak Unlimited’s nonverbal communication boards are full page laminated communication boards with icons on both sides, which fit on a clip board for easy use and access. They have been designed to assist, EMTs, other emergency personnel and people who cannot make their circumstances clear due to the fact that they speak another language or have a medical condition such as autism, Alzheimer's syndrome, stroke, traumatic brain injury, unfamiliar or impaired speech, or other difficulties. The full color icons on the boards are designed to be easily understood, and the text is in both English and Spanish. Speak Unlimited also provides boards for EMT’s, hospital personnel, and school nurses. Available in letter size in English and Spanish for free download @ https://widgit-health.com/downloads/paramedic-board.htm

Communication Displays. EAD & Associates, LLC

EAD & Associates, LLC provides expertise in emergency management and special needs planning that ensures people with disabilities are prepared for natural and manmade disasters, emergencies and their consequences. EAD and associates a disaster Readiness Wheel for people with disabilities. One side of the wheel provides preparedness steps while the reverse side provides response information.


Servision provides readymade and customized Communication Picture Boards to meet the needs of people who rely on AAC and the partners they may meet in emergency situations. Servision’s communication boards can be helpful in a variety of settings: field hospitals, ambulances, shelters and assistance centers.

Other Organisations:

United States Department of Justice

An ADA Guide for Local Governments: Making Community Emergency Preparedness and Response Programs Accessible to People with Disabilities. https://www.ada.gov/emergencyprepguide.htm

June Isaacson Kailes (JIK)

Disaster Resources for People with Disabilities, Disability-related Organizations and Emergency Managers.


The Red Cross.

This is where you will find information on “Go Bags.”

www.redcross.org www.redcrossstore.org/shopper/ProdList.aspx


Emergency Preparedness Guide for People with Disabilities/Special Needs

This guide from Canada provides information on preparing an emergency plan and kit for people with disabilities / special needs and for caregivers. https://www.getprepared.gc.ca/cnt/rsrcs/pblctns/pplwthdsblts/pplwthdsblts-eng.pdf.



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