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Lost in Translation: An Examination of EMS Refusals, Hypoglycemia Patients, and Language Barriers

Author: Vicente Bremner | Lost in Translation: An Examination of EMS Refusals, Hypoglycemia | UCLA

<Over 26 million individuals in the United States have Limited English Proficiency (LEP), often presenting language barriers (LB) when accessing healthcare services. In hospital settings, LB can result in disparate care, lower patient satisfaction, and decreased interpersonal connection, causing poorer patient outcomes. In prehospital environments, Emergency Medical Services (EMS) clinicians often transport patients due to miscommunication concerns, regardless of medical necessity. Hypoglycemic emergencies are common conditions effectively managed on-scene by EMS personnel, often not requiring ambulance transportation or emergency department visits, thus reducing patient costs and saving system resources. It is currently not well understood how LB impact care prehospitally. Our objective was to determine the relationship between LB and EMS transport in hypoglycemia patients.

<We performed a retrospective analysis of EMS 9-1-1 charts for patients (>17 years) with a primary impression of hypoglycemia from the 2024 national ImageTrend Collaborate dataset. Unresponsive patients (GCS of 3 or AVPU of Unresponsive) were excluded from analysis. Our outcome variable was patient transport (dichotomous) and primary independent variable was the presence of a charted LB (dichotomous). We used descriptive statistics to characterize our sample and multivariable logistic regression models to estimate the relationship between LB and transport status, adjusting for patient age, gender, race, GCS, and CBG value.

<We identified 57,119 EMS charts with a primary impression of hypoglycemia not meeting exclusion criteria. Of these, 29,833 (52%) were transported and 825 (1.4%) had a documented LB. Hypoglycemia patients without a LB were transported 52% of the time, while those with a LB were transported 69% of the time. Compared to patients without a LB, the adjusted odds ratio (95% confidence interval) for transport was 1.76 (1.46 - 2.11) times greater for patients with a LB.

<Patients with LB have greater odds of EMS transport when experiencing hypoglycemia than patients without a LB despite adjusting for several confounders. Our findings highlight communication challenge consequences EMS face, potentially resulting in unnecessary patient financial burdens and additional strain on understaffed EMS agencies. Future research should explore prehospital interpretation services, expanding EMS workforce diversity, and initiatives to improve care for LEP patients.

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