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

About this Research Project

Authors: Vicente Bremner^1,2, Kareen Kazma^2,3, Dennis Derecho⁴, Eric Phan⁵, Dianna Santiago⁶, Morgan Anderson^7,8, Jamie Kennel⁹

¹Department of Psychology, UCLA, Los Angeles, CA
²David Geffen School of Medicine, UCLA, Los Angeles, CA
³Division of Graduate Education and Postdoctoral Scholars, UCSF, San Francisco, CA
⁴College of Doctoral Studies, University of Phoenix, Phoenix, AZ
⁵Department of Human Biology, UCSD, La Jolla, CA
⁶Department of Sociology, USC, Los Angeles, CA
⁷Clinical and Research Services, ImageTrend LLC, Lakeville, MN
⁸Celia Scott Weatherhead School of Public Health & Tropical Medicine, New Orleans, LA
⁹Elson S. Floyd College of Medicine, WSU, Spokane, WA

Introduction

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.

Objective

Determine the relationship between LB and EMS transport in hypoglycemia patients.

Methods

• Retrospective analysis of EMS 9-1-1 charts for patients (≥18 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 the 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.

Results

• We identified 51,289 EMS charts with a primary impression of hypoglycemia not meeting exclusion criteria.
• Of these, 25,685 (50%) were transported and 459 (0.9%) had a documented LB.
• Hypoglycemia patients without an LB were transported 50% of the time, while those with an LB were transported 61% of the time.
• Compared to patients without an LB, the adjusted odds ratio (95% confidence interval) for transport was 1.63 (1.31 – 2.03) times greater for patients with an LB.

Conclusion

Patients with LB have greater odds of EMS transport when experiencing hypoglycemia than patients without an LB, despite adjusting for several confounders. Our findings highlight the 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.