Intended for healthcare professionals

Rapid response to:

Editorials

Breaking down language barriers

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7143.1476 (Published 16 May 1998) Cite this as: BMJ 1998;316:1476

Rapid Response:

An approach to communication problems in healthcare services

Dear Editor,

In a BMJ editorial published in May 1998, D Jones and P Gill (1)
described the communication problems experienced by ethnic minorities in
their attempts to gain access to NHS healthcare services. A number of
readers subsequently reported that the deaf encountered comparable
obstacles and that, in their case, rapid connection to an interpreting
service was no solution (2,3). Evidently, users with hearing deficiencies
face enormous barriers to communicate with any health agency that offers
services through telephone contact.

In Spain, access to in situ emergency health care is provided by a
fast-dial telephone call (061 or 112). As the public company responsible
for the 061 service in Andalusia, we endeavoured to address the above
issue by designing a novel system for access to emergency services by the
deaf. Taking advantage of the widespread use of the fax by deaf people
(over 70% of the deaf population in Andalusia possess a fax), we developed
and validated a medical questionnaire for users to keep at home. In an
emergency, the questionnaire is completed and sent by fax to the 061
centre. Questions for yes/no responses are supported by drawings, and
diagrams are included to be marked as necessary. The questionnaire
contains adequate data for the emergency coordinator to evaluate the
nature of the emergency, type of disease involved, severity of the
situation and other relevant data (4).

Based on this fax alone, the coordinator can assign the most
appropriate health and transport resource (fully equipped mobile intensive
care unit, medicalized ambulance, non-medical care ambulance or referral
to family physician, police or fire brigade, among others).
Simultaneously, the coordinator faxes the user a selection of specially
designed medical advice pages that illustrate the measures to be taken
until help arrives (4).

The application of new communication technologies will undoubtedly
allow the development of systems of even greater benefit to our deaf users
in the near future.

Finally, and returning to the original BMJ editorial, this graphic-
based method could be readily adapted to serve people in emergency
situations who are not fluent in the language of the country they find
themselves in. The need for a feasible solution has become even more
pressing, especially given the escalating labour mobility within and into
Europe.

J Alberto Raya, Emergency care physician

Carmen Martin, Emergency care physician

061 Health Emergency Service, EPES, 18014 Granada

Francisco J Gomez, Associate Professor of Medicine

Manuel J Castillo-Garzon, Professor of Medical Physiology

School of Medicine, University of Granada, 18071 Granada, Spain.

1. Jones D, Gill P. Breaking down language barriers. BMJ
1998;316:1476.

2. Irwin J, Martin S. Don’t forget deaf people. BMJ 1998;317:817.

3. Carter J, Hare-Cockburn K. Sign here, please. BMJ 1998;317:817.

4. Raya JA, Martin C, Gomez FJ, Castillo M. Acceso telefónico para sordos
al Sistema de Emergencias Sanitarias 061. Medicina Clínica (Barc). In
press.

Competing interests:  
None declared

Competing interests: No competing interests

12 March 2003
Manuel J Castillo-Garzon
Professor Of Medical Physiology
J. Alberto Raya, Carmen Martin, Francisco J. Gomez
School of Medicine, University of Granada, 18071 Granada, Spain