With more ill and injured people unable to speak English, hospitals, clinics and rescue squads are turning to picture boards to bridge the communication gap with easily understood images.
The large, double-sided panels let patients point to icons showing their problem — such as pain, a burn, breathing trouble or a fall — as well as the part of the body that is affected. They also can point to their native language in a list so an appropriate interpreter can be located.
"They ought to be in every ambulance, in every hospital, in every clinic," said Dr. Fred M. Jacobs, head of New Jersey's health department. "Communication barriers lead to adverse impacts on (care) quality, misunderstandings and even medical errors."
His department is partnering with the state's hospital association to distribute thousands of the boards to all New Jersey hospitals, rescue squads and public health clinics.
Nine states signed up
Use of the panels is likely to spread under a new U.S. Department of Health and Human Services program aimed at helping hospitals to determine their patients' communication needs and to find tools to meet those needs. At least nine state hospital associations have signed on: New Jersey, New York, Pennsylvania, Kentucky, Missouri, Oklahoma, Rhode Island, Utah and Washington.
At University Hospital in Newark, up to 15 percent of patients speak Spanish, Portuguese or another language besides English, said triage nurse Robert Cagadoc. Since getting the picture boards last month, he's used them a couple times every shift to help patients arriving in the emergency department.
They help "big time," he said Friday.
According to the American Hospital Association, up to 23 million U.S. residents have limited English proficiency, and a recent survey found 48 percent of hospitals encounter patients with limited English skills daily.
Hospitals are required by federal law to provide interpreters as needed for patients, so they generally subscribe to commercial services provided by telephone or, as New Jersey hospitals are now doing, train bilingual staff members.
The boards also are helpful for patients who are deaf, hard of hearing or mute, or who cannot speak because they have had a stroke or have a breathing tube down their throat.
Word of mouth
The boards originated in Florida after Hurricane Andrew in 1992. They sold by Servision Inc., mainly through licensed distributors. Servision founder Michael Weston said he came up with the idea after serving as director of the greater Miami Red Cross and seeing how many people didn't get needed help after Andrew because of communication difficulties. Originally just laminated cardboard, today they are made of a nearly indestructible synthetic.
They gradually caught on through word of mouth among health groups in various states.
"You'll probably find boards in virtually every state in the country at this point," Weston said.
New York City started using the icon panels shortly before the Sept. 11, 2001, attacks and some were used by emergency responders that day, said Elizabeth A. Davis, who had ordered customized versions in her job as a special-needs adviser in the city's Office of Emergency Management. She now distributes Weston's boards through her consulting company, EAD & Associates.
"They're not a silver bullet that solves every single communication problem," but they get the process started, Davis said.
The Metropolitan Chicago Health-care Council has distributed at leased 5,000 copies of the boards to nursing homes and every hospital in the state, used them successfully in disaster drills and is ordering 2,000 more, said spokesman Patrick Finnegan.
"When I found this thing, I was like a kid in a candy store because this is exactly what you need," he said.