InterpreMed’s next comprehensive medical interpreting study guide is all about emergency medicine! In the first installation of our series, we discussed special considerations in the U.S. healthcare system when it comes to emergency medicine, such as barriers to healthcare. Our second post discussed emergency medicine interpretation settings. In this final part of our series, we’ll be delving into just what it’s like to interpret in emergency medicine, straight from interpreters who have interpreted in the field of emergency medicine themselves!

Normally, Nanyi and I draw on our own experiences, as well as incorporate hours upon hours of research to create study guides for medical interpreting specialties. This time, because neither of us have a lot of experience in this area of interpreting, in addition to both of us conducting even more research than ever on a study guide, I decided to reach out to my interpreting colleagues on the Facebook group U.S. Medical Interpreters about their experiences interpreting in emergency medicine.

You can read the entire thread here, but I’ve decided to distill contributors’ replies into an easy-to-read format.

The Gravity of Your Words

It should go without saying that you should interpret everything in emergency medicine. It may be difficult to keep calm and carry on in what can be such a fast-paced environment, but ensuring accuracy and completeness is a must. I’d be remiss if I didn’t mention the infamous case of Willie Ramirez, in which a misinterpretation of the Spanish word “intoxicado” (a false cognate that does not mean intoxicated!) resulted in a chain of events that ultimately left Mr. Ramirez quadriplegic. Even if an error is made in the heat of the moment, it’s of the utmost importance to rectify it as soon as possible. A simple slip-up can have life or death consequences in emergency medicine.

Unpredictability

A common theme across nearly all the experiences that interpreters shared was that of just how unpredictable interpreting in emergency medicine settings can be. You really do have to expect the unexpected, and not just complex or severe medical cases. Emergency medicine can be a rollercoaster: anywhere from a series of back-to-back life-threatening emergencies, to a monotonous string of non-emergencies, peppered with the occasional severe case.

Because of the unpredictable nature of interpreting in emergency medicine, it’s important to be flexible and adaptable. You’ve got to go with the flow! Patience is incredibly important, especially knowing when to be patient and when you need to be on your feet, which brings us to our next point.

Fast-Paced

As mentioned previously, emergency medicine isn’t always how it’s portrayed in the media… but sometimes it is! It can absolutely be chaotic and keep you on your toes. In these sorts of situations, time is absolutely of the essence, but time and time again, interpreters mentioned one issue that they encountered that made managing time-sensitive issues difficult: patients and family members rambling.

We’ve all experienced this while interpreting. Occasionally people for whom you are interpreting will continue talking non-stop, oftentimes not even allowing you a chance to interpret. In situations like these, medical simultaneous interpreting can be a huge help if even after multiple interjections, the person simply won’t stop speaking. But there will be instances in which the rambler will have to be cut short, and you may have to quickly switch to interpret for the person interjecting. It’s of the utmost importance to not take this personally, even if people get short with you!

Incoherent Patients

It’s not uncommon to encounter incoherent patients while interpreting in an emergency room or for a call to emergency services. The reasons for incoherence can vary. Someone may be panicking because their family member is unresponsive, a patient may be crying or upset because they’re in a tremendous amount of pain, and sometimes people may be under the influence (bonus points if all three of these occur in the same encounter). You really have to have a keen ear for listening and exercise good judgment when clarifying or asking for repetitions. But always remember: people will change what they say when asked to repeat!

The “Unconscious” Patient

An interesting ethical scenario came to light in the thread on U.S. Medical Interpreters, in which a patient (an accident victim) passed out while being worked on. The question is: do you interpret when it appears that a patient has lost consciousness? Some may be inclined to say yes, but I can speak from personal experience when I say that you’d be surprised what a patient can hear and remember when people think they’re not conscious. In my own brush with death upon being rushed to the emergency room in 2011, I remember a lot of things that people said around me (thinking I couldn’t hear) when I was thought to be unconscious. Even if a patient may forget something after the fact (i.e. twilight anesthesia), making sure they’re in the loop and understanding everything while things are happening is important. Just because eyes are closed doesn’t mean ears aren’t listening!

Keeping Your Cool

In what can certainly be a high-stress, fast-paced environment, it’s incredibly important to keep your cool and maintain composure. If a provider cuts off your interpretation, if a patient becomes irate, even if you could cut the tension in the room with a knife, you have to remain professional and focused. Some interpreters recommended allowing yourself to become emotionally detached from the situation at hand, or at the very least putting on a good poker face. Even if you’re interpreting over the phone, sometimes simply changing your expression to a more neutral one can help you stay “in the zone.” Other interpreters stressed the importance of selective attention and knowing what to pay attention to, while tuning out other stimuli that will only interfere with your interpretation.

One interpreter mentioned that their go-to trick is staring at their notepad that they use for note-taking while interpreting. This is actually one of my favorite tools in my toolbox when having to interpret for sensitive situations, especially if a patient won’t stop looking at you or staring you down. I will often utilize my notebook to block my view when suddenly being shown something that the patient may find embarrassing! If you feel as if you may be wearing your emotions on your face in a difficult situation, looking down at your notebook or even partially covering your face from behind a notebook can be a sort of emergency maneuver. From my observations in the field, I firmly believe note-taking is a tool that many of us in-person medical interpreters under-utilize, and this is just another way in which your notebook can be a valuable asset.

Safety

When interpreting in-person in emergency departments or in other medical situations that may dip into the realm of emergency medicine, it’s important to have good spatial awareness. I always joke with providers that the most difficult part of my job is staying out of their way, but more often than not, this can be a real hazard in emergency medicine. Staying out of the way of equipment and staff is a must, but can be difficult to manage. The last think you’d want is to impede someone’s access to the patient in a crucial moment. In addition, quite a few interpreters mentioned trip and slip hazards, such as discarded medical supplies and even the occasional accumulation of bodily fluid. These are all things to watch out for.

Whether you’re there in-person or interpreting remotely, always “leave the room” when the provider leaves. For video/phone interpretation, this may be dependent upon the policies and the procedures of the company you’re interpreting for, such as turning on “privacy mode” and/or informing the patient before a provider exits the room that you will not be able to see or hear them. Under no circumstances is it your responsibility to “keep an eye on” a patient, and you shouldn’t put yourself in a situation in which you may have important information disclosed to you outside the presence of a provider. Always keep liability in mind.

Furthermore, there is a reason many emergency departments have a security presence. You never know what sorts of situations may unfold there. One interpreter detailed an experience in which two people who had been in an altercation were sent to the same emergency room and were only a few beds away from each other. Anything can happen in the emergency room, so be sure to be aware of your surroundings.

Not for the Faint of Heart

All in all, interpreting for emergency medicine has its own unique challenges, and it leaves medical interpreters open to witnessing a lot of jarring things. Medical gore, sexual assault, abuse, violence, and death were all difficult situations interpreters mentioned. One interpreter mentioned having to rub Burt’s Bees lip balm under their nostrils to combat nausea and to help with any odors they may encounter! Another interpreter recounted the tragic story of having to deal with multiple deaths during a single shift in an emergency department.

Interpreter Trauma

These precarious life and death situations, as well as the high-stress nature of emergency medicine, combined with our unique role as a medical interpreter, all leave us particularly vulnerable to trauma. Whether it be trauma from witnessing someone fighting for their life, vicarious trauma from having to interpret for a victim of a vicious attack, or even being re-traumatized by witnessing something that hits too close to home, it’s incredibly important for us to remember that we need to take care of ourselves and our mental health when interpreting in emergency medicine.

Preparation is Key

When interpreting in any medical specialty, but especially when interpreting in emergency medicine, it’s especially important to be prepared. Preparation is key to not only interpret effectively, but also to expect the unexpected. Fortunately, Nanyi and I have put countless hours into preparing a wealth of practice materials for interpreting in emergency medicine in our latest emergency medicine study guide.

Each InterpreMed study guide includes:

• Vocabulary Exercises
  Our emergency medicine glossary contains over 23 pages of relevant terms, definitions, and their equivalents in other languages. It’s our biggest glossary yet! You’ll also have access to term comparisons, register grids, quizzes, flash cards, and more.
• Sight Translation Exercises
  Get feedback and check your work while practicing sight translation of documents related to this medical specialty.
• Simultaneous Interpretation Exercises
  We have medical simultaneous interpretation practice in the form of original scripts in Spanish and language-neutral English. They’re based on a variety of emergency medicine scenarios, all recorded at multiple different speeds for different skill levels.
• Note-taking Practice
  Need help coming up with symbols for concepts unique to emergency medicine? No problem! We have interpreting note-taking and symbol exercises for each medical specialty study guide, using Nanyi’s innovative and completely customizable note-taking system.
• Consecutive Interpretation Exercises
  We have original scripts in Spanish and language-neutral English centered on the field of emergency medicine. No need to find a partner to practice with; all of our scripts are available in audio format to interpret over. However, if you prefer to practice with other interpreters in your language pair, you can always attend one of our many live Zoom meetings for consecutive interpreting practice.

To gain access to all these wonderful medical interpreting practice materials we’ve put a lot of our time and expertise into, be sure to join InterpreMed today!