Language barrier in disaster planning, the Bellevue Hospital experience after Hurricane Irene

1. Language Barrier in Disaster Planning—the
Bellevue Hospital Center Experience
Ka Ming Ngai, MD, MPH1,2
Matthew McCarty2
, Silas Smith, MD2
Sch1
The Icahn School of Medicine at MOUNT SINAI, New York City, USA
2
Bellevue Hospital/NYU Langone Medical Center, New York City, USA
This work was partially supported by the National Heart Lung and Blood Institute,
Mount Sinai Emergency Medicine Research Career Development Program
5K12HL109005-02
Previous studies of
disaster responses
suggest that vulnerable
populations (such as
limited English proficiency
(LEP) patients) suffer
disproportionally. Effective
disaster plans must
account for socio-
economic and language
barriers. In addition, little is
known regarding the
characteristics of patients
visiting urban tertiary care
emergency departments,
which provide a unique
safety net for populations
more severely affected in
the aftermath of
catastrophes.
Identify the unique
challenges and needs of
the LEP population for
future hurricane related
and natural disaster
planning.
A prospective survey
containing 38 questions
including demographic,
vulnerability, and personal
disaster preparedness was
administered to a
convenience sample of
1,000 patients presenting to
the New York University
Langone Medical Center
(NYULMC) or Bellevue
Hospital Center (BHC)
Emergency Department in
New York City, New York,
between February and
October 2012. The study
was terminated prior to
completion due to the
mandatory evacuation and
closure of the two hospitals
upon Hurricane Sandy’s
landfall on October 29,
2012.
248 surveys were completed at NYULMC and 511
were completed at BHC. Of the 759 completed
surveys, 494 (65.1%) subjects knew their SLOSH
(Sea, Lake, and Overland Surges from Hurricanes)
Zone. 553 (72.9%) subjects were in NYC during
Hurricane Irene. 55 (10%) of the 553 subjects who
remained in NYC received mandatory evacuation
orders, only 28 (50.9%) of them evacuated (chi-
square=28.32, p<0.001).
The five most common non-English languages among
BHC patients are Spanish (57%), Mandarin Chinese
(17%), Cantonese Chinese (5.7%), Bengali (4.3%),
and Polish (4.1%). Of the 511 surveys conducted at
BHC, 41 (8.0%) LEP patients comprised a smaller
proportion of respondents than the expected 28.6%,
based on historic demographic data (chi-square
goodness of fit test with one degree of freedom =
105.95, p<0.001).
The challenges of investigating, understanding and
subsequently providing care for the LEP population
is highlighted in the non-representative proportion of
LEP patients in the survey respondents. This is
despite the survey being conducted in an
environment where LEP patients comprise a
significant proportion of the population sample and
where previous studies suggest that LEP patients
are most likely to seek care. Understanding the
unique characteristics of this vulnerable population
would provide policy makers the opportunity to more
effectively plan and respond during a disaster to
ensure continuity of healthcare to these
communities. However, as this study demonstrates,
significant challenges remain in elucidating the true
healthcare needs of LEP populations.
Background
Objective
Method
Results
Acknowledgements
Conclusions