Language barriers and limited language proficiency in patients in emergency care: a scoping review

Background

Language barriers in prehospital emergency medical services (EMS) pose significant risks to patient safety, timeliness of care and health equity in diverse health systems. This study aims to map evidence on communication barriers and identify system-level responses for patients with limited language proficiency in EMS.

Methods

A scoping review was conducted following Arksey and O’Malley’s framework and PRISMA-ScR guidelines. Five databases (Web of Science, Embase, CINAHL, Nursing & Allied Health, PsycINFO) were searched in March 2025, with no restrictions on publication date. Studies published in English and examining patient-provider communication in prehospital EMS settings involving LPP populations were included.

Results

Of 1,438 records, 21 studies from 11 countries were included, covering over 2.3 million encounters. Language barriers were consistently associated with delays in dispatch and care (n = 18), reduced diagnostic accuracy (n = 12), and intervention strategies (n = 9). Communication challenges were most evident during emergency calls and on-scene care, leading to misinterpretation of symptoms and incomplete patient histories. Informal interpretation (e.g., family members) was commonly used despite concerns about accuracy and confidentiality. Interventions included telephone interpretation, simplified dispatch protocols, multilingual visual tools, and cultural competence training, although most were small-scale with limited evaluation.

Conclusions

Language barriers in EMS represent a structural gap affecting dispatch accuracy, clinical decision-making, and continuity of care. Current practices rely on informal solutions, reflecting a lack of standardized protocols and system-level preparedness. Strengthening EMS requires interpreter integration, simplified communication protocols, and inclusion of language support in emergency planning. Embedding language equity in health system policies is essential to ensure safe, and timely emergency care.

Key messages

• Language barriers in prehospital Emergency Medical Services are a consistent and under-recognized risk to patient safety, affecting dispatch, assessment, and clinical decision-making.

• Current Emergency Medical Services responses rely heavily on informal interpretation, highlighting the need for standardized, system-level communication solutions.