This month, I’ve had the privilege to sit down and interview an emergency call handler for the UK’s 999 ambulance service. This is some of the highest-stakes interpreting there is, with added distractions, time pressure and stress all adding to what is already a difficult task.
I interviewed B, who has worked as an emergency call handler for the ambulance service for two and a half years, saving lives, delivering babies, and communicating in some of the most tense situations imaginable. So, how does the presence of an interpreter change the dynamic of a call, and how does interpreter quality, training, and professionalism affect the outcome of a life-or-death scenario taking place in a different language? Let’s find out:
G (Georgia): So, how often do you work with interpreters when taking calls?
B (Call Handler): Probably once a shift at least. No, I’d say on average, once a shift. Definitely.
G: And how many calls would you usually take in a shift?
B: Thirty to fifty… about thirty to fifty?
G: Do you like taking interpreter calls?
B: I’d say… there are many added challenges when working with them, for sure.
G: Like what?
B: Well, the challenges with working with an interpreter are not necessarily the actual interpreter, but for me, it’s the patients. The issue is that you cannot control the call. In my line of work, you have to make sure that you are controlling the speed of the call, you’re controlling the answers. I mean, because we’re an emergency service, we want succinct, factual answers. When you’re relying on an interpreter, you are less in control at that point. So the interpreter is simply asking the questions that you want them to ask, but then having a conversation with the patient, whereas I would only want a yes or no answer. The translation leaves an opening for the patient to then not necessarily answer that question, but continue to talk about everything else that they want to talk about, whereas the call flow and procedure that we have to go through is set out. We use algorithms, we’re going to ask the questions that the computer needs to make an actual decision at the end of the call as to where we go with that patient. But essentially, a patient has free rein when we’re working with an interpreter. But yeah, I don’t have a problem working with interpreters themselves, the only issue is you have no control.
G: Anything else?
B: Well, I’ve had some interpreters get upset or frustrated at the patient, not about me or the service, but about the patient. And I have heard in the last two and a half years, maybe a couple of instances where an interpreter said they can’t continue, but that’s been because of the patient’s behaviour or because of the subject matter. So I understand it’s not easy to hear these things and stay calm, it’s not necessarily…normal.
G: That’s understandable. It sounds like the calls are much harder.
B: Yeah, the main issue is that the interpreting calls end up being so much longer because you are trying to gain control… So our rules are that we speak through the interpreter as if we were speaking to the patient. We have to ignore the fact that there is an interpreter. So I am speaking directly to the patient as a sign of respect. But we don’t always get that back in return. It’s not reciprocated from the patient’s point of view.
G: How do you mean?
B: Well, the patient will then talk to the interpreter and not me.
G: Oh, okay. You mean they try to start a conversation with the interpreter?
B: Yeah, and it’s frustrating for the interpreters as well. I get it. But obviously, for us, we have guidelines. We have set guidelines that each call should take no more than eight minutes, but interpreting calls can take anything up to 30, 40 minutes sometimes. That’s not ideal when you’ve got other emergency calls coming through. I think it all depends on their training whether they let it drag on.
G: What do you mean?
B: I think quite often we can tell when someone has been trained as an interpreter, rather than just having a second language. You can often tell the difference between the ones that have just got a second language because that’s how they’ve been raised, and the ones that have actually been educated in interpreting.
G: You notice a difference in quality?
B: You do absolutely notice a difference in quality, without a doubt. The ones that have actually had education and training on how to interpret are far more professional. Quite often, I’ve had untrained interpreters arguing with patients before now, or having conversations with the patients that don’t include me. That’s not professional at all.
G: What would you do in that scenario?
B: I mean, what do I do? I stop the conversation and I say, what is it you’re talking about? We need to move on here. Sometimes I feel like the interpreter doesn’t understand the gravity of the call either. And a patient will, especially when they’re speaking in their mother tongue, will want to have a much more in-depth conversation. That’s not appropriate for us. This is an emergency.
G: So, do you think there should be a requirement for being an interpreter in terms of training?
B: Without a doubt.
G: And what do you think interpreters could do in those situations to improve?
B: I think the most important thing for interpreters is to, in our service, ask the questions as we are presenting them, because they are presented in a way that is appropriate for our service in order to speed up the process. Don’t forget, they’re calling an emergency service. An emergency service is a life-threatening emergency call. Nine times out of 10, these calls aren’t life-threatening crises, but we still have to treat them like they are. So if they want to talk about something that happened two years ago, we’re not the appropriate service. That’s their GP, or that’s someone else. But at that point, I think it would be useful for an interpreter to actually have the knowledge to be able to say, That isn’t appropriate for this call.
G: Would that not make you feel like you were losing control more if the interpreter were making decisions?
B: Hmm.. Well, what might be useful is for the interpreter to actually come back to us after half a minute and just say, look, they’re talking about X, Y, and Z. And then at that point we can interrupt and say to the interpreter, Please tell them that it is simply yes or no answers that we require. Not about what happened last week or two years ago. That’s not what this is about. I can’t help them at that point. We need to know right now, why are you calling an ambulance? So it’s about the control of the call. And I think interpreters could make that a lot easier for themselves and for us if they involved us more.
G: What would you recommend for interpreters wanting to get better at emergency service call taking?
B: I mean, there is absolutely no reason why they can’t come in and actually observe; that’s something people do. So, observer shifts without a doubt. As long as they’ve signed an NDA and stuff, there’s no reason why they couldn’t actually understand how the service works more fully. I mean, we do get some interpreters who are very used to taking the calls for the emergency services. But yeah, I think more fully understanding what is expected of them in that particular instance.
G: So if you had an interpreter who picks up an emergency phone call, what would be your top tips?
B: Keep it brief and stick to the exact wording of the questions, without a doubt. Be more in control of the person that you’re interpreting for, so, of the call itself. Cut them off if they talk too long or ramble and feed back to me, the call handler, tell me everything they are saying so I can decide if it is relevant. Staying calm is also so important. Sometimes, callers will be quite distressed, so being able to focus and extract the necessary information is absolutely fundamental. The faster we get through the questions, the faster I can get an ambulance on the way. They shouldn’t be having private conversations that aren’t translated; that’s not good. It’s not professional.
G: Do you think there should be regulations around the interpreting industry and training?
B: Without a doubt. I imagine it’s very hard, you definitely need training to do it well. We can tell when someone isn’t trained.
G: Do you think that training should include responding to NHS 999 calls?
B: I mean, yeah, if they’re going to work for it, they should understand what it is that’s required of them, for sure. Yeah. We have to have a lot of training to take these calls; it’s not easy. It would be best if the NHS gave training.
In this interview, B touches on some fundamental aspects of interpreter ethics and role debates, mostly pointing to the lack of regulation in the interpreting industry.
A recurring theme is the occurrence of side conversations or non-direct translations. Whilst Codes of Professional Conduct differ between contexts and organisations, it is generally agreed that interpreters should maintain a neutral, “conduit” role, translating exactly what is said and not engaging in side discussions. B suggests that the call handlers (CH) are aware of this and are trained to “ignore” the interpreter, speaking directly to the caller. The interview indicates that some of those providing interpreting services, however, are unaware of this, and block the CH from the conversation by providing summary translations of conversations held in the other language. This contributes to what B calls “losing control” of the call, which is something echoed by the literature. Studies mention service providers feeling excluded or competing for the “power” in an interaction (Miller, et al., 2005, cited in Costa, 2022, p.3), and trying to exert their control to avoid inappropriate behaviours such as side conversations or assumedly poor interpretations (Becher and Wieling, 2015). This is exemplified by B interrupting the conversations and asking for direct interpretations. As the latter study highlights, stepping outside of role boundaries in this way is a sign that the interpreter has received no training in the field, as these are covered in basic interpreting training programs.
I would be preaching to the choir to underline the importance of basic interpreter training (and far beyond!), but B’s experience of this being seemingly the norm for the interpreters working on emergency calls is a worrying sign. B mentioned several behaviours that are clearly violations of professional codes of conduct, and it appears that, unfortunately, most of the interpreters that B has worked with have been unqualified or untrained. Whilst this blog is not the place to dive into the dysregulation of the interpreting profession in the UK, it is clear that service providers know the difference, and patients suffer the consequences when their emergency calls are taking so much longer. If you would like to know more about professionalisation and training in public service interpreting, I’d recommend checking out the National Register of Public Service Interpreters (NRPSI), whose aim is to prevent experiences like the ones detailed in today’s interview.
I’d also like to mention the often overlooked point made by B that interpreters have sometimes had to leave the call due to the distressing content. Anyone who has worked in on-demand telephone interpreting can attest to the fact that you never know what you’re going to get when picking up the phone and, whilst emergency call handlers have specific training to handle these high-stakes scenarios, as well as mental health support within their operating teams; interpreters almost always do not. This was discussed at the most recent CIOL Interpreter’s day conference in London; public service interpreters work in some truly harrowing contexts, and whilst all other professionals involved seem to have some form of industry resource for support, unless the agency provides it, interpreters are on their own. Brave audience members spoke at the conference of domestic violence, sexual assault, murder and all other manner of traumatising cases that have stayed with them for years. Even I can think of some myself.
Being able to handle stress, detach yourself from the scenario, and work through any negative emotions can be hugely beneficial when working in these settings, and many agencies will offer support for interpreters suffering vicarious trauma from their work. There are also interpreter-led groups for connecting with other linguists and sharing experiences, such as the Interpreter & Translator Peer Support Group on Facebook.
However, another way to deal with these situations is to remove some stress factors to feel more in control. A good way to do this is to be more prepared for the event. Whilst there is no way of knowing what will be happening on the other side of the phone when you pick it up, knowing what questions may be asked or how the call is managed can help reduce the surprise factor of each new question. B underlines the value of experience in working in these roles, and interestingly mentions that one might be able to observe at an emergency operations centre and learn how the system works. For those who take many emergency calls, this could be an invaluable, voluntary, career-enriching trip and may provide insight into how to best streamline calls for the CH. For those of us who aren’t quite ready to head down to their nearest EOC, however, I have included some links below from NHS websites explaining a little about how emergency calls are handled. Particularly, the booklet by SECAmb is interesting for its explanation of how calls are categorised by urgency. So, whilst the NHS has seemingly no official guidance for interpreters, we can do our bit to educate ourselves.
To conclude, B mentioned several behaviours to avoid when interpreting for the emergency services: Stalling or taking too long, engaging in side conversations, and not allowing the CH to manage the call. Whilst I imagine most of us would do that regardless, there were also some great tips given that may be of use for your next emergency phone call:
- It is an emergency, be brief and stick closely to what the CH says.
- Let the CH know if the patient’s answer is seemingly unrelated to the question, or if they begin to ramble; most questions require only a “yes” or “no” answer!
- Be professional with the patient, do not engage in side conversations, even if they speak to you (the interpreter) directly.
- Train and gain experience in the setting; the more calls you have taken, the more confident you will be!
- Don’t be afraid to engage in voluntary CPD, working to learn more about the services you interpret for.
- Stay calm! Remember, with your help, the situation is far more likely to have a happy outcome.
999 Emergency call information:
https://111.wales.nhs.uk/localservices/informationinotherlanguages/LSInfoOtherLanguagePage9/
http://www.secamb.nhs.uk/what-we-do/answering-999-calls/
References:
Becher, E. and Wieling, E. (2015) ‘The intersections of culture and power in clinician and interpreter relationships: A qualitative study’, Cultural Diversity and Ethnic Minority Psychology, 21(3), pp. 450-457. Available at: https://doi.org/10.1037/a0037535
Costa, B. (2022) ‘Interpreter-mediated CBT – A practical implementation guide for working with spoken language interpreters’, The Cognitive Behaviour Therapist, 15(1). Available at: https://doi.org/10.1017/S1754470X2200006X
Georgia Meakins 
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