Impact of Language Barriers on Out-of-Hospital Cardiac Arrest Recognition and Response

Out-of-hospital cardiac arrest (OHCA) causes nearly 350,000 deaths annually in the U.S., with survival largely depending on the timely recognition of cardiac arrest and the initiation of bystander CPR by emergency dispatchers. However, English-centric dispatch systems create barriers for individuals with limited English proficiency, potentially delaying critical responses. This study aims to synthesize research on how language differences impact OHCA recognition and CPR initiation in emergency dispatch settings. We hypothesize that language barriers cause significant delays. PubMed, Scopus, and Web of Science databases were used to identify relevant studies, using search terms like "language barriers," "cardiac arrest," and "CPR." Inclusion criteria covered studies published from January 2011 to October 2024 that reported average times for OHCA recognition and CPR initiation in limited English proficient (LEP) and English proficient (EP) cases. The review synthesized three studies, totaling 4,519 calls – 3.6% from LEP callers and 96.4% from EP callers. Significant delays in OHCA recognition and CPR initiation within the LEP group were found, with delays ranging from 17.7 to 73.2 seconds for recognition and 44 to 116.5 seconds for CPR initiation. One study found that 16.5% of EP cases survived to hospital discharge compared to 8.8% of LEP cases. This review demonstrates how LEP delays OHCA recognition and bystander CPR initiation during emergency dispatch. Further research with larger LEP sample sizes is needed to establish stronger correlations. As linguistic diversity continues to grow, EMS dispatch systems must be reassessed to reduce disparities.