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Disaster Medicine and Public
Health Preparedness
www.cambridge.org/dmp
Original Research
Cite this article: Al-Wathinani AM,
Al-Sudairi NF, Alhallaf MA, et al. Raising
awareness of hearing and communication
disorders among emergency medical services
students: are knowledge translation
workshops useful? Disaster Med Public Health
Prep. doi: https://doi.org/10.1017/
dmp.2022.120.
Keywords:
communication disorders; EMS; hearing loss;
students; workshops
Abbreviations:
EMS, Emergency Medical Services
Corresponding author:
Ahmed M. Al-Wathinani,
Email: ahmalotaibi@ksu.edu.sa.
© The Author(s), 2022. Published by Cambridge
University Press on behalf of Society for
Disaster Medicine and Public Health, Inc.
Raising Awareness of Hearing and
Communication Disorders Among Emergency
Medical Services Students: Are Knowledge
Translation Workshops Useful?
Ahmed M. Al-Wathinani1, Nora F. Al-Sudairi2, Mohammed A. Alhallaf1,
Nawaf A. Albaqami1, Abdullah A. Alghamdi1, Satu Turunen-Taheri3
,
4,
Amir Khorram-Manesh5
,
6, Mohammad Aljuaid7and Krzysztof Goniewicz8
1Department of Emergency Medical Services, Prince Sultan Bin Abdulaziz College Emergency Medical Services, King
Saud University, Saudi Arabia; 2Department of Rehabilitation-Speech and Hearing Program, College of Applied
Medical Sciences, King Saud University, Saudi Arabia; 3Department of CLINTEC, Division of Audiology, Karolinska
Institutet, Stockholm, Sweden; 4Department of Audiology and Neurotology, Karolinska University Hospital,
Stockholm, Sweden; 5Department of Surgey, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg
University, Sweden; 6Gothenburg Emergency Medical Research Group (GEMREG), Sahlgrenska Academy,
Gothenburg University, Sweden; 7Department of Health Administration College of Business Administration, King
Saud University, Saudi Arabia and 8Department of Security, Polish Air Force University, Dęblin, Poland
Abstract
Objective: In numerous countries, emergency medical services (EMS) students receive curricu-
lum training in effective patient–provider communication, but most of this training assumes
patients have intact communication capabilities, leading to a lack of preparedness to interact
with patients, who have communication disorders. In such cases, first responders could end up
delivering suboptimal care or possibly wrong procedures that could harm the disabled person.
Method: A quasi-experimental design (pretest–posttest) was used to assess the knowledge of
EMS students both before and after a translation workshop on how to deal with patients who
have hearing and communication disorders during emergencies. Comparisons between pretest
and posttest scores were examined using the Wilcoxon signed rank test. The level of knowledge
scores was compared before and after the workshop.
Results: The results indicated that EMS students’scores improved after the workshop. There
was a 0.763 increase in the average score of knowledge level. The results of this study show that
knowledge translation workshops are a useful intervention to enhance the level of knowledge
among EMS students when interacting with hearing and communication patients.
Conclusions: Our results show that such training workshops lead to better performance.
Communication is a vital element in a medical encounter between health care providers
and patients at all levels of health care but specifically in the prehospital arena. Insufficient
or lack of communication with a vulnerable population, who may suffer from various disabil-
ities, has a significant impact on the outcome of treatment or emergency management.
Although numerous publications emphasize the significance of careful attention to vulnerable
groups during emergency management, a few have valid and utilized guidelines and instructions
on how to handle this population.1,2In the context of emergencies, vulnerable groups may
include individuals with disabilities, pregnant women, children, elderly persons, ethnic minor-
ities, socioeconomically disadvantaged, underinsured, or those with certain medical conditions.
Members of vulnerable populations often have health conditions that are exacerbated by unnec-
essarily inadequate health care.1,2
One major group within the vulnerable populations is people with hearing loss. In 2019, an
estimated 1.57 billion people had hearing loss, of whom 403 million (26%) had moderate hear-
ing loss to deafness in the better ear.3Hearing loss affects people of all ages and can be caused by
many different factors. The 3 basic categories of hearing loss are sensorineural hearing loss
(most common type of hearing loss. It occurs when the inner ear nerves and hair cells are dam-
aged—perhaps due to age, noise damage, or something else), conductive hearing loss (typically,
the result of obstructions in the outer or middle ear—perhaps due to fluid, tumors, earwax, or
even ear formation), and mixed hearing loss (a combination of sensorineural and conductive
hearing loss).4–6
It is approximated that there are currently 1.16 million individuals with mild hearing loss,
more than 400 million people with moderate-to-severe hearing loss, and about 30 million people
with profound or complete hearing loss in both ears.7The World Health Organization8forecasts
that in the next 10 years, there will be 630 million people living with hearing disorders, with that
https://doi.org/10.1017/dmp.2022.120 Published online by Cambridge University Press
number expected to grow to over 900 million by the year 2050. All
grades of hearing loss are estimated to increase in 2030-2050,
whereas the largest number of people with moderate-to-complete
hearing loss is in the Western Pacific, Southeast Asia, and the
Americas.7A maximum rise of hearing loss is estimated in the
regions of Eastern Mediterranean and Africa.7
Hearing loss affects communication with others. Not being able
to hear what is going on around them or hear other people speak
can add to their confusion, and consequences can be social isola-
tion,7depression, and reduced quality of life.9Communication dif-
ficulties related to hearing loss is negatively associated with mental
health and psychosocial and physical functioning.10 The use of
protective devices like face masks by health care personnel as in
the current coronavirus disease (COVID-19) pandemic reduces
lip reading, used by people with hearing loss and worsens their
communication during emergencies.11
Although medical students in Saudi Arabia receive curriculum
training in effective patient–provider communication, most of this
training assumes patients have intact communication capabil-
ities, leading to a lack of preparedness among health care pro-
viders when interacting with patients with communication
disorders, including hearing impairment and speech stutter-
ing.12 Communication disorders are defined as an impairment
in the ability to receive, send, process, and comprehend concepts
or verbal, nonverbal, and graphic symbol systems.13
Emergency medical services (EMS) rely on well-established
protocols based on the most frequent cases encountered by EMS
providers in the field. This leads to the exclusion of special case
procedures concerning individuals with disabilities (sensory,
motor, or cognitive).14 In such cases, first responders might end
up delivering suboptimal care or possibly wrong procedures that
could harm the disabled person.14
Recent studies show that good clinician–patient communica-
tion has been associated with better health outcomes,15 better qual-
ity,16 and safer patient care.17
A systematic review quantified the extent to which hearing loss
is mentioned in studies of physician–patient communication. The
results showed that less than one-quarter of studies mentioned the
impacts of hearing loss on physician-patient communication, indi-
cating the lack of scientific research addressing the issue of the vul-
nerable population with disabling hearing and communication
disorders.18
Since the lack of knowledge about hearing and communication
disorders in emergencies worsens the quality of EMS service pro-
vision for this population,19,20 this study aimed to assess the level of
knowledge of EMS students both before and after a translation
workshop on how to deal with patients suffering from hearing
and communication disorders during medical emergencies.
Materials and Methods
Location of the Study
The study was conducted in the city of Riyadh in King Saud
University. Riyadh is the capital of Saudi Arabia and one of the
largest cities on the Arabian Peninsula with a population of 6.5 mil-
lion people living in an area of 3115 square kilometers.21 Riyadh
citizens represent one-sixth of the population of Saudi Arabia.
Design
A quasi-experimental design (pretest–posttest) was used. The
study was conducted on September 6, 2021. Comparisons between
pretest and posttest scores were examined to test the effectiveness
of the translation workshop.
Participants
Recruited was a sample of 57 EMS students from Prince Sultan
College for Emergency Medical Services in King Saud University
in Riyadh. To be eligible for the study, participants had to be cur-
rently in the final year of the paramedic program and not have had
knowledge translation lectures/workshops before. To verify the
research tool, we tested it on a sample of 5 EMS students, to check
whether respondents understood the test, and how respondents
understand it. This group was then excluded from the study and
their results were not included in the final analysis.
Workshop Settings
The workshop was conducted virtually via a web conferencing
platform, Zoom, due to the COVID-19 pandemic.
Procedures
Students were notified about the workshop via an announce-
ment on WhatsApp and invited to participate on a voluntary
basis. The workshop was held on a Zoom meeting by a commu-
nication and swallowing clinician from the Rehabilitation
Sciences Department at the College of Applied Medical
Sciences of King Saud University. Once an initial introduction
of the workshop was done, students were provided with an elec-
tronic information sheet and a written informed consent was
obtained from all subjects. Following to that, a pretest composed
of 10 multiple choice questions (see online Appendices 1,2)was
electronically handed to students before the initiation of train-
ing. The pretest’s main aim was to assess the participants’gen-
eral knowledge about the communication, swallowing, and
hearing disorders that are secondary to medical problems.
Therefore, the questions were designed to target all the disorders
mentioned during the workshop. The workshop began with an
introduction of the general knowledge about the communica-
tion and swallowing profession, the role of the communication
and swallowing clinicians, the audiology and balance profession
along with the role of the audiologists, and the disorders result-
ing in problems related to those professions, such as Down syn-
drome, hearing impairment, autism, attention deficiency and
hyperactivity disorder, spina bifida, aphasia and traumatic brain
injury, stuttering, and cognitive problems. Following that, steps,
tips, and instructions on how to deal with individuals with dis-
abilities and/or disorders (mentioned earlier) that negatively
affect the communication abilities and skills of those individuals
were explained, emphasized, and modeled. Once the workshop
completed, the posttest was administered in the same format
and way of the pretest. Effectiveness of workshop was assessed
by the pretest and posttest scores. Feedback was taken from the
students regarding their perception on introducing pre- and
post-in learning the salient concepts by administering a ques-
tionnaire (Appendix 1). Students received instruction in a tradi-
tional learning setting and format by faculty from the
Department of Emergency Medical Services who had not par-
ticipated in the interdisciplinary teaching workshop. The infor-
mation sheet for participants was attached as Appendix 2.
Written informed consent was obtained from all subjects.
2 AM Al-Wathinani et al.
https://doi.org/10.1017/dmp.2022.120 Published online by Cambridge University Press
Data Analysis
All data analyses were conducted using Python 3.8 for Mac
https://www.python.org/downloads/macos/. Continuous data were
screened for outliers, and participants with a missing pretest or
posttest were excluded from further analysis. Descriptive statistics
are reported for demographic characteristics and pretest and postt-
est scores. Comparisons between pretest and posttest scores were
examined using the Wilcoxon signed rank test. Statistical signifi-
cance was set at P<0.05.
Ethics
Ethics approval was granted through the King Saud University
Institutional Review Board (KSU-IRB 017E).
Results
Univariate Analysis
According to Table 1, paramedic students’average knowledge on
how to communicate and provide emergency care to the hearing
and communication disorders population before being given the
workshop was 4.98. The lowest was 1, and the highest was 8. The
median value was 5, with a standard deviation of 1.789. The aver-
age after being in the workshop was 5.74. The lowest was 1, and the
highest was 9. The median value was 5, with a standard deviation
of 2.083. There was a 0.763 increase in the average knowledge
level score.
Normality Test
The data normality test was conducted using Shapiro–Wilk with
computer software (Python 3.8).
According to Table 2, based on the normality test data using
Shapiro–Wilk, pretest and posttest scores have a significant P-value,
which means each variable violates the assumption of normality.
Because the data are not normally distributed, the Wilcoxon test
was used to analyze the data.22
Wilcoxon Test
The workshop improved the level of knowledge significantly
among the EMS students. Table 3 shows the results of the
Wilcoxon t-test. It can be concluded that there is an influence of
hearing and communication disorders workshops on the level of
knowledge of EMS students about such disorders and how to deal
with the population of hearing and communication disorders dur-
ing emergencies at Prince Sultan bin Abdulaziz College for
Emergency Medical Services.
The level of knowledge scores was compared before and after
the hearing and communication disorders awareness workshop.
EMS students’scores before the workshop were lower (M=4.98
±1.78) compared with EMS students’scores after the workshop
(M=5.74 ±2.08). A Wilcoxon signed rank test indicated that this
difference was statistically significant: z=−3.51726 and P<0.001.
Discussion
The primary objective of this quasi-experimental study was to
assess a group of final-year EMS students’knowledge about commu-
nicating with patients with hearing and communication disorders
both before and after receiving a knowledge translation workshop.
The results showed that after participating in the workshop, Saudi
EMS students demonstrated a significant improvement in knowl-
edge to enhance their ability in communicating with this group
of vulnerable population, whose conditions negatively impact their
hearing and communication abilities and skills, such as Down syn-
drome, hearing impairment, autism, attention deficiency and hyper-
activity disorder, spina bifida, aphasia and traumatic brain injury,
stuttering, and cognitive problems.
The knowledge translation workshop in this study proved to be
beneficial to the EMS students in filling the gap in their education
by providing information related to communicating with individuals
experiencing hearing and/or communication difficulties. The results
of this study are promising and concordant with earlier reports. For
instance, EMS providers reported that educational training helped
them effectively communicate when encountering hearing loss
patients.23 Similarly, training medical students to interact with com-
munication disorder patients was shown to promote patient-pro-
vider communication, thus enhancing provided care.11,24–26
This study, in addition, sheds light on patient–provider com-
munication barriers in the prehospital setting, where time and
rapid intervention are critical matters. Patient–provider communi-
cation in the prehospital setting is inherently challenging due to
reasons associated with the prehospital environment, such as insta-
bility of the scene, weather conditions, crowded scenes, and inter-
acting with patients having special needs in hectic times.27–29 EMS
providers are required to act promptly, within a short time frame,
to determine the nature of the illness, medical history, ask specific
questions related to the chief complaint, and intervene properly
based on the gathered information.27 The lack of or ineffective
EMS provider–patient communication in unstable conditions
and limited time can lead to unwanted outcomes as the possibility
of medical errors or delayed intervention increases.30–32 Poor com-
munication with deaf patients can interfere with the quality of pro-
vided care and threaten patients’safety.33,34
Table 1. Distribution of pretest and posttest knowledge of respondents
Knowledge NMin Max Mean SD Median
Pretest 55 1 8 4.981818 1.789795 5
Posttest 55 1 9 5.745455 2.083606 6
Table 2. Normality test results of paramedic students’knowledge level about
hearing and communication disorders
Shapiro-Wilk
Difference Statistics Significance
Pretest 0.93769 0.00680
Posttest 0.95099 0.02546
Table 3. The effect of workshops on paramedic students ’knowledge level about
hearing and communication disorders at Prince Sultan bin Abdulaziz College for
Emergency Medical Services in 2021
NMedian
Sum of ranks
Z-score P-value
Knowledge before
intervention
55 5
154.0 −3.51726 0.001
Knowledge after
intervention
55 6
Disaster Medicine and Public Health Preparedness 3
https://doi.org/10.1017/dmp.2022.120 Published online by Cambridge University Press
The global number of people with hearing loss will increase
parallel with an increasing population age.7Consequently, health
care providers are faced with greater demands in terms of commu-
nicating with hearing impaired people, as demonstrated by the
challenges caused by using face masks due to the COVID-19 pan-
demic,35,36 preventing lip reading, which is used to communicate
by this population. Such difficulties may be reduced by using trans-
parent masks. Other measures and in-depth knowledge about the
consequences of hearing loss are required to provide correct infor-
mation in emergency contingency plans.37
Patients with disabilities reserve the right to receive the same
quality of health care provided to patients without disabilities.38
EMS program directors and policy-makers can benefit from the
present study results to develop programs and workshops to
increase EMS providers’knowledge, ability, and confidence when
interacting with patients who have a compromised ability to com-
municate. Although training workshops seem helpful, it is only 1
step in the right direction. Further refinement is needed to ensure
that the best quality of health care is offered to deaf patients in the
prehospital environment and to save valuable time for patients and
EMS providers.39 For instance, standard question sheets could be
developed to guide EMS providers when dealing with patients with
hearing loss, captioned videos, and awareness programs to educate
deaf patients on interacting effectively with EMS providers. Such
procedures can help ensure communication efficiency and
patients’safety. Still, they need to be tested scientifically to prove
their effectiveness.
Limitations
Limitations of this study include the small sample size of EMS stu-
dents who were recruited; moreover, the sample was only males
because the program is for males only.
Pretests and posttests may not be the best tools to use for every
type of training but still offer a good overview of the tested group’s
advancement. It measures growth or value-added; helps identify
student knowledge, cognitive learning, and skills, although less
so for measuring values; can be easily scored; and relatively can
be easily analyzed using statistical procedures. Wishing to under-
stand what knowledge can be credited to the training itself, using a
pretest and posttest methodology is essential. It has, however, some
disadvantages. It offers little useful information about the student’s
present knowledge and the subject of the program. There is also a
risk that it should be so basic that any additional learning could be
seen as “growth”or value added.
Despite these limitations, the findings from this study provide a
rich source of data on this topic among the Saudi population. Due
to the essence of the problem, further research must be conducted
with a larger and diverse sample. Further research could explore
and involve assessing EMS students during an emergency and as
they interact with various patients with different hearing and com-
munication disorders.
Conclusions
The contribution to the growing literature is novel, in regard to
educating health care providers on the essential skills to deal with
individuals with hearing and communication disorders. Our
results show that such training workshops lead to a better perfor-
mance. Communication is a vital element in a medical encounter
between health care providers and patients at all levels of health
care but specifically in the prehospital arena.40–42 Insufficient or
lack of communication with a vulnerable population, who may suf-
fer from various disabilities, has a significant impacton the outcome
of treatment or emergency management.43–45 This is the first paper
to outline EMS provider-patient communication barriers in the pre-
hospital environment in Saudi Arabia. Knowledge translation work-
shops may fill a gap in EMS students’education by offering the
necessary information about how to interact with hearing and com-
munication disabled patients in emergencies.
Supplementary material. To view supplementary material for this article,
please visit https://doi.org/10.1017/dmp.2022.120
Acknowledgments. The authors would like to extend their appreciation to
King Saud University for funding this work through the Researcher
Supporting Project (RSP2022R481), King Saud University, Riyadh, Saudi
Arabia.
Author contributions. AAW provided the main framework, identified pri-
mary materials, and collaborated on the writing of the paper. KG identified
appropriate references and collaborated on the writing of the paper. The
remaining authors collaborated on writing and editing paper. All authors have
read and approved the manuscript.
Availability of data. Data sets used and analyzed during the current study are
available from the corresponding author on a reasonable request.
Funding statement. The author (MA) received a fund from the Researcher
Supporting Project number (RSP2022R481), King Saud University, Riyadh,
Saudi Arabia, to support the publication of this article. The funding agency
had no role in designing the study, conducting the analysis, interpreting the
data, or writing the manuscript.
Conflict(s) of interest. AK is Deputy Editor (DE) at this journal and KG is
Associate Editor (AE) but does not participate in any level of the evaluation
process. The remaining authors declare no conflicts of interest.
Ethical standards. Ethics approval was granted through the King Saud
University Institutional Review Board (KSU-IRB 017E).
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