By Devin Hanes, Central Zone ski patroller (devin.somers@gmail.com)
In our role as members of the Canadian Ski Patrol, we may need to treat a patient who is deaf or hard of hearing. In my day job, I am a DHH (deaf and hard of hearing) teacher, within the deaf community. I am hearing. I wear hearing aids, my main language of communication is English, and I identify as hearing. As such, I do not speak for the deaf community, I am attempting to assist my fellow patrollers to respectfully and efficiently treat skiers/snowboarders who are deaf or hard of hearing, based upon my experience as a hearing person that works within the deaf community.
Clarification on terms
A deaf person most likely communicates in ASL (American Sign Language), and most likely is profoundly deaf, meaning that they are unable to clearly hear spoken language. Deaf people may or may not wear assistive hearing devices – such as cochlear implants or hearing aids. If they are wearing a hearing device, and depending upon when they became deaf (birth, childhood, adult), they may be able to understand some spoken language, but most likely in a quiet, isolated environment (not a ski hill/chalet); and this is not the norm.
Within the DHH umbrella are also people who have cochlear implants or hearing aids. People with cochlear implants can only hear if the exterior portion of the implant is attached – should it become dislodge or fall off in an accident – they will not be able to hear. Usually, their language of communication is a spoken language, not ASL.
People with hearing aids can have a range of hearing loss from moderate to severe. Their language of communication is most likely a spoken language, not ASL. Again, should the hearing aid become dislodged, damaged, etc., in an incident, their ability to hear and understand spoken language will be lower.
Not all deaf people who communicate though ASL read and write English. Most do, but ASL is its own language, within its own language rules. Depending on where the person learned ASL, they may not have learned English. While most deaf people do read and write English, trying to write back and forth is often not the quickest or efficient way to communicate in our situation.
Things to keep in mind
- Face-to-face is even more important with DHH patients. DHH people rely heavily on facial expressions and body language for communication.
- In ASL, facial expressions and body-positioning are part of the grammar structure of the language, such as punctuation, possession, and tense. A smile communicates caring, eyebrows raised communicates a question (like a question mark).
- As we already know when doing our patient diagnostic, we are looking for facial responses when touching our patients patient assessment, in addition to asking if they feel pain. With DHH patients, they may not hear you ask if they feel pain when you are examining their clavicle, for example, but you will see the discomfort in their face.
- Thumbs up/down is a universal sign. You could point to a body part, their knee for example, with one hand, while alternating a “thumbs up/ thumbs down” with the other hand and raising the eyebrows (the question mark in ASL punctuation).
- It is much harder for a person with cochlear implants or hearing aids to hear/understand you when there are competing noises (chair lift, other voices, the patrol radio, wind, etc.).
- If in a chalet, if possible, try to take the patient to a separate room or space, as a room full of voices tends to be very echo-y for someone with a hearing device, and it is very challenging to differentiate voices.
- If outside, sheltered from the wind, and inside, out of the wind, as soon as possible. The microphone in a hearing aid or cochlear implant amplifies wind noise, often making it louder than voices.
- Should spinal immobilization be required, continue to maintain eye contact with the patient. If using your hands, or any apparatus such as a blanket roll, Ferno head immobilizer, vacuum bag, etc. cover the ears or implants; the patient will not be able to hear anything. A patroller maintaining eye contact and communicating with the patient will help their stress level.
- Continue to speak to the patient. Just because they are deaf or hard of hearing, does not mean they cannot communicate. Speak calmly and clearly, but do not yell. While Hollywood has greatly exaggerated the supposed ability of lip-reading, we can communicate a lot through our facial expressions. The patient may not be able to hear you, but they are a patient, a person, and need to be respected, included, and reassured.
- If the patient is skiing or riding with a hearing person that can interpret for you – great. Continue to speak directly to the patient, not the hearing companion. The hearing companion will interpret your message. The patient may sign to communicate back to their companion and look at their companion while doing so. Continue to look at the patient, not their companion, when their companion speaks to you.
- ASL is spoken with both hands, as well facial expressions and hand/body positioning (moving inward/outward/sideways, etc.) The patient’s injury may be severe enough that they are unable to effectively communicate (broken wrist, dislocated shoulder, etc.). This may mean that it takes a little longer to identify the injury; but watching for limitation in motion, as well a facial expression while the patient signs, can provide valuable information as to the nature and severity of any injuries.
Helpful resources
There are some live, 24/hour ASL-English video interpreting relay services/apps available. Many deaf people have one of these installed on their phone. SRV Canada VRS is the most popular one.
The Canadian Hearing Society also offers emergency ASL Interpreter Services. https://www.chs.ca/page/emergency-sign-language-interpreting-service
There are some amazing deaf skiers and snowboarders out on our hills. Just check out the Winter Deaf Olympics to see some incredible athletes.