Reprinted with permission of Journal of Emergency Medical Services, copyright July, 1996, JEMS Communications, PO Box 2789, Carlsbad, CA 92018.
Deaf Medics and the ADA
By, E. Scott Dunlap and Mike Grafton
In March 1996, JEMS explored how the American with Disabilities Act (ADA) affects EMS program admission policies. This month, we consider its application to EMS employment.
The ADA is a civil rights law enacted in 1990 that prohibits discrimination on the basis of disability. In other words, EMS services are required to consider disabled applicants for employment if the candidate "with or without reasonable accommodations, can perform the essential functions of the employment position." The key phrases are "essential functions" or the job and "reasonable accommodations."
Essential Job Functions
Essential job functions often are listed as part of a job description. They also may be determined through the use of a job analysis. In relations to the deaf, one must ask, Is hearing an essential job function?
Hearing affects EMS work on three levels: patient communication, patient assessment and radio communication.
Patient communication is often difficult even for hearing medics. For the deaf, lip reading offers an alternative to facilitate information exchange. Other deaf medics find that hearing aids provide enough amplification to allow them to hear most patients. Lip reading, of course, is not possible in the dark, nor in situations in which the patient and provider cannot be face-to-face. Verbal communication even with hearing medics is likely to be problematic in these cases as well.
Patient assessment is a related are of concern, as breathing sounds cannot be heard by most deaf medics. Stridor, wheezing, rales and rhonchi cannot be distinguished by many medics with profound hearing loss. Most deaf medics also cannot hear heart and bowel sounds. The question to be considered is whether these sounds are central to patient assessment, or whether they are peripheral. If they are peripheral, then the skill cannot be considered essential, and employment cannot be denied based on the disability. If they are central to patient assessment an employer must consider if "reasonable accommodations" could be made such as providing the deaf medic with an electronic stethoscope or having a partner perform these tasks. Can the deaf medic have an interpreter for this task, or can the task be reassigned to a hearing medic? An interpreter or job reassignment may be a viable option under the ADA.
While radio communication is admittedly difficult for the deaf, interviews with working medics show that accommodations can be made. A mobile date terminal, for example, allows the medic to sent vital patient information to a hospital or base station by way of a monitor and keyboard. Other medics memorize the sequence of radio procedure or work on specially created protocols.
Is the use of an Interpreter or other hearing adjuncts considered a "reasonable accommodation" or would these accommodations cause "undue hardship" on the employer? "Undue hardship" is defined as "a significant difficulty or expense" in relations to the "nature and cost of accommodation, overall financial resources of the facility [and] type of operation or operations of the covered entity."
Proving undue hardship depends on the organization involved. In situations in which an EMS system operates on a tight budget, it may be easy to prove excess expenditures to be an undue hardship on that system. Organizations that have larger, more flexible budges or are funded as a for-profit business may have the resources to make accommodations thus falling outside the bounds of "undue hardship."
Employment may be denied if "reasonable accommodations" is not practical and if hiring the disable person poses a risk to the health and safety of others or himself. Is a deaf medic a "direct threat" to the safety of himself and his colleagues?
The threat to safety must be shown as representing a significant risk of substantial harm. The risk must be identified and shown as current and not speculative. The assessment of the risk must be based on medical and other factual evidence, and it must be proven that the threat cannot be lessened or totally removed through "reasonable accommodation." If all of these conditions apply, a deaf applicant can be denied employment within ADA guidelines."