“I Don't Speak English Well.” Do Language Barriers Affect Automated External Defibrillator Use? A Randomized Simulation Study With Spanish-Speaking Laypeople

Introduction: Early defibrillation significantly improves survival following out-of-hospital cardiac arrest. Public access automated external defibrillators (AEDs) facilitate rapid shock delivery, enhancing survival rates and neurological outcomes. Language barriers may impede the effectiveness of these devices, particularly in multilingual environments. This study aimed to evaluate AED operation skills and time during a simulated cardiac arrest scenario, comparing native language instructions (Spanish: AEDnative) with foreign language instructions (English: AEDforeign). Materials and Methods: A randomized pilot study was conducted with 50 Spanish-speaking university students (42% female, median age: 21 years) with no prior AED training and a minimum B1 level of foreign language proficiency (English). Participants were randomly assigned to either the AEDnative or AEDforeign group. The simulated cardiac arrest scenario was performed on a mannequin using a multilingual AED trainer. AED performance, response times, language proficiency, and demographic data were recorded. Participant actions were video-recorded and analyzed using observational methodology. Results: Both groups achieved high completion rates (>70%) in most AED operation steps. However, the AEDnative group performed significantly better in two critical safety actions: ensuring no one touched the victim before shock (96% vs. 12%) and initiating CPR after shock delivery (83% vs. 12%). No differences were found in the time to pad placement, but the AEDforeign group delivered the shock significantly faster after pad placement (19 s vs. 33 s; P  = 0.016). Conclusions: AED use remains feasible, even in a nonnative language; however, foreign-language instructions may compromise performance safety and delay or omit postshock CPR initiation.