Paramedics can point to a question such as "Does it hurt here?" and patients can then indicate "Yes" or "No".

The multi-lingual emergency phrasebook called Positively Diverse flips open at the back to reveal a short message in 31 different languages.

Once the crew has identified the patient's preferred language, they can then go to the relevant section and point to up to 21 clinical questions.

Sign language

The English translation for their own reference is alongside.

Avon Ambulance Service NHS Trust says the book, part of a national initiative by the Ambulance Service Association, will help its staff meet the needs of the increasing black and minority ethnic communities.

It also has a section on the use of sign language.

The phrasebook will complement an existing scheme called the Language Line, which puts ambulance staff in touch with a pool of interpreters fluent in a range of languages.

Paramedic Neville Levy, a member of the Trust's black and minority ethnic staff support group, said: "The multi-lingual phrasebook is an excellent initiative which will enable us to communicate with non-English speaking patients.

Preliminary diagnosis

"Every day ambulance personnel respond to emergency calls involving patients for whom English may not be their first language.

"We will ask questions to make a preliminary diagnosis and then provide the appropriate care for that patient.

"This is a positive step forward for the trust which will both modernise the service and improve the patients' experience."

The languages in the phrasebook are Albanian, Amharic, Arabic, Bengali, Chinese, Czech, Farsi, French, German, Greek, Gujarati, Hindi, Hungarian, Italian, Japanese, Kurdish, Polish, Portuguese, Punjabi, Romanian, Russian, Serbo-Croatian, Somali, Spanish, Swahili, Tamil, Tigrinya, Turkish, Urdu, Vietnamese and Welsh.

The trust said though not strictly necessary, Welsh had been included as it did not wish to leave out a major language.