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In medical emergencies, phoning the ambulance service constitutes a high-stakes interaction. Call-takers rely on callers to provide information about the patient so they can promptly recognise the medical problem and take swift action to remedy it. When a language barrier exists between the call-taker and caller, this can add a further challenge, given that third-party interpreters are rarely engaged, especially for time-critical conditions such as cardiac arrest. Research in cardiac arrest calls has found that language barrier calls experience longer delays to critical points such as recognition of cardiac arrest and commencement of resuscitation. This study aimed to understand, in the absence of interpreters, the interactional challenges that emerged in language barrier emergency calls, as parties worked to communicate the nature of the medical problem. Based on a critical conversation analysis approach, we conducted fine-grained analysis of interactions in audio recordings and transcripts of 33 language barrier calls from an Australian ambulance service in 2019. We found that call takers regularly failed to recognise that the patient had a cardiac arrest. Non-fluent-English callers often provided vital information about the patient, which could have led to cardiac arrest recognition by the call-taker, however such information was missed if it was delivered in an unsolicited or atypical way. Opportunities to recognise cardiac arrest were also missed when call-takers did not probe further after such information was provided or did not provide enough interactional space for callers to complete their turns. We found that the main reason for delays in recognising cardiac arrest was a lack of mutual understanding, which most of the time seemed to remain unbeknownst to participants. The study makes recommendations for emergency medical dispatch centres to cater for language barrier calls, with the goal of fostering a more inclusive prehospital care system and addressing health disparities for non-fluent-English speakers., Competing Interests: Conflicts of interest AW is employed by St John Western Australia (SJ-WA); JF and SB hold adjunct appointments with SJ-WA and JF receives research project funding from SJ-WA., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)