<p>People who prefer a language other than English (LOTE) face barriers across the healthcare system, including hospital emergency departments (EDs). A thematic analysis was employed to gather patient and caregiver perspectives on language access in two St. Louis EDs. Fifteen semi-structured interviews were conducted with Spanish-speaking patients and caregivers, and transcripts were analyzed to identify common perceptions of language barriers. Participants reported gaps in video remote interpretation services at security, triage, and during short interactions in the exam room. They also felt obligated to learn English and worried that other patients and staff members judged them for their language preferences. Language-concordant nurses gave patients and caregivers a sense of security through clear communication and advocacy. Participants recommended that the study EDs hire additional bilingual staff members and increase access to video remote interpreters. To reduce health disparities for people who prefer a LOTE, it is essential for emergency departments to gather community perspectives and invest in language service improvements.</p>