In emergency care settings, there is a crucial need for automated translation tools. We focus here on the BabelDr system, a speech-enabled fixed-phrase translator used to improve communication in emergency settings between doctors and allophone patients. The aim of the chapter is two-fold. First, we will assess if a bidirectional version of the phraselator allowing patients to answer doctors’ questions by selecting pictures from open-source databases will improve user satisfaction. Second, we wish to evaluate pictograph usability in this context. Our hypotheses are that images will in fact help to improve patient satisfaction and that multiple factors influence pictograph usability. Factors of interest include not only the comprehensibility of the pictographs per se, but also how the images are presented to the user with respect to their number and ordering. We showed that most respondents prefer to use the interface with pictographs and that multiple factors influence participants’ ability to find a pictograph based on a written form, but that the comprehensibility of the individual pictographs is probably the most important.