Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Paramedic Care:

Principles & Practice

Volume 2

Patient Assessment

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Chapter 5

Communications

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Topics

Basic Communication Model

Verbal Communication

Written Communication

The EMS Response

Communication Technology

Reporting Procedures

Federal Communications Commission (FCC)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Introduction

All aspects of prehospital care require

effective, efficient communications.

Communication is the key link in the chain

that results in the best possible patient

outcome.

Effective communication optimizes patient

care.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication

The process of exchanging information

between individuals

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Basic Communication Model

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Basic Communication Model

Sender has an idea or message

Sender encodes message

Sender sends message

Receiver receives message

Receiver decodes message

Receiver gives feedback to sender

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Verbal Communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Verbal Communication

Factors that enhance or impede effective

communication may be either:

– Semantic (the meaning of words)

– Technical (communications hardware)

Communication requires a mutual language.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Verbal Communication

“10” Codes

– Many departments

use plain English to

avoid confusion.

Receiver must be

able to decode

message

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Verbal Communication

Technical considerations – Network must consist of reliable equipment

designed to afford clear communication among all agencies within the system.

– Developing hardware (equipment and network) and software (language) will be essential to improving emergency communications.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Verbal Communications

Technical Considerations

Use of repeaters

Band

Frequency

– UHF

Less susceptible to

interference

– VHF

Better over varied

terrain

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Written Communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Written Communication

An important aspect of EMS

communications.

A prehospital care report (PCR) is a written

record of an EMS response.

– Be objective

– Write legibly

– Thoroughly document

– Use correct terminology

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

A PCR is a legal

document,

admissible

in court.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The EMS Response

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The EMS Response

Detection and citizen access

Call-taking and emergency response

Pre-arrival instructions

Call coordination and incident

recording

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

The EMS Response

Discussion with medical direction physician

Transfer communications

Back in service, ready for next call

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Detection and Citizen Response

Someone must detect

the problem and

summon EMS.

Public safety

answering point

(PSAP)

Enhanced 911 system

– ANI

– ALI

© On Scene Photography/Michael Grill

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Detection and Citizen

Response NHTSA sponsored Automatic Collision Notification (ACN) – Collision sensors connected to in-vehicle systems

automatically send a wireless alert signal to response centers.

Technology for transmission and acceptance of ANI and ALI from wireless phones – Triangulation of a wireless signal

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Call Taking and

Emergency Response

Emergency Medical

Dispatcher (EMD)

Priority dispatching

– Questions to elicit

essential

information about

the chief complaint

– Only the necessary

resources are sent © Jeff Forster

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Prearrival Instructions

Prearrival

instructions

complement the

call screening

process.

Provide vital

information to the

patient and

responding

personnel.

© Mark C. Ide

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Call Coordination and

Incident Recording

The emergency medical dispatcher’s main

duties are support and coordination.

He or she will provide additional units,

record call information, and may facilitate

communications with other entities

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Discussion With

Medical Direction

Communication with medical direction to

discuss the case

– Further orders for interventions

May include radio, telephone, and cellular

phone

Provide clear, concise, controlled reports

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Transfer Communications

Formal verbal briefing

– Emergency physician or nurse

Should include:

– Patient’s vital information

– Chief complaint

– History and physical exam findings

– Treatments rendered

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Technology

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Technology

EMS systems use all of today’s

various communication technologies.

These include traditional forms of radio

communication as well as innovations in

radio technology and other media.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Technology

Simplex technology

Transmits and

receives on same

frequency

Allows one-way

communication

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Duplex transmissions allow

simultaneous two-way

communications.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Multiplex systems can transmit

voice and data at the

same time.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Technology

Trunking system

– 800-MHz pooled frequency

Signal is routed to first available frequency

Allows assignment of “groups”

– Responders working the same incident

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Communication Technology

Digital Communications Technology translates, or encodes, sounds

into digital code for broadcast.

– Faster, more accurate transmission

Eases overcrowding of frequencies.

Secures communications.

– Requires decoder

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Cellular Phones

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Cellular Phones

Communication less formal, promotes discussion, and reduces on-line time

Widely available and highly reliable

Digitized transmission – Allows voice and data

Disadvantages – Congestion

– Geography

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Other Digital Technologies

Facsimile

Computers

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

New Technology

Touch pads

Diagnostic technology

– 12-lead, pulse oximetry, capnography

Legal guidelines still apply to electronic

communications

– Libel and slander concerns

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Reporting Procedures

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Reporting Procedures

One of your most important skills will be

gathering essential patient information,

organizing it, and relaying it to the medical

direction physician.

Verbal communications give hospital staff

information to prepare for the patient.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Standard Reporting Format

Identification of unit and provider

Description of scene

Patient’s age, sex, and approximate weight

Patient’s chief complaint

Brief pertinent history (OPQRST)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Standard Reporting Format

Pertinent past medical history (SAMPLE)

Pertinent physical exam findings

Treatment given so far/request for orders

Estimated time of arrival at the hospital

Other pertinent information

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Being concise,

descriptive, and

thorough are

hallmarks of a

professional.

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

General Radio Procedures

Listen to channel

first

Press transmit for

at least one second

Speak 2–3” from

the microphone

Speak slowly and

clearly

Normal pitch

Be brief

Avoid 10-codes

Don’t waste airtime

Protect the

patient’s privacy

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

General Radio Procedures

Proper

identification

Do not use slang or

profanity

Standard

transmitting formats

Be concise

Echo procedure

Always write

addresses, orders,

and other important

communications

Obtain feedback

that transmission

was received

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Elements of Trauma

Patient Report Paramedic identification

Patient identification

Mechanism of injury

Injuries

Plan

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Federal Communications

Commission (FCC)

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Federal Communications

Commission (FCC) The agency that controls all

nongovernmental communications in

the United States

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Federal Communications

Commission (FCC) Licenses and allocates radio

frequencies

Establishes technical standards

Monitors frequencies to assure

appropriate usage

Spot checks base stations and dispatch

centers for appropriate licenses and records

Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.

© 2009 by Pearson Education, Inc. Upper Saddle River, NJ

Summary

Basic Communication Model

Verbal Communication

Written Communication

The EMS Response

Communication Technology

Reporting Procedures

Federal Communications Commission (FCC)