1 Car 54 Where Are You?

2 Types of Radios Types of Communications Helpful Hints (to Stay Out of Trouble With Dispatch)

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5 When in doubt of Treatment - Call Rampart

6 Communications Communication is an essential piece of any EMS system and a skill that must be mastered by the EMT. Fig

7 Communications System ► Complex Network  People  Facilities  Equipment ► Functions  Receive calls for assistance from public  Dispatch and coordinate response  Provide for communication between scene and medical facility

8 Communications — Equipment ► Base station ► Mobile two-way radios ► Portable handheld radios ► Repeaters

9 Communications — Equipment ► Base Station  Located at a fixed site such as a hospital or dispatch center  Usually runs off community electrical power, not off a battery  Transmits at a much higher rate than portables  Often has an alternate power source (generator) Fig

10 Communications — Equipment (cont.) ► Mobile Two-Way Radio  Mounted in a vehicle  Operates off of vehicle power  More powerful than portable radios  Broadcasts with much less power than base station  Normal range is less than 20 miles at strength of 50 watts Fig

11 Communications — Equipment (cont.) ► Portable Handheld Radio  Can be easily carried or worn  Operates from a small battery  Transmits power generally under 5 watts  Has a limited range  Typically used for short-range communication  Communication can take place directly from the patient’s side  Gives the EMT the freedom to communicate without being confined to the vehicle Fig

12 Communications — Equipment (cont.) Repeaters  Allow radio broadcasts to cover larger distances and avoid significant obstacles  Unit receives a signal from another unit and rebroadcasts it, boosting strength  Signal can be sent by: ► Radio ► Microwave ► Telephone Fig

13 Communications — Radio Frequencies VHF low band  32 to 50 MHz frequencies  Most susceptible to interference  Able to curve and follow the shape of earth or other obstacles  Allow communication over long distances

14 Communications — Radio Frequencies (cont.) VHF high band  150 to 174 MHz frequencies  Waves travel in a straight line  Does not bend to follow the curve of the earth or around obstacles  Limited to line of site  Less susceptible to interference

15 Communications — Radio Frequencies (cont.) UHF  450 to 470 MHz frequencies  Almost interference free  Only travel short distances  Limited to line of site  Used most often for telemetry

16 Equipment — Radio Frequencies Telemetry allows the transmission of electrical signals such as electrocardiograms between the scene and the hospital. Fig

17 Equipment — Digital Radio Equipment 800 MHz Frequencies  Clean and interference free  Trunking allows simultaneous communication between different agencies or to same unit  Radio selects available channels as necessary  Computer controlled

18 Equipment — 800 MHz Frequencies Advantages ► Highly reliable ► Error free Disadvantages ► Costly ► Has the shortest range ► Requires numerous repeaters

19 Equipment — Cellular Telephone Combines radio frequencies above 800 MHz range with telephone lines Advantages  Cost effective  Readily available Disadvantages  No protected channels or frequencies  EMS must compete with general public for access  May be useless in disaster or during heavy usage periods

20 Equipment — Automatic Vehicle Locator (AVL) ► A way to determine the ambulance closest to the medical emergency ► A device forwards ambulance and emergency response vehicle locations to communications center to ensure faster response ► Information is sent by 800 MHz trunking system

21 Equipment — Automatic Crash Notification (ACN) ► New technology ► Device sends data via wireless telecommunications ► Device contacts EMS providers and notifies responders in less than 1 minute ► Can direct EMS providers to exact location of vehicular crash ► Crash sensor instantly measures impact and translates rating of injury probability ► EMT can use data to determine need for additional resources before arrival

22 Equipment — Automatic Crash Notification (ACN) (cont.) ► Medical records of occupants can be sent to EMT or ED  Medications  Drug reactions  Allergies  Blood type ► Devised to save time during an emergency

23 Communications System Personnel ► Dispatchers ► Hospital staff ► Field personnel  EMT  Paramedic  Fire personnel  Others

24 Public Access Influenced by several factors ► Capability of local telephone company equipment ► Public service budgets ► Formal politics between differing jurisdictions ► Competition with single political jurisdictions over control of public access

25 Public Access ► Seven-digit access number ► 911 ► Enhanced 911

26 Public Access 911 has become the standard number for public access to emergency services in the United States. Although not yet in place in every community, this number will eventually be in place everywhere. Fig

27 Emergency Medical Dispatch — General Principles ► Involves the dispatcher in the delivery of emergency medical care ► Carefully designed questions and directions provide instructions to callers until EMS arrives ► Not universally available ► Some dispatchers make decisions about the priority or type of required EMS response

28 Emergency Medical Dispatch — Dispatch Methods ► Occur when the dispatch center receives a request for EMS assistance ► Notification occurs in a variety of ways  Fixed locations (telephone lines, teletype transmission, computers)  Out of base (radio or voice pager) ► System status management method  Deploys EMS resources (people and vehicles) in a dynamic pattern based on anticipated call volume and location  Vehicles are constantly moving to provide maximum coverage with the least amount of resource expended

29 Emergency Medical Dispatch — En Route Communication ► As the unit responds, notify the dispatch center that you are en route. ► While en route to the scene, dispatch may provide additional information obtained from the caller or others at the scene.  Allows responding personnel to prepare medically and mentally ► On arrival at the scene, notify dispatch.

30 General Guidelines for Radio Communication ► Think ► Transmit ► Transfer ► Obtain ► Interpret

31 General Guidelines for Radio Communication ► Make sure the radio is turned on and properly adjusted. ► Listen to the frequency to make sure there is no other traffic before transmitting. ► Think about the message before the transmit button is pushed; assemble notes for patient report. ► Press the push-to-talk switch on the microphone; wait 1 second before speaking.

32 General Guidelines for Radio Communication (cont.) ► Use plain English; the use of codes in modern systems is uncommon. ► Keep transmissions brief; avoid the use of unnecessary phrases such as “thank you” or “please.” ► Remember that every word is being transmitted and can be picked up by anyone with a scanner (including the general public and news media). ► Protect the patient’s privacy.

33 Communication with Medical Direction or Destination Facility Purpose ► Provides an opportunity to receive instructions or advice from a physician  Direct or on-line medical direction ► Notifies the receiving hospital and personnel so preparations can be made for the patient  Can dramatically reduce the time interval between patient arrival and definitive treatment

34 Communication with Medical Direction or Destination Facility Radio provides the connection between the EMT and medical direction. It also provides the emergency department with advance warning about an impending patient arrival. Fig

35 Essential Elements and Proper Sequence of Patient Report ► Unit number and level of provider ► Estimated time of arrival (ETA) * ► Age and sex of patient ► Chief complaint ► Brief, pertinent history of present illness ► Major past illnesses

36 Essential Elements and Proper Sequence of Patient Report ► Mental status ► Baseline vital signs ► Pertinent findings of physical examination ► Emergency medical care given ► Response to interventions

37 Essential Elements and Proper Sequence of Patient Report The EMT is responsible for presenting all important patient information to the hospital in a standard order. Fig

38 Communication En Route to the Hospital ► Notify dispatch when leaving the scene with the patient.  Inform dispatch that transport phase has begun.  Some systems may include prompts or alarms in the dispatch center if a unit is out of contact for too long a time. ► Inform dispatch that the transport phase is completed and personnel can be reached at the hospital or by radio.

39 In-Person Communication with Facility Staff — Verbal Report The EMT’s verbal report to hospital personnel is an essential component of transferring responsibility for the patient to the Emergency Department. Fig

40 In-Person Communication with Facility Staff — Verbal Report Essential elements ► Identify the EMT and unit ► Introduce the patient to hospital personnel ► Summarize the information provided on the radio ► Chief complaint ► Pertinent history not previously relayed ► Additional treatment given en route ► Significant changes in vital signs or response to treatment

41 Essential Principles of Interpersonal Communication ► Act and speak in a calm and confident manner ► Make and maintain eye contact with the patient ► Speak clearly, slowly, and distinctly ► Treat the patient with respect; ask them how they would prefer to be addressed

42 Essential Principles of Interpersonal Communication ► Use words the patient can understand; avoid medical terminology or abbreviations ► Be honest and direct with the patient ► Be constantly aware of body language — the patient’s and the EMTs

43 Essential Principles of Interpersonal Communication Successfully communicating with patients requires that the EMT keep general principles of communication in mind at all times. Fig

44 Communication with Special Patients Hearing and/or Speech Impaired Patients ► Patients may be capable of reading lips ► Speak clearly with lips clearly visible ► Consider learning and using basic sign language ► Communicate with written notes if possible

45 Communication with Special Patients (cont.) Non-English Speaking Patients ► Consider learning a second language if you are working in an area with a large non-English speaking population ► Use a family member or friend who can communicate with the patient ► Advise the hospital of the patient’s language  Many have interpreters on call ► Be innovative and imaginative in communication  Proceed slowly and cautiously  Use gestures to indicate what will be done

46 Communication with Special Patients (cont.) Children ► Children are usually emotionally overwhelmed with what is happening to them, making communication difficult ► Children are not little adults, either physically or emotionally  Win their trust and confidence ► A parent or sibling might be of help  They might also aggravate the emotional situation

47 Communication with Special Patients (cont.) Elderly ► Often (not always) have difficulty hearing  Speak louder or more clearly ► May have poor vision ► Common diseases can contribute to disorientation or confusion ► Take time to make sure that the patient understands what is being said and what is taking place

48 Lesson Summary ► Communication is required throughout all phases of EMS. ► Communication systems include various types of radios, computer equipment, and specially trained personnel. ► Communication provides the opportunity for the EMT to receive on-line medical direction from a physician. ► Notifying the receiving hospital allows for advanced preparation.

49 Lesson Summary (cont.) ► Radio communication with the receiving facility has essential components that should be delivered in a specific order. ► The EMT should keep the dispatch center informed of the unit’s location and status throughout the call. ► EMTs will often be exposed to situations that present special communication challenges.