1. Chapter 4 EMS System Communications
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2. Objectives
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3. Communications Systems

4. Communication Communication
The exchange of thoughts and messages that occurs by sending and receiving information
Use clear text or speech to relay data
Communication is the exchange of thoughts and messages by sending and receiving information. Effective communication requires that we send and receive this information using an understandable and commonly recognized language. This “language” requirement is not as simple as just speaking English or Spanish. Using terminology that is too technical or too advanced may create confusion. Information that is misunderstood can lead to inappropriate treatment or care. To alleviate this potential problem, most EMS systems in the United States require the use of clear text or speech to relay data from one point to another.

5. Regulation Federal Communications Commission (FCC)
Responsible for regulation of interstate and international communications
Develops and enforces rules and regulations pertaining to radio transmissions
Controls licenses and allocates frequencies
Establishes technical standards for radio equipment
Monitors frequencies for appropriate usage
Spot-checks for licenses and records
The Federal Communications Commission (FCC) is the United States government agency responsible for regulation of interstate and international communications by radio, television, wire, satellite, and cable. The FCC is charged with the development and enforcement of rules and regulations pertaining to radio transmissions. In addition, the FCC is mandated to do the following:
Control licenses and allocate frequencies
Establish technical standards for radio equipment
Monitor frequencies for appropriate usage
Spot-check for licenses and records

6. Radio Frequencies and Ranges

7. Very High Frequency (VHF)
Band
VHF low band frequencies
Bend and follow the curvature of the earth
VHF high band frequencies
Travel in a straight line

8. Ultra-High Frequency (UHF)
Radio waves travel in a straight line
Can reflect off or bounce around buildings
Shorter range than VHF high or low bands
Often requires the use of repeaters
Radio waves in the UHF frequency travel in a straight line but do have an ability to reflect off or bounce around buildings. This band has a shorter range than VHF high or low bands. This type of frequency has a greater ability to enter buildings or structures through openings or mediums that are radio-frequency permeable. UHF frequently requires the use of repeaters because of its short range. A repeater is a device that receives a transmission from a low-power portable or mobile radio on one frequency and then retransmits it at a higher power on another frequency so it can be received at a distant location.

9. 800-Megahertz Frequencies
UHF radio signals
Allow clear communication with minimal interference
Trunking system
Allows routing of a transmission to the first available frequency
Use multiple repeaters
The 800-MHz frequencies are UHF radio signals that use computer technology to make transmissions more secure than the other types of radio transmission. These frequencies allow clear communication with minimal interference. They also use a trunking system, which allows routing of a transmission to the first available frequency. Many channels are available to choose from. Although 800-MHz frequencies generally have a limited range and are very straight line, these problems are overcome using multiple repeaters. This makes 800-MHz frequencies very effective for use in urban areas.

10. Communications Equipment

11. Base Station
A radio located at a stationary site such as a hospital, mountain top, or public safety agency
At a minimum, a base station is made up of a transmitter, a receiver, a transmission line, and an antenna. A transmitter is a device that sends out data on a given radio frequency. A radio signal generated by the base station may be sent directly to a receiving unit or to a repeater as needed.

12. Mobile Two-Way Radios Vehicle-mounted device
Usually transmit at lower power than base stations (20 to 50 watts)
Typical transmission range is 10 to 15 miles over average terrain
A mobile two-way radio is a vehicular-mounted communication device. It usually transmits at a lower power than base stations (typically 20 to 50 watts). The typical transmission range is 10 to 15 miles over average terrain. Transmission over flat land or water increases range. Urban areas, mountains, and dense foliage decrease transmission range.

13. Portable Radios Handheld device
Typically have power output of 1 to 5 watts
Limited range

14. Repeater
Receives a transmission from a low-power device on one frequency and retransmits at a higher power on another frequency

15. Digital Radio Equipment
Pagers
Mobile data computers (MDCs)
Automatic vehicle locator (AVL)
Global positioning system (GPS)
Digital pagers are used in many EMS systems. An audible signal and/or text message can be transmitted quickly by the dispatch center to alert EMS personnel to respond to a call.
Some EMS systems use mobile data computers (MDCs) (also called mobile data terminals or MDTs). An MDC is a computer that is mounted in an emergency vehicle. The computer displays information pertaining to the calls for which EMS personnel are dispatched. Examples of information displayed include text from dispatch pertaining to the call, the address of the incident, and a local map pointing directly to the incident. The computer is used to log response times and indicate the status of the EMS crew/vehicle (in service and available for calls, on the scene, responding to a call, en route to the hospital, etc.). The computer is also used to send and receive text messages between the EMS crew and the dispatch center.
Many EMS vehicles are equipped with an Automatic Vehicle Locator (AVL). An AVL is a device that uses the Global Positioning System (GPS) to track a vehicle’s location. GPS uses a system of satellites and receiving devices to compute the receiver’s geographic position on the earth. If the MDC is equipped with the necessary software, EMS vehicles equipped with an automatic vehicle locator appear on the local map that is displayed on the computer terminal.

16. Cellular Telephones Geographic “cells”
Each cell has a base station to transmit and receive signals
Transfer unit’s radio activity to the appropriate cell base station
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17. Transmission Modes One-way Simplex Duplex Multiplex
Four transmission modes are generally used in an EMS communications system: one-way, simplex, duplex, and multiplex. A one-way transmission mode is generally used for paging systems. In one-way mode, a signal is sent to any unit monitoring the appropriate frequency, but the receiving unit has no ability to transmit a message.
A simplex system uses a single frequency to transmit and receive messages. As a result, only one signal may be transmitted or received at a time. Simultaneous radio transmissions will block a message from being received. An advantage of this type of system is that it allows the speaker to relay her message without interruption. However, communication using a simplex system takes away the ability for discussion regarding a patient or situation.
A duplex system is a mode of radio transmission that uses two frequencies to transmit and receive messages, allowing simultaneous two-way communication. An advantage of using this system for radio transmission is that either party can interrupt as necessary. Two-way communication aids discussion regarding a patient or situation. A disadvantage of this type of system is that the user at each end has a tendency to interrupt the other.
A multiplex system is a mode of radio transmission that permits simultaneous transmission of voice and other data using one frequency. Advantages of using this system for radio transmission are that either party can interrupt as necessary and two-way communication aids discussion regarding a patient or situation. Disadvantages of this type of system are that voice signals can interfere with data transmission.

18. 9-1-1
9-1-1
Official national emergency number in the United States and Canada
Enhanced 9-1-1
Routes call to center closest to caller
Automatically displays caller’s phone number and address
Most systems are Enhanced systems
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An EMS communications network must provide a means by which a citizen can reliably access the EMS system (usually by dialing 9-1-1). To ensure adequate EMS system response and coordination, there must also be a means for dispatch-center-to-emergency-vehicle communication, communication between emergency vehicles, communication from the emergency vehicle to the hospital, hospital-to-hospital communication, and communication between agencies, such as between EMS and law enforcement personnel.
9-1-1 is the official national emergency number in the United States and Canada. When the numbers are dialed, the caller is quickly connected to a single location called a Public Safety Answering Point (PSAP). A dispatch center, alarm room, and police department are examples of facilities that may host the PSAP. Information coming into the PSAP may be processed at the PSAP, or the PSAP may route the call to an appropriate agency for processing. The PSAP dispatcher is trained to route the call to the appropriate local emergency medical, fire, and law-enforcement agencies. Although EMS is usually activated by dialing 9-1-1, other methods of activating an emergency response include emergency alarm boxes, citizen band radios, and wireless telephones.
Enhanced 9-1-1, or E9-1-1, is a system that routes an emergency call to the center closest to the caller and automatically displays the caller’s phone number and address. E9-1-1 speeds up the transfer of information from the caller to the call taker and helps decrease the number of false alarms. It also assists in callbacks to obtain more complete information. Most systems that exist today are E9-1-1 systems.

19. Dispatch
Formal emergency medical dispatch protocols and training began in the 1980s. Before this time, medical dispatchers averaged less than 1 hour of medical training. The Emergency Medical Dispatch program has been developed to certify personnel as Emergency Medical Dispatchers (EMDs). An EMD is knowledgeable about the geography of the area, the EMS system’s capabilities, and the activities of other public service agencies. An EMD is responsible for:
Verifying the address of the incident
Asking questions of the caller
Assigning responders to the incident
Alerting/activating responders to the incident
Providing prearrival instructions to the caller
Communicating with responders
Recording incident times

20. Computer-Aided Dispatch (CAD)
Computer-aided dispatch (CAD) is used in many EMS systems. When a call comes into a PSAP that uses CAD, the address and phone number of the caller are automatically entered into the CAD system. The dispatcher types a description of the emergency into the computer and then assigns a priority level to the call. As a result, an “event” is created for which many activities related to it can be tracked, retrieved, and evaluated. The software used by the CAD system can connect dispatchers with local, state, and national computer database systems.

21. Guidelines for Effective Radio Communication

22. Guidelines for Effective Radio Communication
Check equipment at the start of your shift
Before speaking into the radio:
Make sure radio is on and the volume is properly adjusted
Reduce background noise as much as possible
Listen to make sure frequency is clear before speaking
Hold the radio’s microphone 2 to 3 inches away from your mouth
Locate and press the “push to talk” (PTT) button
Pause (with the PTT button depressed) for one to two seconds before speaking
Make sure that you have checked that your equipment is available and in good working order at the start of your shift.
Before speaking into the radio:
Make sure the radio is on and the volume is properly adjusted.
Reduce background noise as much as possible.
Listen to the frequency that you will be transmitting on to make sure that it is clear before speaking.
Hold the radio’s microphone 2 to 3 inches away from your mouth.
Locate and press the “push to talk” (PTT) button. To make sure your first words are not cut off, pause (with the PTT button depressed) for 1 to 2 seconds before speaking.

23. Guidelines for Effective Radio Communication
Address unit being called by name and number
Identify the name/number of your unit
Wait for unit being called to signal you to begin
Relay your message
Speak clearly
Keep transmissions brief
“Clear” at the end of your message
Using a normal tone of voice, address the unit being called by its name and number. Then identify the name of your unit (and number, if appropriate) as determined by your local protocols.
Wait for the unit being called to signal you to begin your transmission by saying, “Go ahead,” or some other term standard in your area. A response of “Stand by” means, “Wait until further notice.”
When the unit being called has acknowledged your call (and has stopped speaking), relay your message. Speak clearly, keeping your transmissions brief.
At the end of your message, the unit being called may repeat back the pertinent information from your message to make sure that the unit has received the information correctly. If the information is verified as correct, acknowledge the unit’s transmission and announce that you are clear.

24. Guidelines for Effective Radio Communication
Use plain English
Avoid use of “ten codes” and slang
Avoid meaningless phrases, such as “Be advised”
Do not use profanity on the air
Avoid words that are hard to hear like “yes” and “no”
Use “affirmative” and “negative”
Courtesy is assumed
No need to say “please,” “thank you,” and “you’re welcome”
When transmitting numbers, give the number, then give the individual digits
Do not offer a diagnosis of the patient’s complaint or injury
Use plain English in your radio communications. Avoid the use of “ten codes” and slang.
Avoid meaningless phrases, such as “be advised.”
Do not use profanity on the air (the FCC may impose substantial fines).
Avoid words that are hard to hear like “yes” and “no”; use “affirmative” and “negative.”
Courtesy is assumed; there is no need to say “please,” “thank you,” and “you’re welcome.”
When transmitting a number that might be confused with another, give the number, then give the individual digits. For example, do not say “fifty one.” Instead, say “five one.”
Do not offer a diagnosis of the patient’s complaint or injury. Remain objective and impartial in describing patients.

25. En Route to the Call

26. En Route to the Call Dispatch:
“Medic 51 (five, one), respond code 3 to 4321 (four, three, two, one) East Main Street for a report of difficulty breathing. Call number 987 (nine, eight, seven). Time out 1402 (one, four, zero, two).”
Medic 51:
Dispatch, Medic 51 (five, one) received. Responding to report of difficulty breathing at four, three, two, one East Main Street.”
“Medic 51, Dispatch received, you are responding. Caller reports your patient is 70-year-old female in the kitchen of this address. The door will be unlocked ”
“Dispatch, Medic 51, received. 70-year-old female in the kitchen and the door will be unlocked.”

27. Arrival at the Scene

28. Arrival at the Scene Medic 51: “Dispatch, Medic 51. We are on scene.”
Dispatch Center:
“Medic 51, Dispatch received, on scene at 1406.”

29. When to Notify Dispatch
Receiving the call
Responding to the call
Arriving at the scene
Leaving the scene for the receiving facility
Arriving at the receiving facility
Leaving the hospital for the station
Arriving at the station

30. Communicating with the Patient
Identify yourself
Respectfully explain that you are there to provide assistance
When communicating with a patient, begin by identifying yourself and establishing your role. Explain that you are there to provide assistance.

31. Communicating with Individuals from Other Agencies
Organized
Concise
Thorough
Accurate
Communications with individuals from other agencies should be organized, concise, thorough, and accurate. When receiving a report from others at the scene (such as family members or bystanders), listen carefully to their report. Ask questions if any information is unclear.

32. Communicating with Individuals from Other Agencies
Hand-off report to ALS personnel:
Identify yourself as an EMT
Report the patient’s name (if known), age, gender, primary problem (chief complaint), and current condition
Describe what happened and the position in which the patient was found
Describe pertinent assessment findings, including vital signs
Report any medical history you obtained from the patient
Describe the emergency medical care that you gave
Describe the patient’s response to the treatment given
Orders received from medical direction (if applicable )
You must give a verbal report to EMS professionals arriving on the scene where you have been providing care. Keeping your report brief and pertinent, you will need to relay the following information:
Identify yourself as an EMT
Report the patient’s name (if known), age, gender, primary problem (chief complaint), and current condition
Describe what happened and the position in which the patient was found
Describe pertinent assessment findings, including vital signs
Report any medical history you obtained from the patient
Describe the emergency medical care that you gave
Describe the patient’s response to the treatment given
Orders received from medical direction (if applicable )

33. Communicating with Medical Direction

34. Communicating with Medical Direction
Communications should be:
Professional
Organized
Concise
Accurate
Pertinent
“Echo” any orders received
You may need to contact medical direction for advice if a patient refuses care or during difficult patient-management situations. When communicating with medical direction, it is very important that your radio or telephone communication be professional, organized, concise, accurate, and pertinent.
After receiving an order (or denial of such a request), use the “echo” procedure. This means that you must repeat the order back to the physician, word for word. Be sure to document any orders received and question any orders that are unclear or appear to be inappropriate.

35. En Route to the Receiving Facility
Whether or not you are responsible for patient transport will often depend on the environment in which you work. For example, if you are a law enforcement officer, lifeguard, teacher, hotel employee, truck driver, or coach, you will most likely render patient care at the scene and then turn over patient care to EMS professionals from the fire department or ambulance service. If you are responsible for patient transport, contact your dispatch center as you begin patient transport to the receiving facility.

36. En Route to the Receiving Facility
Receiving facility radio report
Identify unit and level of care provider (such as BLS, ALS)
Estimate time of arrival at facility
Patient’s age and gender
Chief complaint
Brief, pertinent history of present illness or problem
Major past illnesses
Mental status
Vital signs
Pertinent physical exam findings
Emergency medical care given
Response to emergency medical care
Notify the receiving facility of the condition of the patient they are about to receive. The essential elements of this type of report and the order in which they should occur are as follows:
Identify the unit and the level of the care provider (such as BLS, ALS)
Estimate time of arrival at facility
Patient’s age and gender
Chief complaint
Brief, pertinent history of present illness or problem
Major past illnesses
Mental status
Vital signs
Pertinent physical exam findings
Emergency medical care given
Response to emergency medical care

37. Arrival at the Receiving Facility

38. Arrival at the Receiving Facility
Notify dispatch as soon as you arrive at the receiving facility.
Medic 51:
“Dispatch, Medic 51. Arrival at Anytown Medical Center.”
Dispatch Center:
“Received, Medic 51. Arrival at Anytown Medical Center at 1448.”

39. Arrival at the Receiving Facility
Verbal (“hand-off”) report
Introduce the patient by name (if known)
Patient’s chief complaint
Pertinent patient history
Emergency medical care given
Patient’s response to care given
Vital signs taken en route
Any additional information
On arrival at the receiving facility, the staff expects a verbal report that follows a specific format. The verbal report (sometimes called a hand-off report) is essentially a summary of the information that you gave over the radio. Give your verbal report to a healthcare professional of equal or higher medical skills. Begin the verbal report by introducing the patient by name (if known). Summarize the information already provided by radio or telephone to the receiving facility:
Patient’s chief complaint
Pertinent patient history that was not previously given
Emergency medical care given en route and the patient’s response to the treatment given
Vital signs taken en route
Any additional information collected en route but not transmitted to the receiving facility

40. En Route to the Station

41. En Route to the Station
Notify dispatch when you are leaving the receiving facility and are en route to the station.
Medic 51: “Medic 51 to Dispatch.”
Dispatch: “Dispatch. Go ahead Medic 51.”
Medic 51: “Dispatch, Medic 51 is leaving Anytown Medical Center en route to our station.”
Dispatch: “Received, Medic 51. En route to your station. Time: 1510.”

42. En Route to the Station
Contact dispatch again on arrival at the station or when you enter your service area, per your agency’s guidelines.
Medic 51: “Medic 51 to Dispatch.”
Dispatch: “Dispatch. Medic 51 – go ahead.”
Medic 51: “Dispatch, Medic 51 is back at our station and in service.”
Dispatch: “Received, Medic 51. In station and available for service. Time: 1518.”

43. Legal Considerations
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44. Legal Considerations Communication with a patient should always be:
Direct
Polite
Honest
Health Insurance Portability and Accountability Act (HIPAA)
Your interaction with a patient should always be direct, polite, and honest. There are legal limits to the information that you may share with others about your patient. These legal limitations are found in the Health Insurance Portability and Accountability Act (HIPAA). Generally, you may only share medical information about your patient with those healthcare professionals who will have direct contact with your patient. These legal limitations extend to the radio report given to the receiving facility. Do not use any patient “identifiers” beyond the age and gender of your patient over the radio. Individuals who disobey HIPAA privacy rules face criminal and civil penalties.

45. Questions?