1. Chapter 4 Communications and Documentation

2. National EMS Education Standard Competencies (1 of 3) Preparatory Uses simple knowledge of the emergency medical services (EMS) system, safety/well- being of the emergency medical responder (EMR), and medical/legal issues at the scene of an emergency while awaiting a higher level of care.

3. National EMS Education Standard Competencies (2 of 3) Documentation Recording patient findings EMS System Communication Communication needed to: Call for resources Transfer care of the patient Interact within the team structure

4. National EMS Education Standard Competencies (3 of 3) Therapeutic Communication Principles of communicating with patients in a manner that achieves a positive relationship Interviewing techniques Medical Terminology Uses simple medical and anatomic terms.

5. Introduction Communications are important during every phase of a call. –The dispatcher must communicate the location and type of call to responders. –EMRs need to communicate with patients, bystanders, family members, dispatchers, and members of the public safety community. –After a call, you must document the condition of the patient and the treatment given.

6. Communications Systems and Equipment (1 of 2) The purpose of a communications system is to relay information from one location to another when it is impossible to communicate face to face. The results of using a communication system will be only as accurate as the information that is put into the system.

7. Communications Systems and Equipment (2 of 2) Communications systems can be divided into two categories: –Those that transmit voice communications –Those that transmit data

8. Voice Systems (1 of 3) Voice communications systems transmit the spoken word from one location to another. Radio systems –Regulated by the Federal Communications Commission (FCC) –Frequencies are assigned according to the function of the organization.

9. Voice Systems (2 of 3) Radio systems (cont’d) –Types of radios: Base station Mobile radio Portable radios Repeater

10. Voice Systems (3 of 3) Telephone systems –Primarily convey voice communications –Landline phone systems: tied together through an above-ground or below-ground hardwired system –Cellular phones: rely on radio waves between a cellular phone and a cellular tower to send and receive phone messages

11. Data Systems (1 of 2) Data can be transmitted through radio systems or phone systems. –Paging systems can transmit text messages or voice communications. –Mobile data terminals (MDTs) transmit data messages through a radio system.

12. Data Systems (2 of 2) Fax machines use phone lines or radio systems to send written data. Telemetry is used by ALS providers to transmit ECGs and other patient data to online medical control. E-mail is used to transmit a wide variety of messages.

13. The Functions of Radio Communications (1 of 9) Dispatch –Dispatch may be voice, text messaging, or an MDT to alert responders to an emergency. –It is your duty to keep your equipment ready to receive a call when you are on duty. –If you are unsure that all information has been received correctly, ask the dispatcher to repeat it.

14. The Functions of Radio Communications (2 of 9) Response to the scene –Learn how to use your map books or GPS. –The dispatcher may give you further information while you are en route to the scene. –If you are delayed or encounter any problems, notify dispatch.

15. The Functions of Radio Communications (3 of 9) Arrival at the scene –Perform a visual survey of the scene. –Give the communications center a concise verbal picture of the scene: Location and type of incident Any hazards present Number of patients Any additional assistance required

16. The Functions of Radio Communications (4 of 9) Update responding EMS units –Your report should include: Age and sex of the patient Chief complaint Level of responsiveness Status of airway, breathing, and circulation Transferring care to other EMS personnel –Provide EMTs or paramedics with a “hand-off” report.

17. The Functions of Radio Communications (5 of 9) Transferring care (cont’d) –Use the same approach you follow during patient assessment: Provide the age and sex of the patient. Describe the history of the incident. Describe the patient’s chief complaint. Describe the patient’s level of responsiveness. Describe how you found the patient.

18. The Functions of Radio Communications (6 of 9) Transferring care (cont’d) –Patient assessment: (cont’d) Report the status of the patient’s vital signs, airway, breathing, and circulation. Describe the results of the physical examination. Report any pertinent medical conditions using the SAMPLE format. Report the interventions provided and the patient’s response to them.

19. The Functions of Radio Communications (7 of 9) Transferring care (cont’d) –Online medical control is generally used by EMTs and paramedics to: Secure permission to perform certain skills Get direction regarding patient care Give patient care reports to the hospital

20. The Functions of Radio Communications (8 of 9) Postrun activities –After you have transferred care, you need to report your status to your communications center. –Let the communications center know how long it will take you to get your unit ready for service and when you will be available for another call.

21. The Functions of Radio Communications (9 of 9)

22. Verbal Communications (1 of 2) Good communication means that the person receiving the message understands exactly what the person who sent the message meant. –Effective communication requires feedback. –The receiver needs to communicate to the sender that the message has been received and understood.

23. Verbal Communications (2 of 2) Both external and internal distractions can hinder effective communication. –External distractions: noise and other people talking –Internal distractions: letting yourself think about a personal matter while on scene

24. Guidelines for Effective Communications With Patients (1 of 3) Introduce yourself by name and title. Ask the patient’s name and use it. Make and keep eye contact. Use language the patient can understand. Speak slowly, clearly, and distinctly.

25. Guidelines for Effective Communications With Patients (2 of 3) Tell the truth. Allow time for the patient to respond. Limit the number of people talking with the patient. Be aware of your body language. Act and speak in a calm, confident manner.

26. Guidelines for Effective Communications With Patients (3 of 3) Respect the cultural norms of the patient. Use open-ended and closed-ended questions appropriately. Treat all patients as if they were members of your family.

27. Communicating With Patients With Special Needs (1 of 10) Hearing-impaired patients –Identify yourself by showing the patient your patch or badge. –Touch the patient. –Face the patient when you speak so he or she can see your lips and facial expressions. –Speak slowly and distinctly; do not shout. –Watch the patient’s face for expressions of understanding or uncertainty.

28. Communicating With Patients With Special Needs (2 of 10) Hearing-impaired patients (cont’d) –Repeat or rephrase your comments in clear, simple language. –If all else fails, write down your questions.

29. Communicating With Patients With Special Needs (3 of 10) Visually impaired patients –Tell the patient what is happening, identify noises, and describe the situation and surroundings. –Find out the patient’s name and use it throughout your examination and treatment. –If the patient has a service dog, try to keep the patient and dog together. –It is not necessary to talk louder.

30. Communicating With Patients With Special Needs (4 of 10) Non–English-speaking patients –Determine how much English the patient speaks, if any, and try to find an interpreter. –Supplement your questions with hand gestures, finger-pointing, and facial expressions.

31. Communicating With Patients With Special Needs (5 of 10) Geriatric patients –Do not assume that all older patients have physical or mental impairments. –Assess all patients carefully and give them time to respond to your questions.

32. Communicating With Patients With Special Needs (6 of 10) Pediatric patients –Familiar objects and faces can help reduce fear for children. –Talk to the parents and the child as much as possible and tell them what is happening. –Ask a parent to hold the child if the illness or injury permits. –Tell the child your first name and explain what you are doing.

33. Communicating With Patients With Special Needs (7 of 10) Pediatric patients (cont’d) –Squat, kneel, or sit down to the child’s level and establish eye contact. –Be honest.

34. Communicating With Patients With Special Needs (8 of 10) Developmentally disabled patients –Ask the family about the patient’s typical level of communication. –Speak slowly, using short sentences and simple words. –You may need to repeat or rephrase statements several times until the patient understands what you want.

35. Communicating With Patients With Special Needs (9 of 10) Persons displaying disruptive behavior –Assess the situation; try to determine the cause of the patient’s disruptive behavior. –Protect the patient and yourself. –Stay between the patient and an exit. –Do not take your eyes off the patient or turn your back. –If the patient has a weapon, stay clear and wait for law enforcement personnel.

36. Communicating With Patients With Special Needs (10 of 10) Persons displaying disruptive behavior (cont’d) –As soon as your personal safety is assured, carry out the appropriate emergency medical care. –You cannot take a disruptive patient to the hospital against his or her wishes.

37. Medical Terminology (1 of 3) Collection of technical terms used by medical personnel to: –Identify anatomic parts of the body –Specify illnesses –Designate injuries –Indicate treatments

38. Medical Terminology (2 of 3) Your job as an EMR is to communicate your message to other medical providers as clearly as possible. –Do not use medical terms if you are unsure of their meaning. –As new terminology is introduced, look at the construction of each word. –Learn commonly occurring prefixes and suffixes.

39. Medical Terminology (3 of 3)

40. Documentation (1 of 4) Documentation is a process for verifying your actions using written records or computer-based records. Proper documentation includes: –The age and sex of the patient –The history of the incident –The condition of the patient when found –The patient’s description of the injury/illness

41. Documentation (2 of 4) Proper documentation includes: (cont’d) –The patient’s chief complaint –The patient’s level of responsiveness –The status of initial and subsequent vital signs –The results of the physical examination –Pertinent medical conditions using the SAMPLE format –The treatment you gave the patient

42. Documentation (3 of 4) Proper documentation includes: (cont’d) –Any change in the patient’s condition –The agency and personnel who took over treatment –The following times: The time you were dispatched The time you arrived on the scene The time other providers arrived on the scene The time you departed the scene

43. Documentation (4 of 4) Proper documentation includes: (cont’d) –Any reportable conditions present –Any infectious disease exposure –Anything unusual about the case –Any other helpful facts Complete your patient care report as soon as possible after each call.

44. Summary (1 of 4) Communications systems allow you to relay information from one location to another when it is impossible to communicate face to face. Excellent communication skills are crucial during every phase of a call.

45. Summary (2 of 4) In addition to radio and oral communications, you must have excellent person-to-person communication skills. You should be able to effectively interact with the patient and any family members, friends, or bystanders. Your body language and attitude are very important in gaining the trust of both the patient and the family.

46. Summary (3 of 4) You must take special care of individuals such as children, geriatric patients, hearing- impaired and visually impaired patients, non–English-speaking patients, developmentally disabled patients, and persons displaying disruptive behavior.

47. Summary (4 of 4) Along with your radio report and oral report, you must complete a formal written hand-off report that will be given to other EMS professionals at the scene.

48. Review 1.When communicating with a sick or injured person, it is important to: A.use terms such as “dear” and “buddy” when addressing the patient. B.only use medical terminology. C.ask the patient as little as possible. D.maintain eye contact with the patient when you can.

49. Review Answer: D. maintain eye contact with the patient when you can.

50. Review 2.Which of the following would be considered good communication? A.You talk louder so you can be heard over the television. B.You initiate care without telling the patient what you are doing. C.You assess the patient while thinking about your last call. D.You minimize distractions during your conversation with the patient.

51. Review Answer: D.You minimize distractions during your conversation with the patient.

52. Review 3.When caring for a pediatric patient, you should consider: A.separating the child from the parents to avoid upsetting them. B.speaking in an authoritative tone. C.allowing the parent to hold the child, if the situation permits it. D.performing painful procedures without giving the child any warning.

53. Review Answer: C. allowing the parent to hold the child, if the situation permits it.

54. Credits Background slide image (ambulance): © Comstock Images/Alamy Images Background slide images (non-ambulance): © Jones & Bartlett Learning. Courtesy of MIEMSS.