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EMS, Chapter 4

Terms in this set (125)

Communication
the transmission of information to another person.
Verbal
Nonverbal (through body language)
Verbal communication skills
important for EMTs.
Enable you to gather critical information, coordinate with other responders, and interact with other health care professionals
Documentation
Patient's permanent medical record
Demonstrates appropriate care was delivered
Helps others in patient's future care
Complete patient records
Guarantee proper transfer of responsibility
Comply with requirements of health departments and law enforcement agencies
Fulfill your organization's administrative needs
Radio and telephone communications
Link the EMT to EMS, fire department, and law enforcement
Therapeutic Communication
Uses various communication techniques and strategies:
Both verbal and nonverbal
Encourages patients to express how they feel
Achieves a positive relationship with each patient
Shannon-Weaver communication model
Sender takes a thought
Encodes it into a message
Sends the message to the receiver
Receiver decodes the message
Sends feedback to the sender
Age, Culture, and Personal Experience
Shape how a person communicates
Culture
Body language and eye contact are greatly affected by this.
In some of these, direct eye contact is impolite.
In others, it is impolite to look away while speaking.
Tone, pace, and volume of language
Reflect mood of the person and perceived importance of the message
Ethnocentrism
considering your own cultural values more important than those of others
Cultural imposition
forcing your values onto others
Body language
provides more information than words alone.
Even without exchanging any words, you should be able to tell the mood of your patient.
Facial expressions, body language, and eye contact
powerful communication tools.
Help people understand messages being sent
awareness of own body language
When treating a potentially hostile patient
defuse the situation
Assess the safety of the scene.
Do not assume an aggressive posture.
Make good eye contact, but do not stare.
Speak calmly, confidently, and slowly
Never threaten the patient, either verbally or physically.
Nonverbal Communication
Physical factors
Literal noise, sounds in the environment, lighting, distance, or physical obstacles may affect your communication.
Nonverbal Communication
Physical factors
Cultural norms often dictate the amount of space, or proximity, between people when communicating.
Gestures, body movements, and attitude toward the patient are critically important.
Asking questions
a fundamental aspect of prehospital care.
Open-ended questions
require some level of detail.
Use whenever possible
Example: "What seems to be bothering you?"
Closed-ended questions
can be answered in very short responses.
Response is sometimes a single word
Use if patients cannot provide long answers
Example: "Are you having trouble breathing?"
interviewing a patient
consider using touch to show caring and compassion.
Use consciously and sparingly.
Avoid touching the torso, chest, and face.
Interviewing Techniques to Avoid
Providing false assurance or reassurance
Giving unsolicited advice
Asking leading or biased questions
Talking too much
Interviewing Techniques to Avoid
Interrupting
Using "why" questions
Using authoritative language
Speaking in professional jargon
Friends and family
may be valuable during the patient interview process.
let patient answer
if well-meaning family members attempt to answer for the individual.
Do not be afraid
ask others to step aside for a moment.
Facilitation
Encourage the patient to talk more or provide more information
Silence
Do not speak. Give patient time to think.
Reflection
restating a patients statement made to you to confirm your understanding.
Empathy
Be sensitive to the patient's feelings and thoughts
Clarification
Ask the patient to explain what he or she meant by an explanation.
Confrontation
Make the patient who is in denial or in a mental state of shock focus on urgent and life-critical issues.
Interpretation
Restate the patients complaint to confirm your understanding
Explanation
Provide factual information to support a conversation.
Summary
Provide the patient with an overview of the conversation and the steps you will take.
eye contact
make and keep at all times
Provide your name
use the patient's proper name
truth
Tell the patient
language
make sure patient can understand
Be careful
what you say about the patient to others.
Be aware
of your body language
Speak
slowly, clearly, and distinctly
If the patient is hard of hearing
face the patient so he or she can read your lips
Allow the patient time
to answer or respond
Act and speak
in a calm, confident manner
Communicating With Older Patients
Identify yourself.
Present yourself as competent, confident, and caring.
Do not assume that an older patient is senile or confused.
hostility, irritability, and some confusion
Do not assume this is normal behavior for the elderly
older patient
Approach slowly and calmly
Allow plenty of time
for the patient to respond to your questions
Communicating With Older Patients
Watch for signs of confusion, anxiety, or impaired hearing or vision.
The patient
should feel confident that you are in charge and that everything possible is being done for him or her. BE PATIENT
Older patients
Often do not feel much pain
May not be fully aware of important changes in their body systems
You must be especially vigilant for objective changes.
Communicating With Older Patients
When possible, give patients time to pack a few personal items before leaving for hospital.
Locate hearing aids, glasses, and dentures before departure.
older patients
often worried about the safety of their home, valuable items, and pets.
children
Emergency situations are frightening.
Fear is most obvious and severe
children
may be frightened by:
Your uniform
The ambulance
A crowd of people gathered around them
child
let keep a favorite toy, doll, security blanket
parent or guardian
If practical, let hold the child during evaluation and treatment
Be honest
Children easily see through lies or deception
Tell the child
if something will hurt
Respect
the child's modesty
Communicating With Children
Speak in a professional, friendly way.
Maintain eye contact.
Position yourself
at the child's
level.
Hearing-Impaired Patients
Most have normal intelligence and are not embarrassed by their disability.
Position yourself so the patient can see your lips.
Hearing aids
Be careful that they are not lost during an accident.
They may be forgotten if the patient is confused.
Ask family about use of a hearing aid
Steps to take to efficiently communicate with patients who are hard of hearing
Have paper and pen available.
If the patient can read lips, face the patient and speak slowly and distinctly.
Never shout.
Listen carefully, ask short questions, and give short answers.
.Visually Impaired Patients
Ask the patient if he or she can see at all.
patients are not necessarily completely.
Expect the patient to have normal intelligence
Explain everything you are doing as you are doing it
Communicating With Visually Impaired Patients
Stay in physical contact with the patient as you begin your care.
If the patient can walk to ambulance, place his or her hand on your arm.
Transport mobility aids such as a cane with the patient to the hospital.
Communicating With Visually Impaired Patients
Guide dogs
Easily identified by special harnesses
If possible, transport dog with patient
Alleviates stress for both patient and dog
Otherwise, arrange for care of the dog
Non-English-Speaking Patients
You must find a way to obtain a medical history.
Find out if the patient speaks some English.
Use short, simple questions.
Point to parts of the body.
Have a family member or friend interpret.
Non-English-Speaking Patients
Consider learning some common phrases in another language that is used in your area.
Pocket cards that show the pronunciation of terms are available.
Use a smartphone app or website to help you translate.
Remember to request a translator at the hospital.
Communicating With Other Health Care Professionals
Your reporting responsibilities do not end when you arrive at the hospital.
Give an oral report to a hospital staff member who has at least your level of training.
Communicating With Other Health Care Professionals
Oral report components:
Opening information-
Name, chief complaint, illness
Detailed information-
Not provided during radio report
Any important history-
Not already provided

Patient's response to treatment given en route.
Vital signs.
Patient care report
Also known as prehospital care report
Legal document
Records all care from dispatch to hospital arrival
Patient care report
two types: written and electronic
PCR functions
Continuity of care
Legal documentation
Education
Administrative information
Essential research record
Evaluation and continuous quality improvement
Information collected on the PCR
Chief complaint
Level of consciousness or mental status
Vital signs
Initial assessment
Patient demographics
PCR times
The incident was reported
The EMS unit was notified
The EMS unit arrived at the scene
The EMS unit left the scene
The EMS unit arrived at the receiving facility
Patient care was transferred
Types of Forms
Traditional written form with:
Check boxes
Narrative section
Computerized version
Narrative Section of the PCR
Time of events
Assessment findings
Emergency medical care provided
Changes in patient after treatment
Observations at the scene
Final patient disposition
Refusal of care
Staff person who continued care
Narrative Section of the PCR
Include significant negative findings and important observations about the scene.
Do not make any judgments about the patient's condition.
Narrative Section of the PCR
Avoid radio codes and use only standard abbreviations.
Remember that the report itself is considered a confidential document
Reporting Errors
If you leave something out or record it incorrectly, do not try to cover it up
Falsification
Results in poor patient care
May result in suspension and/or legal action
Reporting Errors
If you discover an error as you are writing your report, draw a single horizontal line through the error, initial it, and write the correct information next to it.
Do not try to erase or cover the error with correction fluid.
Documenting Refusal of Care
A common source of lawsuits.
Thorough documentation is crucial.
Document any assessment findings and emergency medical care given.
Have patient sign a refusal of care form.
Have family member, police officer, or bystander also sign as witness.
Complete the PCR.
Special Reporting Situations
Depending on local requirements:
Gunshot wounds
Dog bites
Some infectious diseases
Suspected physical or sexual abuse
Multiple-casualty incident (MCI)
Radio and telephone communications
link you and your team with other members of the EMS, fire, and law enforcement communities.
Help the entire team work together more effectively
Provide an important layer of safety and protection
base station
contains a transmitter and a receiver in a fixed place
Two-way radio
consists of a transmitter and a receiver
Mobile radio
is installed in a vehicle.
Used to communicate with:
Dispatcher
Medical control
Ambulances often have more than one.
Portable radios
hand-held devices.
Essential at the scene of an MCI
Helpful when away from the ambulance to communicate with:
Dispatch
Another unit
Medical control
repeater
a special base station radio.
Receives messages and signals on one frequency
Automatically retransmits them on a second frequency
Allows two mobile or portable units that cannot reach each other directly to communicate using its greater power and antenna
Digital signals
a part of EMS communications
Telemetry
allows electronic signals to be converted into coded, audible signals.
Signals can be transmitted by radio or telephone to a receiver with a decoder at the hospital.
Data from cardiac monitors can be transmitted via Bluetooth-enabled mobile devices
cellular telephone
EMTs often communicate with receiving facilities
Simply low-power portable radios
Satellite phones
another option.
Can be easily overheard on scanners
Ambulances
usually have an external public address system
EMS systems
may use a variety of two-way radio hardware
Simplex
push to talk, release to listen
Duplex
simultaneous talk-listen
Multiplex
utilizes two or more frequencies
MED channels
reserved for EMS use
Trunking systems
use the latest technology to allow greater traffic
interoperable communications system
allows all of the agencies involved to share valuable information in real time
Mobile data terminals inside ambulance
Receive data directly from dispatch center
Allow for expanded communication capabilities (eg, maps)
Federal Communications Commission
regulates all radio operations in the United States
Allocates specific radio frequencies
Licenses call signs
Establishes licensing standards and operating specifications
Establishes limitations for transmitter output
Monitors radio operations
The dispatcher
Receives and determines the relative importance of the 911 call
Assigns appropriate EMS response unit(
The dispatcher
Coordinates with other public safety services
Provides emergency medical instructions to the telephone caller
EMT
report any problems that took place during a run to the dispatcher. inform the dispatcher upon arrival at the scene
reason for radio communication
to facilitate communication between you and medical control
Medical control
may be located at the receiving hospital, at another facility, or sometimes even in another city or state
medical control purposes
Notifies the hospital of an incoming patient
Provides an opportunity to request advice or orders from medical control
Advises the hospital of special situations
Giving a Patient Report
Follow the established format and include:
Your unit identification and level of services
The receiving hospital and your estimated time of arrival (ETA)
The patient's age and gender
The patient's chief complaint
Giving a Patient Report
Follow the established format and include (cont'd):
A brief history of the patient's problem
A brief report of physical findings
A brief summary of the care given
A brief description of the patient's response to treatment
Medical control
either off-line (indirect) or online (direct)
medical control for permission
Administer certain treatments
Determine the transport destination of patients
Stop treatment and/or not transport a patient
medical control
provided by the physicians working at the receiving hospital.
Many variations have developed across the country
link to medical control
vital to maintain a high quality of care
Calling Medical Control
There are a number of ways to control access on ambulance-to-hospital channels.
The dispatcher monitors and assigns appropriate, clear medical control channels.
Centralized medical emergency dispatch or resource coordination centers
Calling Medical Control
The physician bases his or her instructions on the information the EMT provides.
Never use codes unless directed to do so by local protocol
Repeat orders back word for word and then receive confirmation.
Do not blindly follow an order that does not make sense to you.
initiate communication with hospitals
advise them of an extraordinary call or situation.
Example special situations:
Hazardous materials situations
Rescues in progress
Multiple-casualty incidents

The earlier the notification, the better.
Provide an estimate of the number of patients
Identify any special needs
radio equipment
must be serviced like other ems equipment
The radio is your lifeline
To other public safety agencies (who protect you)
To medical control
At the beginning of your shift
check the radio equipment.
Radio equipment may fail during a run.
Backup plan must then be followed.
May include standing orders
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