Chapter 5 EMS Communications National EMS Education Standard Competencies Preparatory Integrates comprehensive knowledge of the EMS system, safety/well-being of the paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community. National EMS Education Standard Competencies EMS System Communication Communication needed to • Call for resources • Transfer care of the patient • Interact within the team structure National EMS Education Standard Competencies EMS System Communication Communication needed to (cont’d) • EMS communication system • Communication with other health care professionals • Team communication and dynamics National EMS Education Standard Competencies Therapeutic Communication Principles of communicating with patients in a manner that achieves a positive relationship • Interviewing techniques • Adjusting communication strategies for age, stage of development, patients with special needs, and differing cultures • Verbal defusing strategies National EMS Education Standard Competencies Therapeutic Communication Principles of communicating with patients in a manner that achieves a positive relationship (cont’d) • Family presence issues • Dealing with difficult patients • Factors that affect communication National EMS Education Standard Competencies Medical Terminology Integrates comprehensive anatomic and medical terminology and abbreviations into written and oral communication with colleagues and other health care professionals. Introduction • In EMS communication, information must move rapidly, efficiently, and effectively. – Know how to make communication as efficient as possible. – The EMD facilitates communication. – Therapeutic communication requires skill. EMS Communications System • Requires specialized equipment – Systems are based on radio signals. – You need a reliable way to communicate with medical direction. – Always have a backup system. • Critical during disasters Communications System Components • Base stations – Serve as dispatch and coordination areas – Should be in contact with all other system elements • Transceivers – Two-way radios mounted on vehicles • Portable transmitter/ receivers – Handheld radios Communications System Components • Repeaters – Miniature base stations – Extend system range • Remote consoles – Receive transmissions from field – Send messages back Radio Communications • Radio transmits by electromagnetic waves – When transmitted by waves, energy can be characterized by length of wave it produces – Frequency: how frequently the wave recurs – Radio wavelengths are designated in cycles per second or hertz. Radio Communications • Radio waves occur from 3kHz to 3,000 GHz. – Frequency bands are portions of the radio frequency spectrum assigned to specific uses. – Medical communications are usually VHF/UHF. • UHF better in dense populations and buildings – Shorter range, easily absorbed by rain Radio Communications • 800 MHz is commonly used for EMS. – High penetration works well in cities – Minimal interference – Reduced channel noise – Allows trunking Radio Communications • FCC – Allocates and monitors US radio frequencies • Assigns VHF bands for general emergencies • Assigns UHF bands for ambulance-to-hospital telemetry • EMS systems must perform COMM CHEKs routinely. Modes of Radio Operation • Simplex – Uses one frequency to either transmit or receive • Duplex – Uses two frequencies to transmit and receive simultaneously • Multiplex – Combines signals to transmit simultaneously on one frequency Digital Radio and Trunked Systems • Digital radio helps clear up distorted or lost transmissions. • Digital trunked radios have channels related by groups. – Allow simultaneous exchanges on one channel • Digital systems relay data from CAD. Cellular Telephones • Used in EMS Courtesy of Anthony Caliguire, NREMT-P. – Basically, lowpower radios – Be familiar with important/ commonly used phone numbers. – Know the location of dead spots. Cellular Telephones • Have a backup plan to prevent overload during an MCI. • Most new cell phones have GPS. – Many vehicles have similar features. • In most cases, the caller’s call-back number and location are delivered to the PSAP. Backup Communications System • Landlines – Less expensive – Give clearer signals – Link various fixed components of the – Allow communication system with anyone with a phone – Calls can be patched into radio • Older systems may transmissions be used if a disaster occurs. • Cell phones Biotelemetry • Measures and transmits vital life signs – Started with ECGs – “Telemetry” for short • Signal must be encoded if submitted over radio channels used to transmit voice. Biotelemetry • Over UHF, confined to one lead – For more complex cases, all 12 leads transmitted • Noise may arise from a number of sources. • Allows doctors to supervise paramedics – Helped gain acceptance for paramedic practice Biotelemetry • As paramedics have gained skill, the trend has been to rely on ECG telemetry less. • Recent research indicates telemetry still serves a purpose. – Early diagnosis/treatment of AMI – New technology allows instant data transmission Factors That May Affect Communications • You may experience: – Equipment failures – System problems • Be prepared to troubleshoot quickly. – If you cannot fix it, use planned redundancy. • Follow protocols regarding radio failure. Communicating by Radio • Effectiveness depends on: – Technical hardware – People who use it • You must: – Know the rules. – Understand the conventions. Communicating by Radio • Keep messages simple, brief, and direct. – Practice effective communications skills. – Know the required methods of communication. • You must effectively communicate with: – Dispatch – Receiving facility FCC Regulations • For radio, the FCC: – – – – Issues licenses Allocates frequencies Establishes technical standards Establishes/enforces rules/regulations for radio equipment operation FCC Regulations • Ensures frequencies for emergency medical use are confined to that use • The FCC forbids: – Use of obscenities – Transmission of nonmedical messages Clarity of Transmission • Basic model of communication – – – – Sender Clear message Receiver Feedback loop • Communications equipment is designed to permit communication. Clarity of Transmission • Many guidelines can improve clarity, such as: – – – – – Make sure the channel is clear. Speak clearly and distinctly. Keep calm and free of emotion. Keep transmissions brief. Use the NATO phonetic alphabet. Content of Transmissions • Be brief, to the point, and professional. • Guidelines include: – Protect the patient’s privacy at all times. – Be impersonal. – Use clear text. – Question orders you did not hear/ understand. Codes • Some EMS services • To be effective: use radio codes to: – Everyone must learn – Maintain security. – Keep airtime brief. – Prevent patient, etc, from understanding what is being said. them. – Codes should be: • Simple and standardized • Posted – Should not be used during MCIs Response to the Scene • When a call is received, you should follow a standard method of communications. – Usually standardized for agency • When first contacted by dispatch: – Record location and call information. • After dispatch and recording information: – Respond that you received information. Response to the Scene • A standard sequence – Tell dispatch you received the message and are responding to the alert. • EMS unit begins its trip to the scene. – Next transmission is your arrival on scene. Response to the Scene • A standard sequence (cont’d) – After you treat your patient(s) and are ready to transport, contact dispatch again to confirm. – Notify dispatch when you arrive at the hospital. – Contact to confirm call completion and establish status. Relaying Information to Medical Control • Communications with medical control should be concise and accurate. – Use a standard format. • Going to a different facility than medical control is not uncommon. – Know protocol. Reporting Medical Information • Include the following when reporting medical information: – Patient’s age and sex – Patient’s chief complaint – A brief, pertinent history of present problem – Other medical history relative to current situation Reporting Medical Information Information to include (cont’d): – Patient’s level of consciousness/ degree of distress – Patient’s mental status – Patient’s vital signs – Physical findings in head-to-toe order – ECG findings – Treatment given so far and response – Estimated time of arrival Reporting Medical Information • Disorganized and incomplete communication is inefficient and causes frustration. • To avoid ineffective dialogues: – Gather and organize your information before reporting to physician. – Write reporting format on a card for reference. – Continue to assess patient and report changes. Communication With Health Care Professionals • Phases of communication – You will exchange information with many people. • Especially your partner – Use terminology understood by the people you are communicating with. • Avoid slang. Communication With Health Care Professionals • Medical terminology – Use it correctly. – Learn established terms and abbreviations. – Review anatomy and physiology and documentation chapters. Communication With Health Care Professionals • In-person report – Be mindful of information relayed in front of patient. • You may want to step away. – Be brief. – Share information not given on radio. – Ensure continuity of care. Dispatching • EMD is a vital part of the paramedic team: – – – – Obtains as much information as possible Directs appropriate vehicle(s) to the scene Provides caller with information Monitors and coordinates communication – Maintains written records Receipt of the Call for Help • The EMD must: – – – – Answer the telephone promptly. Identify himself or herself and the agency. Speak directly into the mouthpiece. Observe telephone instructions. – Take charge of the conversation. Information Gathering • EMD should elicit, at minimum: – Patient’s exact location – Call-back number – Caller’s perception of the nature of the problem – Information about the patient’s condition to determine urgency • For a motor vehicle crash: – Kinds of vehicles involved – Number of persons injured • Estimate of extent – Apparent hazards • EMD may need to contact other agencies to assist. Dispatch • EMD decides which crew/vehicle to dispatch. – Depends on: • Location and nature of call • Availability of various units • EMD may provide additional information en route. Advice to the Caller • EMD will tell the caller: – What is being done – Provide instructions in an emergency situation • EMDs should undergo training in providing emergency care instructions. Ongoing Communications With the Field • The EMD must monitor the communications of the ambulance. – Coordinates communications between ambulance and medical control – Contacts other agencies who may be needed • Use standard military time to document calls. Therapeutic Communication • Your job will involve daily interactions with people at their most vulnerable. – At least half of calls involve going in someone’s home • See every invitation into a home as a personal honor. Therapeutic Communication • Convince the patient you are listening: – Give patients your undivided attention. – Do not talk about someone in front of him or her. – Listen. • Never repeat a question. Therapeutic Communication • Use “active listening.” – Repeat key parts of a patient’s response. • Especially when taking notes – Helps confirm the information patients are providing Therapeutic Communication • Try hard not to shout. – Reduce noise when possible. – Move the patient to a quiet area. – Speak close to the patient’s ear in a calm voice. • Complete all your history taking at once. Therapeutic Communication • Ask personal questions quietly and in private. – Ask payoff questions. • Communication is critical in challenging environments. Developing Rapport • Try to develop a good rapport as soon as you meet the patient. – Set an atmosphere of trust and comfort. – Convey calm, genuine concern. • Obtaining information is a learned skill. – Getting information can be difficult. Developing Rapport • If patient is reluctant, explain why you need the information. – Remind them it is protected by law. • If you can safely move a patient, do so. – For patients who cannot focus Developing Rapport • If a patient seems threatened: – – – – Approach cautiously. Use open posturing. Smile. Be calm. – Reassure the patient. – If possible, take things slowly. Developing Rapport • Tips for positive communication: – Introduce yourself; get and use the patient’s name. – Make and keep eye contact. – Position yourself at or below patient’s level. – Be honest. Developing Rapport • Tips (cont’d): – – – – Use language the patient can understand. Be aware of your body language. Speak calmly/clearly. For patients with hearing deficits, ensure your lips are visible. Developing Rapport • Tips (cont’d): – Give the patient time to answer. – Act confident and professional. • Even with the best techniques, communication may be difficult. – Consider internal and external factors. – Take good notes. Respect and Protect People’s Modesty • Modesty matters. – No matter how acute the condition – Especially for: • Elderly • Adolescents • Children • Even if patient is not sensitive, family members will be. © Glen E. Ellman Conducting an Interview • Two types of questions – Open-ended, which allow: • The patient to give you feedback • You to judge mentation – Closed-ended • Used to elicit specific answers Conducting an Interview • Have a standard set of questions concerning medical history to ask almost all patients. – Avoid talking down to patients. – Use terms people without medical training can understand. Conducting an Interview • Know what to ask women of childbearing age. • Most paramedics have additional questions for patients in specific circumstances. – Called payoff questions • Sample payoff questions include: – Have you ever felt like this before? – Have you been upset about anything lately? – Are you afraid of someone? • Do not use leading questions. Assessing Mental Status • Mental status is often a prime indicator of the extent of the illness or injury. • AVPU is one of the quickest ways to asses. – A: Alert to person, place, and day – V: Verbal response – P: Pain response – U: Unresponsive Strategies to Elicit Useful Responses • Use the following tools: – Reflection • Repeat a word or phrase a patient used to encourage more detail. – Empathy Strategies to Elicit Useful Responses • Communication tools (cont’d): – Confrontation • Make the patient aware that you know something is not “right” or consistent without provoking them. – Interpretation • Vocalize what you think the patient said, and have him or her correct you. Strategies to Elicit Useful Responses • Communication tools (cont’d): – Facilitation • Encourage hesitant patients to provide more detail. – Being quiet – Clarification Strategies to Elicit Useful Responses • Communication tools (cont’d): – Redirection – Simplification and summarization • Use when you receive a confusing/disorganized response. Common Interviewing Errors • Some errors can be considered “traps.” – – – – Never provide false assurance. Do not give advice. Do not consider yourself an authority. Do not use avoidance language. – Do not interrupt the patient or talk too much. Nonverbal Skills • First impressions are important. – Maintain a professional demeanor/appearance. – Be patient. – Keep body language positive. – Touch may provide comfort. • Varies by patient Special Interview Situations • Some situations require special techniques. – Remain nonjudgmental about your patients. • Difficult patients are especially challenging. – Consider why the patient is being difficult. – Use patience, persistence, and persuasion. Special Interview Situations General tips for caring for difficult patients: – Approach with caution; maintain eye contact. – Introduce yourself; ask for the patient’s name. – Use open-ended questions. – Provide positive feedback. – Make sure patient understands you. – Continue to ask questions; rephrase if necessary. People Who Are Hostile • Acknowledge a hostile person’s concerns. – Remain calm and empathize. – Help the person feel heard and understood. • Consider asking law enforcement for help. • You will likely be insulted on the job. – Never respond in kind. People Who Are Hostile • Hostile or angry patients may present a threat. – Approach with caution, maintaining eye contact. – Try not to interview an angry patient alone. • Have your partner stay a little farther back. People Who Are Hostile • Additional tips include: – – – – Identify escape routes. Approach from the front, with hands visible/open. Ask permission to interact with the patient. Be wary for signs of impending attack. – Be prepared to escape if necessary. Sexually Aggressive Patients • Follow your agency’s policies. • Make sure someone else is always present. • Communicate professionally and politely. – Avoid sexually ambiguous words. • Document your encounter meticulously. – Get witness names and signatures on notes. Special Considerations of Age • Do not presume older patients are harder to communicate with than anyone else. – Illnesses may be more complex. – May be differences in hearing, mobility, etc • Children can be difficult patients. – Practice skills to help improve these interactions. Special Considerations of Age • With children: – Maintain friendly eye contact. – Smile – Give calm, subdued, age-appropriate explanations. – Minimize movements – Lower your voice. – Keep eye level at or below child’s. • If possible, involve a parent with the care of a small child. © Craig Jackson/IntheDarkPhotography.com Special Considerations of Age • Adolescents: – May not want their parents present • An adult who insists on monitoring is disconcerting. • For young children: – Toys may be useful. – Create a toy to connect with the child • Do not refuse, but inform ED physician. – Offer options; honor their choices. – Modesty is especially important. People Who Live With Special Challenges • Family members and caregivers can facilitate communication. • Help patients access any devices to aid communication or reduce fear. – Touch and eye contact can convey kindness or reassurance. People Who Live With Special Challenges • Encountering patients with autism is becoming more common. – Autism is a PDD. • Patient may not be able to: – Understand what you are saying – Communicate nonverbally People Who Live With Special Challenges • Children with autism who can speak may say things that have no meaning or seem out of context. • Caregivers are your best resource for communicating with patients with PDDs. Cross-Cultural Communication • You will interact with people of differing race, religion, gender, class, and lifestyle. – Always remain considerate and professional. • Learn as much as you can about the languages and cultures of your service area. Cross-Cultural Communication • Consider attending a cultural sensitivity or cultural diversity seminar. – Be open to educating yourself. • A patient’s views may differ from his or her family’s. Cross-Cultural Communication • Some cultures’ views about treatment may affect your care plan. – Remain sensitive to the patient’s beliefs. • Even if you disagree about the cause of the illness, the patient can still accept treatment. Manners • Manners are important. – They are not uniform across cultures. • Do not use slang. – Address patients with niceties. • Ask permission to touch or treat. Hand Gestures and Body Language • Hand gestures can be misunderstood. – One gesture can have many meanings. • The most crosscultural gesture is the smile. – Use it often! • Examples of body language that differ by culture: – Touching the head – Touching with the left hand – Feet – Slouching – Hands on hips – Nodding Summary • Communicate rapidly, efficiently, and effectively. • The phases of communication: notification, potential prearrival instructions for the caller, dispatch, communication during on-scene care, and communication with the receiving facility while en route. • The dispatcher communicates with people who call in an emergency, and with the EMS unit in sending it to the scene. Summary • The dispatcher identifies the exact location of the patient, the telephone number, the nature of the problem, and specific information about the patient’s condition and emergency. • The dispatcher is also responsible for monitoring communications with the ambulance, coordinating communication with medical control and other agencies, and recording the times when the various phases of the call occurred. Summary • EMD requires special training that teaches dispatchers to provide basic medical instructions to emergency callers over the phone. Updates can be communicated to the EMS crew as they are en route. • Radio is one of the main methods of communication in EMS. The most commonly used bands for medical communications are the VHF and UHF band. The higher the band, the less interference, but the shorter the range. Summary • Trunking is the ability for multiple agencies or systems to share frequencies. • The FCC controls frequency allocation and licensing in the United States. It also establishes technical standards for radio equipment, establishes/enforces rules and regulations for the operation of radio equipment, and monitors transmissions. Frequencies allotted for medical purposes must be used strictly for that purpose. Summary • Telemetry is used to transmit vital life signs to a distant terminal. In EMS, it is usually used for transmitting an ECG. • Cell phones are becoming more common in EMS communications systems. Many newer cell phones have GPS built in. • Systems used for radio transmission include simplex, duplex, and multiplex. Summary • An EMS communications system consists of a base station, mobile and portable transmitters or receivers, a repeater, a remote console, and a landline or backup communications system. • Keep radio communication simple, brief, and direct. One of the main goals is clarity. • Remember that your words can be heard by anyone who is listening. Summary • Most ambulance systems use plain English in radio communications, but some use radio codes. If your agency uses codes, be sure to learn them. • When reporting medical information, include the patient’s age and sex, chief complaint, brief history, level of consciousness, degree of distress, vital signs, mental status, physical findings, ECG findings, treatment, and response to treatment. Summary • Most of the people you will meet during responses will be in crisis and having the worst day of their lives. • At least half of the calls you will run as a paramedic will take you into people’s homes. See every invitation into the home of someone else as a personal honor. • If you want people to tell you about their problems, convince them you want to hear what they have to say. Summary • Active listening is repeating the key parts of a patient’s responses to questions. • A therapeutic communicator’s most essential challenge is to convey calm, unmistakable, genuine concern for someone he or she has never met. • When you first meet your patients, introduce yourself and ask them for their name. This communicates your respect for them. Summary • Even if you are not convinced that patients are in real trouble, consider the possibility that they are terribly frightened. • External factors can make communication with a patient difficult. • Patient modesty matters, no matter how acute the medical condition. • When you need to know how patients feel, try asking open-ended questions. Summary • When you are trying to find facts, use closedended or direct questions. • If you sense that patients are trying to put something into words but are having trouble, be patient. • If you have tried clarification and you are still not sure what patients are trying to tell you, sometimes it helps to vocalize what you think they have said and invite them to correct you. • Summary • Nonverbal communication can be as powerful as words. • Direct eye contact generally communicates honesty and concern. • Posture is important. Try to position your eyes at the same level or below the level of the patient’s eyes. • Some people do not like to be touched at all; to others, it is a valuable assurance. Summary • Hostile or angry patients may present a threat to you and others. Always approach with caution and maintain eye contact. Try not to interview them by yourself. • Do not to presume that older people are any harder to communicate with than anyone else. • Children can pose treatment and communication challenges even to the best EMS personnel. Practice techniques for communicating with this group. Summary • When you encounter a patient who has trouble communicating, remember that family members or primary caregivers who know these patients well can facilitate your efforts and they can help you alleviate fear. • Dealing with people of cultures different from your own can be challenging. It is always considered a mark of your respect if you make an effort to learn about their language and culture. Summary • Manners, hand gestures, and body language may differ among cultures. Remember that another person’s culture may have different rules for polite behavior from your own. Credits • Chapter opener: © Jones & Bartlett Learning. Courtesy of MIEMSS • Backgrounds: Gold – Jones & Bartlett Learning. Courtesy of MIEMSS; Orange – © Keith Brofsky/Photodisc/Getty Images; Purple – Courtesy of Rhonda Beck; Red – © Margo Harrison/ShutterStock, Inc. • Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.