Chapter 5
EMS Communications
National EMS Education
Standard Competencies
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
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
• 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
• 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
• 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
• Base stations
– Serve as dispatch
and coordination
– Should be in contact
with all other system
• Transceivers
– Two-way radios
mounted on vehicles
• Portable transmitter/
– Handheld radios
Communications System
• 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
– 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
– Allocates and monitors US radio frequencies
• Assigns VHF bands for general emergencies
• Assigns UHF bands for ambulance-to-hospital
• EMS systems must perform COMM CHEKs
Modes of Radio Operation
• Simplex
– Uses one frequency to either transmit or receive
• Duplex
– Uses two frequencies to transmit and receive
• Multiplex
– Combines signals to transmit simultaneously on
one frequency
Digital Radio and Trunked
• Digital radio helps clear up distorted or lost
• 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
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
• Landlines
– Less expensive
– Give clearer signals
– Link various fixed
components of the
– Allow communication
with anyone with a
– Calls can be patched
into radio
• Older systems may
be used if a disaster
• Cell phones
• 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.
• 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
• 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
• 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
Clear message
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/
• 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.
– Codes should be:
• Simple and
• 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
Relaying Information to
Medical Control
• Communications with
medical control should
be concise and
– Use a standard format.
• Going to a different
facility than medical
control is not
– Know protocol.
Reporting Medical Information
• Include the following when reporting medical
– 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
degree of distress
– Patient’s mental
– Patient’s vital signs
– Physical findings in
head-to-toe order
– ECG findings
– Treatment given so
far and response
– Estimated time of
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
• 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
– Patient’s exact
– Call-back number
– Caller’s perception
of the nature of the
– Information about the
patient’s condition to
determine urgency
• For a motor vehicle
– Kinds of vehicles
– Number of persons
• Estimate of extent
– Apparent hazards
• EMD may need to
contact other
agencies to assist.
• EMD decides which crew/vehicle to dispatch.
– Depends on:
• Location and nature of call
• Availability of various units
• EMD may provide additional information en
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
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
– Ask payoff questions.
• Communication is critical in challenging
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.
Be calm.
– Reassure the patient.
– If possible, take things slowly.
Developing Rapport
• Tips for positive communication:
– Introduce yourself; get and use the patient’s
– 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 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
Conducting an Interview
• Know what to ask
women of
childbearing age.
• Most paramedics
have additional
questions for
patients in specific
– Called payoff
• Sample payoff
questions include:
– Have you ever felt like
this before?
– Have you been upset
about anything lately?
– Are you afraid of
• Do not use leading
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
• Use the following tools:
– Reflection
• Repeat a word or phrase a patient used to
encourage more detail.
– Empathy
Strategies to Elicit Useful
• 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
• Communication tools (cont’d):
– Facilitation
• Encourage hesitant patients to provide more
– Being quiet
– Clarification
Strategies to Elicit Useful
• Communication tools (cont’d):
– Redirection
– Simplification and summarization
• Use when you receive a confusing/disorganized
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
– Maintain a professional
– Be patient.
– Keep body language
– Touch may provide
• 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
– Introduce yourself;
ask for the patient’s
– Use open-ended
– Provide positive
– Make sure patient
understands you.
– Continue to ask
questions; rephrase if
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
– 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
– Smile
– Give calm, subdued,
– 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/
Special Considerations of Age
• Adolescents:
– May not want their
parents present
• An adult who insists
on monitoring is
• 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
People Who Live With Special
• 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
People Who Live With Special
• 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
• Children with autism who can speak may say
things that have no meaning or seem out of
• 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
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 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
• Hand gestures can
be misunderstood.
– One gesture can
have many
• 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
• Communicate rapidly, efficiently, and
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.
• 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.