Alexander ch06 lecture

Copyright © 2017, 2012 Pearson Education, Inc. All Rights Reserved.
Advanced EMT
A Clinical-Reasoning Approach, 2nd Edition
Chapter 6
Communication and
Teamwork

• The Advanced EMT applies fundamental
knowledge of the EMS system, safety/well-being
of the Advanced EMT, and medical/legal and
ethical issues to the provision of emergency care.
Advanced EMT
Education Standard

1. Define key terms introduced in this chapter.
2. Describe the components of the communication process,
including factors that can interfere with effective
communication.
3. Identify the impact of nonverbal behaviors on
communication.
4. Demonstrate effective communications that promote
continuity and safety in patient care.
5. Given a scenario, demonstrate effective communication
that improves team dynamics.
Objectives

6. Describe the responsibilities of the Federal
Communications Commission with respect to EMS
communication.
7. Discuss the purpose and characteristics of each
component of an EMS communication system.
8. List the key points in an EMS call at which you should
communicate, and with whom you should communicate.
9. Demonstrate standard rules of radio communications.
Objectives (1 of 6)

10.Deliver a concise, organized radio report that clearly
communicates essential information to medical direction
or the receiving facility.
11.Demonstrate the ability to receive and confirm an order
for medical treatment over the radio.
12.Discuss the advantages and disadvantages of using
radio codes.
13.Convert back and forth between standard clock and 24-
hour (military) time.
Objectives (2 of 6)

14.Explain the importance of establishing rapport with
patients and their families in the therapeutic
communication process.
15.Given a scenario, engage in effective, empathetic,
culturally sensitive communication.
16.Give examples of the appropriate use of specific
therapeutic communication behaviors.
17.Analyze your communication to avoid common pitfalls.
Objectives (3 of 6)

18.Given a scenario, demonstrate modifications in
communication in challenging situations.
19.Explain the purposes and importance of documenting
patient care.
20.Describe the elements of the U.S. Department of
Transportation (DOT)/National EMS Information System
(NEMSIS) minimum data set for the patient care report
(PCR).
21.Accurately complete the contents of each section of a
PCR.
Objectives (4 of 6)

22.Give examples of each of the following types of PCR
narrative data: chief complaint, pertinent history,
subjective information, and objective information.
23.Explain the importance of using proper abbreviations and
terminology in the PCR.
24.Describe the SOAP, CHART, and CHEATED methods of
PCR narrative documentation.
25.Explain legal concerns with respect to the PCR.
Objectives (5 of 6)

26.Discuss how to handle each of the following situations
with respect to documentation: transfer of patient care
when returning to service before the PCR is complete;
multiple-casualty incidents; and supplemental reports for
special situations, such as exposure to infectious disease
and injury to a patient in the course of treatment and
transport
Objectives (6 of 6)

• Not possible to perform roles of EMS provider
without communication and teamwork.
– required in every phase of EMS call.
– requires teamwork to coordinate efforts and achieve
high-quality patient care.
• Be aware of principles of communication process.
• Understand how to use specialized EMS system
communication equipment.
Introduction

• What additional communication will Rescue 15
need to have with dispatch?
• How should Stan and Lucas interact with the
engine crew, law enforcement officers, and
bystanders?
• What actions should the crew take to establish
rapport with the patient and gain his trust?
• What written documentation must be completed
on this call?
Think About It

• Communication
– Exchange of messages between sender and receiver.
• Many factors have an impact on communication
– Environment
– Sender and receiver
– Message
– Channel or medium
Communication (1 of 6)

• Sender characteristics
– Establish credibility, expertise, trustworthiness
 Credentials
 Appearance
– Be easy to talk to
 Convey empathy and respect

• Sender characteristics (continued)
– Keep an open mind; do not make judgments
– Maintain composure
– Pay attention to your nonverbal communication

• Receiver characteristics
– Personality, intelligence, self-esteem, language, stress
– Use active listening
• Exchange information in a way that both parties
understand.
– Adjust your communication

• Communication channels
– Verbal or nonverbal
• Interference
– Technical issues (radio or cellular phone)
– Problems with hearing, seeing, or speaking
– Intruding thoughts, feelings, environmental noise
– Cultural differences
– Language barriers

• Feedback
– Receiver sends information back to the sender about
his understanding.
 Nod head
 Respond verbally
– Ask for feedback to minimize misunderstanding.

Team Dynamics and Communication (1
of 2)
• Team
– Group of individuals with specific common goals.
• EMS teams
– Common understanding of goal
– Must know roles
– Requires effective communication

Team Dynamics and Communication (2
of 2)
• Communication extends beyond EMS on scene
– Dispatch
– Medical direction
• Communication through technology
– Confirm and repeat

EMS System Communication (1 of 5)
• Communication technology rapidly evolving.
• FCC responsible for oversight of EMS radio
communication.
– Approves equipment standards
– Assigns broadcast frequencies
– Licenses base stations
– Assigns radio call signs
– Issues and enforces regulations

• Essential to have system maintenance/backup
systems.
• Important to have interoperability between multiple
agencies and jurisdictions.
– Uniform standards and processes

• EMS radio systems operate on assigned radio
frequencies, or channels.
– Public/private or digital.
• Push-to-talk (PTT) system
– Button on radio depressed to open channel for
transmission.
• Traffic
– Messages sent back and forth in radio communications
(use plain language).

• What are the three main reasons for documenting
times?

Figure 6-4
An example of a base station radio.

• Communication equipment
– Base stations
– Mobile radios
– Portable radios
– Repeaters
– Digital equipment
– Cellular telephones

Table 6-2
Guidelines for Radio Communication
• Make sure the radio is powered on and you have selected the correct frequency.
• Listen before transmitting to avoid interrupting other transmissions.
• Press the PTT button and wait one second to avoid cutting off the first part of your transmission.
• Hold the microphone two to three inches away from your mouth. Speak clearly and in a normal
volume. Control voice inflection and aim for a neutral, professional tone.
• First state the name of the entity or unit you are calling, followed by your unit identification. If you
are Medic One and you are contacting Methodist Hospital, say, “Methodist Hospital, Medic One.”
• Wait for the unit being called to respond. “Go ahead” means proceed with your transmission. “Stand
by” means wait for the unit to let you know they are ready for your transmission.
• Transmit for no more than 30 seconds without a pause.
• Deliver information in a concise, organized format.

Figure 6-8
Cultural differences and language barriers can present communication challenges.

Therapeutic Communication and
Interviewing Patients (1 of 8)
• Therapeutic Communication
– Difficulties
 Cultural differences and language barriers
 Use surnames
 Uncooperative patients
• Possible solutions
– Speak calm, clearly, and with a nonaggressive tone
– Courtesy and compassion

• Control the environment
– Provide privacy
– Control noise
• Nonverbal communication
– Posture, gestures, facial expressions
– Personal space considerations
– Touch can be a sensitive issue

• Verbal communication
– Active listening
– Be available
– Open-ended questions
 Do not have limited range of options
– Closed-ended questions
 Narrow range of expected responses
– Leading questions
 Suggest answer to patients

• Verbal communication (continued)
– Check understanding
– Clarify information
– Confrontation
 Point out inconsistencies in the patient’s communication

• Verbal communication (continued)
– Facilitation
– Reflection
– Silence
– Summarize

• Pitfalls in communication
– Multitasking
– Requesting explanation
– Overloading patient with information or questions
– Giving advice and opinions
– Changing subject
– Interrupting
– False reassurances

• Special patient communication situations
– Age-related psychosocial characteristics
– Sensory deficits
– Cognitive impairment
• Begin by communicating with the patient directly.

• Hostile patients
– Your safety first
– Defusing strategies
• Uncommunicative patients
– Try closed-ended questions
– Gain their trust

Documentation (1 of 3)
• Patient care report (PCR) documents patient care
(paper or electronic)
– Continuity of care
– Information for billing, insurance claims, statistical
information
– Legal documents
– Data for research and education

• Standardized data collection
– Types of patients who seek EMS
– Types of care provided
– Outcomes of patients
• National EMS Information System (NEMSIS)
– Patient information
– Administration information

• Sections of patient care report
– Administrative information
– Patient demographic data
– Vital signs
– Narrative report of call
– Treatment provided

Table 6-6 (1 of 3)
Patient Care Report Narrative Formats
SOAP
• S—Subjective: Information about the problem as it is given by the patient, including the chief complaint,
history of the present illness, and symptoms.
Example: Pt. c/o difficulty breathing that started 90 min. ago. Hx: asthma. States he has used his albuterol
inhaler relief of symptoms.
• O—Objective: Information observed in some way by the Advanced EMT, such as vital signs, pupil reaction,
response to pain, and other physical findings. Also includes description of the circumstances in which the
patient was found
Example: Pt. found prone on living room floor pool of emesis next to his face. Did not respond to painful
stimuli but was breathing spontaneously at a rate of 12 breaths per minute.
• A—Assessment: Your field impression of the patient’s problem, based on subjective and objective information.
Example: Suspected hypoglycemia.
• P—Plan: Treatment provided and transport information.
Example: Airway opened with a head-tilt/chin-lift. Pt. unable to tolerate OPA. O2, 15 L/min by NRB. IV NS
TKO, lt. forearm. 25 g dextrose, IVP. LOC ↑ within 2 minutes. Pt. remained A&O  3 throughout transport to
Cass County Hospital.

Table 6-6 (2 of 3)
CHART
• Usually starts with an introductory statement.
Example: 48 yowf found LLR on sofa with empty emesis basin on floor.
• C—Chief complaint (CC): Describes the patient’s chief complaint; also includes associated complaints and
pertinent negatives.
Example: Pt. c/o RUQ abd pain radiating to rt. Shoulder  2 hours, with no provoking or alleviating factors.
Pain described as “sharp and crampy,” and constant. Pt. rates pain 7/10. Pt. c/o nausea, but denies vomiting.
• H—History: Includes history of the present illness (HPI) and pertinent past medical history (PMH).
Example: Pt. states the pain has been increasing in severity and becoming more constant over the past 2 hrs.
PMH: NKDA, no medications, no major illnesses or surgeries, last oral intake: catfish, fries, cole slaw, and
soda at 1230 hrs. Pt. felt well until onset of pain at 1600 hrs.
• A—Assessment: Information from primary and secondary assessments and reassessment.
Example: Pt. A&O  3, initial VS above. Skin warm, moist, normal color. RUQ tender to palpation. No
guarding, masses, or discoloration noted.
• R—Rx (treatment): Lists treatments provided and the patient’s response to them.
Example: Pt. placed in position of comfort (LLR) on stretcher.
• T—Transport: How and where patient was transported, changes in transport, transfer of care.
Example: Transported nonemergent to Douglas Medical Center in condition. Released with report to RN in
room number 6.

Table 6-6 (3 of 3)
CHEATED (Variation on CHART)
• C—Chief complaint
• H—History
• E—Exam: Information from primary and secondary assessments.
• A—Assessment: Field impression, based on chief complaint, history, and exam.
• T—Treatment
• D—Disposition: Transport and transfer of care information.
(Refer to Chapter 7 for symbols and abbreviations.)

• Legal considerations in documentation
– PCRs are legal/medical records protected by HIPAA
– Correcting error on written PCR
 Draw single line through error
 Initial it
 Write correct information

Figure 6-12
Correct errors with a single line drawn through them.

• Special documentation circumstances
– Leave abbreviated PCR at minimum
– Multiple-casualty incidents
– Patient refuses care
– Documentation outside scope of PCR

Chapter Summary (1 of 2)
• Effective communication essential to every aspect
of EMS provider’s job.
• Be aware of your verbal and nonverbal
communication.
• Strive to improve communication and teamwork.

Chapter Summary (2 of 2)
• Establish rapport with patients and use
therapeutic communication techniques.
• Be proficient in use of EMS communication
equipment and adhere to guidelines.
• Breakdowns in communication can jeopardize
your safety and that of your patient.

Alexander ch06 lecture

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Alexander ch06 lecture