paramedic

1. Copyright © 2023 by Jones & Bartlett Learning, LLC, an Ascend Learning Company and the American Academy of Orthopaedic Surgeons.
Communications
CHAPTER 5

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Introduction (1 of 3)
 The ability to communicate is a core EMS skill.
 You must be able to communicate with dispatch, other members of the EMS
system, patients, family members, and bystanders.
 Many factors influence how effectively you communicate.

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Introduction (2 of 3)
 Communication is both an interactive and a circular process.
© Jones & Bartlett Learning. Original illustration courtesy of Gordon Worley.

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Introduction (3 of 3)
 Often times, there are barriers to effective communication.
 Adjust how you communicate to minimize barriers.
 Your attitude and demeanor can also affect communication.
 Treat every patient you encounter professionally.

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Response to the Call for EMS (1 of 7)
 Crew resource management (CRM)
 Operational practice developed by US Air Force and airline industry
 Enhances communication and teamwork
 Reduces preventable errors

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Response to the Call for EMS (2 of 7)
 Crew resource management (CRM) (cont’d)
 CRM begins with prebriefing while en route to call.
 On scene, includes:
 Frequent check-ins and updates
 Reassessments of the situation
 Cross-checks
 Situational awareness
 CRM training and practice should be part of EMS education.

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Response to the Call for EMS (3 of 7)
 EMS calls originate when someone recognizes a potential emergency and calls
9-1-1.
 Responsibilities of the 9-1-1 dispatcher:
 Elicits information from the caller
 Determine which resources are needed
 Notify responders of additional information while they are en route

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Response to the Call for EMS (4 of 7)
 Computer-assisted dispatch (CAD) systems
 Enables dispatcher to view all information about the call and may provide:
 Maps
 Fastest routes to call location
 Known hazards at call location
 Dispatcher can send information to crew via mobile data terminal (MDT)

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Response to the Call for EMS (5 of 7)
 Advice to the caller
 After dispatching the appropriate resources and alerting responders to any special
circumstances, the dispatcher:
 Informs the caller of what is being done
 Gives prearrival medical instructions by phone, if required

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Response to the Call for EMS (6 of 7)
 Ongoing communications with responding units in the field
 Dispatcher must remain aware of what is occurring in the field and stay in contact
with ambulance and other responders.

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Response to the Call for EMS (7 of 7)
Data from: Association of Public-Safety Communications Officials. Minimum training standards for
public safety telecommunicators. APCO ANS 3.103.2.2015. https://www.apcointl.org/training-and-
certification/comm-center-training-programs/training-standards-guidelines/. Accessed July 6, 2021.

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EMS Communications Systems
 Systems and devices use radio signals to send and receive information.
 Backup systems are essential.

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Basic Radio Communications Theory (1 of 2)
 A radio transmits by electromagnetic waves.
 Radio frequency is measure in hertz.
 Frequencies are grouped into bands by the FCC.
 VHF band extends from 30 to 300 MHz
 UHF band extends from 300 MHz to 3.0 GHz

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Basic Radio Communications Theory (2 of 2)
 Radio communications require two types of devices.
 The transmitter converts data into a radio signal and transmits it on the designated
frequency.
 The receiver collects the radio signal and translates it back into data or sound.
 Transceivers (two-way radios) contain both a transmitter and a receiver.

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Communications System Components (1 of 4)
 Base stations
 Have a fixed location
 Serve as dispatch and coordination
areas
 Mobile transceivers
 Two-way radios mounted on
vehicles
© Jones & Bartlett Learning. Courtesy of MIEMSS.

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Communications System Components (2 of 4)
 Portable transceivers
 Small battery-powered units
 Handheld
 Radio systems
 Simplex
 Duplex
 Multiplex
 Digital

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Communications System Components (3 of 4)
 Repeaters
 Specialized base station
transceiver
 Pick up signals and rebroadcast
them at higher power level on
another frequency
 Extend system range © Jones & Bartlett Learning. Original illustration courtesy of Gordon Worley.

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Communications System Components (4 of 4)
 Encoded radio signals allow multiple users to share frequencies and repeaters.
 Digital trunked radio systems utilize multiple repeaters and computers to route
radio traffic within the system.
 Be aware of radio dead spots in your service area.

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Interoperability
 Mutual aid agreements with neighboring jurisdictions
 SAFECOM
 Project 25 (P25)

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Cellular Technology (1 of 2)
 Cell phones are commonly used in
EMS.
 Know commonly used phone
numbers.
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Cellular Technology (2 of 2)
 Telephone calls can be patched into radio networks.
 Allow for recording
 Smartphones allow users to:
 Take and send photographs or videos
 Use GPS
 Access medical applications
 Be aware of privacy implications regarding photographs or videos.

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Automatic Crash Notification (ACN)
 Use onboard computers to send data to a monitoring station
 Location
 Vehicle type
 Severity of crash
 Whether seat belts or airbags were used
 May allow two-way voice communication with the occupants of the vehicle

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Satellite Communications
 Satellite phones can be valuable in rural and remote areas.
 Global positioning system (GPS) utilizes handheld or vehicle-mounted receivers
to locate the user’s position and provide directions.

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Backup Communications Systems
 Necessary for all public safety communications systems
 VHF/UHF simplex or duplex radios
 Landlines, cell phones
 Amateur radio groups
 Amateur Radio Emergency Service (ARES)
 Radio Amateur Civil Emergency Services (RACES)

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Biotelemetry
 Measures and transmits vital signs
 Mostly used with ECGs
 Advances in prehospital ECG telemetry
 Early diagnosis/treatment of STEMI
 Two-way data transmission

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Communicating by Radio
 Effectiveness depends on:
 Technical hardware/software
 People who use it
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FCC Regulations (1 of 2)
 The FCC:
 Issues radio licenses
 Allocates frequencies
 Develops technical standards
 Establishes/enforces rules/regulations for radio equipment operation
 Monitors transmissions

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FCC Regulations (2 of 2)
 The FCC ensures frequencies for public safety and EMS communications are
confined to that use.
 The FCC forbids:
 Use of obscenities
 Transmission of nonmedical messages

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Clarity of Transmission (1 of 2)
 Guidelines to improve clarity:
 Know what you want to say before beginning.
 Make sure the channel is clear.
 Start with identifying information.
 Speak clearly and distinctly.
 Keep calm and free of emotion.
 Use clear text plain language.
 Keep transmissions brief.
 Spell out words or numbers to prevent confusion.

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Clarity of Transmission (2 of 2)
Data from: International Civilian Aviation Organization. Alphabet—radiotelephony.
https://www.icao.int/pages/alphabetradiotelephony.aspx. Accessed January 30, 2021.

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Content of Transmissions
 Be accurate and concise.
 Guidelines include:
 Protect the patient’s privacy at all times.
 Be impersonal.
 Use proper medical terminology.
 Act professionally.
 Question orders you did not hear or understand.

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Codes
 Most EMS systems have phased out the 10-code system and other radio
codes.
 The Medical Priority Dispatch system (MPDS) uses a specific format to indicate
the nature of the emergency and priority.
 The National Incident Management System (NIMS) discourages use of radio
codes.

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Communications Formats During Phases of the Response
 Different formats for each agency’s or region’s radio communications
 Dispatch communications
 Respond to the dispatcher that you have received the message.
 Confirm location and call reference.
 Establish your dispatch time.

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Response to the Scene
 Contact dispatch when you begin your trip to the scene.
 Your next transmission should be at your arrival on scene.

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On-Scene Communications
 You need to stay in contact with other responders at the scene.
 Contact dispatch when you are ready to provide transport.
 Your next transmission is to notify dispatch of your arrival at the medical facility.
 Your last transmission confirms call completion and establishes status.

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Relaying Information to Medical Control
 Communications should be clear,
concise, and accurate.
© PeopleImages/iStock/Getty Images Plus/Getty Images.

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Reporting Medical Information (1 of 3)
 Medical information should include:
 Destination facility and ETA
 Patient’s age and sex
 Patient’s chief complaint
 Brief, pertinent history of present illness or injury
 Medications and allergies
 Other medical history relative to current situation
 Patient’s level of consciousness/distress

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Reporting Medical Information (2 of 3)
 Medical information should include (cont’d):
 Patient’s mental status
 Patient’s vital signs
 Physical findings in head-to-toe order
 ECG findings
 Treatment given so far and response

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Reporting Medical Information (3 of 3)
 Transmit information quickly, completely, and in a well-organized fashion.
 Gather information thoroughly at the scene and organize it clearly before
reporting.
 Continue to monitor and assess the patient and report any changes.

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Communication With Health Care Professionals (1 of 2)
 In-person report
 Share information not given on the
radio.
 Be mindful of who can hear you.
 Answer all questions.
 Provide written documentation.
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Communication With Health Care Professionals (2 of 2)
 Medical terminology
 Learn established terms and abbreviations.
 Your EMS system may have approved list of terms.

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Therapeutic Communication (1 of 7)
 Paramedics often see people at
their most vulnerable.
 See every invitation into a home as
a personal honor.
© John Moore/Getty Images News/Getty Images.

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Therapeutic Communication (2 of 7)
 When working in a noisy environment:
 Reduce noise.
 Promote quiet, calm atmosphere.
 Try not to shout.
 Speak close to the patient’s ear in a calm voice.

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Therapeutic Communication (3 of 7)
 Use strategies to encourage the patient to express ideas and feelings.
 Convince the patient you want to hear what he or she has to say.
 Give patients your undivided attention.
 Pay attention to what patients say.
 Jot down the patient’s responses.
 Use active listening.

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Therapeutic Communication (4 of 7)
 Good rapport is essential for obtaining good medical information.
 If the patient is reluctant, explain why you need personal information.
 If patients have trouble focusing, move them safely to the ambulance.

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Therapeutic Communication (5 of 7)
 If a patient seems threatened:
 Approach cautiously
 Use open posturing
 Smile
 Be calm
 Reassure the patient
 If possible, take things slowly

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Therapeutic Communication (6 of 7)
 Introductions are the first step in promoting open communication.
 Introduce yourself as soon as possible.
 Make and keep eye contact.
 Get on the patient’s level.
 Be aware of body language.
 Use the patient’s name.
 Speak slowly and calmly.
 Always be honest.

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Therapeutic Communication (7 of 7)
 Respect and protect the patient’s
modesty.
 Even if the patient is not sensitive,
family members will be.
Courtesy of Rhonda Hunt.

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Conducting an Interview (1 of 2)
 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
 Also known as direct questions

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Conducting an Interview (2 of 2)
 Let the patients answer at their own pace.
 Have a standard set of questions for collecting medical history.
 Use simple language that people without medical training can understand.
 Avoid talking down to patients.

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Strategies to Elicit Useful Responses (1 of 3)
 Reflection
 Repeat a word or phrase a patient used to encourage more detail.
 Empathy
 Put yourself in the patient’s position.
 Confrontation
 Make patients aware that you understand something is inconsistent about their
story.
 Remain professional and nonjudgmental.

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Strategies to Elicit Useful Responses (2 of 3)
 Interpretation
 Repeat what you think the patient said and invite the patient to correct you.
 Facilitation
 Encourage patients to provide more detail.
 Silence
 Be patient and give the patient time to speak.

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Strategies to Elicit Useful Responses (3 of 3)
 Clarification
 Ask patients to explain what you do not understand.
 Redirection
 Redirect patients to something mentioned in passing to get an answer.
 Simplification and summarization
 Summarize the patient’s comments in simpler terms.

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Common Interviewing Errors
 Providing false assurance or making unlikely claims
 Offering a diagnosis or giving medical advice that is beyond your scope of
practice
 Asking leading questions
 Interrupting the patient or talking too much

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Nonverbal Skills
 First impressions are important.
 Maintain a professional
demeanor/appearance.
 Be patient.
 Keep body language positive.
 Touch may provide comfort.
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Special Interview Situations
 Some situations require special techniques.
 Patients who are uncommunicative, hostile or violent, older patients, young
children, or those with special challenges
 Avoid stereotyping any patient group.

57. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
People Who Are Hostile or Violent (1 of 3)
 Acknowledge a hostile person’s concerns.
 Remain calm and try to understand.
 Consider asking law enforcement for help.
 You may be insulted.
 Never respond in kind.

58. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
People Who Are Hostile or Violent (2 of 3)
 Hostile or angry patients may present a threat.
 Approach with caution, maintaining eye contact.
 Avoid interviewing an angry patient alone.
 Have law enforcement or EMS responders close by as backup.
 Identify escape routes from the scene.
 Approach the patient from the front, with hands visible and open.
 Introduce yourself, explain your role, ask for the patient’s name.

59. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
People Who Are Hostile or Violent (3 of 3)
 Hostile or angry patients may present a threat. (cont’d)
 If safe, get on the patient’s level.
 Ask permission to ask questions and touch the patient.
 Always be honest.
 Be wary for signs of impending attack, such as clenched fists, hostile language,
tensed neck and face muscles, and threatening gestures.

60. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Sexually Aggressive Patients
 Make sure a second person is always present.
 Communicate professionally and politely.
 Follow your agency’s policies:
 Document your encounter.
 Get witness names and signatures.

61. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Special Considerations of Age (1 of 4)
 Do not assume older patients are harder to communicate with than anyone
else.
 Illnesses may be more complex.
 There may be differences in hearing, mobility, etc.
 Children tend to protest pain.
 They may panic when separated from their parents.

62. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Special Considerations of Age (2 of 4)
 Communicating with children:
 Maintain friendly eye contact.
 Smile.
 Give calm explanations.
 Minimize movements.
 Lower your voice.
 Keep eye level at or below the child’s.
 If possible, involve a parent in the care of a small child.

63. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Special Considerations of Age (3 of 4)
 For young children:
 Toys may be useful.
 Create a toy to connect with the child.
Photo illustration by Craig Jackson inthedarkphotography.com. © Jones & Bartlett Learning. Courtesy of MIEMSS.

64. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Special Considerations of Age (4 of 4)
 Adolescents
 Generally, deal with adolescents as adults, offering realistic options and choices.
 Adolescents may not want their parents present.
 Protect the patient’s modesty.
 Avoid disrobing patients unless necessary.

65. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
People With Special Challenges (1 of 2)
 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.

66. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
People With Special Challenges (2 of 2)
 Encountering patients with pervasive developmental disorders, such as autism,
is becoming more common.
 A patient may not be able to understand what you are saying or communicate
nonverbally.
 Patients have a wide range of skill development.
 Communicate through a caregiver if possible.

67. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cross-Cultural Communication (1 of 3)
 Ethnocentrism
 The belief that one’s own culture or ethnic group is inherently superior to others
 May interfere with your ability to provide appropriate emergency medical care

68. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cross-Cultural Communication (2 of 3)
 Cultures and religions may have certain beliefs that conflict with standard
medical procedures.
 Try to understand why the patient is reacting in a manner you did not anticipate.

69. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cross-Cultural Communication (3 of 3)
 Culture
 System of beliefs, attitudes, and behaviors that are learned and shared by
members of a group
 Learned from others
 Cultural competence
 Ability to recognize cultural differences and understand how they may affect your
interactions with the diverse population you serve

70. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Cultural Awareness
 Body language may be interpreted differently by different cultures.
 Eye contact
 Touching with the left hand
 Touching the head
 Showing bottom of feet
 Hands on hips
 Nodding
 Hand gestures

71. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Traditional Folk Medicine and Understanding of Illness (1 of 4)
 Many immigrants to the United States follow traditional folk medicine practices
of their culture or homeland.
 May believe that health is the result of a balance of forces
 May believe illness is the result of loss of spirit or magical influences
 May practice a blend of Western and traditional health practices

72. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Traditional Folk Medicine and Understanding of Illness (2 of 4)
Data from: Juckett J. Cross-cultural medicine. Am Fam Physician. 2005;72(11):2267-2274; Lipson JG, Dibble SL.
Culture and Clinical Care. San Francisco, CA: UCSF Nursing Press; 2005.

73. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Traditional Folk Medicine and Understanding of Illness (3 of 4)
 Cupping and coining
 May be easily misinterpreted as signs of physical abuse
 Herbal medicines
 May be a source of symptoms or interact with prescribed medications
 Collect all medications and bring them to the hospital

74. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Traditional Folk Medicine and Understanding of Illness (4 of 4)
 Some patients may not share the beliefs of their families or cultural
backgrounds.
 Always remain sensitive to the patient’s individual religious, cultural, and
sociological beliefs.

75. Copyright
©
2023
by
Jones
&
Bartlett
Learning,
LLC,
an
Ascend
Learning
Company
and
the
American
Academy
of
Orthopaedic
Surgeons.
Language Interpretation
 The most significant communication challenge with members of other cultures
is lack of a common language.
 It may be impossible to perform a good history and assessment.
 Use a qualified interpreter if possible.
 Assume you are missing something important.