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Paramedic Communications
- 1.
- 2. Preparatory Integrates comprehensive knowledgeof 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
- 3. EMS System Communication Communicationneeded to • Call for resources • Transfer care of the patient • Interact within the team structure National EMS Education Standard Competencies
- 4. Communication needed to(cont’d) • Use the EMS system • Coordinate care with other health care professionals • Improve team dynamics National EMS Education Standard Competencies
- 5. Therapeutic Communication Principles ofcommunicating 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
- 6. Principles of communicatingwith 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
- 7. Medical Terminology Integrates comprehensiveanatomic and medical terminology and abbreviations into written and oral communication with colleagues and other health care professionals. National EMS Education Standard Competencies
- 8. Introduction • The abilityto communicate clearly 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.
- 9. Introduction • Communication isboth an interactive and a circular process. – The sender formulates and encodes the message. – The message is transmitted to a receiver. – The receiver receives and decodes the message. – Feedback is confirmation the message was accurately received.
- 10. Introduction © Jones &Bartlett Learning. Original Illustration Courtesy of Gordon Worley.
- 11. Introduction • Barriers toeffective communication: – Language barriers – Vision or hearing impairment – Impaired cognition or confusion – Psychiatric conditions – Substance abuse – Preexisting medical conditions
- 12. Introduction • Barriers toeffective communication (cont’d): – Lack of ability to comprehend – Stress – Preconceptions • Adjust how you communicate to minimize barriers. • Your attitude and demeanor can also affect communication.
- 13. Response to theCall for EMS • EMS calls originate when someone recognizes a potential emergency and calls 9-1-1. • The dispatcher elicits information from the caller. – Location of patient – Phone number of caller – Why EMS was called – Patient’s condition
- 14. Response to theCall for EMS • Dispatcher will determine which resources are needed and notify them. – Computer-assisted dispatch (CAD) – May provide prearrival medical instructions to the caller • Dispatcher must remain aware of what is occurring in the field and stay in contact with the responders.
- 15. EMS Communications Systems • Systemsand devices use radio signals to send and receive information. – Basic two-way radio – Computerized radio systems – Cellular technology • Backup systems are essential.
- 16. Basic Radio Communications Theory •A radio transmits by electromagnetic waves. – Frequency is number of cycles per second (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
- 17. Basic Radio Communications Theory •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.
- 18. Communications System Components • Basestations – Have a fixed location – Serve as dispatch and coordination areas • Mobile transceivers – Two-way radios mounted on vehicles • Portable transceivers – Small battery- powered units – Handheld © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 19. Communications System Components • Radiosystems – Simplex: All transmissions on the same frequency – Duplex: Radio signals transmitted on one frequency and received on a second frequency – Multiplex: Carry multiple streams of audio/data at the same time – Digital: Transmit digital or digitized signals
- 20. Communications System Components • Repeaters –Specialized base station transceiver – Pick up weak signals and retransmit them at higher power on another frequency – Extend system range ©Jones&BartlettLearning.OriginalIllustration CourtesyofGordonWorley.
- 21. Communications System Components • Encodedradio signals allow multiple users to share frequencies and repeaters. – Continuous Tone-Coded Squelch System (CTCSS) • 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.
- 22. Interoperability • Mutual aidagreements with neighboring jurisdictions • SAFECOM – Program developed by the US Department of Homeland Security • Project 25 (P25) – Digital radio hardware standards established by the Association of Public Safety Communications
- 23. Cellular Technology • Cellphones are commonly used in EMS. – Low-power portable radios – Connected to the telephone network • Know commonly used phone numbers. © Jones & Bartlett Learning.
- 24. Cellular Technology • Smartphonesallow users to: – Take and send photographs or videos – Use GPS – Access a huge range of medical applications • Be aware of privacy implications regarding photographs or videos.
- 25. Automatic Crash Notification (ACN) •Use onboard computers to send data to a monitoring stations. – 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.
- 26. Satellite Communications • Satellitephones can be valuable in rural and remote areas. • Technology is expensive. • Global positioning system (GPS) utilizes handheld or vehicle-mounted receivers to locate the user’s position and provide directions.
- 27. Backup Communications Systems • Necessaryfor all public safety communications systems • Landlines, cell phones • Amateur radio groups – Amateur Radio Emergency Service (ARES) – Radio Amateur Civil Emergency Services (RACES)
- 28. Biotelemetry • Measures andtransmits vital life signs – Biotelemetry is mostly used with ECGs. – As paramedics have gained skill, the trend has been to rely on ECG telemetry less. • New developments in prehospital ECG telemetry – Early diagnosis/treatment of STEMI – Two-way data transmission
- 29. Communicating by Radio •Effectiveness depends on: – Technical hardware/software – People who use it © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 30. FCC Regulations • TheFCC: – Issues radio licenses – Allocates frequencies – Develops technical standards – Establishes/enforces rules/regulations for radio equipment operation – Monitors transmissions
- 31. FCC Regulations • TheFCC ensures frequencies for emergency medical use are confined to that use. • The FCC forbids: – Use of obscenities – Transmission of nonmedical messages
- 32. Clarity of Transmission •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 plain language. – Keep transmissions brief. – Spell out words or numbers to prevent confusion.
- 33. 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.
- 34. Codes • Most EMSsystems 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. – Clear text is the preferred format.
- 35. Communications Formats During Phasesof the Response • Different formats for each agency’s or region’s radio communication • Dispatch communications – Respond to the dispatcher that you have received the message. – Confirm location and call reference. – Establish your dispatch time.
- 36. Response to theScene • Contact dispatch when you begin your trip to the scene. – Establishes your en route time • Your next transmission should be at your arrival on scene. – Establishes arrival time – Opportunity to call for additional resources
- 37. On-Scene Communications • Youneed 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.
- 38. Relaying Information to MedicalControl • The legal basis for paramedic practice is supervision by a physician. – Off-line medical control – Online medical control • Communications should be concise and accurate. © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 39. Reporting Medical Information •Medical information should include: – Destination facility and ETA – Patient’s age and sex – Patient’s chief complaint – Brief history of present illness or injury – Medications and allergies – Other medical history relative to current situation – Patient’s level of consciousness/distress
- 40. Reporting Medical Information •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
- 41. Reporting Medical Information •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.
- 42. Communication With Health CareProfessionals • In-person report – Share information not given on the radio. – Be mindful of information relayed in front of the patient. • You may want to step away. – Answer all questions. – Provide written documentation. © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 43. Communication With Health CareProfessionals • Medical terminology – Learn established terms and abbreviations. – Your EMS system may have approved list of terms.
- 44. Therapeutic Communication • Paramedicsoften see 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. © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 45. Therapeutic Communication • Whenworking in a noisy environment: – 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.
- 46. Therapeutic Communication • Usestrategies 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 the patient’s answers the first time. – Jot down the patient’s responses. – Use active listening.
- 47. Therapeutic Communication • Goodrapport is essential for obtaining good medical information. • If the patient is reluctant, explain why you need personal information. – Remind him or her it is protected by law. • If patients have trouble focusing, move them safely to the ambulance. – Talking and listening is easier there.
- 48. Therapeutic Communication • Ifa patient seems threatened: – Approach cautiously – Use open posturing – Smile – Be calm – Reassure the patient – If possible, take things slowly
- 49. Therapeutic Communication • Introductionsare 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.
- 50. Therapeutic Communication • Respectand protect the patient’s modesty. – Especially for: • Elderly • Adolescents • Children • Even if the patient is not sensitive, family members will be. © Glen E. Ellman.
- 51. 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 • Also known as direct questions
- 52. Conducting an Interview •Let the patient answer at his or her own pace. • Have a standard set of questions for collecting medical history. – Avoid talking down to patients. – Use terms people without medical training can understand.
- 53. Strategies to ElicitUseful Responses • 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.
- 54. Strategies to ElicitUseful Responses • Interpretation – Repeat what you think the patient said, and have him or her correct you. • Facilitation – Encourage patients to provide more detail. • Silence – Be patient and give the patient time to speak.
- 55. Strategies to ElicitUseful Responses • 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.
- 56. 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.
- 57. Nonverbal Skills • Firstimpressions are important. – Maintain a professional demeanor/appearance. – Be patient. – Keep body language positive. – Touch may provide comfort. • Varies by patient © Jones & Bartlett Learning. Courtesy of MIEMSS.
- 58. Special Interview Situations •Some situations require special techniques. – These techniques might be helpful with patients who are uncommunicative, hostile, very young or old, or who have special needs. – Avoid stereotyping any patient group.
- 59. People Who AreHostile or Violent • Acknowledge a hostile person’s concerns. – Remain calm and empathize. – Use interpretation, clarification, and summarization. • Consider asking law enforcement for help. • You may be insulted on the job. – Never respond in kind.
- 60. People Who AreHostile or Violent • Hostile or angry patients may present a threat. – Approach with caution, maintaining eye contact. – Try not to interview an angry patient alone. – Identify escape routes from the scene. – Approach the patient from the front, with hands visible and open. – Watch for signs of possible attack such as violent language or body language.
- 61. 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. – Get witness names and signatures on notes.
- 62. Special Considerations ofAge • 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. – Children may panic when separated from their parents. – Practice skills to help improve these interactions.
- 63. Special Considerations ofAge • 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.
- 64. Special Considerations ofAge • For young children: – Toys may be useful. – Create a toy to connect with the child. © Craig Jackson/IntheDarkPhotography.com. © Jones & Bartlett Learning. Photographed by Glen E. Ellman.
- 65. Special Considerations ofAge • Adolescents – Adolescents may not want their parents present. • Communicate to the physician if a parent insists over the adolescent’s wishes. – Offer options; honor their choices. – Protect the patient’s modesty.
- 66. People With Special Challenges •Family members and caregivers can facilitate communication. • Help patients access any devices to aid communication or reduce fear. – Glasses, hearing aids • Touch and eye contact can convey kindness or reassurance.
- 67. People With Special Challenges •Encountering patients with pervasive developmental disorders is becoming more common. – Autism • 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.
- 68. Cross-Cultural Communication • Ethnocentrism –The belief that one’s own culture or ethnic group is inherently superior to others – Can lead to incorrect assumptions • May interfere with your ability to provide appropriate emergency medical care
- 69. Cross-Cultural Communication • Culturesand 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.
- 70. Cross-Cultural Communication • 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
- 71. Cultural Awareness • Bodylanguage 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
- 72. Traditional Folk Medicineand Understanding of Illness • 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
- 73. Traditional Folk Medicineand Understanding of Illness
- 74. Traditional Folk Medicineand Understanding of Illness • 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
- 75. Traditional Folk Medicineand Understanding of Illness • The patient may not share the beliefs of his or her family or cultural background. – Always remain sensitive to the patient’s individual religious, cultural, and sociological beliefs.
- 76. Language Interpretation • Thebiggest communication challenge with members of other cultures is a situation in which no common language exists. – It may be impossible to perform a good history and assessment. – Use a qualified interpreter if possible. – Assume you are missing something important.