Chapter 4 Communications And Documentation PDF

CHAPTER 4 Communications and Documentation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 5)...

CHAPTER 4 Communications and Documentation Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com. National EMS Education Standard Competencies (1 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Preparatory Applies fundamental knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical technician (EMT), medical/legal and ethical issues to the provision of emergency care. National EMS Education Standard Competencies (2 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com 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  Family presence issues National EMS Education Standard Competencies (3 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com EMS System Communication Communication needed to  Call for resources  Transfer care of the patient  Interact within the team structure  EMS communication system  Communication with other health care professionals  Team communication and dynamics National EMS Education Standard Competencies (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Documentation  Recording patient findings  Principles of medical documentation and report writing National EMS Education Standard Competencies (5 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Medical Terminology Uses foundational anatomical and medical terms and abbreviations in written and oral communication with colleagues and other health care professionals Introduction (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Communication is the transmission of information to another person.  Verbal  Nonverbal (through body language)  Verbal communication skills are important.  Enables you to gather critical information, coordinate with other responders, and interact with other health care professionals Introduction (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Documentation  Patient’s permanent medical record  Demonstrates appropriate care was delivered  Helps others in patient’s future care  Complete patient records  Guarantee proper transfer of responsibility  Comply with requirements of health departments and law enforcement agencies  Fulfill your organization’s administrative needs Introduction (3 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Computer, radio and telephone communications  Link the EMT to EMS, fire department, and law enforcement  You must know:  What your system can and cannot do  How to use the system efficiently and effectively Therapeutic Communication (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Uses various communication techniques and strategies:  Both verbal and nonverbal  Encourages patients to express how they feel  Achieves a positive relationship with each patient Therapeutic Communication (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Shannon-Weaver communication model  Sender takes a thought  Encodes it into a message  Sends the message to the receiver  Receiver decodes the message  Sends feedback to the sender Therapeutic Communication (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 4-1 Shannon–Weaver communication model. © Jones & Bartlett Learning.  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Therapeutic Communication (4 of 4) Age, Culture, and Personal Experience (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Influences how a person communicates  Body language and eye contact are greatly affected by culture.  In some cultures, expressing emotion is a weakness.  In other cultures, it is impolite to look away while speaking. Age, Culture, and Personal Experience (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Tone, pace, and volume of language  Reflect mood of the person and perceived importance of the message  Ethnocentrism: considering your own cultural values more important than those of others  Cultural imposition: forcing your values onto others Nonverbal Communication (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Body language provides more information than words alone.  Even without exchanging any words, you should be able to tell the mood of your patient.  Facial expressions, body language, and eye contact are powerful communication tools.  Help people understand messages being sent Nonverbal Communication (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  When treating a potentially hostile patient, be aware of your own body language.  Stay calm and try to defuse the situation:  Assess the safety of the scene.  Do not assume an aggressive posture.  Make good eye contact, but do not stare.  Speak calmly, confidently, and slowly  Never threaten the patient, either verbally or physically. Nonverbal Communication (3 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Physical factors  Literal noise, or sounds in the environment, lighting, distance, or physical obstacles may affect your communication.  Cultural norms often dictate the amount of space, or proximity, between people when communicating.  Gestures, body movements, and attitude toward the patient are critically important. Verbal Communication (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Asking questions is a fundamental aspect of prehospital care.  Open-ended questions require some level of detail.  Use whenever possible.  Example: “What seems to be bothering you?” Verbal Communication (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Closed-ended questions can be answered in very short responses.  Response is sometimes a single word.  Use if patients cannot provide long answers.  Example: “Are you having trouble breathing?” Communication Tools Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Facilitation Confrontation  Interpretation Pause  Reflection Explanation  Summary Empathy  Clarification Interviewing Techniques  When interviewing a patient, consider using touch to show caring and compassion. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Use consciously and sparingly.  Avoid touching the torso, chest, and face. FIGURE 4-3 Using touch conveys a sense of caring and compassion. © Jones & Bartlett Learning. Interviewing Techniques to Avoid  Providing false assurance or  Interrupting reassurance Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Using “why” questions  Giving unsolicited advice  Using authoritative language  Asking leading or biased questions  Speaking in professional jargon  Talking too much Presence of Family, Friends, and Bystanders  Friends and family may be valuable during the patient interview process. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Allow the patient to answer even if well-meaning family members attempt to answer for the individual.  Do not be afraid to ask others to step aside for a moment. Golden Rules (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Make and keep eye contact at all times.  Provide your name and use the patient’s proper name.  Tell the patient the truth.  Use language the patient can understand.  Be careful what you say about the patient to others.  Be aware of your body language. Golden Rules (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Speak slowly, clearly, and distinctly.  If the patient is hard of hearing, face the patient so he or she can read your lips.  Allow the patient time to answer or respond.  Act and speak in a calm, confident manner. Emotional Intelligence (1 of 4)  Ability to understand and manage your emotions and properly respond to others’ emotions Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Helps with:  Defusing conflict  Building rapport  Communicating effectively  Managing difficult situations Emotional Intelligence (2 of 4)  Attributes of emotional intelligence  Self-awareness Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Self-regulation  Motivation  Empathy  Social skills Emotional Intelligence (3 of 4)  Improving emotional intelligence  Assess how you react to a stressful situation. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Practice mindfulness.  Focus attention on the present moment.  Take responsibility for your actions.  Consider how your actions will affect others. Emotional Intelligence (4 of 4)  Behavioral change stairway model Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Developed by the FBI to manage hostage situations  Adapted for crisis management  Employ active listening.  Display empathy.  Build a rapport.  Exert influence.  Initiate behavior change. Communicating With Older Patients (1 of 5)  Identify yourself.  Present yourself as competent, Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com confident, and caring.  Do not assume that an older patient is senile or confused. FIGURE 4-5 You need a great deal of compassion and patience when caring for older patients. Never assume that a patient isLearning. © Jones & Bartlett senile or ofconfused. Courtesy MIEMSS. Communicating With Older Patients (2 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  You may encounter hostility, irritability, and some confusion.  Do not assume this is normal behavior.  Approach an older patient slowly and calmly.  Allow plenty of time for the patient to respond to your questions. Communicating With Older Patients (3 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Watch for signs of confusion, anxiety, or impaired hearing or vision.  The patient should feel confident that you are in charge and that everything possible is being done for him or her.  Be patient! Communicating With Older Patients (4 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Older patients:  Often do not feel much pain  May not be fully aware of important changes in their body systems  You must be especially vigilant for objective changes. Communicating With Older Patients (5 of 5) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  When possible, give patients time to pack a few personal items before leaving for hospital.  Locate hearing aids, glasses, and dentures before departure.  Older patients are often worried about the safety of their home, valuable items, and pets. Communicating With Children (1 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Fear is most obvious and severe in children.  Children may be frightened by:  Your uniform  The ambulance  A crowd of people gathered around them Communicating With Children (2 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Let a child keep a favorite toy, doll, security blanket.  If possible, have a family member or friend nearby.  If practical, let the parent or guardian hold the child during evaluation and treatment. Communicating With Children (3 of 4) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Be honest.  Children easily see through lies or deception.  Tell the child ahead of time if something will hurt.  Respect the child’s modesty. Communicating With Children (4 of 4)  Speak in a professional, friendly way.  Maintain eye contact. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Position yourself at the child’s level. FIGURE 4-6 Maintain eye contact with a child to let the child know that you are there to help and that © Jones you & Bartlettcan be Learning. trusted. Courtesy of MIEMSS. Communicating With Hearing-Impaired Patients (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Most have normal intelligence and are not embarrassed by their disability.  Position yourself so the patient can see your lips.  Hearing aids  Be careful that they are not lost during an accident.  They may be forgotten if the patient is confused.  Ask family about use of a hearing aid. Communicating With Hearing-Impaired Patients (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Steps to take to efficiently communicate with patients who are hard of hearing:  Have paper and pen available.  If the patient can read lips, face the patient and speak slowly and distinctly.  Never shout. Communicating With Hearing-Impaired Patients (3 of 3)  Steps (cont’d):  Listen carefully, ask short questions, and give short answers. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Learn some simple sign language. FIGURE 4-7 Learn simple phrases in sign language. Signing requires movement and is best learned by attending a sign language class. A, B, C: © Jones & Bartlett A. Sick. B. Hurt. C. Help. Learning. Communicating With Visually Impaired Patients (1 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ask the patient if he or she can see at all.  Visually impaired patients are not necessarily completely blind.  Expect the patient to have normal intelligence.  Explain everything you are doing as you are doing it. Communicating With Visually Impaired Patients (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Stay in physical contact with the patient as you begin your care.  If the patient can walk to ambulance, place his or her hand on your arm.  Transport mobility aids such as a cane with the patient to the hospital. Communicating With Visually Impaired Patients (3 of 3)  Guide dogs  Easily identified by special harnesses Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If possible, transport dog with patient.  Alleviates stress for both patient and dog  Otherwise, arrange for care of the dog. FIGURE 4-8 A guide dog is easily identified by its special harness. Courtesy of the Guide Dog Foundation for the Blind. Photographed by Christopher Appoldt. Non–English-Speaking Patients (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  You must find a way to obtain a medical history.  Find out if the patient speaks some English.  Use short, simple questions.  Point to parts of the body.  Have a family member or friend interpret. Non–English-Speaking Patients (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Consider learning some common phrases in another language that is used in your area.  Pocket cards that show the pronunciation of terms are available.  Use a smartphone app or website to help you translate.  Remember to request a translator at the hospital. Mission-Critical Communications (1 of 2)  Communications where disruption will result in failure of the task at hand Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Shared mental model  A mental model is the picture an individual has in their head of “what’s going on.”  All team members must share a mental model. Mission-Critical Communications (2 of 2)  Shared mental model (cont’d)  Questions to answer: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  What is the focused priority for the patient?  What is the history of prior care?  What is the patient’s current state?  What is the patent’s immediate needs? Patient Care Hand-Over (1 of 3)  Effective communication is essential to efficient, effective, and appropriate patient care. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Transfer of pertinent patient information and responsibility for patient care. Patient Care Hand-Over (2 of 3)  Giving the hand-over report  Initiate eye contact. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Manage the environment.  Minimize noise, interruptions, and distractions.  Ensure the ABCs. Patient Care Hand-Over (3 of 3)  Provide a structured report.  SBAR (situation, background, assessment, recap/treatment) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  SBAT (situation, background, assessment, treatment)  Provide documentation.  Should include patient’s priority condition, prior care, current state, and immediate needs Receiving the Hand-Over Report  Maintain eye contact. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Manage the environment.  Ensure understanding.  Summarize.  Gather supplementary patient documentation. Written Communications and Documentation (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Patient care report (PCR)  Also known as prehospital care report  Legal document  Records all care from dispatch to hospital arrival  There are two types of PCRs: written and electronic. Written Communications and Documentation (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The PCR serves six functions:  Continuity of care  Compliance and legal documentation  Administrative information  Reimbursement  Education  Data collection for continuous quality improvement and research Information Collected on a PCR (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Information collected on the PCR:  Chief complaint  Mechanism of injury and illness  Level of consciousness or mental status  Vital signs  Initial and ongoing assessment  Patient demographics  Transport information Information Collected on a PCR (2 of 2)  Administrative information gathered from a PCR includes when:  The incident was reported Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The EMS unit was notified  The EMS unit arrived at the scene  The EMS unit left the scene  The EMS unit arrived at the receiving facility  Patient care was transferred  The unit is back in service  Types of Forms  Traditional written form with:  Checkboxes Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Narrative section  Computerized version FIGURE 4-12 An electronic PCR (ePCR). Courtesy of the Utah Department of Health. Standardized Narrative Formats (1 of 3)  CHART method  Chief complaint or chief concern Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  History  Assessments  Treatment (Rx)  Transport  Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Standardized Narrative Formats (2 of 3) Assessment Subjective Objective Plan  SOAP     Standardized Narrative Formats (3 of 3)  All narrative sections should contain:  Time of events Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Assessment findings  Emergency medical care provided  Changes in the patient after treatment  Observations at the scene  Final patient disposition  Refusal of care  Staff person who continued care Health Information Exchanges (HIEs) (1 of 2)  Improves sharing of data between EMS and other health care providers Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Allows  Access to relevant health data  Unnecessary duplication of effort in data entry  Access to patient outcomes related to hospital care  Contribution and access to electronic health information on a regular basis and during a disaster Health Information Exchanges (HIEs) (2 of 2)  Most HIEs follow the SAFR framework.  Search Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Hospital and other records  Alert  Notifies hospitals of incoming patients  File  Incorporates data directly into the patient’s health records  Reconcile  Outcomes and other data provided to EMS agencies for billing and QI Reporting Errors (1 of 2)  If you leave something out or record it incorrectly, do not try to cover it up. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Falsification:  Results in poor patient care  May result in suspension and/or legal action FIGURE 4-13 If you make a mistake on a handwritten report, the proper way to correct it is to draw a single horizontal line through the error, initial it, and write © Jones &the Bartlett correct Learning. information next to it. Reporting Errors (2 of 2)  If you discover an error as you are writing your report, draw a single horizontal line through the error, initial it, and write the correct information next to it. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  If an error is discovered after you submit your report, follow the same process. Documenting Refusal of Care Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A common source of lawsuits  Thorough documentation is crucial.  Document any assessment findings and emergency medical care given.  Have patient sign a refusal of care form.  Have family member, police officer, or bystander also sign as witness.  Complete the PCR. Special Reporting Situations Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Depending on local requirements:  Gunshot wounds  Dog bites  Some infectious diseases  Suspected physical or sexual abuse  Multiple-casualty incident (MCI) Communications Systems and Equipment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Radio and telephone communications link you and your team with other members of the EMS, fire, and law enforcement communities.  Help the entire team work together more effectively  Provide an important layer of safety and protection Base Station Radios Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Contains a transmitter and a receiver in a fixed place  Two-way radio consists of a transmitter and a receiver.  A dedicated line, also known as a hotline, is used for specific point-to-point contact.  Mobile and Portable Radios (1 of 2)  Mobile radio is installed in a vehicle.  Used to communicate with: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Dispatcher  Medical control  Ambulances often have more than one. FIGURE 4-15 Some ambulances have more than one mobile radio to allow communications with hospitals, mutual aid jurisdictions, © Jones & Bartlett Learning.and other Courtesy agencies. of MIEMSS. Mobile and Portable Radios (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Portable radios are hand-held devices.  Essential at the scene of an MCI  Helpful when away from the ambulance to communicate with:  Dispatch  Another unit  Medical control Repeater-Based Systems (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A repeater is a special base station radio.  Receives messages and signals on one frequency  Automatically retransmits them on a second frequency  Allows two mobile or portable units that cannot reach each other directly to communicate using its greater power and antenna Repeater-Based Systems (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com FIGURE 4-17 A message is sent from the control center to the transmitter by a landline. The radio carrier wave is picked up by the repeater for rebroadcast to outlying units. Return radio traffic is picked up by the repeater and rebroadcast to the © Jonescontrol center. & Bartlett Learning. Digital Equipment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Telemetry allows electronic signals to be converted into coded, audible signals.  Signals can be transmitted by radio or telephone to a receiver with a decoder at the hospital.  Data from cardiac monitors can be transmitted via Bluetooth-enabled mobile devices. Cellular/Satellite Telephones Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  EMTs often communicate with receiving facilities by cellular telephone.  Simply low-power portable radios  Satellite phones (satphones) are another option.  A scanner is a radio receiver that scans across several frequencies.  Conversations can be easily overheard. Other Communications Equipment (1 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Ambulances usually have an external public address system.  EMS systems may use a variety of two-way radio hardware.  Simplex is push to talk, release to listen.  Duplex is simultaneous talk–listen.  Multiplex utilizes two or more frequencies  MED channels are reserved for EMS use. Other Communications Equipment (2 of 2) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Trunking systems assign many frequencies.  An interoperable communications system allows all of the agencies involved to share valuable information in real time.  Mobile data terminals inside ambulance  Receive data directly from dispatch center  Allow for expanded communication capabilities (eg, maps) Radio Communications Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The Federal Communications Commission (FCC) regulates all radio operations in the United States  Allocates specific radio frequencies  Licenses call signs  Establishes licensing standards and operating specifications  Establishes limitations for transmitter output  Monitors radio operations Responding to the Scene (1 of 3)  The dispatcher  Receives and determines the relative Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com importance of the 9-1-1 call  Assigns appropriate EMS response unit(s) FIGURE 4-19 You will be assigned to a call by the dispatcher. © Jones & Bartlett Learning. Courtesy of MIEMSS. Responding to the Scene (2 of 3) Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The dispatcher (cont’d)  Selects, dispatches, and directs the appropriate EMS response unit(s)  Coordinates with other public safety services  Provides emergency medical instructions to the telephone caller Responding to the Scene (3 of 3)  EMTs report any problems that took place during a run to the dispatcher. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  EMTs inform the dispatcher upon arrival at the scene. FIGURE 4-20 The patient report should be given in an objective, accurate, and professional manner. © Jones & Bartlett Learning. Courtesy of MIEMSS. Communicating With Medical Control and Hospitals (1 of 2)  The principal reason for radio communication is to facilitate communication between you and medical control. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Medical control may be located at the receiving hospital, at another facility, or sometimes even in another city or state. Communicating With Medical Control and Hospitals (2 of 2)  Consulting with medical control serves several purposes:  Notifies the hospital of an incoming patient Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Provides an opportunity to request advice or orders from medical control  Advises the hospital of special situations Giving a Patient Report (1 of 2)  The report commonly includes the following 10 elements:  Your unit identification and level of services Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Any special “alert” indicated by the patient’s condition  The receiving hospital and your estimated time of arrival (ETA)  The patient’s age and gender  The patient’s chief complaint Giving a Patient Report (2 of 2)  The report commonly includes the following 10 elements (cont’d):  A brief history of the patient's problem Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  A brief report of physical findings  A brief summary of the care given  A brief description of the patient’s response to treatment  Any questions or orders from the receiving facility The Role of Medical Control (1 of 2)  Medical control is either off-line (indirect) or online (direct). Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  You may need to call medical control for permission to:  Administer certain treatments.  Determine the transport destination of patients.  Stop treatment and/or not transport a patient. The Role of Medical Control (2 of 2)  In most areas, medical control is provided by the physicians working at the receiving hospital. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Many variations have developed across the country.  Freestanding center  Individual physician Calling Medical Control (1 of 3)  There are a number of ways to control access on ambulance-to-hospital channels. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  The dispatcher monitors and assigns appropriate, clear medical control channels.  Centralized medical emergency dispatch or resource coordination centers Calling Medical Control (2 of 3)  Be precise and deliver important information. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Never use codes unless directed to do so by local protocol. FIGURE 4-21 Medical control must be readily available on the radio or telephone at the © Andrei hospital. Malov/Dreamstime.com. Calling Medical Control (3 of 3)  Repeat orders back word for word and then receive confirmation. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Do not blindly follow an order that does not make sense to you. Information Regarding Special Situations (1 of 2)  You may initiate communication with hospitals to advise them of an extraordinary call or situation. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Example special situations:  Hazardous materials situations  Rescues in progress  Multiple-casualty incidents Information Regarding Special Situations (2 of 2)  Keep several points in mind:  The earlier the notification, the better. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Provide an estimate of the number of patients.  Identify any special needs.  Follow your system’s plan. Maintenance of Radio Equipment Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com  Like other EMS equipment, radio equipment must be serviced.  At the beginning of your shift, check the radio equipment.  Radio equipment may fail during a run.  Follow your backup plan. Review 1. When health care providers force their cultural values onto their patients because they believe their values are better, they are displaying: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. ethnocentrism. B. proxemics. C. nonverbal communication. D. cultural imposition. Review Answer: D Rationale: Forcing your own cultural values onto others because you believe Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com your values are better is referred to as cultural imposition. Review 1. When health care providers force their cultural values onto their patients because they believe their values are better, they are displaying: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. ethnocentrism. Rationale: Ethnocentrism means considering your own cultural values as more important. B. proxemics. Rationale: Proxemics is the study of space and how the distance between people affects communication. C. nonverbal communication. Rationale: Nonverbal communication refers to any communication that does not use language. D. cultural imposition. Rationale: Correct answer Review 2. When communicating with an older patient, you should: A. approach the patient slowly and calmly. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. step back to avoid making the patient uncomfortable. C. raise your voice to ensure that the patient can hear you. D. obtain the majority of your information from family members. Review Answer: A Rationale: Approach an older patient slowly and calmly, use him or her as your Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com primary source of information whenever possible, and allow ample time for the patient to respond to your questions. Not all older patients are hearing impaired; if the patient is hearing impaired, you may need to elevate your voice slightly. Review 2. When communicating with an older patient, you should: A. approach the patient slowly and calmly. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Correct answer B. step back to avoid making the patient uncomfortable. Rationale: You may need to get closer. You have to touch the patient to take vital signs. C. raise your voice to ensure that the patient can hear you. Rationale: Not all older patients are hearing impaired. D. obtain the majority of your information from family members. Rationale: Always speak to the patient; the patient’s responses can provide unlimited information. Review 3. While caring for a 5-year-old boy with respiratory distress, you should: A. avoid direct eye contact with the child, as this may frighten him. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. avoid letting the child hold any toys, as this may hinder your care. C. avoid alerting the child prior to a patient procedure. D. allow a parent or caregiver to hold the child if the situation allows. Review Answer: D Rationale: When caring for children, take special care to avoid upsetting them. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Allowing a parent to hold the child or allowing the child to play with a favorite toy often helps to keep the child calm. Never lie to a child, or any other patient for that matter; children can see through lies and deceptions. Assure the child that you can be trusted and are there to help by maintaining eye contact. Review 3. While caring for a 5-year-old boy with respiratory distress, you should: A. avoid direct eye contact with the child, as this may frighten him. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Eye contact helps to establish trust with children. B. avoid letting the child hold any toys, as this may hinder your care. Rationale: Playing with a toy can calm a child and keep the child occupied. C. avoid alerting the child prior to a patient procedure. Rationale: Never lie to a child; children can detect deception. D. allow a parent or caregiver to hold the child if the situation allows. Rationale: Correct answer Review 4. Which of the following pieces of patient information is of LEAST pertinence when giving a verbal report to a nurse or physician at the hospital? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. The patient’s name and age B. The patient’s family medical history C. Vital signs that may have changed D. Medications that the patient is taking Review Answer: B Rationale: Information given to the receiving nurse or physician should include Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the patient’s name and age, vital signs (especially if they have changed), a summary of the past medical history, and the patient’s response to any treatment that you rendered. Family medical history is not essential in the emergency treatment of a patient. Review 4. Which of the following pieces of patient information is of LEAST pertinence when giving a verbal report to a nurse or physician at the hospital? Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. The patient’s name and age Rationale: This is very important in a verbal report. B. The patient’s family medical history Rationale: Correct answer C. Vital signs that may have changed Rationale: This is very important in a verbal report. D. Medications that the patient is taking Rationale: This is very important in a verbal report. Review 5. Which of the following statements about the patient care report (PCR) is true? A. It is not a legal document in the eyes of the law. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. It cannot be used for patient billing information. C. It helps ensure efficient continuity of patient care. D. It is intended for use only by the prehospital care provider. Review Answer: C Rationale: The PCR is an important document for more than one reason. It Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com helps to ensure efficient continuity of patient care by providing the hospital with an account of all prehospital assessments and treatment. It also serves as a legal document that reflects the care provided by the EMT. Review 5. Which of the following statements about the patient care report is true? A. It is not a legal document in the eyes of the law. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: A patient care report is a legal document. B. It cannot be used for patient billing information. Rationale: A patient care report can be used by hospital administration, which includes the billing department. C. It helps ensure efficient continuity of patient care. Rationale: Correct answer D. It is intended for use only by the prehospital care provider. Rationale: While it may not be read immediately by the hospital, it can be used later to review patient care procedures and for quality improvement purposes. Review 6. A device that receives a low-frequency signal and then transmits it at a relatively higher frequency is called a: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. duplex. B. scanner. C. repeater. D. receiver. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: A repeater receives messages and signals from one frequency and then automatically transmits them on a second, higher frequency. Review 6. A device that receives a low-frequency signal and then transmits it at a relatively higher frequency is called a: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. duplex. Rationale: Duplex is the ability to transmit and receive messages simultaneously. B. scanner. Rationale: A scanner is a device that searches or scans across several frequencies until a message is completed. C. repeater. Rationale: Correct answer D. receiver. Rationale: A receiver is a device that only receives and does not transmit. Review 7. When treating a potentially hostile patient, you should try to diffuse the situation by: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. assuming an aggressive posture. B. staring at the patient. C. speaking calmly, confidently, and slowly. D. verbally threatening the patient. Review Answer: C Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Speak calmly, confidently, and slowly. With your backup clearly visible, advise the patient what needs to be done, or provide the patient with limited, acceptable choices. “Sir, I need you to sit on the ambulance cot now. Either you will sit on the cot, or we will help you to the cot.” Review 7. When treating a potentially hostile patient, you should try to diffuse the situation by: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. assuming an aggressive posture. Rationale: Do not assume an aggressive posture. Stand with your palms facing out; this communicates openness and acceptance and allows for quick movement, if necessary. B. staring at the patient. Rationale: Make good eye contact, but do not stare. C. speaking calmly, confidently, and slowly. Rationale: Correct answer. D. verbally threatening the patient. Rationale: Never threaten the patient, either verbally or physically. Review 8. All of the following are functions of the emergency medical dispatcher, EXCEPT: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. alerting the appropriate EMS response unit. B. screening a call and assigning it a priority. C. providing emergency medical instructions to the caller. D. providing medical direction to the EMT in the field. Review Answer: D Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: Functions of the emergency medical dispatcher include screening a call and assigning it a priority, alerting the appropriate EMS response unit, coordinating EMS units with other public safety services, and providing prearrival emergency medical instructions to the caller. Review 8. All of the following are functions of the emergency medical dispatcher, EXCEPT: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. alerting the appropriate EMS response unit. Rationale: The dispatcher notifies the closest appropriate EMS unit. B. screening a call and assigning it a priority. Rationale: The dispatcher prioritizes incoming calls. C. providing emergency medical instructions to the caller. Rationale: The dispatcher helps callers with medical instructions. D. providing medical direction to the EMT in the field. Rationale: Correct answer Review 9. After receiving an order from medical control over the radio, the EMT should: A. carry out the order immediately. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com B. disregard the order if it is not understood. C. obtain the necessary consent from the patient. D. repeat the order to the physician word for word. Review Answer: D Rationale: After receiving an order from medical control, the EMT should repeat Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com the order back to the physician word for word. This will ensure that he or she heard the order correctly. After confirming the order, the EMT should obtain the necessary consent from the patient. Review 9. After receiving an order from medical control over the radio, the EMT should: A. carry out the order immediately. Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: The order must be repeated back first to confirm that it was heard correctly. B. disregard the order if it is not understood. Rationale: Repeating the order will help the EMT to clarify any misunderstandings. C. obtain the necessary consent from the patient. Rationale: This step is carried out after the order has been confirmed and understood by the EMT. D. repeat the order to the physician word for word. Rationale: Correct answer Review 10. When requesting medical direction for a patient who was involved in a major car accident, the EMT should avoid: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. using radio codes to describe the situation. B. questioning an order that seems inappropriate. C. relaying vital signs unless they are abnormal. D. the use of medical terminology when speaking. Review Answer: A Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com Rationale: When giving a report to medical control or requesting medical direction, the EMT should avoid the use of codes, such as “10-50” or “Signal 70.” One cannot assume that the physician is familiar with these codes. Plain English is more effective. Review 10. When requesting medical direction for a patient who was involved in a major car accident, the EMT should avoid: Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com A. using radio codes to describe the situation. Rationale: Correct answer B. questioning an order that seems inappropriate. Rationale: If an order seems inappropriate, EMS providers must question the validity of the order. C. relaying vital signs unless they are abnormal. Rationale: Vital signs are necessary to describe the patient’s condition to the medical director. D. the use of medical terminology when speaking. Rationale: The use of appropriate medical terminology shows the EMS provider’s confidence, knowledge, and expertise to the medical director.