EMS Communications PDF

# Effective communication in EMS ## Communication Systems - Communication systems allow public service agencies to exchange information. - These systems are crucial in an emergency event, as they ensure scene safety and communicate with emergency personnel involved in the incident. ## Role of Co...

# Effective communication in EMS ## Communication Systems - Communication systems allow public service agencies to exchange information. - These systems are crucial in an emergency event, as they ensure scene safety and communicate with emergency personnel involved in the incident. ## Role of Communications in EMS - Communications occur among the paramedic, patient, hospital, and medical director. - The basic communication model describes the relationships between an idea, encoding, a sender, a medium or channel, a receiver, decoding, and feedback. - Common obstacles can prevent successful communication: - Attributes of the receiver - Semantic issues - Time pressures - The terms used in EMS communications should be clear, conveyed in a short narrative form, professional, and preserve a patient's confidentiality. ## Components and Function of Dispatch Communications Systems - The following are some of the functions of an effective EMS dispatch communications system: - Receive and process calls for EMS assistance. - Dispatch and coordinate EMS resources. - Relay medical information. - Coordinate with public safety agencies. - Prepare the EMS crew for the next response. - Emergency medical dispatchers are trained to: - Determine the nature and priority of the call - Dispatch the appropriate response - Provide the caller with instructions to help treat the patient until the responding EMS unit arrives. - A dispatcher can give the caller prearrival instructions. These instructions include: - They provide the caller with instant help. - They may be lifesaving in critical incidents. - They provide emotional support for the caller, bystander, or victim. ## Procedures for EMS Communications - General guidelines for radio communications include: - Think before you speak to ensure that the communication will be effective. - Key the microphone for 2-3 seconds before speaking. - Speak at close range (2–3 inches) when talking into a microphone. - Speak slowly and clearly. - Speak in a normal pitch without emotion. - General guidelines for radio communications include: - Be brief and concise. - Avoid codes unless they are systems-approved. - Avoid slang. - Advise the receiving party when the transmission has been completed. - Confirm that the receiving party has received the message. - Always be professional, polite, and calm. - Patient information can be reported to the hospital or dispatcher by radio or phone and should include: - Unit and personnel identification. - Description of the scene or incident. - Patient's age, gender, and approximate weight (if drug orders are needed). - Patient's chief complaint or chief concern. - Associated symptoms. - Patient information can be reported to the hospital or dispatcher by radio or phone and should include: - Brief pertinent history of the present illness or injury. - Pertinent medical history, medications, and allergies. - Pertinent physical examination findings. - Any treatment given. - Estimated time of arrival. - When communicating with medical direction, the paramedic should repeat all orders received from the physician, confirm anything that is unclear, repeat all drug orders for confirmation, and inform the hospital of any significant changes in the patient's status. - General procedures for the exchange of information include: - Protect the patient's privacy. - Use proper unit numbers, hospital numbers, and titles. - Avoid slang. - Obtain confirmation that the message was received. - When performing the handoff of patient care to the receiving facility, the paramedic should make the final verbal report to the person who will be assuming responsibility for the patient. # Part 2 ## Effective communication - Effective communication strengthens patient autonomy by enhancing understanding and is essential for good medical practice. It is the means of history taking, obtaining consent for examinations and procedures, and explaining diagnoses and treatment. - Effective communicators are able to establish rapport, trust and confidence with patients more easily than ineffective communicators, thereby enhancing the flow of crucial information and increasing the likelihood that advice will be heeded. Effective communication decreases the likelihood of complaints. - Good communication skills alone are not sufficient for professional medical practice and must be accompanied by clinical competence, empathy and ethical behaviour. - Good communication skills are also a necessary prerequisite if the doctor is to provide effective leadership of the 'health-care team'. - Effective communication also improves the quality of health care and can have a very positive effect on the satisfaction gained from a consultation by both HCP and patient. - Breakdowns in communication are the most common basis of patient dissatisfaction. Surveys show that dissatisfied patients criticize HCP for not listening, for not providing adequate explanations or for appearing disinterested. Satisfied patients perceive their HCP to demonstrate humaneness, understanding, ability to listen without hurrying the patient, and the skill of involving the patient in decision making. - The opportunity for a patient to exercise his or her autonomy is undermined when a doctor is a poor communicator or appears to be unapproachable or unwilling to respond to the questions or concerns of patients. ## Obstacles to Effective communication - Obstacles to good communication may relate to a lack of skills and/or to a poor attitude of the doctor, to factors in the clinical practice setting, or to the patient's own communication issues. ### HCP-related obstacles - The reasons why some HCP are poor communicators include: - Lack of training in communication skills. - Lack of insight into communication deficiencies. - Lack of time in clinical practice. - Misapprehensions or subconscious anxieties (for example, the anxiety not to create patient dependence, or discomfort at the inability to cope with information that might arise when a patient has the confidence to be frank) - these anxieties can translate into curtness, professional detachment or authoritarianism. - Lack of attention to emotional content in the consultation. - Unresolved emotional and psychological problems of the HCPs themselves. - A common HCP-related reason for communication failure observed by medical boards and health complaints agencies is lack of insight; that is, HCP are unaware or deny that their style of communication is negatively perceived by their patients. - Lack of insight has been shown also in a study of medical students where students' confidence in their communication skills was negatively correlated with their actual skills independently assessed via videotaped interviews with simulated patients. ### Obstacles in the clinical setting - The adequacy of the waiting area, the attitude of reception staff to the patient and the physical surroundings of the consulting room may affect the subsequent communication between patient and doctor. Good communication may be impeded by failure to ensure a comfortable and secure environment that meets the need for privacy. The consulting room should be soundproof, and staff instructed to knock before entering. - Some doctors consider that a desk between patient and doctor is a barrier to communication, but individual practitioners need to decide what is comfortable and appropriate for the nature of their practice. Computer use can also be a barrier to effective communication. - Use should be limited to what is essential within the consultation. If the patient cannot see the computer screen, an explanation of what the doctor is viewing may be appropriate. - Some interruption to take essential telephone calls about clinical matters is unavoidable for most doctors, but every attempt should be made to minimise this. When calls are taken, an explanation or apology should be made to the patient who is with you and consideration given to the need to move to another telephone. As described later, time constraints, real or anticipated by the patient, can also interfere with communication. ### Patient-related obstacles - Readily recognizable factors include differences between HCP and patient in age, gender, social class, level of education, ethnic background, language barriers and variations in patients' attitudes and emotional responses to their illness. - Other factors include the effects of illness or medication, embarrassment, intimidation related to the setting and difference in status between patient and HCP, the use of medical jargon, reluctance to ask questions and patient concern over time pressure for the HCP. - These barriers can be reduced by the HCP by such steps as asking questions designed to elicit a patient's understanding and by taking care to explain the doctor's understanding of the health issue at hand. ## The Use of Communication Skills in Medical practice - Most HCP-patient interactions occur within the consultation. Of the several separate skills used during the consultation, all except one are critically dependent on effective communication. These skills are the: - Clinical skill of history taking and physical examination. - Diagnostic skill of formulating a hypothesis and pursuing it effectively. - Skills involved in explaining the diagnosis and proposed management, including obtaining consent. - Skill of patient education. - Skill of effective prescribing. - Skill of counselling in some clinical settings. - All of the PREVIOUS skills are capable of being learned and improved. They are skills that need to be accompanied by perceptiveness and an attitude that conveys to the patient respect, sensitivity and empathy. ## Starting a consultation: putting the patient at ease - The technique used will vary according to the setting and the clinical problem. An essential first step is to ensure that the patient is aware that the paramedic has seen and acknowledged him or her as a whole person before the paramedic tackles the clinical problem the patient presents. The introduction should make the patient feel welcome and as comfortable as possible. Paramedic should introduce themselves by name, but should be aware of unconscious signals of power imbalance even at this stage; 'Hello JAN, I'm paramedic Smith' sends a different message from 'Hello Mrs Jones, I'm Dr Smith'. - Having commenced the consultation, it is important to avoid premature control of the flow of spontaneous information by the use of direct and closed questions. Studies have shown that paramedic interrupt patients on average within twenty seconds of the start of the consultation. The same studies have demonstrated that patients are able to convey their issues adequately if the paramedic permits them to express themselves in an uninterrupted fashion for 90-120 seconds. Such listening improves patient satisfaction and improves the quality of the communication. - Premature interruption of this phase of the consultation is likely to prevent the expression of the patient's real concerns and may lead to the paramedic focusing on irrelevant matters. In addition, early interruption reduces the chances of establishing good rapport and trust. There are exceptions to this general advice, as one's approach needs to be modified for garrulous or demented patients and in emergencies. ## Active listening - An active listener can learn more than just what is contained in the spoken words. - Active listeners maintain eye contact and ask open-ended questions. They are attuned to tone of voice, demeanour, vocabulary, gestures, linguistic pattern and non-verbal messages. - It has been estimated that more than half the information communicated in a consultation is by non-verbal means. Body language is a major element of non-verbal communication. paramedics need to be aware also of their own body language (posture, eye contact, fiddling and other actions). For those who have computerised their medical records, this must include taking care that the patient and not the computer screen is the focus of attention. - An active listener also conveys to the patient that the patient is being seen, heard and understood. This may require verbal acknowledgement when distress is apparent (for example, 'I see this distresses you'). - Silence with maintained eye contact or a simple nod of the head will also convey empathy. Limited verbal encouragement such as 'Uh-huh' or 'Yes' assures the patient you are listening and wish them to continue. - Summarizing briefly back to the patient also reassures the patient that the paramedic has listened effectively, as well as providing the patient with the opportunity to correct any misunderstanding. ## The Physical Examination - Communication skills are also an essential element of this part of the consultation. Medical students and new graduates soon become inured to the breach of privacy involved in physical examinations such that patient anxiety and vulnerability may be overlooked. - All new patients and most review patients should be interviewed before being asked to undress. When an examination requires that the patient undress, the need for this should be explained and the paramedic should leave the room or direct the patient to an adequately screened area. A gown and/or a cover sheet should be provided, depending upon the examination to be undertaken. There are certain situations when even greater care must be taken in explaining the need for and nature of the examination, obtaining consent and providing for privacy. - To reduce the anxiety experienced by patients during examination, it may be useful to engage the patient in conversation, for example by completing elements of history taking in regard to family, past medical or social history. Alertness to non-verbal communication is also a skill to be valued during the examination (for example, the first evidence that an area of the abdomen is tender when palpated may come from the patient's facial expression, not from any comment or response to a question). ## Transcultural Issues and the Use of Interpreters - Living in multicultural country means that most paramedic will encounter patients with different backgrounds from their own. While these patients will not expect the paramedic to have a great knowledge of or understanding of their language and culture, the paramedic -patient relationship will be enhanced if the paramedic clearly shows respect for these differences. This can be demonstrated in small ways such as by asking questions of their country and its heritage, by indicating knowledge of their country of origin, or by taking additional trouble to ensure that the patient is fully understood. - As a medical consultation involves the exchange of complex and subtle information, the obstacle of language needs to be reduced using translators, especially when obtaining consent for treatment. - Ideally the interpreter should be properly trained and, if requested by the patient, of the same sex as the patient. Family members or other hospital staff should not be used to interpret medical information. Where in an emergency this is unavoidable, a qualified translator should be called as soon as practicable after the event to ensure that accurate information has been obtained. Contact details for access to telephone translators are provided in. - Problems may arise if the language of the patient has not been correctly identified and if the translator has not been arranged in a timely manner. It may be suitable to provide the translator with some background information about the patient and the purpose of the consultation. - The translator should be introduced by name to the patient and his or her role explained. When using a translator, the questions and eye contact should be directed at the patient, not at the translator. Questions should be brief or, where this is not possible, care should be taken to break up the passages to be interpreted. - Paramedic should be alert to signals from the translator that he or she is being overloaded and to any hint that the patient is not comfortable with the translator. ## Communicating When Things Go Wrong - Special attention to communication is needed when an unexpected or adverse outcome or event transpires in medical practice. It is essential in such situations to be open and frank in communicating with patients and their families. This should involve telling the patient ASAP that something untoward has occurred. In so doing it is important to acknowledge any patient distress and to express concern and regret, without admitting any wrongdoing or liability. ## Coping with angry patients - One of the most challenging situations even for experienced doctors is dealing with angry patients, especially those angered because their complaints have been ignored or badly handled. - Key elements in responding include making time available ASAP to meet with the patient, acknowledging the person's distress, making genuine attempts to respond positively to the complaint) and giving the patient some power in the resolution of the complaint. ## Talking with the Dying - The task of conveying bad news has already been touched on above where it was emphasised that adequate time must be made for this, privacy must be assured, the patient should be encouraged to have a relative or friend present and an early follow-up appointment offered. - On receipt of bad news, patients typically respond over time with a sequence of denial, anger, bargaining, depression and then acceptance, a sequence of reactions that may vary in its pace of evolution, and with overlap of the reaction phases. - After the death of a patient, paramedic also can play a valuable role in assisting the relatives of the deceased to cope with their grief by making themselves available to answer questions about the death. At times, grief will be manifested as anger, which may be directed at others, including the paramedic. ## Intra- and Inter-professional Communication and Relationships - Patient care may be compromised when there is poor communication between health-care professionals. As medical practice and health care frequently involve cooperative teamwork, and as care has become more specialized and at times compartmentalized, with multiple professionals involved concurrently and at different times during patients' illnesses, the risk of communication failure has increased. # The End