Chapter 5

Communication

Copyright ©2010 by Pearson Education, Inc. All rights reserved.

Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich • Keith J. Karren

Objectives

1.  Define key terms introduced in this chapter. 2.  Discuss the purposes and characteristics of each of the

following EMS system communication components (slides 15-27): a.  Base station b.  Mobile radios c.  Portable radios d.  Digitalized radio equipment e.  Mobile data terminals f.  Cell phones

3.  Describe the responsibilities of the Federal Communications Commission (slides 28-29).

Objectives

4.  Explain the importance of EMS system communication equipment maintenance (slides 28-29).

5.  Given a radio transmitter/receiver, demonstrate the standard ground rules for radio communications

(slides 30-35). 6.  List key points in an EMS call at which you should

communicate with dispatch (slides 36-37). 7.  Deliver a concise, organized radio report that clearly

conveys essential information to medical direction or the receiving facility (slides 38-43).

8.  Describe the process of receiving and confirming an order from medical direction over the radio (slide 40).

Objectives

9.  Identify situations in which you should make additional contact with medical direction or the receiving facility after providing an initial radio report.

10.  Given a scenario, deliver an oral report to transfer care of the patient to a receiving facility or another EMS provider (slides 44-47).

11.  Given a scenario, demonstrate effective communication that enhances team dynamics

(slides 48-50). 12.  Discuss the advantages and disadvantages of using

radio codes (slides 51-52). 13.  Convert back and forth between military time and

standard clock times (slides 53-54).

Objectives

14.  Communicate using commonly used radio terms (slides 55-56).

15.  Describe the components of the communication process (slides 57-61).

16.  Discuss factors that can enhance or interfere with effective communication (slides 57-61).

Objectives

17.  Give examples of each of the following techniques of therapeutic communication (slides 62-63): a.  Clarification b.  Summary c.  Explanation d.  Silence e.  Reflection f.  Empathy g.  Confrontation

18.  Given a scenario, engage in an effective communication process with a patient (slides 64-69).

Objectives

19.  Recognize the potential messages that may be communicated via nonverbal behaviors (slides 70-72).

20.  Describe the uses, advantages, and disadvantages of open-ended and closed questions (slides 73-74).

21.  Analyze your communications with a patient in a scenario to recognize the following pitfalls in communication (slides 75-76): a.  Leading or biased questions b.  Interrupting the patient c.  Talking too much d.  Providing false assurance e.  Giving inappropriate advice f.  Implying blame

Objectives

22.  Discuss considerations for each of the following situations (slides 75-83): a.  Communicating with a patient’s family b.  Getting a noncommunicative patient to talk c.  Interviewing a hostile patient d.  Cross-cultural communications e.  Language barriers f.  Communicating with children and elderly patients

Multimedia Directory

Slide 72 Nonverbal Communication Video Slide 83 Alternate Methods of Communication Video

Topics

"  EMS Communication System "  Communicating within the System "  Team Communication and Dynamics "  Therapeutic Communication

Dispatch

EMS Unit 2

Respond to 101 Bate Road for man bleeding in a driveway.

Time out 1128

Upon Arrival

•  Semi-rural area •  Find a 40s male sitting on a bench next to the

garage, clutching hand •  See a workbench in the back of the garage •  Right hand wrapped in blood-soaked rag; shirt

and pants blood-stained

How would you proceed?

Back to Topics

EMS Communications System

Components of an Emergency Communications System

Base Station

Back to Objectives

•  High power •  Power levels limited by FCC •  Transmits to repeaters

Components of an Emergency Communications System

Mobile Radios

•  Vehicle-mounted •  Lower powered than

base station •  10- to 15-mile range •  Transmission affected

by terrain

Components of an Emergency Communications System

Portable Radios

•  Out of vehicle use •  Very limited range •  May be used by

hospital as well

Components of an Emergency Communications System

Repeaters

•  Rebroadcast low power signals •  Can be fixed or mobile

Repeaters

Components of an Emergency Communications System

Digital Equipment

•  Encoder •  Decoder •  Mobile data terminal

Components of an Emergency Communications System

Cell Phones

•  Operation •  Benefits •  Disadvantages

Components of an Emergency Communications System

Broadcast Regulations and System Maintenance

Back to Objectives

•  FCC regulates functions •  Appropriate system maintenance

Back to Objectives

Back to Topics

Communicating within the System

Ground Rules for Radio Communication

Back to Objectives

•  Radio on, correct frequency •  Listen before transmitting •  Push the “press to talk” button; wait one

second before speaking •  Speak with your lips two to three inches

from microphone •  Address the unit being called by its name

and number, then identify your unit by name •  “Go ahead” or “stand by” •  Keep transmissions brief

•  Keep your transmission organized and to the point

•  Say the numerical digits if it would be confusing

•  Avoid diagnosing the patient’s problem •  Use the “echo” method •  Always write down important information •  No personal information; no profanity •  Use “we” not “I” •  Use “affirmative” and “negative” •  Say “over” when finished

Phone/Cell Phone Communication

•  Be familiar with technology •  Be aware of dead spots

Communicating with Dispatch

Back to Objectives

•  Acknowledge the call •  En route •  On Scene •  Leave Scene •  Arrival at hospital •  Clear of hospital •  Back at station

Communicating with Health Care Professionals

Communicating with Medical Direction

Back to Objectives

•  Unit ID and level •  Patient age and sex •  Chief complaint •  History of present

illness •  Past medical history •  Mental status •  Vital signs •  Physical exam •  Care already

rendered •  Current condition •  Request for further

actions

•  Repeat order word for word

•  Ask for repetition if confused

•  Don’t be afraid to question order

Back to Objectives

SBAR

•  S – Situation •  B – Background •  A – Assessment •  R – Recommendation

Communicating with Health Care Professionals

Communicating with the Receiving Facility

•  Same as report to doctor

•  Update hospital with any changes

Communicating with Health Care Professionals

The Oral Report

Back to Objectives

•  Patient’s chief complaint •  Vital signs en route •  Treatment and response •  Pertinent history

Communicating with Health Care Professionals

Transferring Care to Another EMS Provider

•  Follow agency policy and protocols •  Give a verbal report •  Obtain information for your report prior to

departure

(©Maria A.H. Lyle)

Back to Topics

Team Communication and Dynamics

Taking Charge

Back to Objectives

•  Be confident •  Get report from responders on scene

Radio Codes

Back to Objectives

•  Advantages •  Disadvantages •  Ten-Code system

Times

Back to Objectives

Military Time

•  1:00 a.m. to 12 Noon = 0100 to 1200hrs •  1:00 p.m. to Midnight = 1300 to 2400hrs

Radio Terms

Back to Objectives

Frequently Used Radio Terms •  Break •  Clear •  Come in •  Copy •  ETA •  Go ahead •  Landline •  Repeat •  Stand by •  10-4

Back to Topics

Therapeutic Communication

Principles of Patient Communication

Back to Objectives

•  Communication •  Verbal versus nonverbal •  Other factors

The Communication Process

•  Encoding •  Decoding •  Feedback

Communication Responses

Back to Objectives

•  Clarification •  Summary •  Explanation •  Silence •  Reflection •  Empathy •  Confrontation •  Facilitated

communication

Communicating with the Patient

Back to Objectives

•  Competence •  Confidence •  Compassion

Patient Contact

•  First impressions critical

•  Introduce yourself, your team, and ask for patient name

•  Ask permission •  Defense

mechanisms •  Speak clearly •  Use a professional

tone

•  Limit interruptions •  Be aware of body

language •  Be courteous •  Active listening •  Be honest with the

patient

The Patient Interview

Nonverbal Communication

Back to Objectives

•  Posture •  Distance •  Gestures •  Eye contact •  Haptics

Nonverbal Communication

Return to Directory

Click here to view a video on the topic of nonverbal communication.

Asking Questions

Back to Objectives

•  Open-ended questions •  Closed questions

Considerations in Interviewing

Back to Objectives

•  Don’t ask leading questions •  Don’t interrupt •  Don’t give false assurances •  Interviewing a hostile patient

Special Circumstances

Transcultural Considerations

•  Culture •  Ethnocentrism •  Communicating

Special Circumstances

Considerations for Elderly Patients

•  Be patient •  Speak clearly •  Don’t assume all

have problems

Special Circumstances

Considerations for Children

Back to Objectives

•  Have patience •  Parents may help

if they are calm •  Get to eye level •  Be honest

Return to Directory

Click here to view a video on the topic of alternate methods of communication with children.

Alternate Methods of Communication

Follow-Up

Primary Assessment •  Male, mid-40s, alert •  Blood-soaked rag but no dripping •  No signs or symptoms of shock

currently

Secondary Assessment •  Three-inch laceration across the base of

palm •  Sterile dressing applied •  Warm and moist extremity •  BP: 148/86mmHg; HR: 92; RR: 14

Secondary Assessment •  A: PCN •  M: Denies •  P: Denies •  L: Coffee 15 minutes before incident •  E: Denies anything unusual prior to

incident

•  Patient remains alert and oriented •  Report to hospital

–  “Columbia Memorial, this is Craryville BLS Unit 2 en route to you with an ETA of ten minutes. We have a 46-year-old male with a three-inch laceration of the right hand caused by a sabre saw. The patient is alert and oriented. The patient says he is allergic to penicillin…

Reassessment and Transport

•  Report to hospital, continued “…vital signs are blood pressure 146/84, radial pulse 80, respirations 14 and of good quality, skin normal, warm, and moist. We have dressed and bandaged the wound. Bleeding appears to have stopped, and patient acknowledges only slight pain from the wound.”

•  Advise dispatch of arrival at hospital

Reassessment and Transport

•  Assist patient into the hospital •  Partner gives report to ER nurse •  Nurse takes charge of the patient •  You clean your unit and go back in

service

Arrival at Hospital

•  36-year-old female complaining of severe abdominal pain

•  The patient is alert and oriented Vital signs: •  BP: 88/64 mmHg •  HR: 128 bpm with weak radial pulses •  RR: 24 with adequate chest rise •  Skin is pale, cool, and clammy •  SpO2 is 96 percent on room air

Critical Thinking Scenario

SAMPLE history: •  S – Feels light-headed and dizzy every

time she stands up; she’s also nauseated •  A – No known allergies •  M – Over-the-counter Claritin for allergies •  P – No pertinent medical history; tonsils

removed when she was 10 years old •  L – nothing to eat or drink for 7 hours •  E – has “not felt real good” for a few days

Critical Thinking Scenario

Pain assessment: •  O – pain began suddenly and has

progressively worsened; was sitting on the couch watching television when it began

•  P – nothing makes it better or worse •  Q – dull, aching, and intermittent •  R – non-radiating •  S – 8 out of 10 •  T – four hours

Critical Thinking Scenario

Physical exam: •  Pupils are equal and sluggish to respond •  Breath sounds are equal and clear

bilaterally, no JVD •  Abdomen is rigid and tender, no evidence

of trauma to the abdomen •  Good motor and sensory function in all

four extremities, peripheral pulses are very weak

Critical Thinking Scenario

Repeat vital signs: •  BP 82/62 mmHg •  HR 134 bpm, radial pulses barely palpable •  RR 26 with adequate chest rise •  Skin is more pale, cool, and clammy •  Pulse oximeter reading “error”

Critical Thinking Scenario

•  En route to the hospital, the patient begins to close her eyes and you must verbally instruct her to open her eyes

•  Your ETA to the hospital is 7 minutes

Critical Thinking Scenario

1.  What techniques would you use to communicate with this patient?

2.  Are there any special circumstances that you would consider when communicating with this patient?

3.  Would you contact medical direction during your management of this patient?

Critical Thinking Questions

4.  What information is important to relay in the radio report to the receiving facility?

5.  What information would you provide in your oral report to the medical personnel at the receiving medical facility during the transfer of care?

6.  What information would you report regarding the change in the patient’s condition?

Critical Thinking Questions

Reinforce and Review

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