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Chapter 15 Communications Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives Outline the chain of EMS communications Describe the role of communications in EMS Define common EMS communications terms Describe the primary modes of EMS communications Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives Describe how EMS communications are regulated Describe the role of dispatching as it applies to prehospital emergency medical care Outline techniques for relaying clear, effective EMS communications Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Scenario As you respond for a cardiac arrest, dispatch tells you they are giving CPR instructions. You find the location using your computer terminal. After one shock, your patient has a pulse and is complaining of chest pain. You radio medical direction with a report and then fax them a 12-lead ECG strip. The heart team is waiting to take your patient to the cardiac cath lab when you arrive. After your verbal report is complete, you complete your written report while your partner prepares the ambulance for your next call. Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Discussion What elements in the chain of EMS communications are used on this call? What role did dispatch play in this situation? How would you: Notify dispatch? Relay information to the hospital? Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Five Phases of EMS Communication Event occurs Need for emergency services detected Notification/emergency response EMS arrival, treatment, transport preparation Preparation for next emergency response Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. EMS Communications Delivery of patient and scene information to emergency team members Dispatchers EMS providers Emergency response workers EMS control and administration staff Medical direction Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Role of Communication in EMS Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Model of Communication Verbal, nonverbal, or written Vital for decision making Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Barriers to Communication Attributes of receiver Selective perception Semantics Time pressures Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Proper EMS Verbal Communication During EMS event Exchange system and patient information with other team members Terminology during EMS event Unambiguous Common means of communication with other medical professionals Convey in short-narrative form Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Verbal Communication Make sure local policies are followed Observe privacy standards Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Factors Affecting Verbal Communication Avoid technical or semantic jargon not clearly understood by all parties Plain English is usually preferred for written and verbal communications Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Proper Written EMS Communications Written record of incident Legal record of incident Conveys clinical information from EMS to ED Part of professional work Part of patient’s medical record Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Uses of Written Data Medical audit Quality improvement/quality management Billing Data collection System administration Research Quality management Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Other Documentation Personnel records Call records Training and work assignments Dates, times, and other specifics of call Vehicle maintenance records Vehicle and equipment cleaning records Drug and equipment inventory records Incident reports Communicable disease exposure HazMat exposure Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. New Technology Used to collect and exchange patient and/or scene information electronically Reduces dependence on traditional means of verbal and written documentation Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Technology Examples Portable wireless voice and data devices Satellite terminals Global positioning systems for tracking emergency vehicles Diagnostic devices Hand-held, pen-based computers Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Technology May allow "real-time capture" of events and information Integrated with diagnostic technology May influence role of medical direction Advanced notification Potential for reduced time to in-hospital diagnosis and therapy Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Technology Legal-status electronic medical report Same status as written documentation May not have a "paper record" of incident Security safeguards must be in place Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Communications Terminology Amplitude modulation (AM) Automatic vehicle locator Base station Carrier Cellular telephone Channel Communication Control console Coverage Dedicated line Duplex Duplex/multiplex Frequency Frequency modulation (FM) Half-duplex Hertz (Hz) Interference "Nuisance interference" "Destructive interference" Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Communications Terminology KiloHertz (KHz) MegaHertz (MHz) Microwave Mobile data terminal (MDT) Mobile relay stations Multiplex NiCad batteries Paging equipment Range Special emergency radio service (SERS) Simplex Squelch Telemetry Tone Transceiver Trunking system Ultra high frequency (UHF) Very high frequency (VHF) Watt Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Cellular Telephones Alternative to dedicated EMS communications systems Advantages Disadvantages Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Digital Modes of Communication Digital phones Telemetry Fax transmissions Signals used in some wireless phone, paging, and alerting systems Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Telemetry and Facsimiles Converts electronic signals into audio tones Tones converted into electronic signals by receiver’s decoder to display or print Advantages of facsimiles Disadvantages of facsimiles Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Computer Advantages Save steps of data entry Sort information Create reports Quick data retrieval Disadvantages Equipment failure Cost Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Simplex Mode Need transmitter and receiver at each end of communications path Both elements operate on same frequency Only one end may operate at a time Advantages Disadvantages Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Duplex Mode Two frequencies allow both ends to communicate simultaneously Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Multiplex Mode Transmits telemetry and voice simultaneously from field unit Common mode with EMS services Advantages Disadvantages Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Trunked System May be single user Or may be shared by many different public service agencies Five or more repeaters Each on a different channel Work together as a group Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Dispatch Systems 9-1-1 Enhanced 9-1-1 (E9-1-1) Computer-aided dispatch (CAD) Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Global Positioning Systems Tell dispatcher unit closest to call Unit is dispatched to emergency scene Dispatcher monitors call Records changes by digital audiotape Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Dispatch Functions Receives and processes calls Selects appropriate action for each call Dispatcher training Dispatch systems Prearrival instructions Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Regulation—FCC Regulates radio communications in U.S. Develops rules and regulations for radio equipment and radio frequency use Primary functions Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. General Guidelines for Radio Communications Standard format Limits radio air time Assists medical direction • Physicians quickly receive information regarding patient's condition Potential for omitting information is lessened Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Guidelines for Radio Communications Think before you speak Speak 2-3 inches from microphone Speak slowly and clearly Speak in normal pitch without emotion Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Guidelines for Radio Communications Be brief and concise Break up long messages into shorter ones Avoid codes unless they are system approved Avoid dialect or slang Tell receiving party when transmission is complete Confirm receiving party has received message Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Relaying Patient Information Brief radio report should contain: Unit identification/provider identification Description of scene or incident Patient's age, gender • Weight (for medication orders) Chief complaint Associated symptoms Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Relaying Patient Information History of present illness or injury Past medical history Medications, allergies Physical examination findings Treatment given Estimated time of arrival (ETA) Request for orders Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. SOAP Format Subjective data Objective data Assessment data Plan of patient management Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. General Procedures for Patient Report Protect patient privacy Use unit numbers, hospital numbers, proper names, and titles Avoid slang or profanity “Echo” dispatcher or physician directions Confirm message was received Inform hospital of significant changes Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Conclusion EMS communications refers to delivery of patient and scene information to other members of the emergency response team. Effective communication is a vital aspect of prehospital patient care. Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc. Questions? Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.
