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01/08/2013
1
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).
01/08/2013
2
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).
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3
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
01/08/2013
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Topics
EMS Communication System
Communicating within the System
Team Communication and Dynamics
Therapeutic Communication
CASE STUDY
Dispatch
EMS Unit 2
Respond to 101 Bate Road for man bleeding in a
driveway.
Time out 1128
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5
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
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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
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• 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
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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
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• Encoder
• Decoder
• Mobile data terminal
Components of an Emergency
Communications System
Cell Phones
• Operation
• Benefits
• Disadvantages
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10
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
01/08/2013
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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
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Phone/Cell Phone
Communication
• Be familiar with technology
• Be aware of dead spots
Communicating with
Dispatch
Back to Objectives
01/08/2013
13
• 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
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• 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
01/08/2013
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• 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
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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
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Taking Charge
Back to Objectives
• Be confident
• Get report from responders on scene
Radio Codes
Back to Objectives
01/08/2013
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• 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
01/08/2013
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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
01/08/2013
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Principles of Patient
Communication
Back to Objectives
• Communication
• Verbal versus nonverbal
• Other factors
The Communication
Process
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• Encoding
• Decoding
• Feedback
Communication Responses
Back to Objectives
• Clarification
• Summary
• Explanation
• Silence
• Reflection
• Empathy
• Confrontation
• Facilitated
communication
01/08/2013
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Communicating with the
Patient
Back to Objectives
• Competence
• Confidence
• Compassion
Patient Contact
01/08/2013
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• 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
01/08/2013
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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.
01/08/2013
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Asking Questions
Back to Objectives
• Open-ended questions
• Closed questions
Considerations in
Interviewing
Back to Objectives
01/08/2013
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• Don’t ask leading questions
• Don’t interrupt
• Don’t give false assurances
• Interviewing a hostile patient
Special Circumstances
Transcultural
Considerations
• Culture
• Ethnocentrism
• Communicating
01/08/2013
27
Special Circumstances
Considerations for
Elderly Patients
• Be patient
• Speak clearly
• Don’t assume all have problems
Special Circumstances
Considerations for
Children
Back to Objectives
01/08/2013
28
• 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
CASE STUDY
01/08/2013
29
Primary Assessment
CASE STUDY
• Male, mid-40s, alert
• Blood-soaked rag but no dripping
• No signs or symptoms of shock
currently
Secondary Assessment
CASE STUDY
• Three-inch laceration across the base of
palm
• Sterile dressing applied
• Warm and moist extremity
• BP: 148/86mmHg; HR: 92; RR: 14
Secondary Assessment
CASE STUDY
• A: PCN
• M: Denies
• P: Denies
• L: Coffee 15 minutes before incident
• E: Denies anything unusual prior to
incident
01/08/2013
30
CASE STUDY
• 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
CASE STUDY
• 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
CASE STUDY
• 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
01/08/2013
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• 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
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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
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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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