chapter 5ww4.mgh.org/emt/emtlib/mistovich_ch05_pec09.pdf · discuss the advantages and...

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).

01/08/2013

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

4

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

01/08/2013

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

01/08/2013

6

Components of an Emergency

Communications System

Base Station

Back to Objectives

• High power

• Power levels limited by FCC

• Transmits to repeaters



Mobile Radios

01/08/2013

7

• Vehicle-mounted

• Lower powered than base station

• 10- to 15-mile range

• Transmission affected by terrain



Portable Radios

• Out of vehicle use

• Very limited range

• May be used by

hospital as well

01/08/2013

8



Repeaters

• Rebroadcast low power signals

• Can be fixed or mobile

Repeaters



Digital Equipment

01/08/2013

9

• Encoder

• Decoder

• Mobile data terminal



Cell Phones

• Operation

• Benefits

• Disadvantages

01/08/2013

10



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

11

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

01/08/2013

12

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

01/08/2013

14

• 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


Professionals

Communicating with

the Receiving Facility

01/08/2013

15

• Same as report to

doctor

• Update hospital

with any changes


Professionals

The Oral Report

Back to Objectives

• Patient’s chief complaint

• Vital signs en route

• Treatment and response

• Pertinent history

01/08/2013

16


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

01/08/2013

17

Taking Charge

Back to Objectives

• Be confident

• Get report from responders on scene

Radio Codes

Back to Objectives

01/08/2013

18

• 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

19

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

20

Principles of Patient

Communication

Back to Objectives

• Communication

• Verbal versus nonverbal

• Other factors

The Communication

Process

01/08/2013

21

• Encoding

• Decoding

• Feedback

Communication Responses

Back to Objectives

• Clarification

• Summary

• Explanation

• Silence

• Reflection

• Empathy

• Confrontation

• Facilitated

communication

01/08/2013

22

Communicating with the

Patient

Back to Objectives

• Competence

• Confidence

• Compassion

Patient Contact

01/08/2013

23

• 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

24

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.

media/CHN_Nonverbal.htm

01/08/2013

25

Asking Questions

Back to Objectives

• Open-ended questions

• Closed questions

Considerations in

Interviewing

Back to Objectives

01/08/2013

26

• 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


Considerations for

Elderly Patients

• Be patient

• Speak clearly

• Don’t assume all have problems


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

media/CHN_Altcommunication.htm

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

31

• 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


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


01/08/2013

32

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


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”


• 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


01/08/2013

33

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

Please visit

www.bradybooks.com

and follow the myBradykit links

to access content for the text.

http://www.bradybooks.com

chapter 5ww4.mgh.org/emt/emtlib/mistovich_ch05_pec09.pdf · discuss the advantages and...

Documents