EMT CH 4

types of communication

• verbal

• nonverbal

• written

documentation

reported part of patient’s medial record

therapeutic communication

verbal + nonverbal communication techniques that encourage patients to express their feelings + to achieve a positive relationship

• gather info

• defuse tense situations

• achieve a positive relationship w/ the patient

health literacy

patient’s ability to understand + process health information

medical fear

fear of medicine + medical workers

211

line that connects ppl to food, housing, mental health services

ethnocentrism

person considers their own cultural values to be more important when interacting w/ people of a different culture

cultural humility

attribute of being curious about others + keeping an open mind when interacting w/ people fr an unfamiliar culture

cultural imposition

type of bias where individuals impose their beliefs, values, and practices on others because they believe their ideals are superior

• telling someone to stop cupping to reduce fever

unconscious bias

beliefs that a person holds abt others based on experiences they aren’t aware they’re holding

STAMP - acronym

staring, tone of voice, anxiety, mumbling, pacing

noise

any physical factor that makes difficult to understand the meaning of a message

how to reduce noise

moving patient, removing others, turning off loud equipment, adjusting ambient light

open ended questions

require patient to provide some level of detail to give an answer

closed ended questions

used as a starting point - result in short single word responses

facilitation

encourage the patient to talk more or provide more information

pause

do not speak

reflection

restating a patient’s statement made to you to confirm your understanding

empathy

be senstitive to the patient’s feelings + thoughts

clarification

ask the patient to explain their answer

confrontation

make the patient who’s in denial or shock on urgent + life critical issues

interpretation

restate the patient’s complaint to confirm your understanding

explanation

provide factual information to support a conversation

summarization

provide a brief summary of what the patient for family member has told you

10 golden rules

1. establish rapport

2. provide your name + use patient’s name

3. tell patient the truth

4. use language patient can understand

5. be careful what you say abt the patient to others

6. be aware of your body language

7. always speak slowly, clearly, and directly

8. if the patient is hard of hearing, face the person to allow lip-reading

9. allow time for the patient to answer or respond to your questions

10. act + speak in a calm, confident manner while caring for the patient

emotional intelligence

ability to understand + manage one’s own emotions + properly respond to the emotions of others - attributes

• self awareness

• self regulation

• motivation

• empathy

• social skills

behavioral change stairwau model

1. employ active listening

2. display empathy

3. build rapport

4. exert influence

5. initiate behavior change

person first language

how we describe another person - politically correct manner

communicating w/ patients who are deaf or hard of hearing

1. have paper + pen available

2. face patient + speak @ normal pace

3. never shout

4. listen carefully + ask short questions + give short answers

5. learn simple phrases in ASL

mental model

perception of what’s going on

mission critical communications

any communications whose disruption while result in the failure of the mission @ hand

Q’s to build a mental model

1. what is the focused priority

2. what is the history of prior care

3. what is the patient’s current state

4. what are the patient’s immediate needs

patient care handoff

transfer of patient information + the responsibility for the patient’s care

giving handoff report steps

1. initiate eye contact w/ the person to whom the patient is being transferred

2. manage the environment - minimizing noise, interruptions, distractions

3. ensure the ABCs

4. provide a structured report - SBAR / SBAT

5. provide documentation

SBAR / SBAT

• situation = statement of the problem

• background = brief description of the patient situation

• assessment = your findings

• recap/treatment = care that has been provided

patient is alert + responsive w/ GSW, but agitated + hostile, what kind of Q’s should you ask

open ended questions

critically ill + injured patients - communication

don’t alarm them but be honest + provide hope

stages of grief

1. denial

2. anger / hostility

3. bargaining

4. depression

5. acceptance

GRIEV_ING

• gather the family

• resources - call

• identify yourself, patient, state of knowledge of family

• educate family on events that happened

• verify their family member has died

• __ = give the family space + time to absorb the information

• inquire + ask if they have any more questions

• nuts + bolts - ask abt organ donation, funeral services, personal belongings

• give the family your card + access information

death of a child

• excellent, fast, coordinated care

• family presence during attempted resus

• continuous communication

show them the child even though they may not want to see

PCR

patient care report / prehospital care report = legal document used to record all patient care activities

• administrative + quality control functions

1. transfer of info + continuity of care

2. compliance + legal documentation

3. administration information

4. reimbursement

5. education

6. data collection for quality improvement + research

standardized narrative formats.

• what you did

• what you found

• how it affected the patient’s condition

can include refusal of care

CHART

dispatch information

• chief complaint / concern

• history

• assessments

• Rx (treatments)

• transport - how + why they were moved to ambulance

SOAP

• subjective = information provided on scene = chief complain, events leading to incident, mechanism of injury, past medical history

• objective = details gathered through patient assessment

• assessment = key findings, impression of what the patient’s problem might be

• plan = treatment provided

things to include in PCR

• time

• assessment findings

• emergency medical care provided

• changes in the patient after treatment

• observations @ the scene

• final patient disposition

• refusal of care

• staff person who continued care

medical necessity

medicare + medicaid payers ambulance covered when considered medical necessity

• accident, injury, illness preventing transport

• need for restraints

• need for O2

• unconsciousness or shock

• signs + symptoms of acute respiratory distress / cardiac distress

• signs + symptoms indicating acute stroke

• fracture

• hemorrhage

• bed-confined patient

patient’s dispated-reported condition + patient’s condition found on scene must be reported

health information exchange

system that allows EMS providers to access relevant health data

SAFR - HIE

• search

• alert

• file

• reconcile

correcting an error

• draw a single horizontal line through error

• initial it

• write correct information next to it

adding information

• begin new section w/ word addendum or addendum form

• add new info

• add date + your initials

documenting refusal of care

• patient assessment findings

• emergency medical care given

• efforts to obtain consent

• patient’s response to efforts

sign refusal form + inform online medical control

special reports w/ local authorities

• GSW

• dog bites

• certain infectious diseases

• suspected physical or sexual abuse

• mass casualty incidents

EMS voluntary event notification tool

anonymous tool for reporting incidents that may have resulted in injury to a patient or clinicion

base station radios

dispatcher communicates w/ field units on this

• dispatch center, fire station, ambulance bases, hospitals

mobile + portable radios

used in the ambulance

• more power, high effective antenna systems

VHF

very high frequency = 30-300 MHz

UHF

ultra high frequency operate betw 300-3000 MHz

• limited to 10-15 miles

repeater based systems

base station radio that receives messages + signals on one frequency + transmits them on a second frequency

• able to receive lower power signals fr long distance away + rebroadcast w. all the power of the base station

• allows 2 mobile or portable units that can’t reach each other directly to communicate through the repeater

digital telemetry

electronic signals converted into coded, audible signals

• signals are transmitted by radio or telephone to a receiver w/ a decoder @ the hospital

telemonitoring systems

permit direct transmission of electronic patient data

video consultation

allows medical direction w/ hand held devices

• body cameras can be used as well

simplex mode

single frequency radio occurring in one direction

duplex mode

ability to transmit + receive simultaneously

multiplex mode

ability to transmit audio + data signals through the use of more than 1 communication channel

MED channel

VHF + UHF channels that the federal communications commission has designated for EMS use

trunking system

telecom system that allows a computer to maximize utilization of a group of frequencies

• changes channel after each message if you stop talking → greater traffic w/o more # of frequencies

interoperable communications systems

allow several agencies / jurisdictions to share valuable information w/ eachother

• uses voice over internet protocol to connect landlines, phones, + computers to create seamless info exchange

mobile data terminal

small computer terminal inside the ambulance that directly receives data fr dispatch center

• can pinpoint location based on terminal

FCC responsiblities

1. allocate specific radio frequencies for use by EMS clinicians

2. license base stations + assign appropriate radio call signs for those stations

3. establish licensing standards + operating specifications for radio equipment used by EMS clinicians

4. establish limitations for transmitter power output

5. monitor radio operations, making spot field checks to help ensure compliance w/ rules + regulations

call screening

1. patient location

2. severity of problem

3. caller’s phone number

4. patient’s name + age

5. description of scene

dispatch EMS response steps

1. determine nature of situation

2. roles of EMS response units

3. anticipated response time

4. need for additional specialty units

dispatcher gives information

1. nature + severity

2. location

3. # of patients

4. responses by other public safety agencies

5. special directions or advisories

6. time @ which the unit or units are dispatched

responding to dispatch

use affirmative + negative

standing orders

written docs signed by EMS system’s medical director that outline specific directions, permissions, and sometimes prohibitions regarding patient care

primary purpose of using plain language in radio communications

avoids confusion + ensures all parties understand message

after writing the wrong vital signs you should

follow your agency’s directions + make an amendment to the PCR

therapeutic communication

verbal + nonverbal communication techniques that encourage patients to express their feelings + acheive a positive relationship

radio hardware containing a transmitter + receiver that are located in a fixed place

base station

encouraging a patient to provide more information about their injury is an example of

facilitation

helpful therapeutic communication techniques

• i’m sorry for your loss

• ask. the patient if you can call someone for them

• provide reassuring nonverbal communication if the patient seems receptive

unhelpful therapeutic communication techniques

• they’re in a better place now

• explain that the spouse wouldn’t want the patient to be so upset

• standing 25 ft away fr the patient to give them privacy

a patient’s refusal of EMS treatment/transportation must be

noted on a signed refusal form

all information recorded on a patient care report is considered

confidential

4 YO boy w/ seizure + mom starts crying, what do you do

ask the father to hold the child so you can assess him while your parter tries to calm the mother

after being dispatched on an emergency call, you should expect the dispatcher to provide you with all of the following information, except

the general geographic location of the incident

after receiving online orders fr medical control to perform a patient care intervention, you should

repeat the order to medical control word for word

calming + reassuring an anxious patient can be facilitated by

maintaining eye contact w/ the patient whenever possible

during the alert + dispatch phase of EMS communications, the dispatcher’s responsibilities do not include

discouraging the caller fr providing care until the EMS unit arrives

PCR report ensures

continuity of care

2 way communication that requires the EMT to push to talk + release to listen describes which mode of communication

simplex

when communicating w/ a visually impaired patient, you should

determine the degree of the patient’s impairment