Chapter 4: Communications and Documentation

What is a base station?

any radio hardware containing a transmitter and receiver that is located in a fixed place

What is a cellular telephone?

a low-power portable radio that communicates through an interconnected series of repeater stations called cells

What is a channel?

an assigned frequency or frequencies that are used to carry voice and/or data communications

What is a chief complaint?

the reason a patient called for help; also, the patient’s response to questions such as “What’s wrong?”

What are closed-ended questions?

questions that can be answered in short or single-word responses

What is communication?

the transmission of info to another person—verbally or through body language

What is a cultural imposition?

when one person imposes their beliefs, values, and practices on another because they believe their ideals are superior

What is a dedicated line?

a special telephone line that is used for specific point-to-point communications;

aka hotline

What is documentation?

the recorded portion of the EMT’s patient interaction, either written or electronic;

becomes part of the patient’s permanent medical record

What is duplex?

the ability to transmit and receive simultaneously

What is emotional intelligence?

the ability to understand and manage one’s own emotions and properly respond to the emotions of others

What is ethnocentrism?

when a person considers their own cultural values as more important when interacting with people of a different culture

What is the Federal Communications Commission (FCC)?

the federal agency that has jurisdiction over interstate and international telephone and telegraph services and satellite communications, all of which may involve EMS activity

What is handover?

the transfer of pertinent patient info and the responsibility for the patient’s care;

often involves the physical movement of the patient and associated equipment;

aka handoff

What is health information exchange (HIE)?

a system that allows EMS providers to access relevant health data, avoid unnecessary duplication of effort in data entry, and view patient outcomes related to hospital care

What is an interoperable communications system?

a communication system that uses voice-over-Internet protocol (VoIP) technology to allow multiple agencies to communicate and transmit data

What are MED channels?

VHF and UHF channels that the Federal Communications Commission has designated exclusively for EMS use

What is a mental model?

the picture an individual has in their head of “what’s going on” in a given situation

What are mission-critical communications?

any communications where disruptions will result in the failure of the mission at hand

What is mobile data terminal (MDT)?

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

What is multiplex?

the ability to transmit audio and data signals through the use of more than one communications channel

What is noise?

anything that dampens or obscures the true meaning of a message

What are open-ended questions?

questions for which the patient must provide detail to give an answer

What is paging?

the use of a radio signal and a voice or digital message that is transmitted to pagers or desktop monitor radios

What is a patient care report (PCR)?

the legal document used to record all patient care activities;

has direct patient care functions but also administrative and quality control functions;

aka prehospital care reports

What is a rapport?

a trusting relationship that you build with your patient

What is a repeater?

a special base station radio that receives messages and signals on one frequency and then automatically retransmits them on a second frequency

What is a simplex?

single-frequency radio;

transmissions can occur in either direction but not simultaneously

What is a standing orders?

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

aka protocols

What is telemetry?

a process in which electronic signals are converted into coded, audible signals;

these signals can then be transmitted by radio or telephone to a receiver with a decoder at the hospital

What is therapeutic communication?

verbal and nonverbal communication technique that encourage patients to express their feelings and to achieve a positive relationship

What is trunking?

telecommunication systems that allow a computer to maximize utilization of a group of frequencies

What is UHF (ultra-high frequency)?

radio frequencies between 30-3000 MHz

What is VHF (very high frequency)?

radio frequencies between 30-300 MHz;

the VHF spectrum is further divided into high and low bands

What is the Shannon-Weaver communication model?

the sender must take a thought, encode it into a message, send the message to the receiver, the receiver decodes the message and sends feedback to the sender

What are factors to consider during communication?

• age

• body language

• clothing

• culture

• education

• environment

• eye contact

• facial expression

• sex

• posture

• voice tempo

• volume

When treating a potentially hostile patient, you should consider which 5 steps?

1. assess the safety of the scene

2. do not assume an aggressive posture

3. make good eye contact, but do not stare

4. speak calmly, confidently, and slowly

5. never threaten the patient, either verbally or physically

What are some therapeutic communication techniques?

• facilitation

• pause

• reflection

• empathy

• clarification

• confrontation

• interpretation

• explanation

• summary

What are some interview techniques to avoid?

• provide false hope or reassurance

• give unsolicited advice

• ask leading or biased questions

• talk too much

• interrupt the patient

• use “why” questions

• use authoritative language

• speak in professional jargon

What are the 10 golden rules to help calm and reassure a patient and provide a therapeutic rapport?

1. make and keep eye contact

2. provide your name and use the patient’s proper name

3. tell the patient the truth

4. use language that the patient can understand

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

6. be aware of your body language

7. speak slowly, clearly, and distinctly

8. if the patient is hard of hearing, face the person so that they can read your lips

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

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

What are the five attributes of emotional intelligence?

1. self-awareness

2. self-regulation

3. motivation

4. empathy

5. social skills

What is the behavioral change stairway model?

1. employ active listening

2. display empathy

3. build a rapport

4. exert influence

What are the five steps to efficiently communicate with patients who are hard of hearing?

1. have paper and pen

2. face the patient and speak distinctly at a normal pace

3. never shout

4. listen carefully, ask short questions, and give short answers

5. learn some simple phrases in sign language

What four questions must be answered to build a mental model?

1. What is the focused priority for the patient?

2. What is the history of prior care?

3. What is the patient’s current state?

4. What are the patient’s immediate needs?

What are the five things you should do when giving the handover report?

1. initiate eye contact

2. manage the environment

3. ensure the ABCs (airway, breathing, circulation)

4. provide a structured report (SBAR or SBAT)

5. provide documentation

What does SBAT stand for?

S - situation

B- background

A - assessment

T - treatment

What are the five things you should do when receiving the handover report?

1. maintain eye contact

2. manage the environment

3. ensure understanding

4. summarize

5. gather supplementary patient documentation

What are the two kinds of PCR?

1. written

2. electronic (ePCR)

What are the six functions that the patient care report (PCR) serves?

1. transfer of info and continuity of care

2. compliance and legal documentation

3. administrative info

4. reimbursement

5. education

6. data collection for quality improvement and research

What are examples of info collected on a PCR?

• chief complaint

• mechanism of injury or nature of illness

• level of consciousness or mental status

• vital signs

• initial and ongoing assessment

• patient demographics

• transport info

What is the most important portion of a PCR?

narrative section

What is the CHART method?

C - chief complaint

H - history

A - assessments

R - Rx

T - transport

What is the SOAP method?

S - subjective

O - objective

A - assessment

P - plan

What kind of framework do most HIEs follow?

SAFR

What is the SAFR framework?

S - search

A - alert

F - file

R - reconcile

What do HIEs allow EMTs to do?

contribute to and access electronic health info on both a regular basis and during times of disaster

What should you do if you discover an error while completing a handwritten report?

draw a single line through the error, initial it, and write the correct info next to it

If you accidentally left out info in a report, what should you do?

begin the new section with “addendum”, add the new info, then add the date and initial it

Refusal of care is an important potential source of ______ in EMS.

litigation

If you are not able to persuade the patient to proceed with treatment, what should you do?

• document any patient assessment findings, emergency medical care given, your efforts to obtain consent, and the patient’s response to your efforts

• have the patient sign a refusal form

• have a family member, police officer, or bystander sign the form as a witness

• inform online medical control

• complete the PCR

What should you put in the PCR when the patient refuses treatment?

• advice you gave regarding risks associated with refusal of care

• clinical info showing level of consciousness and competency

• pertinent patient comments

• any medical advice given to the patient

• description of the care that you wished to provide for the patient

What do special reporting situations include?

• gunshot wounds

• dog bites

• certain infectious diseases

• suspected physical/sexual abuse

• MCI

In the ambulance, what will be used communicate with the dispatcher and/or medical control?

mobile and portable radios

What are portable radios?

handheld devices that operate at 1 to 5 watts of power;

helpful when you are away from the ambulance and need to communicate

What are the five principal EMS-related responsibilities of the FCC?

1. allocate specific radio frequencies for use by EMS providers

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

3. establish licensing standards and operating specifications for radio equipment used by EMS providers

4. establish limitations for transmitter power output

5. monitor radio operations

What is the dispatcher responsible for?

• properly screen and assign priority to each call

• select and alert the appropriate EMS response unit

• dispatch and direct EMS response units to the correct location

• coordinate the EMS response units with other public safety services until the incident is over

• provide emergency medical instructions to the caller

What should the dispatcher tell the responding units?

• nature and severity of the injury, illness, or incident

• exact location of the incident

• number of patients

• responses by other public safety agencies

• special directions or advisories

• time at which the units are dispatched

What should you report to the dispatcher?

• any problems during your response

• when you have arrived at the scene

• any obvious details you see during scene size-up

All radio communications during dispatch should be…

brief and easily understood

What should you do once you receive an order from medical control?

repeat the order back, word for word, and then receive confirmation

Should you follow an order that does not make sense to you?

no