emt 1-2

what is important when building patient rapport

make/keep eye contact; provide ur name and use patient’s name; be honest; use simple language; be careful abt what u say abt patients to others; body language; speak slowly, clearly, distinctly

how to obtain a better Hx (history)

facilitation - asking additional follow up questions so patient speaks more

patience

reflection - restate patient’s statement to confirm

clarification - ask patient what they mean by their answer

confrontation - help patients in denial/shock

interpretation - reword it to make sure understand

interview techniques to AVOID

avoid…

• giving FALSE reassurance

• giving unsolicited advice

• asking leading/biased questions

• talking too much

• interrupting

• using authoritative language

• speaking in professional jargon

what to do if family, friends, bystanders present

ensure it is still patients themselves that are answering questions

it is OK to ask patients to step aside for a bit

if treating elderly patient… make sure to ____

give them time to pack a few personal items before go to hospital (bc might have glasses, dentures, etc)

what to take into account with children

(get scared more easily) let child keep favorite toy, security blanket, etc —> if allows, can also allow parent/guardian to stay nearby

what to take into account if patient has hearing impairment

position urself where patient can see ur lips; ask patient or caregiver if patient uses hearing aids

what to take into account when visual impairment

ask patient abt visual ability / explain everything u do / stay in physical contact w patient as begin care / if patient can walk over to ambulance, place their hand on ur arm

if patients w service animals…

transport patient WITH service animal OR arrange for care of the dog/horse

ambulance has _______ (fixed location radio)

one base station w two way radios (transmitter and receiver = FIXED in place)

ambulance has ____ (portable radio)

handheld radios —> communicate w dispatch hospitals, medical control, other units, additional resources, and btwn crewmembers if separated

although portable radios are ___, portable radios have a smaller ____ in comparison to fixed radios

effective / range

why is radio communication split btwn different channels?

to allow for reduced radio traffic (split between ems (dispatch, diff hospitals, etc channels) and police/fire)

the vast majority of radio communication for EMTs is ___

simplex — cannot transmit and receive data @ same time

(not used as much) duplex communication

can receive and transmit @ same time

multiplex systems

additional data transmission (ALS)

____ help to expand the effective range of communication

repeaters

what is the purpose of a GPS on an ambulance?

allows ambulance to get to location / tracks ur location

ALS monitors and communications equipment are set up to transmit ___

vital signs from the monitor, EKG information, demographics to receiving facility so they can prepare

ex) STEMI finding —> sent to physician @ receiving hospital

radio etiquette

always monitor radio (listen for dispatch to call ur unit)

BE AWARE that if u speak on the radio, no one else can —> avoid overusage (think abt what u want to say before u speak and keep message clear/concise)

• so… if want to transmit message, make sure there is no ongoing conversation or dispatch

what is “stepping on someone” ?

when u start ur transmission during another conversation —> can delay critical info and lead to confusion

what to do for transmission…

1. state designation (unit # and recipient’s call sign) — “unit xxx to dispatch”

2. wait for acknowledgement from recipient

3. deliver message

4. recipient should acknowledge they receive message correctly (may ask clarification questions)

radio reports (not for medical control)

(CONCISE + BRIEF) only contain most important info

1. state designation

2. wait for response

3. deliver message

4. wait for confirmation from them

5. give priority of response (code 2 or 3) + ETA + specialty activations

6. patient demographics, chief complaint, brief history, any noticeable findings, GCS, vital signs, interventions

7. repeat of ETA

what to do when contacting medical control

1. ask for med control or physician for base contact

2. start w request

3. report… (like for radio report)

4. state original request again —> ask if any questions

if they give advice/orders, REPEAT orders back to them to verify heard it correctly

NATO phonetic alphabet

documentation includes…

demographics, history of present illness, history of present injury, objective findings, subjective findings, assessment findings, treatments provided, what handover occurred, relevant times to patient care, mandated reporting data, any other relevant info

why do we document care?

1. continuity of care (shared goal of high quality care)

2. legal purposes (PCR = legal document)

3. administrative (use data for billing purposes)

4. research

5. quality improvement

how do you write a prehospital care report (PCR)? — DCHART

(D)CHART —

• Dispatch (time, location, complaint)

• Chief complaint

• History (SAMPLE, PASTMEDS, OPQRST, pertinent negatives, info from bystanders)

• Assessment (from environmental & physical assessment

• Rx/Treatment

• Transport (how got patient to ambulance, patient’s position during transport)

how do you write a prehospital care report (PCR)? — SOAP

SOAP —

• Subjective (subjective findings, patient’s complaint, history, allergies, medications, info from bystanders)

• Objective (vitals, level of consciousness, pulse ox)

• Assessment (wrap up subjective and objective findings —> provide clear idea of what is wrong w patient)

• Plan (treatment provided / transport data — how got patient to ambulance, patient’s position during transport)

if want to correct data on an ELECTRONIC document…

submit an addendum

if want to correct data on a PHYSICAL document…

draw single horizontal line through error, initial it, & write correct info next to it

what to do if patient refuses care…

document interaction thoroughly, have them and witnesses sign a refusal of care form

special reporting situations include…

• gunshot wounds

• dog bites

• infectious diseases

• physical abuse

• sexual abuse

• mass casualty incidents

• child abuse

• elder abuse

today, ambulances are designed according to ___ regulations

governmental

3 types of ambulance designs

1. uses a truck cab-chassis —> can even transport ambulance body to newer chassis if needed

2. standard van

3. specialty van

ambulance and fire districts must maintain response times at a compliance of at least ___ % in each of the five zones for paramedic response vehicles (and emergency ambulances)

90%

six branches on the medical star represent _____

6 main tasks executed by rescuers

1. detection (identify issue, keep safe)

2. reporting (call for professional help and dispatches)

3. response (first rescuers provide first aid)

4. care (EMS personnel arrive)

5. care and transit (transport to hospital, etc while providing care on the way)

6. transfer to definitive care (hospital, specialized care)

1st phase of an ambulance call

preparation — have all equipment & PPE & always at least ONE EMT in patient compartment during transport

1. place things for life-threatening conditions @ head of primary stretcher

2. cardiac care, external bleeding, BP @ side of stretcher

phase of ambulance call after preparation

dispatch — dispatcher should note:

• nature of call

• name, present location, call-back number

• location of patient

• # of patients & severity of conditions

• other pertinent info

what is the most dangerous phase for EMTs?

en route to the scene —> collisions — fasten seatbelts & shoulder harnesses

phase of ambulance call after dispatch

arrival at the scene — ENAMES

• park SAFELY

  • leave warning lights/sirens on

  • park 100’ before/past crash scene

  • stay away from fires/explosive hazards / unstable structures

  • set the parking brake

• traffic control —> place warning signs on both sides of crash

if mass casualty incident:

• estimate/communicate # of patients to incident commander

• request additional units through dispatch

• incident command system will be established

phase of ambulance call after arrival on scene

transport —

• secure patient to backboard, stretchers

• lift patient into compartment

• make sure patient is secure with AT LEAST 3 straps

• excessive speed is UNNECESSARY and DANGEROUS

when ready to leave, tell dispatch:

• # of patients

• name of receiving hospital

• code 2 or 3 transport

• if additional crew/resources is also coming

when en route

• monitor patients (recheck stable patient every 15 min & unstable patient every 5 min)

• contact receiving hospital (provide ring down if required OR patient’s condition changes)

• do not abandon the patient emotionally

phase of ambulance call after transport

delivery phase —

• notify dispatch that arrived to hospital

• report arrival to triage nurse

• physically transfer patient

• give complete verbal report to RN or MD

• restock if necessary

what to do during postrun phase

• complete/file PCR

• inform dispatch of status, location, and availability

• perform routine inspections

• refuel vehicle

• disinfect all non-disposable equipment used for patient care

• clean stretcher w germicidal/virucidal solution or 1:100 bleach solution

• clean spillage or other contamination w one of those solutions

cleaning is _____

removing dust/dirt, blood, other visible contaminants from surface/equipment

disinfection is _____

applying a chemical to kill pathogens

sterilization is ____

uses heat to remove all microbial contamination

which lane to stay on for ambulance when on multilane highways (when code 3)

extreme left-hand lane

what does excessive speed when driving ambulance do

• dangerous and does NOT increase patient’s likelihood of surviving

• makes patient care in patient compartment hard

• hinder driver’s reaction time

• increases time and distance needed to stop the ambulance

siren syndrome

drivers drive faster bc of increased anxiety from the sirens

when making a turn in ambulance, enter ___ in the lane and exit ___

high / low

ambulances have a ___ braking time and stopping distance

longer

what u are allowed to do if on emergency call and using lights/sirens

park/stand in illegal location

proceed through red light / stop sign

driver faster than speed limit (EXCEPT in school zones)

drive against flow of traffic

travel left of center to make illegal pass

an emergency vehicle is NEVER allowed to pass ____

a school bus that stopped to load/unload kids

__ crashes are the most common and dangerous

intersection crashes

when getting on/off highway, ______ until reach far left lane

shut down emergency lights and sirens

why call for medivac (air medical transporot)

• ground transportation takes too long

• road, traffic, environmental conditions prohibit ground transport

• patient needs advanced care

• multiple patients will overwhelm hospital reachable by ground transport

auto launch

if any 911 call has a medical component, helicopter is automatically dispatched