Chapter 5

EMS Communication Standards and Objectives

• National EMS Education Standards:

  • Standard: Preparatory (Content Areas: EMS System Communication; Therapeutic Communication).

  • Competency: Applies knowledge of the EMS system, safety and well-being of the EMT, and medical, legal, and ethical issues to the provision of emergency care.

• Educational Objectives:

  • Define key terms introduced in the chapter.

  • Discuss the purposes and characteristics of each component of a typical EMS communication system.

  • Describe the responsibilities of the Federal Communications Commission ($FCC$).

  • Explain the importance of EMS system communication equipment maintenance.

  • Describe standard rules and expectations for using a transmitter/receiver during radio communications.

  • List key times during an EMS call that the EMT should communicate with dispatch.

  • Provide a concise radio report to medical direction or the receiving facility and update reports en route.

  • Describe the process of receiving and confirming an order from medical direction over the radio.

  • Discuss components of an oral report used to transfer patient care to a facility or another provider.

  • Discuss the advantages and disadvantages of using radio codes.

  • Convert between military time and standard clock times and explain the importance of common radio terms.

  • Describe components of the therapeutic communication process and factors enhancing or interfering with effectiveness.

  • Identify and apply techniques to enhance therapeutic communication with patients.

  • Recognize potential messages communicated via nonverbal behaviors.

  • Describe the uses, advantages, and disadvantages of open-ended and closed-ended questions.

  • Discuss pitfalls when an EMT fails to follow good patient-provider interviewing practices.

  • Discuss techniques for interviewing patients with language barriers or family members.

Evolution of EMS Communications systems

• Historical Context:

  • Originally, ambulance crews only transported patients and lacked a role in providing emergency care, negating the need for sophisticated communication.

  • EMS Act of 1973 (Public Law 93-154): Recognized communications as one of the $15$ essential components of an EMS system. It defined the role of communications to include public access to EMS, dispatch for immediate response, and medical oversight.

  • Grant funding allowed systems to equip ambulances with Very High Frequency ($VHF$) and Ultra High Frequency ($UHF$) radio equipment.

  • Most systems today still use narrowband voice radio communication similar to that of the $1970s$.

• Modern Technological Advances:

  • Integration of data transmission by field personnel to medical facilities or medical direction.

  • Establishment of longitudinal electronic medical records ($EMR$) transmitting data via the National EMS Information System ($NEMSIS$) electronic patient care report ($PCR$) systems.

  • Capability for transmission of $12$-lead electrocardiograms ($ECGs$) to medical facilities or medical direction.

  • Development of FirstNet (First Responder Network Authority): Established under the Middle Class Tax Relief and Job Creation Act (Public Law $112-96$), signed by President Obama in $2012$. This is a nationwide public safety broadband network reserved for public safety communications, including EMS.

  • Support for mobile integrated health care ($MIH$) and community paramedicine, managing emergency, unscheduled, and scheduled health services.

Components of Emergency Communication Systems

• Base Station:

  • Serves as a dispatch and coordination area.

  • Ideally located on suitable terrain, such as a hill, close to the hospital serving as a medical command center.

  • Operates at high-power output: $80-150\,watts$.

  • Equipped with a suitable antenna to compensate for transmission and reception limitations caused by man-made noise and FCC power limits.

• Land Mobile Radio Systems ($LMRS$):

  • Include $UHF$, $VHF$, or $700-$ to $800-MHz$ systems.

  • Facet communications between dispatch base-to-vehicle, vehicle-to-vehicle, vehicle-to-medical facility, and facility-to-facility.

• Mobile Radios (Transmitter/Receivers):

  • Vehicle-mounted devices.

  • Transmit at lower power than base stations: $20-50\,watts$.

  • Average range of $10-15\,miles$ on flat terrain; reduced in mountainous areas or cities with tall buildings.

• Portable Radios (Transmitter/Receivers):

  • Handheld units used when away from the vehicle or in the patient compartment.

  • Power output ranges from $1-5\,watts$, resulting in a limited range.

  • Range can be boosted by retransmission through a repeater.

• Repeaters:

  • Devices that receive transmissions from low-powered sources (mobile or portable radios) and rebroadcast them at another frequency and higher power.

  • Essential for EMS systems covering wide areas or difficult terrain.

  • Can be located in emergency vehicles or at fixed sites.

• Digital Equipment:

  • Encoder: Breaks sound waves into unique digital codes.

  • Decoder: Recognizes and responds only to specific digital codes.

  • This allows multiple stations to operate on the same broadcast frequency without interference.

• Mobile Data Terminal ($MDT$):

  • Mounted in the cab of the ambulance.

  • Receives digital radio signals and displays dispatch information on a screen; some may print a hard copy.

  • Allows EMTs to communicate status (en route, on scene, etc.) by pushing designated buttons, reducing voice radio traffic.

Alternative Communication Technology

• Cellular (Wireless) Phones:

  • Divide geographical areas into networks of cells ranging from $2$ to $40\,square\,miles$.

  • Each cell acts as a radio base station; calls are automatically handed off between cells.

  • Benefits: Excellent sound quality, increased privacy, capability to send images and data files, and Internet access.

  • Disadvantage: Part of the public phone system and can be overwhelmed during multiple-casualty disasters.

• Telemetry:

  • Automated transmission of data through wireless technology.

  • Allows for transmission of vital signs, $12$-lead $ECGs$, and advanced patient data.

• Telemedicine/Telehealth:

  • Connects field providers and patients to remote health care practitioners for assessment and care.

  • Reduces unnecessary emergency department visits, a utility highlighted during the $COVID-19$ pandemic.

  • Emergency Triage, Treat and Transport ($ET3$) Model: Launched by CMS on January $1$, $2021$. Allows EMS to partner with providers for on-scene treatment or alternative destination transport (e.g., primary care, urgent care) with Medicare reimbursement.

• Land Mobile Satellite Communications:

  • Utilized in sparsely populated remote rural areas where standard radio communications are nonexistent or too expensive.

Radio Broadcast Regulations and Maintenance

• Federal Communications Commission ($FCC$) Jurisdiction:

  • Licenses base station operations and assigns radio call signs.

  • Approves equipment and establishes limits for transmitter power output.

  • Assigns radio frequencies.

  • Monitors field operations, sets interference limits, and bars obscenity/profanity.

• System Maintenance:

  • Cleaning: Use a damp cloth and mild detergent.

  • Frequency Monitoring: Check regularly to ensure equipment does not drift from assigned frequencies.

  • Battery Management: Battery-powered equipment must be checked daily. Freshly charged batteries should be swapped every day, and a backup set of fully charged batteries must be on hand.

  • Redundancy: Systems should have backup provisions like emergency generators or cellular phones for radio failures.

Guidelines for Radio Communication

• Transmission Techniques:

  • Check for a clear frequency before speaking.

  • Hold the microphone approximately $2\,inches$ from the lips.

  • Speak in a normal, clear voice; avoid shouting.

  • Use the "echo" method (closed-loop communication) to repeat orders back word-for-word.

• Professional Rules:

  • Use plain English and clear text; avoid slang, "Be advised," and excessive politeness like "Please" or "Thank you."

  • Use "affirmative" and "negative" instead of "yes" or "no."

  • Use "we" rather than "I."

  • Identify the unit being called first, then your own unit (e.g., "Dispatch, this is Unit $2$").

  • Wait for the "go ahead" before transmitting the message; "stand by" means wait.

  • Keep transmissions under $30\,seconds$; pause if longer to allow others access.

  • Numbers that could be confused should be spoken as the full number, then individual digits (e.g., "thirteen, one-three").

  • End messages with "Over."

  • Avoid patient names to protect privacy; use objective, impartial language. Avoid profanity or personalized comments that could lead to slander suits.

Communicating with Dispatch

• Dispatcher Role: Point of contact for the public (usually via $911$); directs emergency services and provides pre-arrival instructions.

• Advanced Automatic Collision Notification ($AACN$): Technology in newer cars that provides dispatch with location, change in velocity, direction of force, airbag deployment, rollover, and multi-collision data.

• Key Timeline Points for Dispatch Contact:

  1. Acknowledge receipt of dispatch information.

  2. Advise when the unit is en route.

  3. Provide $ETA$ and report road conditions/delays en route.

  4. Announce arrival on scene and request additional resources. (Report reaching the patient if required).

  5. Announce departure, destination hospital, number of patients, and $ETA$ to the facility.

  6. Announce arrival at the hospital or rendezvous point.

  7. Announce when "clear" and available after transferring care.

  8. Announce leaving the hospital for the station.

  9. Announce arrival at the station.

Communication with Health Care Professionals

• Medical Direction Report Structure:

  • Unit identification and service level ($BLS$ or $ALS$).

  • Patient age and sex.

  • Chief complaint.

  • History of present illness, scene assessment, and mechanism of injury.

  • Major past illnesses and mental status.

  • Baseline vital signs and physical exam findings.

  • Emergency care provided and patient response.

  • Current condition and $ETA$.

  • Requests for specialized teams (Trauma, Stroke, $STEMI$ alert).

• SBAR Method: A standardized format for organizing communication.

  • Situation: Reason for the call and chief complaint.

  • Background: Past medical history and response to treatment so far.

  • Assessment: Subjective and objective findings (vitals, blood glucose, $GCS$).

  • Recommendation: Specific requests for patient care orders.

• Oral Transfer Report (Handoff):

  • Summarize broadcast information with updates from reassessment.

  • Include chief complaint, vital signs en route, treatment given, and additional pertinent history.

  • Provide a copy of the written prehospital care report ($PCR$).

Therapeutic Communication Principles

• Communication Process:

  • Encoding: The sender converts information into words and symbols (a message).

  • Decoding: The receiver translates and interprets the message based on perceptions and values.

  • Feedback: Verbal or nonverbal information received about behavior, facilitating confirmation of the intended meaning.

• Techniques to Facilitate Communication:

  • Facilitation: Encouraging the patient ("Go on," "Please continue").

  • Clarification: Asking questions to resolve unclear messages.

  • Summary: Rephrasing patient statements to confirm understanding.

  • Explanation: Providing information in terms the patient understands, adjusted for age or language.

  • Silence: Allowing the patient time to think or formulate responses.

  • Reflection: Redirecting patient feelings back to them to show understanding.

  • Empathy: Recognizing and understanding the patient's state of mind.

  • Confrontation: Addressing discrepancies in a helpful, assertive manner.

  • Facilitated Communication: Supporting a patient's limbs to help them use communication devices (keyboards/letterboards).

Interacting with the Patient

• Establishing Rapport: Use the three Cs: Competence, Confidence, and Compassion.

• Initial Contact:

  • Professional physical appearance is critical for first impressions.

  • Introduce yourself by the name you wish to be called.

  • Address older patients formally (e.g., "Mrs. Lubeck") unless asked otherwise.

  • Identify all team members and their agencies.

  • Gain consent by saying, "I'm going to help you. Is that all right?"

  • Handle denial/defense mechanisms calmly; redirect focus to the injury.

• Patient Interviewing:

  • Open-ended questions: Allow for detailed responses (e.g., "What seems to be the problem?").

  • Closed-ended questions: Obtain specific data quickly (e.g., "What medications do you take?").

  • Pitfalls: Avoid leading/biased questions, interrupting, providing false assurance, giving inappropriate medical advice, and asking "Why" questions that imply blame.

Nonverbal Behavior and Space

• Body Language:

  • Posture: Open arms and relaxed shoulders convey concern. Avoid crossed arms or pointing fingers. Position yourself at eye level or below (for children/elderly) to avoid being intimidating.

  • Eye Contact: Communicates interest; however, be mindful that some cultures find direct eye contact impolite.

  • Gestures: Acknowledge facial expressions as indicators of fear or pain.

  • Haptics (Touch): Holding a hand or patting a shoulder can be powerful, but always sense reluctance and ask permission.

• Spatial Zones:

  • Intimate Zone: Less than 1\,&\frac{1}{2}\,feet.

  • Personal Distance: $1-4\,feet$.

  • Social Distance: $4-12\,feet$.

  • Public Distance: $12\,feet$ or more.

Special Circumstances in Communication

• Transcultural Considerations:

  • Culture: Thoughts, actions, and values of a racial, ethnic, or social group.

  • Ethnocentrism: The view that one's own culture is superior to others; must be avoided.

  • Language Barriers: Use local interpreters, relatives, or toll-free language lines via dispatch.

• Elderly Patients:

  • Do not assume hearing/vision impairment, but accommodate if detected.

  • Obtain glasses or hearing aids; ensure lips are visible when speaking.

  • Never treat elderly patients as children.

• Pediatric Patients:

  • Position yourself at eye level.

  • Maintain honesty to preserve trust.

  • Use the family-centered care model, acknowledging parents' knowledge of the child's condition (initiative championed by Surgeon General C. Everett Koop).

Questions & Discussion

• What is the function of a repeater? It receives low-power transmissions and broadcasts them at high power on a different frequency to extend system range.

• What procedure follows a medication order from medical direction? The EMT must repeat the order back word-for-word (the echo method).

• How should you communicate with a deaf patient? Ensure lips are visible, check for American Sign Language ($ASL$) interpreters, or use written notes on a pad.

• What are the disadvantages of radio codes? They require everyone to memorize them, can be too simple for complex medical info, and are time-consuming to look up if infrequently used.

• How do you handle a hostile patient? Ensure scene safety first with law enforcement. Establish rapport, explain benefits of cooperation, and inform them of acceptable behavior.

Case Study: 101 Bate Road

• Initial Scene: Man bleeding heavily in a driveway. Unit $2$ responds at $1128\,hours$.

• Patient: Dave Behrens, age $46$, injured hand with a saber saw after being startled by a cat.

• Primary Findings: Alert, breathing patent, radial pulse slightly fast. Hand wrapped in blood-soaked rag; bleeding controlled with sterile dressing.

• Secondary Assessment Vitals: BP $148/86\,mmHg$, HR $92$, RR $14$. Allergy: Penicillin.

• Communication Timeline:

  • $1137\,hours$: Arrived on scene.

  • $1143\,hours$: En route to Columbia Memorial Hospital.

  • $1152\,hours$: Arrived at hospital.

  • $1207\,hours$: Back available for assignment.

• Handoff: Partner gave oral report to the emergency department nurse. Patient refused to ride on the cot; chose the jump seat instead.