EMS System Communications

Paramedic Care: Principles & PracticeParamedic Care: Principles & Practice

Volume 1: Introduction to ParamedicineVolume 1: Introduction to Paramedicine

CHAPTER

Fourth EditionFourth Edition

©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.

EMS SystemCommunications

9


Standard

• Preparatory (EMS System Communication)


Competency

• Integrates comprehensive knowledge of EMS systems, the safety and well-being of the paramedic, and medical/legal and ethical issues, which is intended to improve the health of EMS personnel, patients, and the community.


Introduction

• In EMS, person-to-person communication, face-to-face, telephone, voice radio dialogue, cycles of telemetry data use, handwritten– Lag in development of EMS

communications technology.


Effective Communications

• Emergency medical dispatcher (EMD): manages entire system of EMS response and readiness.

• Patient, family, bystanders, others• Personnel from responding agencies

(police, fire department, mutual aid ambulances)


Effective Communications

• Health care staff: physicians' offices, health care facilities, nursing homes.

• Medical direction physician: interprets patient findings; makes medical decisions.– You must interact effectively with

everyone involved in the call. – EMS is ultimate team endeavor.


Basic Communication Model

• Communication: exchanging information between individuals.– Language includes words, numbers,

symbols, special codes.– Encode message; select medium for

sending it.– Receiver must decode and understand

message and give feedback.


Communication occur when individuals exchange information through an encoded message.


Communication occur when individuals exchange information through an encoded message.


Verbal Communication

• Semantic: meaning of words.• Technical: communications hardware.• Communication: mutual language.• U.S. Department of Homeland

Security's SafeCom Program: plain English in emergency radio communications.



• Reporting Procedures– Relay all relevant medical information to

receiving hospital staff.– Amount and type of information

depends on: Type of technology you use Patient's priority Local communication protocols



• Standard Format– Efficient– Helps physician assimilate information

about patient's condition quickly. – Ensures medical information is

complete.



• Standard Format– Identification of unit and provider– Description of scene– Patient's age, sex, approximate weight – Patient's chief complaint and severity– Brief, pertinent history of present illness

or injury



• Standard Format– Pertinent past medical history,

medications, allergies (SAMPLE)– Pertinent physical exam findings– Treatment given so far/request for

orders– Estimated time of arrival at hospital– Other pertinent information



• General Radio Procedures– Radio transmissions must be clear and

crisp, with concise, professional content.– Listen to channel before transmitting.– Press transmit button.– Speak at close range.– Speak slowly and clearly.



• General Radio Procedures– Speak in normal pitch.– Be brief.– Avoid codes unless part of EMS system.– Do not waste airtime.– Protect patient's privacy.– Use proper unit or hospital numbers and

correct names or titles.



• General Radio Procedures– Do not use slang or profanity.– Use standard formats for transmission.– Be concise.– Use echo procedure.– Write down addresses, dispatch

communications, physician orders.– Obtain confirmation that message

received and understood.


Written Communication

• Prehospital care report (PCR): written or electronic, keyboard-/mouse-entered record of events.– Times, location, agency, crew, medical

information– Legal record of incident– Part of patient's permanent medical

record


The prehospital care report is as important as the run itself. Complete it promptly and legibly.


Written Communication

• Be objective; write legibly.• Thoroughly document patient's

assessment and care.• Use terminology accepted in medical

community.• Illustrates your professionalism• National Emergency Medical Services

Information System (NEMSIS) data dictionary


Terminology

• Medical field uses extensive list of terms, acronyms, abbreviations.


Common Radio Terminology


Terminology

• Terminology considered plain English within discipline in which it is used.


The Importance of Communication in EMS Response

• Communication skills: empathy, confidence, self-control, authority, patience.

• Clinical experience: which skills to use in any particular situation.



• Sequence of Communications in EMS Response– Detection and citizen access– 911 or E911 (enhanced)– Automatic crash notification (CAN)– Public safety answering points (PSAPs)



• Sequence of Communications in EMS Response– E911 technology works with landline

systems.– One-third of 911 calls come from

wireless/cell phones.– Wireless 911 calls that do not carry

address database data cannot be routed to nearest 911 center.



• Sequence of Communications in EMS Response– Wireless phones now located by

terrestrial-based triangulation, global positioning systems (GPS), combination of the two.

– Voice over Internet protocol (VOIP)– Next Generation 911 (NG-911)



• Sequence of Communications in EMS Response– Advanced Automatic Crash Notification

(AACN) Predicting likelihood of serious injury Decreasing response times Assisting with field triage Decreasing time for patients to receive

trauma care



• Sequence of Communications in EMS Response– Emergency Medical Dispatch

Emergency medical dispatcher (EMD): public's first contact with EMS system.

Priority dispatching: dispatcher follows established guidelines to determine appropriate level of response.


The dispatcher determines the appropriate level of response according to established guidelines.



• Sequence of Communications in EMS Response– Prearrival instructions: emergency

measures to carry out while waiting for emergency responders to arrive.

– Call coordination/incident recording: EMD's main duties are support and coordination.



• Sequence of Communications in EMS Response– Contact medical direction physician to

discuss case.– May give orders for interventions.– Taping for use later is advisable.– Relationship based on trust.



• Sequence of Communications in EMS Response– Transfer care to receiving facility staff:

give nurse or physician formal verbal briefing.

– Hand-off: patient's vital information, chief complaint and history, physical exam findings, treatments rendered.


The patient hand-off is an essential aspect of emergency care and ensures continuity of care between the prehospital and hospital environments.



• Sequence of Communications in EMS Response– Never leave patient until you have

completed formal transfer of care; may be charged with abandonment.

– End PCR documentation with information about transfer of care.


Information and Communications Technology

• Situational awareness (SA) and common operating picture (COP) important considerations in EMS.– Address how prepared paramedic and

team are to perform jobs effectively.



• No available systems for EMS providers to access real-time information. – Geographic information system (GIS):

interfaces with smart phone/PDA/communication devices.

– One information communications network linked with networks for fire, police, departments of transportation, responder colleagues



• Traditional communications technology: telecommunications engineers.

• Data systems technology: hardware and software development professionals.

• Information communications technology (ICT): new concept.



• Technology Today– Communication network consists of

equipment for clear communication among all agencies within system.

– Repeaters: receive transmissions from low-power source and rebroadcast them at higher power.


Example of EMS repeater system.



• Technology Today– Radio bands and frequencies:

Ultrahigh frequency (UHF) Very high frequency (VHF)

– Geographically integrating communications networks would enable routine and reliable communication.



• Technology Today– Radio Communication

Simplex transmissions: transmit and receive on same frequency; cannot do both simultaneously.– Dispatch systems and on-scene

communications




Duplex transmissions: simultaneous two-way communications by using two frequencies for each channel.– Works like telephone communications– Transmits voice messages or data




Multiplex systems: duplex systems with additional capability of transmitting voice and data simultaneously.




Trunked systems: pool all frequencies.– 800-MHz range– Computer routes transmission to first

available frequency.



• Technology Today– Digital Communications

Digital radio popular in emergency services communication systems.

Translates (encodes) sounds into digital code for broadcast

Faster and more accurate than analog transmission



• Technology Today– Digital Communications

Ease overcrowding of radio frequencies Mobile data unit (MDU): “ruggedized” or

“hardened” laptop computer. Voice communications will always have

place in emergency services.



• Technology Today– Cellular telephone system: cost-effective

way to transmit patient information to hospital.

– Cellular technology in remote areas – Smart phones: voice capability of cell

phone with ability to perform data messaging functions.


Modern cell phones have amazing capabilities and are becoming increasingly more sophisticated.



• Technology Today– Broadband data capabilities expanding.– Cell and smart phones: communication

less formal, promote discussion, reduce on-line times.

– Voice communications not always reliable in commercial wireless systems.



• Technology Today– EMS agencies: priority access to wire

line and wireless communications services.

– Wireless phones used for on-scene and medical direction communications

– No paramedic or EMS agency should rely solely on commercial wireless communications.



• Technology Today– Virtually all new PCR systems no longer

paper based; rely on electronic input of patient and call data to mobile laptops and/or computers.

– Computers: research faster and easier.



• Technology Today– Software-Defined Radio

Multiband radio: combining wide range of radio bands.

Cognitive radio: “sniffing” airwaves for signal strength and clear channels among bands.



• New Technology– Medical-Quality Video and Imaging

Use of video to send patient images from scene or ambulance to physician consultant/medical director

Urban systems have high call volumes; can afford highly trained EMS personnel.



• New Technology– Medical-Quality Video and Imaging

Rural areas do not have call volume to afford paramedic-level personnel.

Urban areas: expense and process of video transmission not as value-added as in rural areas.

Satellite-based and wired broadband audio/video/imaging systems operate in military and civilian applications.



• New Technology– Community Paramedicine

Provide advanced life-support services and primary health care services

Preventive care services Home follow-up services Respond to some emergency calls

without transport to hospital



• New Technology– Patient multi-vital-signs monitoring– Responder multi-vital-signs monitoring– Stand-off vital-signs monitoring– Infrared crowd disease detection– Wireless speech-to-text translation



• New Technology– Receipt of electronic patient records in

real time– Creation of ad hoc multi-component

patient databases– EMS-mediated remote patient-

monitoring systems and “just in time” patient warning and reference guidance



• New Technology– Advanced automatic crash notification

(AACN) data rebroadcasting and “just in time” training and reference material rebroadcasting

– Closed circuit television (CCTV) scene transmission



• New Technology– Robotic remote hazard suppression and

patient extrication– Wireless vehicle systems, equipment

and supply monitoring– Syndromic surveillance and quick

alerting to specific populations


Public Safety Communications System Planning and Funding

• EMS communications systems part of local, regional, statewide, and national interoperable public safety and health care communications systems.

• 2009: National Emergency Communications Plan (NECP) developed by OEC.


Public Safety Communications System Planning and Funding

• Every state developed statewide communications interoperability plan (SCIP).

• States developing statewide interoperability coordinator (SWIC) positions.


Public Safety Communications Regulation

• Federal Communications Commission (FCC) controls and regulates all nongovernmental communications. – AM and FM radio, television, aircraft,

marine, mobile land-frequency ranges– Designated frequencies within each

radio band for special use



• FCC's Primary Functions– Licensing and allocating radio

frequencies– Establishing technical standards for

radio equipment– Licensing and regulating technical

personnel who repair and operate radio equipment



• FCC's Primary Functions– Monitoring frequencies to ensure

appropriate usage– Spot-checking base stations and

dispatch centers for appropriate licenses and records


Summary

• Advances in communications technology improving among patients, paramedics, physicians.

• Paramedics arrive on scene within a few minutes and, with click of button, obtain necessary medical information from patient.


Summary

• Satellite communications systems link streaming video and audio with physician.

• Accurate and effective communications help ensure EMS system's efficiency and improve patient's survivability.

• Communications include spoken and nonspoken (body language) messages.


Summary

• Communications must:– Be concise.– Be professional.– Be complete.– Conform to national and local protocols

• Allows for quicker and seamless treatment plan through discharge at hospital

Documents

EMS System Communications