Bledsoe v1 ch09_lecture

Copyright © 2017, 2013, 2009 Pearson Education, Inc. All Rights Reserved.

Bryan E. BledsoeRichard A. Cherry Robert S. Porter

Paramedic Care: Principles & PracticeVolume 1, 5e

Chapter 9EMS System

Communications



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 records

– 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.



Figure 9-1 Communication occurs when individuals exchange information through an encoded

message.



Figure 9-1 (continued) Communication occurs 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

– 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.





– 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.





– 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



Figure 9-3 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.



Table 9-1 Common Radio Terminology

Term Meaning

Copy, 10-4, roger I understand

Affirmative Yes

Negative No

Stand by Please wait

Repeat Please repeat what you said

Landline Telephone communications

Rendezvous Meet with

LZ Landing zone (helicopter)

ETA Estimated time of arrival

Over I am finished with my transmission

Mobile status On the air, driving around

Stage Wait before entering a scene

Clear End of transmission

Unfounded We cannot find the incident/patient

Be advised Listen carefully to this



Terminology

• Terminology considered plain English within

discipline in which it is used.



The Importance of Communications

in EMS Response

• Communication skills: empathy, confidence, self-

control, authority, patience.

• Clinical experience: which skills to use in any

particular situation.




in EMS Response

• Sequence of Communications in EMS Response

– Detection and citizen access

– 911 or E911 (enhanced)

– Automatic crash notification (CAN)

– Public safety answering points (PSAPs)




in EMS Response


– E911 technology works with landline systems.

– One-third of 911 calls come from wireless/mobile

phones.

– Wireless 911 calls that do not carry address database

data cannot be routed to nearest 911 center.




in EMS Response


– Wireless phones located by terrestrial-based

triangulation, global positioning systems (GPS),

combination of the two.

– Voice over Internet protocol (VOIP)

– Next Generation 911 (NG-911)




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




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.



Figure 9-5 Priority dispatching and prearrival medical instructions are commonly used in EMS.

(From Advanced MPDS v13.0 © 1979–2015 International Academies of Emergency Dispatch and ProQA

Paramount v5.1 © 2007–2015 Priority Dispatch Corp. All Rights Reserved. Used by permission.)




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.




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.




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.



Figure 9-8 The patient hand-off is an essential aspect of emergency care and ensures continuity

of care between the prehospital and hospital environments.




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.



Information and


• No available systems for EMS providers to access

real-time information.

– Geographic information system (GIS): interfaces with

smart phone/electronic tablet/communication devices.

– One information communications network linked with

networks for fire, police, departments of transportation,

responder colleagues



Information and


• Traditional communications technology:

telecommunications engineers.

• Data systems technology: hardware and software

development professionals.

• Information communications technology (ICT):

blends traditional communications technology

(CT) and information technology (IT) systems.



Information and


• 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.



Figure 9-10 Example of EMS repeater system.



Information and



– Radio bands and frequencies:

Ultrahigh frequency (UHF)

Very high frequency (VHF)

– Geographically integrating communications networks

would enable routine and reliable communication.



Information and



– Radio Communication

Simplex transmissions: transmit and receive on same

frequency; cannot do both simultaneously.

– Dispatch systems and on-scene communications



Information and




Duplex transmissions: simultaneous two-way communications

by using two frequencies for each channel.

– Works like telephone communications

– Transmits voice messages or data



Information and




Multiplex systems: duplex systems with additional capability of

transmitting voice and data simultaneously.



Information and




Trunked systems: pool all frequencies.

– 800-MHz range

– Computer routes transmission to first available frequency.



Information and



– 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



Information and



– 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.



Information and



– 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.



Figure 9-14 Modern mobile phones have amazing capabilities and are becoming increasingly

more sophisticated.



Information and



– 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.



Information and



– 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.



Information and



– 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.



Information and



– Software-Defined Radio

Multiband radio: combining wide range of radio bands.

Cognitive radio: "sniffing" airwaves for signal strength and

clear channels among bands.



Information and


• 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.



Information and


• 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.



Information and


• 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



Information and


• 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



Information and


• 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



Information and


• New Technology

– Advanced automatic crash notification (AACN) data

rebroadcasting and "just in time" training and reference

material rebroadcasting

– Closed circuit television (CCTV) scene transmission



Information and


• 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



Public Safety


• 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



Public Safety


• 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 communications 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