hello and welcome to chapter 4 communications and documentation of the emergency care and transportation of the sick and injured 12th edition after you complete this chapter and the related coursework you will have an understanding of the therapeutic communication means to communicate effectively with special populations such as children geriatric patients and hearing and visually impaired patients methods and procedures for effective communication components of effective written reports types of written reports and ways to correct errors found within written reports documentation of refusal of care special reporting situations use of medical terminology communication systems and equipment regulations and protocols governing radio communications and communication with medical control and hospitals as an introduction communication is the transmission of information from one person to another whether it's verbal or through body language and that's considered non-verbal effective communication is essential component of pre-hospital care it is necessary to achieve a positive relationship with patients and co-workers so verbal communication skills are important this enables you to gather information from the patient and bystanders and makes it possible for you to coordinate all with all the responders who are often present at the scene and it's an integral part of transfer transferring the patient care to the nurses and physicians at the hospitals so let's talk about documentation the written or electronically recorded part of the patient's permanent medical record it demonstrates the appropriate care was delivered communicates the patient's story to others who may participate in the patient's future care adequate reporting and accurate records ensure continuity of patient care complete patient care records guarantee proper transfer of responsibility they guarantee that comply with requirements of health departments and law enforcement agencies and they fulfill your organization's administrative needs this drives funding for ems research so computer radio and telephone communications so the link the emt has to other members in ems fire department and law enforcement communities is through computer radio and telephone communications you must know what your system can do and cannot do and how to use the systems effectively and efficiently okay so next let's talk about therapeutic communication and what it means it uses various communication techniques and strategies both verbal and non-verbal and it encourages patients to express how they feel and achieves a positive relationship with each patient the shannon weaver communication model was developed to assist in the mathematical theory of communication for bell telephone labs in the late 1940s this model remains a valuable tool in understanding communications and how it is how it goes is there's five different um areas and basically it starts with the sender takes a thought encodes it into a message then sends the message to the receiver the receiver decodes the message and then sends feedback to the sender and this figure on this slide illustrates the shannon weaver communication model and then this table on the screen lists the factors and strategies to consider during communication so you have age you want it eye contact body language facial expressions clothing sex culture posture education voice tempo environment and volume so let's start with age and culture and experience and this influences how a person communicates body language and eye contact are greatly affected by culture in some cultures people are encouraged to express emotion while in other other cultures they view it as a sign of weakness so in other cultures it is impolite to look away while speaking tone pace and volume of language offer clues about the mood of the person communicating it provides insight into the perceived importance of the message okay so let's talk about ethnocentrism and that's considering your own cultural values as more important than those of others and these people tend to translate messages they receive using their own world view and then you have cultural imposition and that's forcing your views on to others so healthcare providers may consciously or subconsciously force their cultural views onto the patients because their belief that their views are better next is nonverbal communication and this is body language and it provides information more than words alone even without exchanging any words you should be able to tell the mood of your patient facial expressions body language and eye contact what we're going to talk about next and so eye contact and body language are powerful communication tools pay attention to body language both your own and that of your patients physical clues will help you and your patient truly understand the message being sent when you're treating a potentially hostile patient it's important that you understand and be aware of your own body language stay calm and try and diffuse the situation assess the safety of the scene do not assume an aggressive posture make good eye contact but do not stare speak calmly confidently and slowly and never threaten the patient either verbally or physically okay so next non-verbal communication we're going to talk about is physical factors and this could be the noise so anything that dampens or obscures true meaning of a message literal noise or sounds in the environment such as lightning in the distance or physical obstacles may affect your communication cultural norms often dictate the amount of space or proximity between people when communicating so as a person gets closer a greater sense of trust must be established your gestures body movements and attitude towards the patient are critically important in gaining the trust of both patient and family okay so we just talked about nonverbal communication now let's talk about verbal communication one of the most foundational functions of an emt is to ask the patient's questions so there's two types there's open-ended questions and these are questions that require some level of detail in the response use whenever possible you want to use open-ended questions so for an example what seems to be bothering you close-ended questions they could be answered with very short answers so the response is sometimes a single word like yes or no use if the patient could not provide long answers example are you having trouble breathing you may miss important issues to pertinent questions if if they are not asked you could use the closed ended questions for like difficulty breathing because they can't elaborate on on words right long words all right you can use many powerful communication tools when trying to obtain information for patients okay so facilitation this is encouraging patients to talk more and to provide more information you could use a pause and this gives the patient space and time to think and respond then there's reflection reflection is stating the patient's statements you made to them to confirm your understanding then there's empathy empathy is being sensitive to the patient's feelings and thought you could use clarification and this is asking the patient to explain what he or she meant by the answer confrontation is making the patient who is in denial or in a mental state of shock focus on the urgent and life critical issues then there's interpretation and that is restating the patient's complaint to confirm your understanding there's explanation and that's providing factual information to support a conversation then there's summary providing the patient with an overview of the conversation and the steps you will be taking when interviewing a patient consider the care consider the careful use of touch to show care and compassion so touch is a powerful tool use it consciously and sparingly okay if you are going to touch the patient approach slowly and touch the patient's shoulder arm respectfully or consider holding the patient's hand avoid touching the patient's torso chest or face simply by means of communication because these areas are often viewed as intimate interview techniques to avoid okay so providing false assurance or reassurance you should not do you should not give unsolicited advice you should not ask leading or biased questions you should not talk too much do not interpret interrupt use why questions you should not use authoritative language or speak in a professional jargon okay so the presence of family friends and bystanders they may be a valuable tool during the patient interview process be sure to allow the patient to answer if he or she is able to do so even if well-meaning family members attempt to answer for the individual do not be afraid to ask others to step aside for the for a moment while you talk to the patient you may need to decide if having family and friends nearby will help or hinder your care and there are golden rules to help calm and reassure patients so make eye contact and keep it at all times provide your name and use the patient's proper name tell the patient the truth use language the patient can understand and be careful what you say about the patient to others be aware of your body and language speak slowly clearly and distinctly if the patient is hard of hearing face the patient so he or she can read your lips allow the patient time to answer and respond and act and speak in a calm confident manner emotional intelligence okay that's what we're going to talk about next and this is people skills okay and the ability to understand and manage your own emotions and properly respond to others emotions it helps diffuse conflicts builds rapport communicate more effectively and manage difficult situations and so some attributes of emotional intelligence are self-awareness and this is the ability to recognize your emotions and how they affect your thoughts and behavior and then self-regulation that's the ability to control impulsive emotions and behaviors and to manage emotions in a positive way and then you have motivation the ability to motivate yourself and others in a positive direction empathy empathy is the ability to understand the concerns emotions and needs of others by picking up on communication and social cues and clues and then social skills that's the ability to develop and maintain positive rapport and relationships through effective communication understanding and improving your own emotional intelligence okay so you need to assess how you react to stressful situations and manage your frustration working on staying calm and in control when faced with minor irritations you need to practice mindfulness focus your attention on the present moment without blame and judgment of yourself and others take responsibility for your actions and consider how your actions will affect others next the last thing we're going to talk about emotional intelligence is behavioral change stairway model so this was developed by the federal bureau of investigation to manage hostage situations and adapted for most crisis situations okay so we want to employ active listening we want to display empathy build rapport and exert influence initiate behavior change all right so the next thing we're going to talk about is communication communicating with older patients and when you do this you want to identify yourself present yourself as competent confident and caring and do not assume that an older patient is senile or confused you may encounter hostility irritability or some confusion but do not assume this is a normal behavior so assess for signs of hypoxia a cva drug overdose infection hypoglycemia hyperglycemia or some type of insufficient perfusion okay approach an older patient slowly and calmly and allow plenty of time for the patient to respond to your questions watch for signs of confusion anxiety or impaired hearing or vision the patient should feel confident that you are in charge and that everything possible is being done for him or her be patient often older patients do not feel much pain they may not be fully aware of the important changes in the body systems and you must be especially vigilant for objective changes when possible give the patients time to pack a few personal items before leaving to the hospital locate any hearing aids glasses and dentures before you depart older patients are often worried about safety of their home valuable items and pets so share these concerns with the person assuming care of the patient at the hospital okay now we're going to talk about communicating with children so communicating with children fear is most obvious and severe in children and children may be frightened by your uniform the ambulance or a crowd of people gathering around them so let a child keep a favorite toy doll or security blanket and if possible have a family member friend nearby if practical let the parent or guardian hold the child during evaluation and treatment be honest children easily see through lies or deception and let the child ahead of time know if something's going to hurt and respect the child's modesty speak in a professional yet friendly way use an appropriate tone and vocabulary and maintain eye contact position yourself down at the child's level do not tower over the child okay and next we're going to talk about hearing impaired patients so communicating with patients who are hearing a hard of hearing most people who are hard of hearing have normal intelligence and are not embarrassed by their disability position yourself so that the patient can see your lips so hearing aids be careful that those are not lost during an accident or fall they may be forgotten if the patient is confused so ask the family about the use of hearing aids steps to take to effectively communicate with people who are hard of hearing have a paper and a pen available and if the patient can read lips face the patient speak slowly and distinctly and never shout listen carefully to shark questions and give short answers learn some simple phrases in sign language it can be useful to know the signs for sick hurt and help and on the slide figure 4-7 those are simple phrases in sign language signing requires movement and is best learned by attending a sign language class so a is sick b is hurt and c is help communicating with visually impaired patients so ask the patient if he or she can see at all visually impaired patients are not necessarily completely blind many can perceive light and dark or can see shadows or movement and expect the patient to have normal intelligent explain everything that you're doing as you're doing it stay in physical contact with the patient as you begin at your care so if the patient can walk to the ambulance place his or her hand on your hand transport mobility aids such as a cane with the patient to the hospital so guide dogs these are easily identified by others special by their special harnesses so if possible transport the dog with the patient this alleviates stress for both the patient and the dog guide dogs are trained not to leave their masters otherwise arrange for care of the dog a conscious patient can tell you about the dog and give instructions for its care okay next we're going to talk about communicating with non-english speaking patients so you must obtain a medical history even though the patient does not speak english you cannot skip this step so find out if the patient knows a few english words or phrases use short simple questions point to the parts of your body and have a family member or friend interpret until a professional interpreter is available consider learning some common phrases in another language that is used in your area pocket cards that show the pronunciation of terms is available or use a smart app or website to help you translate remember to request a translator at the hospital all right so the next thing we're going to talk about is mission critical communications and what this is they are any communications where disruption may result in the failure of a task at hand it's shared mental model a mental model is the picture individuals have in their head of what's going on for any team to work effectively together all members must share a mental model to build a mental model the following questions must be answered and what is the focused prime priority of the patient what is the history of the prior care what is the patient's current state and what is the patient's immediate needs so answering the four questions quickly and effectively will help avoid errors and miscommunicate and misunderstandings patient care handover so effective communication between ems providers and other healthcare providers in the receiving facility is essential to efficient effective and appropriate patient care patient care handover is the transfer of pertinent patient information and responsibility for patient care communication failures between reporting providers and receiving providers is a source of medical liability for the provider and organizations giving the handover report so things that you need to do when you give over the report you need to initiate eye contact so make eye contact with the person with whom the patient is being transferred manage the environment so whenever possible try to minimize noise interruptions and distractions and ensure the abcs if there is priority care that must be initiated and or continued it must be immediately conveyed and addressed to by the receiving clinician or team provide a structured report okay so the acronyms you we could use is sbar and this is the situation background assessment and the recap of treatment or sba2 a t this is situation background assessment and treatment okay and so provide documentation the verbal report should consist of the patient's priority condition prior care current state and immediate needs receiving the handover report so when you're receiving the care you need to do the exact same maintain eye contact manage the environment ensure understanding summarize and gather supplementary patient documentation all right so the next thing we're going to talk about is the written communications and documentations everybody's favorite and we're going to begin with the pcr pcr is the patient care report and it's known as the pre-hospital care report it is a legal documentation used to record all aspects of the care your patient received from initial dispatch to the hospital and there are two types of pcrs and it could be written or electronic the pcr serves six functions these six functions are continuity of care compliance and legal documentation administrative information reimbursement education and data collection for continuous quality improvement the following are examples of information collected on the pcr or patient care report so you start chief complaint mechanism of illness or injury level of consciousness using avpoos or mental status the vital signs initial and ongoing assessment management of demographics age gender and ethnic background transport information and how the patient was moved and reasons for the destination choice a lot of administrative information is used in billing research and quality improvement can be gathered in the pcr examples include the incident was reported the ems unit was notified the ems unit arrived on scene the ems unit left the scene the ems unit arrived at the receiving facility patient care was transferred and the unit was back in service okay so types of forms and on this slide you're going to see a very common epcr so that's an electronic format and that's what it's referred to and it's virtually they're designed to comply with nems's data collection requirement okay and epcrs allow patient information to be transmitted directly to the hospital computers and may be integrated with the patient's electronic medical record the narrative section of the pcr may be the most important standard narrative formats okay so there's two most common narrative formats used in healthcare are chart and soap all right so chart method chart method stands for chief complaint history and physical examination assessment treatment and transport it begins with a dispatcher information chief complaint or chief concerned and that states the condition most urgently requiring ems intervention then you have the history the history includes details relating to the current event and the patient's mental medical history prior to the event and then you have details that come from the patient or others on scene from dispatch or from the patient's record then a assessments this describes all assessments you performed on the patient including vital signs and a physical exam then the t or it stands for rx so treatment and that is the r in the chart method and that's detail all interventions that were performed then the t that's the transport so you're going to explain how the patient was moved to the ambulance how the patient was transported positioned and secured whether the emergency lights and sirens were used where the patient was taken including the room number and the name of the person to whom the report was given and the care was transferred next we're going to talk about the soap method and that's another very standard narrative format in the first part so it stands for subjective objective assessment and plan and that's soap subjective means you include information by the patient or others on the scene such as chief complaint events leading up the incident mechanism of injury and past medical history objective is the details you gather through your primary assessment the vital signs physical findings and other measurements such as blood pressure or oxygen saturation then assessment this summarizes the key findings so provide your impression of what the patient's problem might be possible fractured leg or stroke for example and then plan and document the treatment provided for the patient regardless of the method used the epcr's narrative section should include time of events assessment findings emergency medical care that you provided changes in the patient after treatment observations at the scene final patient disposition a refusal of care if obtained staff person who continued care in written documentation avoid radio codes and abbreviations all pcrs are confidential documents and once complete distribute copies to the appropriate locations okay so next we're going to talk about health information exchanges and you'll see this abbreviated as h-i-e this improves the sharing of data between ems and other health care providers it allows ems providers to access relevant data avoid unnecessary duplication of effort in data entry and view patient outcomes related to hospital cares it allows emts to contribute to and assess electronic health information on both a regular basis and during times of the disasters most ehies follow the safer framework and so what safer stands for is search alert file and reconcile so search means ems providers can search for hospital and other records that help make treatment and transport decisions alert is hospitals are notified of incoming patients with automated systems that populate e.d emergency department dashboards with information entered by ems in the field and then file this is the data in the ems electronic patient care report are incorporated directly into the patient's health records and then reconcile and this is feedback on outcomes of the patients other hospital data is provided to ems agencies for billing and quality improvement okay so reporting errors is what we're going to talk about next and if you leave something out of a record or record it inaccurately do not try and copy uh cover that up because this is falsification and it could result in poor patient care and may result in suspension or legal action and so on figure 4-13 if you make a mistake on a handwritten report the proper way to correct it is a single line you're going to draw it draw a single line horizontally through the era initial it and write the correct information next to it if an error is discovered after you submit a report follow the same process so add a note with the correct information if information was accidentally omitted draw begin a new section with the word addendum so you're going to write an addendum to add the new information in and then add and date your initials you're never supposed to use any type of correction fluid so do not erase or cover up the error all right so documenting a refusal of care this is very important so refusal of care is very common source of lawsuits thorough documentation is crucial so document any assessment findings and emergency care given have the patient sign a refusal of care form have a family member police officer or bystander also sign the refusal of care form as a witness depending on local requirements the pcr might contain okay so here we go complete assessment evidence that the patient is able to make a rational informed decision decision with discussion with the patient as to what the care treatment of ems recommends discussion with the family and or patient as to what may happen if he or she does not allow care or transport discussion with family friends and bystanders to try to encourage the patient to allow care discussion with medical direction according to local protocol it should also include providing the patient and other alternatives for example going to see his or her family doctor or having a family member drive him or her to the hospital and the willingness of ems to return also signatures and then complete the pcr special reporting situations and so these are uh depending on local requirements but examples of special reporting situations include gunshot wounds dog bites certain infectious diseases suspected physical and sexual abuse or mcis which is a multi-casualty incident okay so communication systems and equipment next we're going to talk about ways to communicate so radio and telephone communications link your team with other members in ems fire and law enforcement community communities help the entire they help the entire team to work together more effectively and they provide an important layer of safety and protection the first one we're going to talk about is a base station radio so the base station is a radio hardware containing the transmitter and receiver and it's usually located at a fixed place may also be equipped with one multi-channel and several single channel receivers a channel is assigned frequency or frequencies used to carry voice or other data communications a dedicated line also known as a hotline is used for specific point-to-point contact we talked about base station now we're going to talk about mobile and portable radios so a mobile radio is installed in the vehicle so mobile radios are used in the ambulance to communicate with the dispatcher or medical control and then an ambulance often has more than one mobile radio portable radios those are the handheld ones and portable radios are essential at a scene of a mass casualty incident when away from the ambulance a portable radio is helpful to communicate with a dispatch another unit or medical control repeater based systems okay so a repeater is a special base station radio this repeater based system receives messages and signals on one frequency then automatically transmits them to a second frequency and it allows two mobile or portable units that cannot reach each other directly to communicate using a greater power and antenna so the figure on the slide illustrates a rep repeater system and you can see a message is sent from the control center to a transmitter by a landline the radio carrier wave is picked up by a repeater for broadcast to the outline units return radio traffic is picked up by the repeater and broadcast to the control center okay digital equipment and so digital equipment is used in the field the first one we're going to talk about is telemetry and this allows electronic signals to be converted into coded audible signals signals can be transmitted by radio or telephone to a receiver with a decoder at the hospital and so what we use these for is data from the cardiac monitors they can be transmitted via bluetooth enabled devices to monitoring centers digital signals are also used in some kinds of pacing and tone alerting systems and of course there's cellular and satellite telephones so emts often communicate with receiving facilities via cellular telephone and then you have a sat phone or satellite phone and that's another option a scanner is a radio receiver that searches or scans across several frequencies and stops when it receives a radio broadcast on that frequency and continues once the message is complete conversations can be easily overheard other communication equipment so ambulances usually have an external public address system ems systems may use a variety of two-way radio hardware and these two-way radio hardware could be broken down into simplex duplex or multiplex so simplex is a push-to-talk you release and then you listen duplex is a simultaneous talk to listen and then a multiplex utilizes two or more frequencies which enables more than one transmission to occur simultaneously then you have the med channels and those are reserved for ems use trunking or 800 millihertz systems assign many frequencies allowing the computer to constantly monitor for an open frequency so an inoperable communication system allows all of the agencies involved to share valuable information with one another in real time mobile data terminals inside the ambulance and so mobile data terminals are the computers in the ambulance and you could receive data directly from the dispatcher and allow for expanded communication capabilities so for example it'll have a map that pops up on the screen when you're dispatched to the the address okay now that we've talked about the different types of radios let's talk about the communications okay the federal communications commission fcc regulates all radio operations in the united states and the fcc has five principal ems related responsibilities so what they do is they allocate specific radio frequencies for use by ems providers they license base stations and assign appropriate radio call signs for stations they establishing license standards and operated specifications for radio equipment used by ems providers they establish limitations for transmitter power outputs and they monitor radio operations the fcc's rules and regulations section part 90 subpart b deals with ems communications issues okay so let's talk about responding to the scene the dispatcher will receive the call first from when the call is placed to 9-1-1 the responsibility of the dispatcher starts by properly screening and assigning a pro prime priority to each call so it's according to pre-determined protocols they select and alert the appropriate ems unit they dispatch the direct the ems unit to the correct location and they coordinate ems response units with other public safety services until the incident is over they provide emergency medical instructions to the cell phone caller the dispatcher signs the appropriate ems units based on several criteria so the nature and severity of the problem the anticipated response time to the scene the level of training and the need for additional support so the dispatcher should give the responding units information and this is the nature and severity of the injury or illness they should give us the exact location of the incident they should give us the number of patients they should give us the response of other public safety agencies and special directions or advisories so like is there road traffic problems or severe weather reports and then time the units are dispatched okay and then the emt should report any other problems that take place during the run to the dispatchers so the emt should inform the dispatcher upon arrival of the scene and what we should tell them is our arrival report and it should include any obvious details we observed during a scene size up radio communications must be brief and easily understood and we have to talk in plain english and not use code words then we need to report only in important information then when we communicate with medical control or hospitals we need to to tell them the primary reason for radio communication is to facilitate communication between you and the medical control all right so medical control may be located at a receiving hospital in another facility and or sometimes even in another city or state when consulting with medical control it serves many purposes okay so it notifies a hospital of an incoming patient it provides an opportunity to request advice or receive orders from medical control and it advises the hospital in special situations also plans and organize your radio communication before you transmit all right so when you're ready you're going to give the patient report and the report is commonly includes 10 elements okay so 10 elements that is included and so it includes your unit identification level of services any special alert incident by the patient condition the receiving facility hospital and your estimated time your patient's age and gender the patient's chief complaint or other perception of the problem and its severity a brief history of the patient's condition a brief report of the physical findings a brief summary of the care given a brief description of the patient's response to the treatment provided and determine whether the receiving facility has any additional questions or concerns so what's the role of medical control medical control is offline which is indirect or online which is direct and depending on how your protocols are written you may need to call medical control for direct orders which is the permission to conduct certain tasks so you may need to call if administering certain treatments determining the transport destination of the patients or stopping treatment or not transporting the patient you may need the call in most areas medical control is provided by physicians working at receiving hospitals many variations have developed across the country though in some areas medical direction may come from freestanding center or from an individual physician all right so when we call medical control there are a number of ways to control access on ambulance to hospital channels the dispatcher can monitor an assigned appropriate clear medical control channels or centralized medical emergency dispatch or response coordination centers your report must be precise and contain only important information never use codes when communicating with medical control unless you are directed to do so by your local protocol once you receive an order from medical control repeat the order back word for word and then receive confirmation do not blindly follow an order that does not make sense to you okay so let's talk about information regarding special situations you may initiate communication with hospitals to advise them of an extraordinary color situation so let's say a small royal hospital may be able to respond to multiple patients from a highway crash if notified when the ambulance is first responding or an entire hospital system must be notified of any disaster and so other special situations that you um they that you need to relay is hazardous material situations or rescues in progress or possible multiple cassidy casualty incidents or mcis when identifying the hospital of special situations keep several points in mind the earlier you notify them the better provide an estimated number of individuals who may need to be transported to the facility and identify any special needs the patients might have so let's say that there's burns or hazmat material exposure to assist the hospital in prepping and then follow your plan for your system maintenance of radio equipment so like other ems equipment radio equipment must be serviced at the beginning of each shift check your radio equipment radio equipment may fail during a run so you must have a backup plan and it must be followed standing orders written are written documents signed by an ems systems medical director outlining specific directions and permissions when properly followed they have the same authority and legal status as orders given over the radio so this concludes the uh chapter four lecture next we're going to go into the questions see if we missed anything okay so when healthcare providers force their cultural values onto other patients because they believe their values are better this is displaying i think it's ethnocentrism nope forcing your own values on others because you believe it better is cultural imposition okay so cultural imposition when communicating with an older patient you should you should approach the patient slowly and calmly okay when caring for a five-year-old boy in respiratory distress you should allow a patient or caregiver to hold the patient if the situation allows right okay so d which of the following pieces of patient information is least pertinent when we're given that verbal report what is least pertinent so um patient's family medical history that's right which of the following stations statements about a patient care report is true okay which is true see yeah it can the continuity of patient care okay a device that receives low frequency signals and then transmits transmits it to a relatively higher frequency is and this is a repeater yeah c a repeater repeats the signal when treating a potentially hostile patient you should try to diffuse the situation by and this is going to be speaking calmly confidently and slowly okay all of the following are functions of the emergency medical dispatcher except d providing medical direction to the empty in the field right yeah so the emergency medical dispatcher is not giving us um coordinating medical direction after receiving an order from the medical director of the radio you should and it's repeat the order to the physician word for word okay and then finally you when requesting medical direction for a patient who was involved in the car accident the emt should and we're the mt should avoid using codes such as 1050 or signal 70. okay this includes the lecture for chapter 4 communications and documentation go ahead and if you like this go ahead and subscribe to the channel because we're going to have the rest of the chapters thank you