EMS System Communications
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Transcript of 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Standard
• Preparatory (EMS System Communication)
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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)
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Communication occur when individuals exchange information through an encoded message.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Communication occur when individuals exchange information through an encoded message.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• Standard Format– Efficient– Helps physician assimilate information
about patient's condition quickly. – Ensures medical information is
complete.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Verbal Communication
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The prehospital care report is as important as the run itself. Complete it promptly and legibly.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Terminology
• Medical field uses extensive list of terms, acronyms, abbreviations.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Common Radio Terminology
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Terminology
• Terminology considered plain English within discipline in which it is used.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication 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)
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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)
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The dispatcher determines the appropriate level of response according to established guidelines.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The patient hand-off is an essential aspect of emergency care and ensures continuity of care between the prehospital and hospital environments.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
The Importance of Communication in EMS Response
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Traditional communications technology: telecommunications engineers.
• Data systems technology: hardware and software development professionals.
• Information communications technology (ICT): new concept.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Example of EMS repeater system.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Technology Today– Radio bands and frequencies:
Ultrahigh frequency (UHF) Very high frequency (VHF)
– Geographically integrating communications networks would enable routine and reliable communication.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Technology Today– Radio Communication
Simplex transmissions: transmit and receive on same frequency; cannot do both simultaneously.– Dispatch systems and on-scene
communications
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Technology Today– Radio Communication
Duplex transmissions: simultaneous two-way communications by using two frequencies for each channel.– Works like telephone communications– Transmits voice messages or data
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Technology Today– Radio Communication
Multiplex systems: duplex systems with additional capability of transmitting voice and data simultaneously.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• Technology Today– Radio Communication
Trunked systems: pool all frequencies.– 800-MHz range– Computer routes transmission to first
available frequency.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Modern cell phones have amazing capabilities and are becoming increasingly more sophisticated.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• New Technology– Advanced automatic crash notification
(AACN) data rebroadcasting and “just in time” training and reference material rebroadcasting
– Closed circuit television (CCTV) scene transmission
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Information and Communications Technology
• New Technology– Robotic remote hazard suppression and
patient extrication– Wireless vehicle systems, equipment
and supply monitoring– Syndromic surveillance and quick
alerting to specific populations
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Public Safety Communications System Planning and Funding
• Every state developed statewide communications interoperability plan (SCIP).
• States developing statewide interoperability coordinator (SWIC) positions.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Public Safety Communications Regulation
• 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
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
Public Safety Communications Regulation
• FCC's Primary Functions– Monitoring frequencies to ensure
appropriate usage– Spot-checking base stations and
dispatch centers for appropriate licenses and records
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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.
©2013 Pearson Education, Inc.Paramedic Care: Principles & Practice, 4th Ed.
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