Transcript bledsoe_pcpp1_ch09_lecture - McLaren

Paramedic Care: Principles & Practice
Fourth Edition
Volume 1: Introduction to Paramedicine
CHAPTER
9
EMS System
Communications
©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
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.
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 twoway 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: costeffective 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 patientmonitoring 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
©2013 Pearson Education, Inc.
Paramedic Care: Principles & Practice, 4th Ed.