Chapter 4 – Communications and Documentation

v  Ethnocentricism and Cultural Imposition

Ø  Ethnocentricism – Belief that our culture values > than those of others.

Ø  Cultural imposition – Forcing your values onto others.

v  Therapeutic communication – Encourages patients to express how they feel to achieve + relationship w/ patients (verbal + nonverbal)

Ø  Shannon-Weaver communication model

§  Sender: takes thought

§  Encodes thought into message

§  Sends message to receiver

§  Receiver: decodes message

§  Sends feedback to sender

Ø  Factors to consider in therapeutic communication:

§  Age

§  Clothing

§  Culture

§  Education

§  Environment

§  Gender

§  Posture

§  Voice tempo

§  Volume

v  Non-verbal communication (Body language)

Ø  Facial expressions

Ø  Body language – Do NOT assume an aggressive posture

Ø  Eye contact – maintain good eye contact, BUT do NOT stare.

Ø  Environment plays role in communication

§  Sounds and noise from surroundings may impede communication.

v  Verbal communication

Ø  Use open ended questions to get more specific details

Ø  Use closed ended questions if patient cannot provide long answers (ex: trouble breathing)

v  Communication Tools

Ø  Facilitation – encouraging patients to talk more.

Ø  Silence – give patient time to think.

Ø  Reflection – restate patient’s statement to confirm your understanding.

Ø  Empathy – Sensitive to other feelings and thoughts

Ø  Clarification – asking patient to explain what they meant.

Ø  Confrontation – making patient focus on urgent and life-critical issues (exp for patients in denial/shock).

Ø  Interpretation – summing up the patient’s complaint to confirm your understanding.

Ø  Explanation – providing factual information to support conversation.

Ø  Summary – provide patients w/ overview of conversation and the steps you will be taking.

v  Techniques to AVOID when communicating with patients:

Ø  Providing assurance/reassurance

Ø  Giving unsolicited advice

Ø  Asking leading/biased questions

Ø  Talking too much

Ø  Interrupting

Ø  Using “why” questions

Ø  Speaking in profeccional jargon.

v  Golden Rules About Communication

§  Keep eye contact at all times.

§  Provider your name & use patient’s proper name.

§  Tell the patient the truth.

§  Use language on a level that the patient can understand.

§  Be careful about what you say about the patient to others.

§  Be aware of your body language.

§  Speak slowly and clearly.

§  If patient has difficulty hearing, face them so they can read your lips.

§  Allow patient time to answer/respond.

§  Act and speak in a calm and confident manner.

Ø  For Elderly patients:

§  Watch for signs of confusion, anxiety, or impaired hearing/vision.

§  Patient should feel confident about your skills.

§  When possible, give them time to pack a few personal items before leaving for the hospital.

·       Hearing aids

·       Glasses

·       Dentures

§  Older patients are often worried about the safety of their home, and property they have left unattended.

Ø  For Children:

§  Fear is more obvious and pronounced in children.

§  Let child keep favorite toy, doll, or blanket.

§  If possible have a family member/friend nearby.

·       Let the parent/guardian hold the child during evaluation & treatment.

§  Notify child ahead of time if something will hurt.

§  Position your self at child’s level while also maintaining eye contact.

Ø  For deaf patients:

§  Keep eye on hearing aids so they don’t get lost.

§  Try some simple sign language.

§  Have pen and paper available for written discussion.

Ø  For blind patients:

§  Ask patient if he/she can see at all (some forms of blindness are more limited vision).

§  Explain everything as you are doing it.

§  Transport mobility aids like canes and guide dogs w/ patient.

Ø  For non-English speaking patients:

§  Must find a way to obtain medical history. à Use broken English + combination of visual cues

§  Have a family member interpret.

§  Use smartphone to help you translate.

§  Request translator at the hospital.

At the hospital vital communication continues …

·       Oral report

o   Opening information

§  Name

§  Chief complaint

§  Illness

o   Detailed information

§  NOT to be provided during radio report (HIPAA)

o   Any important history

o   Patient’s response to treatment provided so far

o   Vital signs

o   Other info.

·       Give oral report to hospital staff member about patient (staff member reported to must have at least your level of training).

·       Patient care report (PCR, aka prehospital care report)

o   Legal document

o   Records all care from dispatch to hospital arrival

o   Function:

§  Continuity of care

§  Legal documentation

§  Education

§  Administrative information

§  Essential research record

§  Evaluation and continuous quality improvement

o   Can be in 2 forms:

§  Written

§  Electronic

o   Contains:

§  Chief complaint

§  Level of consciousness/mental status

§  Vital signs

§  Initial assessment

§  Patient demographics

§  Administrative data

·       Time incident reported

·       Time EMS unit arrived

·       Time EMS left scene

·       Time EMS arrived at receiving facility

o   Narrative section of PCR is the MOST important

§  Contains:

·       Time of events

·       Assessment findings

·       Emergency medical care provided

·       Observations at scene

·       Final patient disposition

·       Refusal of Care

o   Have patient sign refusal form

o   Have family member, police officer, or bystander as a witnes

·       Staff who continued care.

§  Document facts, NOT opinions

§  Avoid putting any judgement in the reports.

§  PCR is considered a confidential document (HIPAA rules apply)

o   When editing the PCR …

§  Cross with a single horizontal line, initial it

§  Do NOT use eraser or change with correction fluid

v  Communication systems & equipment

Ø  Base station: radio hardware w/ transmitter and receiver in a fixed place.

§  2 way radio = radio with transmitter and receiver.

Ø  Mobile radio: Radio installed on ambulance to communicate with …

§  Dispatch

§  Medical control

Ø  Portable radio

§  Helpful when away from ambulance to communicate with …

·       Dispatch

·       Another unit

·       Medical control

Ø  Repeater = Special base station radio

§  Takes message on one frequency and retransmits them on a 2^nd frequency

§  Boosts the signa allowing two mobile units that cannot reach each other to communicate

Ø  Digital Equipment

§  Can transmit signals to hospitals via Bluetooth enable devices

Ø  Cellular phones and satellite phones

§  Alternative methods off communication

§  Can be overheard by scanners à Take care to maintain patient privacy.

Radio communications

v  EMS systems use 2 way radio hardware.

Ø  Simplex – Push to talk, release to listen

Ø  Duplex simultaneous talk and listen.

Ø  Multiplex utilizes 2+ frequencies.

v  Federal Communications Commission (FCC) regulates all radio operations in US

Ø  Allocates specific radio frequencies

Ø  Licenses base stations and assign appropriate call signs for stations

Ø  Establish licensing standards & operating specifications

Ø  Establishes limitations on transmitter output

Ø  Monitors radio operations

Responding to the Scene

1.      Dispatcher receives and determines importance of 911 call

2.      Assigns appropriate EMS response unit

a.      Criteria for selection:

                                                              i.       Nature and severity of problem

                                                             ii.      Anticipated response time to scene

                                                           iii.      Level of training available to EMS response unit

                                                           iv.      The need for additional support

3.      Dispatch and direct EMS to correct location

a.      Provides unit with …

                                                              i.      Nature & severity of the illness/injury

                                                             ii.      Exact location of incident

                                                           iii.      # of patients

                                                           iv.      Response by other public safety agencies

                                                             v.      Special directions/advisories

1.      Adverse road conditions

2.      Severe weather reports

                                                           vi.      Time when units are dispatched

4.      Coordinates EMS response w/ other public safety services

5.      Provide emergency medical instructions to telephone caller

6.      EMT should report any problems during run to scene

7.      EMT should inform dispatch upon arrival at scene

a.      Report important obvious details during scene size up

8.      Assessment of patient

9.      Transportation of patient

10.  Consulting with medical control

a.      Notifies hospital of an incoming patient

                                                              i.      Earlier the notice the better.

                                                             ii.      Provide an estimate of the # of patients

                                                           iii.      ID any special needs.

b.      Provides opportunity to request advice/orders from medical control

c.       Advise hospital of special situations

                                                              i.      Hazardous materials situations

                                                             ii.      Rescues in progress

                                                           iii.      Multiple casualty incident

11.  Give patient report using standard format, report should have…

a.      Unit ID and level of service

b.      Receiving hospital and estimate time of arrival (ETA)

c.       Patient’s age & gender

d.      Patient’s chief compliant/your perception of the problem & its severity

e.      Brief hx of patient’s problem

f.        Brief rpt of physical findings

g.       Brief summary of care given and response

h.      Brief description of patient’s response to treatment.

v  Role of Medical Control

Ø  Can be either offline (indirect) OR online (direct)

Ø  Usually provided by physicians working at receiving hospital

Ø  Need to be called when …

§  Administering certain treatments

§  Determining the transportation destination of patients.

§   Stopping treatment and/ NOT transporting a patient.

Ø  Called through:

§  Dispatcher monitors and assigns medical control channels

§  Centralized medical emergency dispatch OR resource coordination center

*** Repeat orders back word for word and then receive a confirmation to ensure message is accurate.

*** Advise hospital of an special situations to help prepare in advance: hazardous materials incident, rescues in process, multiple casualty incident.

At the beginning of your shift check the radio equipment and make sure it works. W/o radio à rely on standing orders.