Bledsoe v1 ch09_lecture

Copyright © 2017, 2013, 2009 Pearson
Education, Inc. All Rights Reserved.
Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Paramedic Care: Principles & Practice
Volume 1, 5e
Chapter 9
EMS System
Communications

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Standard
• Preparatory (EMS System Communication)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 9-1 Communication occurs when individuals exchange information through an encoded
message.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 9-1 (continued) Communication occurs when individuals exchange information through
an encoded message.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• Standard Format
– Efficient
– Helps physician assimilate information about patient's
condition quickly.
– Ensures medical information is complete.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
• 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
– 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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 9-3 The prehospital care report is as important as the run itself. Complete it promptly and
legibly.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Terminology
• Medical field uses extensive list of terms,
acronyms, abbreviations.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Terminology
• Terminology considered plain English within
discipline in which it is used.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.)

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 9-10 Example of EMS repeater system.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Information and
– Radio bands and frequencies:
 Ultrahigh frequency (UHF)
 Very high frequency (VHF)
– Geographically integrating communications networks
would enable routine and reliable communication.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Information and
– Radio Communication
 Simplex transmissions: transmit and receive on same
frequency; cannot do both simultaneously.
– Dispatch systems and on-scene communications

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Information and
 Duplex transmissions: simultaneous two-way communications
by using two frequencies for each channel.
– Works like telephone communications
– Transmits voice messages or data

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Information and
 Multiplex systems: duplex systems with additional capability of
transmitting voice and data simultaneously.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Information and
 Trunked systems: pool all frequencies.
– 800-MHz range
– Computer routes transmission to first available frequency.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Figure 9-14 Modern mobile phones have amazing capabilities and are becoming increasingly
more sophisticated.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Public Safety Communications System
Planning and Funding
• Every state developed statewide communications
interoperability plan (SCIP).
• States developing statewide interoperability
coordinator (SWIC) positions.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
Public Safety
• FCC's Primary Functions
– Monitoring frequencies to ensure appropriate usage
– Spot-checking base stations and dispatch centers for
appropriate licenses and records

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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.

Bryan E. Bledsoe
Richard A. Cherry
Robert S. Porter
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

Bledsoe v1 ch09_lecture

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