Class 25 (Communications, Documentation & Geriatric Emergencies) Ch9, Ch33 & Ch34

1. Class 25 (Communications, Documentation & Geriatric Emergencies)Ch9, Ch33 & Ch34

2. Communications and Documentation • Essential components of prehospital care: • Verbal communications are vital. • Adequate reporting and accurate records ensure continuity of patient care. • Reporting and record keeping are essential aspects of patient care.

3. Base Station Radios • Transmitter and receiver located in a fixed place • Power of 100 watts or more • A dedicated line (hot line) is always open. • Immediately “on” when you lift up the receiver

4. Mobile and Portable Radios • Mobile radios installed in vehicle • Range of 10 to 15 miles • Portable radios hand-held • Operate at 1 to 5 watts of power

5. Repeater-Based Systems • Receives radio messages and retransmits • A repeater is a base station able to receive low-power signals.

6. Digital Equipment • Some EMS systems use telemetry to send an ECG from the unit to the hospital. • Telemetry is the process of converting electronic signals into coded, audible signals. • Signals can be decoded by the hospital.

7. Cellular Telephones • Low-powered portable radios that communicate through interconnected repeater stations • Cellular telephones can be easily scanned.

8. Other • Simplex • Push-to-talk communication • Duplex • Simultaneous talk-listen • MED channels • Reserved for EMS

9. Communication Quality • Affected by power and location of antennas • Changes in location can affect quality of transmission • Check communication equipment at beginning of each shift.

10. FCC Duties • Allocate radio frequencies • License base stations and assign call signs. • Establish licensing standards and operating specifications • Establish limits on transmitter power output • Monitor radio operations

11. Dispatch Responsibilities • Screen and assign priorities • Select and alert appropriate units to respond • Dispatch and direct units to the location • Coordinate response with other agencies • Provide pre-arrival instructions to the caller

12. Information Receivedfrom Dispatch • Nature and severity of injury, illness, or incident • Location of incident • Number of patients • Responses by other agencies • Special information • Time dispatched

13. Communicating With Dispatch • Report any problems during run. • Advise of arrival. • Communicate scene size-up. • Keep communications brief. Insert EMTB9e Fig. 9-4.

14. CommunicatingWith Medical Control • Radio communications facilitate contact between providers and medical control. • Consult with medical control to: • Notify hospital of incoming patient. • Request advice or orders. • Advise hospital of special circumstances. • Organize your thoughts before transmitting.

15. Patient Report • Identification and level of services • Receiving hospital and ETA • Patient’s age and gender • Chief complaint • History of current problem • Physical findings • Summary of care given and patient response

16. Role of Medical Control • May be off-line or online • Guides treatment of patients • May have to contact directly for orders • Many variations from system to system

17. Calling Medical Control • Physician bases his or her instructions on report received from the EMT-B. • Never use codes while communicating. • Repeat all orders received. • Do not blindly follow an order that does not make sense to you.

18. Special Situations • Notify as early as possible. • Estimate the potential number of patients. • Identify special needs.

19. Standard Procedures and Protocols • Keep transmission brief. • Develop effective radio discipline. • Identify the called unit, followed by the calling unit. • “Dispatch, this is Medic One.”

20. Reporting Requirements • Acknowledge dispatch information. • Notify arrival at scene. • Notify departure from scene. • Notify arrival at hospital or facility. • Notify you are clear of the incident. • Notify arrival back in quarters.

21. Maintenance of Equipment • Radio equipment must be properly serviced. • Nonfunctioning equipment should be removed from service. • Backup plans should be in place in case of communication failure. • Standing orders: Written documents signed by the EMS system’s medical director.

22. Verbal Communication • Essential part of quality patient care • You must be able to find out what the patient needs and then tell others. • You are a vital link between the patient and the health care team.

23. Components of an Oral Report • Patient’s name, chief complaint, nature of illness, mechanism of injury • Summary of information from radio report • Any important history not given earlier • Patient’s response to treatment • The vital signs assessed • Any other helpful information

24. Communicating With Patients (1 of 2) • Make and keep eye contact. • Use the patient’s proper name. • Tell the patient the truth. • Use language the patient can understand. • Be careful of what you say about the patient to others.

25. Communicating With Patients (2 of 2) • Be aware of your body language. • Always speak slowly, clearly, and distinctly. • If the patient is hearing impaired, speak clearly and face him or her. • Allow time for the patient to answer questions. • Act and speak in a calm, confident manner.

26. Communicating With GeriatricPatients • Determine the person’s functional age. • Do not assume that an older patient is senile or confused. • Allow patient ample time to respond. • Watch for confusion, anxiety, or impaired hearing or vision. • Explain what is being done and why.

27. Communicating With Children • Children are aware of what is going on. • Allow people or objects that provide comfort to remain close. • Explain procedures to children truthfully. • Position yourself on their level.

28. Communicating With Hearing-Impaired Patients • Always assume that the patient has normal intelligence. • Make sure you have a paper and pen. • Face the patient and speak slowly, clearly and distinctly. • Never shout! • Learn simple phrases used in sign language.

29. Communicating With Vision-Impaired Patients • Ask the patient if he or she can see at all. • Explain all procedures as they are being performed. • If a guide dog is present, transport it also, if possible.

30. Communicating With Non-English-Speaking Patients • Use short, simple questions and answers. • Point to specific parts of the body as you ask questions. • Learn common words and phrases in the non-English languages used in your area.

31. Written Communication and Documentation Written Communication and Documentation

32. Minimum Data Set (1 of 2) • Patient information • Chief complaint • Mental status • Systolic BP (patients older than 3 years) • Capillary refill (patients younger than 6 years) • Skin color and temperature • Pulse • Respirations and effort

33. Minimum Data Set (2 of 2) • Time incident was reported • Time that EMS unit was notified • Time EMS unit arrived on scene • Time EMS unit left scene • Time EMS unit arrived at facility • Time that patient care was transferred

34. Functions of the PrehospitalCare Report • Prehospital care report serves six functions • Continuity of care • Legal documentation • Education • Administrative • Research • Evaluation and quality improvement

35. Types of Forms • Written forms • Computerized versions • Narrative sections of the form • Use only standard abbreviations. • Spell correctly. • Record time with assessment findings. • Report is considered confidential.

36. Reporting Errors • Do not write false statements on report. • If error made on report then: • Draw a single horizontal line through error. • Initial and date error. • Write the correct information .

37. Documenting Right of Refusal • Document assessment findings and care given. • Have the patient sign the form. • Have a witness sign the form. • Include a statement that you explained the possible consequences of refusing care to the patient.

38. Special Reporting Situations • Be familiar with required reporting in your jurisdiction, including: • Gunshot wounds • Animal bites • Certain infectious diseases • Suspected physical, sexual, or substance abuse • Multiple-casualty incidents (MCI)

39. 33 & 34: Geriatric Emergencies

40. Geriatrics (1 of 2) • Geriatric patients are individuals older than 65 years of age. • In 2000, the geriatric population was almost 35 million. • By 2020, the geriatric population is projected to be greater than 54 million.

41. Geriatrics (2 of 2) • Older people are major users of EMS and health care in general. • Effective treatment will require an increased understanding of geriatric care issues.

42. Common Stereotypes • Common stereotypes include mental confusion, illness, sedentary lifestyle, and immobility • Older people can stay fit; most older people lead very active lives.

43. Geriatric Assessment • Geriatric assessment has unique challenges. • The GEMS diamond can be a helpful tool. • Preexisting conditions may affect findings.

44. The GEMS Diamond • Geriatric patients: Normal aging, atypical presentation • Environmental assessment: Safety, neglect • Medical assessment: Past history, medications • Social assessment: Basic needs, social network

45. Scene Size-up (1 of 2) • Be keenly aware of the environment and why you were called. • Scene safety should include looking for unsafe conditions. • Look for hazards. • Steep stairs, missing handrails, poor lighting, other fall hazards

46. Scene Size-up (2 of 2) • The general condition of the home will provide clues. • Cleanliness, heat, lighting, food • Look for signs of activities of daily living. • Personal hygiene, getting dressed, food preparation • Scene size-up continues throughout call.

47. Initial Assessment • Never assume altered mental status is normal. • May have to rely on family or caregiver to establish patient’s baseline LOC • Assess the patient’s chief complaint and ABCs.

48. Focused History and Physical Exam (1 of 2) • History is usually the key in helping to assess a patient’s problem. • Patience and good communication skills are essential. • Treat the patient with respect. • Face the patient and speak in a normal tone.

49. Communications • Show the patient respect. • Position yourself at eye level in front of the patient. • Speak slowly and distinctly. • Give the patient time to answer. • Be patient.

50. Focused History and Physical Exam (2 of 2) • Medication history • Often have multiple medication • Average number is four • Obtain a list of medications and doses. • Ask about medications recently started or stopped. • Determine if the patient has taken other medications.