class 25 communications documentation geriatric emergencies ch9 ch33 ch34 n.
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Class 25 (Communications, Documentation & Geriatric Emergencies) Ch9, Ch33 & Ch34. Communications and Documentation. Essential components of prehospital care: Verbal communications are vital. Adequate reporting and accurate records ensure continuity of patient care.

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communications and documentation
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.
base station radios
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
mobile and portable radios
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
repeater based systems
Repeater-Based Systems
  • Receives radio messages and retransmits
  • A repeater is a base station able to receive low-power signals.
digital equipment
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.
cellular telephones
Cellular Telephones
  • Low-powered portable radios that communicate through interconnected repeater stations
  • Cellular telephones can be easily scanned.
other
Other
  • Simplex
    • Push-to-talk communication
  • Duplex
    • Simultaneous talk-listen
  • MED channels
    • Reserved for EMS
communication quality
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.
fcc duties
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
dispatch responsibilities
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
information received from dispatch
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
communicating with dispatch
Communicating With Dispatch
  • Report any problems during run.
  • Advise of arrival.
  • Communicate scene size-up.
  • Keep communications brief.

Insert EMTB9e Fig. 9-4.

communicating with medical control
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.
patient report
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
role of medical control
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
calling medical control
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.
special situations
Special Situations
  • Notify as early as possible.
  • Estimate the potential number of patients.
  • Identify special needs.
standard procedures and protocols
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.”
reporting requirements
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.
maintenance of equipment
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.
verbal communication
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.
components of an oral report
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
communicating with patients 1 of 2
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.
communicating with patients 2 of 2
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.
communicating with geriatric patients
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.
communicating with children
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.
communicating with hearing impaired patients
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.
communicating with vision impaired patients
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.
communicating with non english speaking patients
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.
written communication and documentation
Written Communication and Documentation

Written Communication and Documentation

minimum data set 1 of 2
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
minimum data set 2 of 2
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
functions of the prehospital care report
Functions of the PrehospitalCare Report
  • Prehospital care report serves six functions
    • Continuity of care
    • Legal documentation
    • Education
    • Administrative
    • Research
    • Evaluation and quality improvement
types of forms
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.
reporting errors
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 .
documenting right of refusal
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.
special reporting situations
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)
geriatrics 1 of 2
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.
geriatrics 2 of 2
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.
common stereotypes
Common Stereotypes
  • Common stereotypes include mental confusion, illness, sedentary lifestyle, and immobility
  • Older people can stay fit; most older people lead very active lives.
geriatric assessment
Geriatric Assessment
  • Geriatric assessment has unique challenges.
  • The GEMS diamond can be a helpful tool.
  • Preexisting conditions may affect findings.
the gems diamond
The GEMS Diamond
  • Geriatric patients: Normal aging, atypical presentation
  • Environmental assessment: Safety, neglect
  • Medical assessment: Past history, medications
  • Social assessment: Basic needs, social network
scene size up 1 of 2
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
scene size up 2 of 2
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.
initial assessment
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.
focused history and physical exam 1 of 2
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.
communications
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.
focused history and physical exam 2 of 2
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.
polypharmacy
Polypharmacy
  • Older people account for a large portion of overall medication usage.
  • Many medications can have interactions or counter actions when taken together.
  • Polypharmacy refers to the use of multiple prescriptions by a single patient.
detailed and ongoing exams
Detailed and Ongoing Exams
  • Normal aging may affect physical findings.
    • Increased BP, respiratory changes
  • Chronic changes can mask acute problems.
  • Ongoing assessments will help determine changes.
    • Geriatric patients have decreased ability to compensate.
physiologic changes 1 of 3
Physiologic Changes (1 of 3)
  • Skin
    • Susceptible to injury; longer healing time
  • Senses
    • Dulling of the senses
  • Respiratory system
    • Decreased ability to exchange gases
physiologic changes 2 of 3
Physiologic Changes (2 of 3)
  • Cardiovascular system
    • Increased risk of cardiovascular disease
  • Renal system
    • Decline in kidney function
  • Nervous system
    • Memory impairment, decreased psychomotor skills
physiologic changes 3 of 3
Physiologic Changes (3 of 3)
  • Musculoskeletal system
    • Decrease in muscle mass and strength
  • Gastrointestinal system
    • Decrease in ability of body to digest food properly
leading causes of death
Leading Causes of Death
  • Heart disease
  • Cancer
  • Stroke
  • COPD and other respiratory illnesses
  • Diabetes
  • Trauma
common complaints
Dyspnea

Chest pain

Altered mental status

Dizziness or weakness

Fever

Trauma

Falls

Generalized pain

Nausea, vomiting, and diarrhea

Common Complaints
medical emergencies
Medical Emergencies
  • Determining chief complaint is challenging.
    • Multiple conditions and complaints
    • Ask what bothers them most today.
  • Sensation of pain may be diminished.
  • Fear of hospitalization
  • Conditions may present differently.
cardiovascular emergencies
Cardiovascular Emergencies
  • Syncope
    • Interruption of blood flow to the brain
    • Many underlying causes
  • Heart attack
    • Classic symptoms often not present
syncope
Syncope
  • Can occur for many reasons in geriatric patients
    • Standing up too fast
    • Straining to have bowel movement
    • Myocardial infarction
    • Diabetic shock
cardiovascular emergencies1
Cardiovascular Emergencies
  • Classic symptoms are often not present.
  • Many have “silent” heart attacks.
  • Common signs and symptoms
    • Difficulty breathing
    • Toothache
    • Arm pain
    • Back pain
dyspnea
Dyspnea
  • Related to many causes
    • Asthma
    • COPD
    • Congestive heart failure
    • Pneumonia
  • Provide oxygen for all patients experiencing dyspnea.
acute abdomen
Acute Abdomen
  • Complaints of abdominal pain in older patients usually indicate a serious event.
  • Nervous system response to pain is lessened.
  • Consider gastrointestinal problems or abdominal aortic aneurysm.
acute abdomen 1 of 3
Acute Abdomen (1 of 3)
  • Acute abdominal aneurysm
    • Walls of the aorta weaken.
    • Treat for shock and provide prompt transport.
  • Gastrointestinal bleeding
    • Blood in emesis
    • May cause shock
acute abdomen 2 of 3
Acute Abdomen (2 of 3)
  • Bowel obstructions
    • Vagus nerve is stimulated and produces vasovagal syndrome.
    • Vasovagal syndrome can cause dizziness and fainting.
    • Patient requires transport to rule out other conditions.
acute abdomen 3 of 3
Acute Abdomen (3 of 3)

Older patients with abdominal pain have higher chances of hospitalization, surgery, and death than younger patients.

septicemia
Septicemia
  • Results from presence of microorganisms or their toxic products in bloodstream
  • Patients may present with:
    • Hot, flushed appearance
    • Tachycardia and tachypnea
    • Hypotension
    • Chills, cough
altered mental status
Altered Mental Status
  • Acute onset is not normal in any patient.
  • Most sudden changes are caused by a reversible condition.
  • Evaluate and treat for hypoxia or hypoglycemia if present.
altered mental status1
Altered Mental Status
  • Delirium
    • Recent onset
    • Usually associated with underlying cause
  • Dementia
    • Develops slowly over a period of years
psychiatric emergencies 1 of 2
Psychiatric Emergencies (1 of 2)
  • Depression is common among older adults.
  • Physical pain, psychological distress, and loss of loved ones can lead to depression.
  • Women are more likely to suffer depression.
psychiatric emergencies 2 of 2
Psychiatric Emergencies (2 of 2)
  • Older men have the highest suicide rate.
  • Older patients use much more lethal means.
  • EMT-Bs should consider all suicidal thoughts or actions to be serious.
geriatrics and trauma
Geriatrics and Trauma
  • An older patient may have decreased ability to localize even simple injuries.
  • Assessment must include all past medical conditions.
trauma assessment 1 of 2
Trauma Assessment (1 of 2)
  • Common mechanisms of injury
    • Falls
    • Motor vehicle trauma
    • Pedestrian accidents
    • Burns
trauma assessment 2 of 2
Trauma Assessment (2 of 2)
  • Priorities in rapid trauma are the same.
  • Confounding factors:
    • Medical conditions or previous injuries
    • Dentures or other dental implants
    • Decreased ability to compensate
    • Changes associated with aging
injuries to the spine
Injuries to the Spine
  • Classified as stable or unstable
  • Osteoporosis is a contributing factor to spinal injuries.
  • Prompt spinal immobilization can reduce further damage and pain.
    • Pad void spaces.
head injuries
Head Injuries
  • Assume a significant injury in older patients who have signs and symptoms of head injury.
  • Suspect brain injury in patients who take blood thinners and who suffer head injury.
  • Maintain oxygen delivery to brain.
injuries to pelvis and hip fractures
Injuries to Pelvis and Hip Fractures
  • Often present as hip or buttock pain
  • Pelvic ring disruption can lead to hemorrhage or internal organ injury.
  • Hip fractures:
    • Common debilitating injury
    • Maintain leg in static position to prevent further injury.
hip fracture
Hip Fracture

Blanket rolls maintain the leg in a static position so that further injury does not occur.

elder abuse 1 of 2
Elder Abuse (1 of 2)
  • This problem is largely hidden from society.
  • Definitions of abuse and neglect among older people vary.
  • Victims are often hesitant to report an incident.
  • Signs of abuse are often overlooked.
elder abuse 2 of 2
Elder Abuse (2 of 2)

Nursing home residents who receive no visitors have a higher likelihood of abuse and neglect.

assessment of elder abuse 1 of 2
Assessment of Elder Abuse (1 of 2)
  • Repeated visits to the emergency room
  • A history of being “accident prone”
  • Soft-tissue injuries
  • Vague explanation of injuries
  • Psychosomatic complaints
assessment of elder abuse 2 of 2
Assessment of Elder Abuse (2 of 2)
  • Chronic pain
  • Self-destructive behavior
  • Eating and sleeping disorders
  • Depression or a lack of energy
  • Substance and/or sexual abuse
signs of physical abuse
Signs of Physical Abuse
  • Signs of abuse may be obvious or subtle.
  • Obvious signs include bruises, bites, and burns.
  • Look for injuries to the ears.
  • Consider injuries to the genitals or rectum with no reported trauma as evidence of abuse.
response to nursing and skilled care facilities
Response to Nursing andSkilled Care Facilities
  • Important information to know from staff:
    • What is the patient’s chief complaint today?
    • What initial problem caused the patient to be admitted to the facility?
  • Ask the staff about the patient’s overall condition.
  • Obtain any type of transfer papers.
advance directives
Advance Directives
  • Do not resuscitate (DNR) orders give you permission not to attempt to resuscitate.
  • DNR orders may only be valid in the health care facility.
  • You should know state and local protocols regarding advance directives.
  • When in doubt, initiate resuscitation.