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Chapter 5: Communications and Documentation
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National EMS Education Standard Competencies (1 of 3)
Preparatory Uses simple knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical responder (EMR), and medical/legal issues at the scene of an emergency while awaiting a higher level of care. Preparatory Uses simple knowledge of the emergency medical services (EMS) system, safety/well-being of the emergency medical responder (EMR), and medical/legal issues at the scene of an emergency while awaiting a higher level of care.
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National EMS Education Standard Competencies (2 of 3)
Documentation Recording patient findings EMS System Communication Communication is needed to Call for resources Transfer care of the patient Interact within the team structure Documentation • Recording patient findings (p 85) EMS System Communication Communication is needed to • Call for resources (pp 76-77) • Transfer care of the patient (p 77) • Interact within the team structure (pp 74-78)
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National EMS Education Standard Competencies (3 of 3)
Therapeutic Communication Principles of communicating with patients in a manner that achieves a positive relationship Interviewing techniques Medical Terminology Uses simple medical and anatomic terms. Therapeutic Communication Principles of communicating with patients in a manner that achieves a positive relationship: • Interviewing techniques (pp 78-83) Medical Terminology Uses simple medical and anatomic terms.
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Introduction Communications are important during every phase of a call. The dispatcher must communicate the location and type of call to responders. EMRs need to communicate with patients, bystanders, family members, dispatchers, and members of the public safety community. After a call, you must document the condition of the patient and the treatment given. I. Introduction A. Communications are important during every phase of a call. 1. The dispatcher must communicate the location and type of call to the designated responders. 2. EMRs need to communicate with patients, bystanders, family members, dispatchers, and other members of the public safety community. 3. Once you have completed a call, it is important to document the condition of the patient and the treatment given.
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Data and Communications Systems (1 of 2)
The purpose of a communications system is to send information from one location to another when it is impossible to communicate face-to-face. The results of using a communication system will be only as accurate as the information that is put into the system. II. Data and Communications Systems A. The purpose of a communications system is to send information from one location to another when it is impossible to communicate face-to-face. B. The results of using a communication system will be only as accurate as the information that is put into the system. C. You must have a basic idea of how your department’s communications system works.
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Data and Communications Systems (2 of 2)
Communications systems can be divided into two categories: Those that transmit voice communications Those that transmit data D. Communications systems can be divided into two categories: 1. Those that transmit voice communications 2. Those that transmit data
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Voice Systems (1 of 3) Voice communications systems transmit the spoken word from one location to another. Radio systems Regulated by the Federal Communications Commission (FCC) Frequencies are assigned according to the function of the organization. E. Voice systems 1. Voice communications systems a. Transmit the spoken word from one location to another 2. Radio systems a. You must understand the basics of a radio communication system and know how to properly operate the radio system used by your department. b. Radio communications are regulated by the Federal Communications Commission (FCC). c. Frequencies (channels) are assigned according to the function of the organization.
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Voice Systems (2 of 3) Radio systems (cont’d) Types of radios:
Base station Mobile radio Portable radios Repeater d. Several types of radios exist. i. Base station: A powerful stationary two-way radio that is located in a fixed place and attached to one or more fixed antennas ii. Mobile radio: A device that is mounted in a vehicle and draws electricity from the electrical system of the vehicle iii. Portable radios: A handheld, self-contained unit that includes a two-way radio with a battery, a built-in microphone, and a built-in antenna Repeater: A device that receives a weak radio signal, strengthens that signal, and then automatically rebroadcasts it Figure: A portable radio. © Jones & Bartlett Learning. Courtesy of MIEMSS.
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Voice Systems (3 of 3) Telephone systems
Primarily send voice communications Landline phone systems: tied together through an above-ground or below-ground hardwired system Mobile phones: rely on radio waves between a mobile phone and a cellular tower to send and receive phone messages 3. Telephone systems a. Telephone systems primarily send voice communications. b. Landline phone systems are tied together through an above-ground or below-ground hardwired system. c. Mobile phones rely on radio waves between a mobile phone and a cellular tower to send and receive phone messages. i Smart phones use advanced operating systems that combine the features of a cellular phone with those of a personal computer and global positioning systems (GPS).
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Data Systems (1 of 2) Data can be transmitted through radios, phones, or the Internet. Paging systems can transmit text messages or voice communications. Mobile data terminals (MDTs) transmit data messages through a radio system. F. Data systems 1. Communication systems are increasingly used to send and receive data. a. Data can be transmitted through radios phones, or the Internet. 2. Paging systems can transmit text messages or voice communications. Mobile data terminals (MDTs) transmit data messages through a radio system and are frequently incorporated into a mobile radio system. Figure: A mobile data terminal (MDT) can be used to display routing information transmitted from the dispatch center. © Jones & Bartlett Learning. Courtesy of MIEMSS.
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Data Systems (2 of 2) Fax machines use phone lines or radio systems to send written data. Telemetry is used by advanced life support (ALS) providers to transmit electrocardiograms (ECGs) and other patient data to online medical control. Digital messaging, including , text messages, and social media, can be used to transmit a wide variety of messages. 4. Fax machines use phone lines or radio systems to send written data. 5. Telemetry is used by advanced life support (ALS) providers to transmit electrocardiograms (ECGs) and other patient data to online medical control. 6. Digital messaging is a technology that includes , text messages, and social media, which are increasingly used by EMRs to send and receive information within public safety agencies.
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The Functions of Radio Communications (1 of 9)
Dispatch Dispatch may be voice, text messaging, or an MDT to alert responders to an emergency. It is your responsibility to keep your equipment ready to receive a call when you are on duty. If you are not sure that all information has been received correctly, ask the dispatcher to repeat it. G. The functions of radio communications 1. Communication systems are used for different functions. 2. Calls for medical assistance can be broken into six phases: a. Dispatch b. Response to the scene c. Arrival at the scene d. Update responding EMS units e. Transferring the care of patient to other personnel f. Postrun activities 3. Dispatch a. Dispatch may use voice, text messaging, or an MDT to alert responders to an emergency. b. It is your responsibility to keep your equipment ready to receive a call whenever you are on duty. c. If you are not sure that all information has been received correctly, ask the dispatcher to repeat it.
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The Functions of Radio Communications (2 of 9)
Response to the scene Learn how to use maps or GPS. The dispatcher may give you further information while you are en route to the scene. If you are delayed or encounter any problems, notify dispatch. 4. Response to the scene a. You need to know your response area. b. Learn how to use maps or global positioning system (GPS) devices. c. The dispatcher may give you further information about the location of the call or the condition of the patient while you are en route to the scene. d. If you are unexpectedly delayed or encounter any problems en route, notify dispatch of the situation. Figure: Notify your dispatcher if you encounter any problems while en route to the scene. © Jones & Bartlett Learning. Courtesy of MIEMSS.
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The Functions of Radio Communications (3 of 9)
Arrival at the scene Perform a visual survey of the scene. Give the communications center a brief verbal description of the scene: Location and type of incident Any hazards present Number of patients Any additional assistance required 5. Arrival at the scene a. Perform a visual survey of the scene as you arrive. b. Give the communications center a brief verbal description of the scene. c. Your report should verify i. Location of the incident ii. Type of incident iii. Any hazards present iv. Number of patients v. Any additional assistance required
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The Functions of Radio Communications (4 of 9)
Update responding EMS units Your report should include Age and sex of the patient Chief complaint Level of responsiveness Status of airway, breathing, and circulation Transferring care to other EMS personnel Provide EMTs or paramedics with a “hand-off” report. 6. Update responding EMS units a. You will be expected to update responding EMS units about the condition of your patient. b. Your report should include i. Age and sex of the patient ii. Chief complaint iii. Level of responsiveness iv. Status of airway, breathing, and circulation 7. Transfer of patient care to other EMS personnel a. When EMTs or paramedics arrive on the scene, it is important for you to provide them with a “hand-off” report.
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The Functions of Radio Communications (5 of 9)
Transferring care (cont’d) Use the same approach you follow during patient assessment: Provide the age and sex of the patient. Describe the history of the incident. Describe the patient’s chief complaint. Describe the patient’s level of responsiveness. Describe how you found the patient. b. The easiest way to report your patient assessment results is to use the same systematic approach that you follow during patient assessment: i. Provide the age and sex of the patient. ii. Describe the history of the incident. iii. Describe the patient’s chief complaint. iv. Describe the patient’s level of responsiveness. v. Describe how you found the patient.
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The Functions of Radio Communications (6 of 9)
Transferring care (cont’d) Patient assessment: (cont’d) Report the status of the patient’s vital signs, airway, breathing, and circulation. Describe the results of the physical examination. Report any pertinent medical conditions using the SAMPLE format. Report the interventions provided and the patient’s response to them. vi. Report the status of the patient’s vital signs, airway, breathing, and circulation. vii. Describe the results of the physical examination. viii. Report any pertinent medical conditions using the SAMPLE format. ix. Report the interventions provided and the patient’s response to them. c. Use the same systematic approach you follow during patient assessment to help ensure that you do not overlook any significant symptoms, signs, or injuries.
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The Functions of Radio Communications (7 of 9)
Transferring care (cont’d) Online medical control is generally used by EMTs and paramedics to Secure permission to perform certain skills Get direction regarding patient care Give patient care reports to the hospital d. Online medical control is generally used by EMTs and paramedics to i. Secure permission to perform certain skills ii. Get direction regarding patient care iii. Give patient care reports to the hospital e. If your EMS system uses online medical control for EMRs, you will need to learn how and when to contact medical control.
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The Functions of Radio Communications (8 of 9)
Postrun activities After you have turned over the care of the patient, you need to report your status to your communications center. Let the communications center know how long it will take you to get your unit ready for service and when you will be available for another call. 8. Postrun activities a. After you have turned over the care of the patient to other EMS providers, you need to report your status to your communications center. b. Let the communications center know how long it will take you to get your unit ready for service and when you will be available for another call. c. Providing a written report of a call is covered under the section on documentation.
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The Functions of Radio Communications (9 of 9)
Table: Guidelines for Effective Radio Communications © Jones & Bartlett Learning.
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Verbal Communications (1 of 2)
Effective communication means that the person receiving the message understands exactly what the person who sent the message meant. Effective communication requires feedback. The receiver needs to communicate to the sender that the message has been received and understood. III. Verbal Communication A. Effective communication means that the person receiving the message understands exactly what the person who sent the message meant. 1. Effective communication requires feedback; the receiver needs to communicate to the sender that the message has been received and understood.
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Verbal Communications (2 of 2)
Both external and internal distractions can negatively affect communication. External distractions: noise and the use of electronic devices Internal distractions: letting yourself think about a personal matter while on scene B. Both external and internal distractions can negatively affect communication. 1. Noise and other the use of electronic devices constitute external distractions. 2. Internal distractions, such as letting yourself think about a personal matter while on scene, can negatively affect your ability to communicate. 3. Communication can also be affected when an EMR lacks empathy for a patient or shows prejudice against a certain type or group of people. C. Verbal communications with the patient, the family, and the rest of the health care team are an essential part of high-quality patient care. 1. You must be able to determine what the patient needs and then explain this information to others.
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Guidelines for Effective Communications With Patients (1 of 3)
Introduce yourself by name and title. Ask the patient’s name and use it. Make and keep eye contact. Use language the patient can understand. Speak slowly and clearly. © Jones & Bartlett Learning. Courtesy of MIEMSS. D. Guidelines for effective communication with patients 1. Your gestures, body movements, and attitude toward the patient are critically important in gaining the trust of both the patient and family. 2. The following guidelines for communication will help you calm and reassure your patients: a. Introduce yourself by name and title. b. Ask the patient’s name and use it. c. Make and keep eye contact. d. Use language that the patient can understand. e. Speak slowly and clearly. Figure: Introduce yourself by name and title.
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Guidelines for Effective Communications With Patients (2 of 3)
Tell the truth. Allow time for the patient to respond. Limit the number of people talking with the patient. Be aware of your body language. Act and speak in a calm, confident manner. f. Tell the truth. g. Allow time for the patient to respond. h. Limit the number of people talking with the patient. i. Be aware of your body language. j. Act and speak in a calm, confident manner.
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Guidelines for Effective Communications With Patients (3 of 3)
Respect the cultural norms of the patient. Use open-ended and closed-ended questions appropriately. Treat all patients as if they were members of your family. k. Respect the cultural norms of the patient. l. Use open-ended and closed-ended questions appropriately. m. Treat all patients as if they were members of your family.
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Communicating With Patients With Special Needs (1 of 10)
Patients who are hard of hearing or deaf Identify yourself by showing the patient your patch or badge. Touch the patient. Face the patient when you speak so he or she can see your lips and facial expressions. Speak slowly and distinctly; do not shout. Watch the patient’s face for expressions of understanding or uncertainty. E. Communicating with patients with special needs 1. Communicating with patients who are hearing-impaired a. A patient of any age may be unable to hear you for a variety of reasons: i. Hereditary deafness ii. Long-term deafness caused by illness, ear infections, or injury iii. Temporary deafness caused by an explosion or other loud noise b. Ask, or write out the question, “Can you hear me?” c. After you determine that the patient is hearing impaired or deaf, do not continue to rely on verbal communication. d. When working with patients who are hard of hearing or deaf, use the following techniques: i. Identify yourself by showing the patient your patch or badge. ii. Touch the patient; a patient who is hard of hearing or deaf needs human contact just as much as a hearing patient. iii. Face the patient when you speak so he or she can see your lips and facial expressions. iv. Speak slowly and distinctly; do not shout. v. Watch the patient’s face for expressions of understanding or uncertainty.
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Communicating With Patients With Special Needs (2 of 10)
Patients who are hard of hearing or deaf (cont’d) Repeat or rephrase your comments in clear, simple language. If all else fails, write down your questions. vi. Repeat or rephrase your comments in clear, simple language. vii. If all this fails, write down your questions and offer paper and a pencil to the patient to respond. viii. Some people are both deaf and blind. Take your time, be patient, and use touch as a way of communicating. e. Like all other parents in similar circumstances, deaf parents must give their consent for you to treat their child.
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Communicating With Patients With Special Needs (3 of 10)
Patients who are visually impaired Tell the patient what is happening, identify noises, and describe the situation and surroundings. Find out the patient’s name and use it throughout your examination and treatment. If the patient has a service dog, try to keep the patient and dog together. It is not necessary to talk louder. 2. Communicating with patients who are visually impaired a. Look for signs that suggest the patient may be visually impaired. b. Tell the patient what is happening, identify noises, and describe the situation and surroundings, particularly if you must move the patient. c. Learn the patient’s name and use it throughout your examination and treatment, just as you would with a sighted patient. d. If the patient has a service dog, try to keep the patient and dog together. e. Visual impairment and hearing impairment are not related; it is not necessary to talk louder to a visually impaired patient.
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Communicating With Patients With Special Needs (4 of 10)
Non–English-speaking patients Determine how much English the patient speaks, if any, and try to find an interpreter. Supplement your questions with hand gestures, finger-pointing, and facial expressions. 3. Communicating with non–English-speaking patients a. You may be able to adapt some of the techniques recommended for communicating with a patient who is hard of hearing or deaf. b. Supplement your questions with hand gestures, finger-pointing, and facial expressions. c. Determine how much English the patient speaks, if any, and find out if a family member or a friend can function as an interpreter for you. d. Some communities offer language assistance services that EMRs can access by telephone or through the agency dispatcher.
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Communicating With Patients With Special Needs (5 of 10)
Geriatric patients Do not assume that all older patients have physical or mental impairments. Assess all patients carefully and give them time to respond to your questions. 4. Communicating with geriatric patients a. When dealing with older patients who suffer from hearing or visual impairment, use the same communication skills you would with any other patients with similar conditions. b. Do not assume that all older patients have physical or mental impairments. c. Assess all patients carefully and give them time to respond to your questions.
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Communicating With Patients With Special Needs (6 of 10)
Pediatric patients Familiar objects and faces can help reduce fear for children. Talk to the parents and the child as much as possible and tell them what is happening. Ask a parent to hold the child if the illness or injury permits. Tell the child your first name and explain what you are doing. 5. Communicating with pediatric patients a. Caring for ill or injured children is a stress-producing situation for most EMS providers. b. Children and their parents or caregivers are often frightened and anxious. c. Familiar objects and faces can help calm a child. d. Talk to both the parents and the child as much as possible and tell them what is happening. e. Ask a parent to hold the child if the illness or injury permits. f. Tell the child your first name and explain what you are doing.
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Communicating With Patients With Special Needs (7 of 10)
Pediatric patients (cont’d) Squat, kneel, or sit down to the child’s level and establish eye contact. Be honest. g. Squat, kneel, or sit down to the child’s level and establish eye contact. h. Be honest. Figure: Squat, kneel, or sit when treating a pediatric patient. © Jones & Bartlett Learning.
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Communicating With Patients With Special Needs (8 of 10)
Patients with a developmental disability Ask the family about the patient’s typical level of communication. Speak slowly, using short sentences and simple words. You may need to repeat or rephrase statements several times until the patient understands what you want. 6. Communicating with patients with a developmental disability a. Ask the family or caregiver about the patient’s typical level of communication. b. Speak slowly, using short sentences and simple words. c. You may need to repeat or rephrase statements several times until the patient understands what you want. d. You may be able to adapt many of the techniques that you use when treating children to your work with developmentally disabled patients.
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Communicating With Patients With Special Needs (9 of 10)
Persons displaying disruptive behavior Assess the situation; try to determine the cause of the patient’s disruptive behavior. Protect the patient and yourself. Stay between the patient and an exit. Do not take your eyes off the patient or turn your back. If the patient has a weapon, stay clear and wait for law enforcement personnel. 7. Persons displaying disruptive behavior a. Disruptive behavior can present a danger to you, the patient, and other persons at the scene and can cause delays in treatment. b. In managing any patient who is exhibiting disruptive behavior, take the following steps: i. Assess the situation. Try to determine the cause of the patient’s disruptive behavior. ii. Protect the patient and yourself. iii. Stay between the patient and an exit whenever possible. iv. Do not take your eyes off the patient or turn your back. v. If the patient has a weapon, stay clear and wait for law enforcement personnel—no matter how badly injured the patient seems to be.
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Communicating With Patients With Special Needs (10 of 10)
Persons displaying disruptive behavior (cont’d) As soon as your personal safety is assured, carry out the appropriate emergency medical care. You cannot take a disruptive patient to the hospital against his or her wishes. vi. As soon as your personal safety is assured, provide the appropriate emergency medical care. c. Sometimes family members or friends of the disruptive patient may insist that you take the person to the hospital, but you cannot take a competent individual against his or her wishes.
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Medical Terminology (1 of 3)
Collection of technical terms used by medical personnel to Identify anatomic parts of the body Specify illnesses and injuries Indicate treatments given IV. Medical Terminology A. Medical terminology is a collection of technical terms used by medical personnel to 1. Identify anatomic parts of the body 2. Specify illnesses and injuries 3. Indicate treatments given B. Medical terminology is intended to clarify language so that one person can communicate clearly to another the anatomic location of an injury, signs and symptoms of a disease, and treatments given.
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Medical Terminology (2 of 3)
Your job as an EMR is to communicate your message to other medical providers as clearly as possible. Do not use medical terms if you are unsure of their meaning. As new terminology is introduced, look at the parts of each word. Learn commonly occurring prefixes and suffixes. C. You job as an EMR is to communicate your message to other medical providers as clearly as possible. 1. Do not use medical terms if you are unsure of their meaning. 2. As new terminology is introduced, look at the parts of each word. 3. By learning commonly occurring prefixes and suffixes, you will gain some insight into new words.
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Medical Terminology (3 of 3)
Table: Prefixes Commonly Used in Medical Terminology © Jones & Bartlett Learning.
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Documentation (1 of 4) Documentation is a process for verifying your actions using written records or computer-based records. Proper documentation includes The age and sex of the patient The history of the incident The condition of the patient when found The patient’s description of the injury/illness V. Documentation A. Documentation is the second major type of communication that you will use in your daily work as an EMR. B. Documentation is a process for verifying your actions using written records or computer-based (electronic) records. 1. By recording your actions, you provide a record for others and a document you can refer to in the future if necessary. 2. Documentation provides a legal record of the actions you took. 3. It also offers a basis to evaluate the quality of care given. C. Proper documentation includes the following: 1. The age and sex of the patient 2. The history of the incident 3. The condition of the patient when found 4. The patient’s description of the injury or illness
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Documentation (2 of 4) Proper documentation includes (cont’d)
The patient’s chief complaint The patient’s level of responsiveness The status of initial and subsequent vital signs The results of the physical examination Pertinent medical conditions using the SAMPLE format The treatment you gave the patient 5. The patient’s chief complaint 6. The patient’s level of responsiveness 7. The status of initial and subsequent vital signs: airway, breathing, and circulation 8. The results of the physical examination 9. Pertinent medical conditions using the SAMPLE format 10. The treatment you gave the patient
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Documentation (3 of 4) Proper documentation includes (cont’d)
Any change in the patient’s condition The agency and personnel who took over treatment The following times: The time you were dispatched The time you arrived on the scene The time other providers arrived on the scene The time you departed the scene 11. Any change in the patient’s condition after treatment 12. The agency and personnel who took over treatment of the patient 13. The following times: a. The time you were dispatched b. The time you arrived on the scene c. The time other providers arrived on the scene d. The time you departed the scene
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Documentation (4 of 4) Proper documentation includes (cont’d)
Any reportable conditions present Any infectious disease exposure Anything unusual about the case Any other helpful facts Complete your patient care report as soon as possible after each call. D. Complete your patient care report as soon as possible after each call. 1. Your documentation should be clear, concise, and accurate. 2. If you make a mistake, draw a line through it, initial the error, and correct it. E. Your organization may rely on patient care reports for documenting reportable events. 1. Reportable events include certain crimes and infectious diseases. a. Knife wounds b. Gunshot wounds c. Motor vehicle collisions d. Suspected child abuse e. Domestic violence f. Elder abuse g. Dog bites h. Rape 2. It is important that you learn how the reporting process is handled in your agency and what you are required to do.
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Summary (1 of 5) Communications systems allow you to relay information from one location to another when it is impossible to communicate face to face. Excellent communication skills are crucial during every phase of a call. You must have a basic idea of how your department’s communications systems work. VI. Summary A. Communications systems allow you to relay information from one location to another when it is impossible to communicate face to face. Excellent communication skills are crucial during every phase of a call. B. It is important for you to have a basic idea of how your department’s communications system works.
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Summary (2 of 5) You must be familiar with two-way radio communications and have a working knowledge of mobile and hand-held portable radios, when to use them, and what information you can transmit. C. You must be familiar with two-way radio communications and have a working knowledge of mobile and hand-held portable radios. You must know when to use them and which types of information you can transmit.
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Summary (3 of 5) Communication systems are used for different functions. The phases of an EMS call include dispatch, response to the scene, arrival at the scene, updating the responding EMS units, transferring care, and postrun activities. It is important that you learn and follow the standard procedures and protocols used by your department for communications. D. Throughout the different phases of an EMS call, communication systems are used for different functions. The phases of an EMS call include dispatch, response to the scene, arrival at the scene, updating the responding EMS units, transferring care of the patient to other personnel, and postrun activities. E. The protocols for communicating with others during each phase of an EMS call vary from one system to another. It is important that you learn and follow the standard procedures and protocols used by your department.
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Summary (4 of 5) In addition to radio and oral communications, you must have excellent person-to-person communication skills. Body language and attitude are very important. You must take special care of individuals such as children, geriatric patients, hearing-impaired and visually impaired patients, non–English-speaking patients, developmentally disabled patients, and persons displaying disruptive behavior. F. In addition to radio and oral communications, you must have excellent person-to-person communication skills. You should be able to effectively interact with the patient and any family members, friends, or bystanders. G. People who are sick or injured may not understand what you are doing or saying. For this reason, your body language and attitude are very important in gaining the trust of both the patient and the family. You must also take special care of individuals such as children, geriatric patients, patients who are hard of hearing or deaf, patients who are visually impaired, non–English-speaking patients, patients with a developmental disability, and patients displaying disruptive behavior.
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Summary (5 of 5) Along with your radio report and oral report, you must complete a formal written hand-off report that will be given to other EMS professionals at the scene. H. Along with your radio report and oral report, you must complete a formal written hand-off report that will be given to other EMS professionals at the scene. Documentation provides a legal record of the actions you took and offers a basis to evaluate the quality of care given. Remember that the call is not over until the paperwork is completed.
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Review When communicating with a sick or injured person, it is important to use terms such as “dear” and “buddy” when addressing the patient. only use medical terminology. ask the patient as little as possible. maintain eye contact with the patient when you can.
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Review Answer: D. maintain eye contact with the patient when you can.
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Review Which of the following would be considered good communication?
You talk louder so you can be heard over the television. You initiate care without telling the patient what you are doing. You assess the patient while thinking about your last call. You minimize distractions during your conversation with the patient.
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Review Answer: D. You minimize distractions during your conversation with the patient.
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Review When caring for a pediatric patient, you should consider
separating the child from the parents to avoid upsetting them. speaking in an authoritative tone. allowing the parent to hold the child, if the situation permits it. performing painful procedures without giving the child any warning.
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Review Answer: C. allowing the parent to hold the child, if the situation permits it.
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