Chapter 4

Communications
and Documentation
 Introduction (1 of 2)
• Communication is the transmission of information to
another person.
– Verbal
– Nonverbal (through body language)
• Verbal communication skills are important for EMTs.
– Enable you to gather critical information, coordinate with other
responders, and interact with other health care professionals
• Documentation
– Patient’s permanent medical record
– Demonstrates appropriate care was delivered
– Helps others in patient’s future care
 Introduction (2 of 2)
• Complete patient records
– Guarantee proper transfer of responsibility
– Comply with requirements of health departments
and law enforcement agencies
– Fulfill your organization’s administrative needs
• Radio and telephone communications
– Link you to EMS, fire department, and law
enforcement
– You must know:
• What your system can and cannot do
• How to use system efficiently and effectively
Therapeutic Communication (1 of 3)
• Uses various communication techniques
and strategies:
– Both verbal and nonverbal
– Encourages patients to express how they feel
– Achieves a positive relationship with patient
• Shannon-Weaver communication model
– Sender takes a thought
– Encodes it into a message
– Sends the message to receiver
– Receiver decodes the message
– Sends feedback to the sender
Therapeutic Communication
(2 of 3)
Therapeutic Communication
(3 of 3)
Age, Culture, and Personal Experience

• Shape how a person communicates

• Body language and eye contact greatly affected by
culture
– In some cultures, direct eye contact is impolite.
– In other cultures, it is impolite to look away while speaking.
• Tone, pace, and volume of language
– Reflect mood of person and perceived importance of
message
• Ethnocentrism: Considering your own cultural values
more important than those of others
• Cultural imposition: Forcing your values onto others
 Nonverbal Communication
(1 of 2)

• Body language provides more information

than words alone.
• Facial expressions, body language, and eye
contact are physical cues.
– Help people understand messages being sent
• Physical factors
– Noise: Anything that dampens or obscures true
meaning of message
– Proxemics: Study of space and how distance
between people affects communication
 Verbal Communication
• Asking questions is a fundamental aspect of
prehospital care.
 Open-ended questions require some level of
detail.
• Use whenever possible.
• Example: “What seems to be bothering you?”
 Closed-ended questions can be answered in
very short responses.
• Response is sometimes a single word.
• Use if patients cannot provide long answers.
• Example: “Are you having trouble breathing?”
 Communication Tools

• There are many – Clarification

powerful – Confrontation
communication – Interpretation
tools that EMTs – Explanation
can use: – Summary
– Facilitation
– Silence
– Reflection
– Empathy
Interviewing Techniques (1 of 3)

• When interviewing a patient, consider using

touch to show caring and compassion.
– Use consciously and sparingly.
– Avoid touching the torso, chest, and face.
Interviewing Techniques (2 of 3)

• Golden Rules to help calm and reassure

patient:
– Make and keep eye contact at all times.
– Provide your name and use patient’s proper
name.
– Tell patient the truth.
– Use language the patient can understand.
Interviewing Techniques (3 of 3)

• Golden Rules (cont’d):

– Be careful what you say about patient to others.
– Be aware of your body language.
– Speak slowly, clearly, and distinctly.
– For the hearing-impaired patient, face patient
so he or she can read your lips.
– Allow the patient time to answer or respond.
– Act and speak in a calm, confident manner.
Communicating With Older
Patients (1 of 2)
• Identify yourself.
• Be aware of how you
present yourself.
• Look directly at patient.
• Speak slowly and distinctly.
• Explain what you are going
to do before you do it.
• Listen to the answer the
patient gives you
• Show the patient respect.
 Communicating With Older
Patients (2 of 2)
• Do not talk about the patient in front of him or her.
• Be patient!
• Older patients:
– Often do not feel much pain
– May not be fully aware of important changes in their
body systems
– You must be especially vigilant for objective
changes.
• When possible, give patients time to pack a few
personal items before leaving for hospital.
• Locate hearing aids, glasses, and dentures before
departure.
Communicating With Children (1 of 2)
• Emergency situations are frightening.
– Fear is most obvious and severe in children.
• Children may be frightened by:
– Your uniform
– The ambulance
– A crowd of people gathered around them
• Let a child keep a favorite toy, doll, security
blanket.
• If possible, have a family member or friend
nearby.
– If practical, let parent or guardian hold child during
evaluation and treatment.
Communicating With Children (2 of 2)
• Be honest.
 Children easily see through lies
or deception.
• Tell the child ahead of time if
something will hurt.
• Respect the child’s modesty.
• Speak in a professional, friendly
way.
• Maintain eye contact.
• Position yourself
at the child’s
level.
– Do not tower over the child.
Communicating With Hearing
Impaired Patients (2 of 4)
• Most have normal intelligence and are not
embarrassed by their disability.
• Position yourself so patient can see your
lips.
• Hearing aids
– Be careful they are not lost during accident.
– They may be forgotten if patient is confused.
– Ask family about use of a hearing aid.
 Communicating With Hearing
Impaired Patients (4 of 4)

Source: © Jones and Bartlett Publishers

. Courtesy of MIEMSS.
• Steps to take:
– Have paper and pen available.
– If patient can read lips, face patient and speak
slowly and distinctly.
– Never shout.
– Listen carefully, ask short questions, and give
short answers.
– Learn some simple sign language.
• Useful to know signs for “sick,” “hurt,” and “help”
Communicating With Visually
Impaired Patients (1 of 2)
• Ask the patient if he or she can see at all.
– Visually impaired patients are not necessarily
completely blind.
– Expect your patient to have normal intelligence.
• Explain everything you are doing as you are
doing it.
• Stay in physical contact with patient as you
begin your care.
 Communicating With Visually
Impaired Patients (2 of 2)
• If patient can walk to ambulance,
place his or her hand on your arm.
• Transport mobility aids such as
cane with patient to hospital.

• Guide dogs
– Easily identified by special harnesses
– If possible, transport dog with patient.
• Alleviates stress for both patient
and dog
– Otherwise, arrange for care of the
dog.

Source: Courtesy of the Guide Dog Foundation for the Blind.

Photographed by Christopher Appoldt.
 Communicating With Non
English-Speaking Patients
• You must find a way to obtain a medical
history.
• Find out if patient speaks some English.
• Use short, simple questions.
• Point to parts of the body.
• Have a family member or friend interpret.
• Your reporting responsibilities do not end
when you arrive at the hospital.
• Give oral report to hospital staff member
who has at least your level of training.
 Communicating With Other
Health Care Professionals (2 of 3)
• Oral report components:
 Opening information
• Name, chief complaint, illness
 Detailed information
• Not provided during radio report
 Any important history
• Not already provided
 Patient’s response to treatment given en route
• Vital signs
• Other information
Written Communications and
Documentation (1 of 2)
• Patient care report (PCR)
– Also known as prehospital care report
– Legal document
– Records all care from dispatch to hospital arrival
Written Communications and
Documentation (2 of 2)
• The PCR serves six functions:
– Continuity of care
– Legal documentation
– Education
– Administrative information
– Essential research record
– Evaluation and continuous quality improvement
 Patient Care Reports

• Information collected on the PCR includes:

– Chief complaint
– Level of consciousness or mental status
– Vital signs
– Initial assessment
– Patient demographics
Types of Forms (1 of 3)

• Traditional written
form with:
– Check boxes
– Narrative section
• Computerized
version

Source: Courtesy of the Utah Department of Health

 Types of Forms (2 of 3)

• The narrative section of the PCR may be

the most important.
• Includes:
– Time of events
– Assessment findings
– Emergency medical care provided
 Types of Forms (3 of 3)

• Narrative section (cont’d):

– Changes in patient after treatment
– Observations at the scene
– Final patient disposition
– Refusal of care
– Staff person who continued care
 Reporting Errors

• If you leave something out or record it

incorrectly, do not try to cover it up.
• Falsification:
– Results in poor patient care
– May result in suspension and/or legal action
 Refusal of Care

• A common source of lawsuits.

– Thorough documentation is crucial.
• Document any assessment findings and
emergency medical care given.
• Have patient sign a refusal form.
– Have family member, police officer, or bystander
also sign as witness.
• Complete the PCR.
 Special Reporting Situations

• Depending on local requirements:

– Gunshot wounds
– Dog bites
– Some infectious diseases
– Suspected physical or sexual abuse
– Mass-casualty incident (MCI)
 Medical Terminology

• Common terminology among all medical

providers
• Medical personnel around the globe speak
same language: Latin.
• Taking a medical terminology course can be
helpful.
 Communications Systems
and Equipment
• Base station radios
• Mobile and portable radios
• Repeater-based systems
• Digital equipment
• Cellular/satellite telephones
• Other equipment
 Base Station Radios

• Base station contains transmitter and

receiver in a fixed place.
• Two-way radio consists of transmitter and
receiver.
Mobile and Portable Radios
(1 of 2)

• Mobile radio is
installed in a
vehicle.
• Used to
communicate with:
– Dispatcher
– Medical control
• Ambulances often
have more than
one.
 Mobile and Portable Radios
(2 of 2)

• Portable radios are hand-held devices.

• Essential at the scene of an MCI
• Helpful when away from the ambulance to
communicate with:
– Dispatch
– Another unit
– Medical control
Repeater-Based Systems (1 of 2)

• The repeater is a special base station radio.

– Receives messages and signals on one
frequency
– Automatically retransmits them on a second
frequency
– Provides outstanding EMS communications
Repeater-Based Systems (2 of 2)
 Digital Equipment

• Voice is not the only EMS communication

• Some EMS systems also transmit:
– Electrocardiograms from unit to hospital
– Paging and tone alerts
 Cellular/Satellite Telephones

• EMTs often communicate with receiving

facilities by cellular telephone.
– Simply low-power portable radios
• Satellite phones (satphones) are another
option.
– Can be easily overheard on scanners
 Other Communications
Equipment (1 of 2)
• Ambulances usually have an external public
address system.
• Two-way radio hardware may be simplex or
duplex mode.
• MED channels are reserved for EMS use.
 Other Communications
Equipment (2 of 2)
• Trunking systems use latest technology to
allow greater traffic.
• Mobile data terminals inside ambulance
– Receive data directly from dispatch center
– Allow for expanded communication capabilities
(eg, maps)
 Radio Communications

• The Federal Communications Commission

(FCC) regulates all radio operations in the
United States
– Allocates specific radio frequencies
– Licenses call signs
– Establishes licensing standards and operating
specifications
– Establishes limitations for transmitter output
– Monitors radio operations
Responding to the Scene (1 of 2)

• All EMS systems depend on skill of

dispatcher.
– Determines relative importance of 9-1-1 call
– Assigns appropriate EMS response unit(s)
– Provides key information to responding units,
including nature of emergency and exact
location
Communicating With Medical
Control and Hospitals (1 of 2)
• Plan and organize
your radio
communication.
• Concise, well-
organized patient
report
– Usually follows
standard format
established by
local EMS system
Communicating With Medical
Control and Hospitals (2 of 2)
• Medical control must be readily available:
– On the radio at the hospital or
– On a mobile or portable unit when you call

Source: © Andrei Malov/Dreamstime.com

 Maintenance of Radio
Equipment (1 of 2)
• Like other EMS equipment, radio equipment
must be serviced.
• The radio is your lifeline.
– To other public safety agencies (who protect you)
– To medical control
 Maintenance of Radio
Equipment (2 of 2)
• At the beginning of your shift, check the
radio equipment.
• Radio equipment may fail during a run.
– Backup plan must then be followed.
– May include standing orders
 Summary (1 of 6)

• The Shannon-Weaver model of communication

is a valuable tool in understanding the variables
involved in human communications.
• There are many verbal and nonverbal factors
and strategies that are necessary for
therapeutic communication.
• Excellent communication skills are crucial in
relaying pertinent information to the hospital
before arrival.
 Summary (2 of 6)
• Sick or injured people may not understand what
you are doing or saying. Therefore body language
and attitude are very important in gaining the trust
of the patient and family.
• Take special care with children, geriatric patients,
hearing-impaired patients, visually impaired
patients, and non-English-speaking patients.
• You must complete a patient care report before
you leave the hospital. This is a vital part of
providing emergency medical care and ensuring
continuity of patient care.
 Summary (3 of 6)
• Radio and telephone communication links you to
other members of the EMS, fire, and law
enforcement communities.
• An EMT must understand and be able to use
many forms of communication, including mobile
and hand-held radios.
• It is your job to know what your communication
system can and cannot handle. You must be able
to communicate effectively by sending precise,
accurate reports on scene, patient’s condition, and
treatment provided.