Saturday, May 21, 2016

EMT Training: Communicating with patients

EMT communication isn't just about radio reports and speaking with other EMS personnel. How we perform around a patient is also important. With cities becoming more multicultural there are ways off communication that can enhance or interfere with patient interaction. 

A persons perceptions, values, and experiences can interfere with communication with a patient. This is why it is important to receive feedback from the patient, work partners, and supervisors. Information about a persons religion or culture can be extremely helpful when dealing 
with a patient. 

Using clarification, summary, explanation, silence, reflection, empathy, and confrontation all assist when dealing with a patient. It's just important to know when to use each one. By the EMT using:

Clarification - They are letting the patient know that they do not understand and are asking them to repeat the information. This could be do to staggered speech because of pain or due to language barriers. I remember having a call where the client could only speak Spanish and I didn't know Spanish at the time. Thankfully, the EMS Dispatcher did know how to speak the language.

Summary - Rephrase what you have interpreted from the patient and repeat it back to him.

Explanation - You will have to explain things in a way the patient understands. Create a good rapport with the patient. Watch for verbal and nonverbal clues for feedback.

Silence - Silence may help patients. Patients may allow insight to what's going on if the EMT is quiet and simply watches the patient.

Reflection - Redirects patient and feelings back to him/her. Reflection promotes empathy, respect, and understanding of the patient.

Empathy - Allows an EMT to understand how something has affected the patient. an important characteristic to have. Recognize someone else state of mind and feelings.

Confrontation - Sometimes EMT's have to confront a patient's feelings, attitudes, beliefs, and behaviors. Confrontation should be done with the desire to help the patient not just be confrontational.

EMT Training: Advantages and disadvantages of radio codes

EMT radio codes allow concise and clear information but radio codes can be useless if not everyone uses the same radio codes. Medical information may be too complex for codes or codes may not be used enough to be remembered.

There are several codes that are universal. Communicate using military time, standard clock times, and common radio terms. 1 a.m. to noon is 0100 to 1200 hours in military time. 1 p.m. to midnight is 1300 to 2400 hours military time.

Break - Afford a "Pause" so that the hospital can respond or interrupt if necessary.

Clear - End of transmission

Come In - Requesting acknowledgement of transmission

Copy - Message received and understood

ETA - Estimated Time of Arrival

Go Ahead - Proceed with your message

Land Line - Refers to telephone communications or need of land line communications

Over - End of message awaiting reply

Repeat - Did not understand message

Spell Out - Asking sender to spell out phonetically words that are unclear


Is there a way to enhance team dynamics through communication?

When an EMT or Paramedic is dealing with a patient they are also communicating with a lot of people. A person never knows where important pieces of information can arrive from. It could be from the next door neighbor, the Police Officer that was first on scene, the Firefighter that's willing to assist you.

It's important for an Emergency Medical Technician to:

  • Communicate professionally with EMS personnel
  • SBAR Method - Situation, Background, Assessment, Recommendation
  • Take Charge of the situation
  • Use radio codes
  • Use military time
  • Use radio terms

EMT Training: Transferring care to another facility or another medical provider

I remember my first call to another medical provider. We had a Diabetic in our truck and we had to air rescue him out. It was my job to relay all the medical information to the nurse and paramedic on the chopper. Boy did I fumble. Thankfully not bad enough to hurt the patient but enough to get myself the nickname "Green" for a couple of weeks.

What important information need to be relayed to the waiting facility or another EMS unit?

  • The patients current condition
  • Patients age and gender
  • Patients chief complaint
  • Pertinent history of what happened
  • Description on how you found the patient
  • Any major past illnesses
  • Vital signs you obtained from patient
  • Findings of physical exam
  • Emergency medical care that was given
  • Patients response to medical care that was given

EMT Training: Receiving and confirming medical direction

The EMS team has made their radio report to the medical direction. They are obtaining directions for the patient. What should an EMT do when dealing with radio reports from the medical direction. What if they do not understand the directions?


  • Be sure the information provided is clear and accurate
  • Repeat order back to medical directive word for word
  • If orders are not understandable then as for the orders to be repeated
  • If orders seem inappropriate then question them or reconfirm orders.
After making a radio report and receiving orders, when should an EMT recontact the receiving facility?

An EMS unit will always want to keep the receiving facility informed about the patient. Call in another report if the patient is deteriorating or if there is improvement in the patient. 

If the estimated time of arrival has changed, be sure to let the receiving facility know. The longer a patient is away from the facility could mean different measures to be made. It also allows staff to be coordinated better to deal with what is going on in the Emergency Center.

Emergency Medical Technician Communication With Radio Dispatch

The EMS Dispatchers are feeling a little unappreciated in our group during EMS 2016. Some feel that since they sit behind a desk that they are not completely part of a team. What they need to remember is that they are the first person that a patient or patients family comes into contact with. If I could hug every 911 Dispatcher that I have dealt with in the past two years on the job, I would.

With that said..Today we're going to discuss the importance of concise radio reports, communication with the medical directive, and much more. So what is a concise and organized radio report?

A concise and organized EMT radio report is one that consist of:

  • Unit Identification number and level of service (Basic Life Support/Advance Life Support)
  • Patients age and sex
  • Chief complain of patient
  • History, scene assessment and mechanism of injury
  • Major illness history
  • Patients mental status
  • Patients baseline vitals
  • Findings of examination of patient
  • Description of medical care given
  • Patients response to medical care given
  • Patients current condition
  • Request for further actions at receiving facility
  • Estimated time of arrival


Wednesday, May 11, 2016

EMT Training: Communication with dispatch

We discussed what an EMT call transmission should be like. Are there other things that EMS dispatch should know while an EMS unit is on a call. In previous blog posts we discussed that time units are important on patient care reports. Do you think that time is an important thing to report.

There are ten EMT communication key points:
  • Acknowledgement that the dispatched call information was received
  • Advise dispatch that the unit is en route to the call
  • ETA (Estimated Time Of Arrival) on scene
  • ETA to scene while en route and road conditions
  • Announce arrival on scene and any additional resources that might be needed
  • Announce departure of scene and destination hospital, number of patients, estimated ETA to destination hospital
  • Announce arrival to hospital
  • Announce clear and ready when EMS unit has delivered patient to hospital
  • Announce leaving hospital
  • Announce arrival back at station
 

EMT Training: Ground rules for radio transmissions

What would a radio transmission between and EMT and EMS Dispatch look like? There are certain ground rules that every communication transmission should follow.

  • EMS dispatch transmits the call to the EMS unit
  • EMS unit acknowledges that call was received
  • EMT notifies dispatch that they are in route
  • EMS notifies other agencies if necessary such as medical control and local hospitals
  • EMS unit notifies dispatch when at scene
  • Contact medical direction. Report patients condition and seek orders
  • EMS unit notifies dispatch when leaving the scene
  • Contact receiving hospital and give patient report
  • Notify dispatch on your arrival at hospital
  • Notify dispatch when you have left the hospital
  • Notify hospital of your arrival back at station or when available

EMT Training: Communication upkeep

EMT communication equipment doesn't last forever. There isn't a day that goes by where our own radio antennas don't lose their top, nobs, and buttons. Thankfully our Vertex Standard radios are easy to repair. Maintenance is key for the upkeep of EMS communication equipment.

  • Don't mishandle equipment
  • Don't expose to harsh elements
  • Regular cleaning with a damp cloth
  • Check assigned frequency
  • Always check batteries
Most radios come with a charging stand. Every couple of years EMS radios will have to have their battery changed. I have found that by the time the batteries do need to be changed it's just be better to upgrade the radios.

EMT Training: The FCC and EMT Communications

What is the FCC? How does this organization affect EMS Communication and EMT Communications? Are they an organization that we should keep an eye on? Should EMS around the United States have a say on how the FCC conducts business?

The Federal Communications Commission has jurisdiction over all communicative operations in the United States. The FCC license base station operations, radio call signs, approves equipment, regulates transmission output, assign radio frequencies, and monitor field operations.

What happens when the Federal Communications Commission doesn't agree with EMS upgrades. I am personally blessed to have friendships with EMT, Paramedics, and Firefighters from around the United States. So it's easy to stay informed about issues that happen on a scene and how things need to be improved.

In truth, all a person has to do is a Google search, if you are an EMT that wants to stay informed about the FCC and EMS.

EMT Training: What is the purpose of EMS communication

In the field, communication is key. It's not only important how EMS communicate with each other but how we also communicate with patients. Ultimately what does EMS system communications consist of?

Every EMS system will have a base station, mobile radios, portable radios, repeaters and digital equipment. All are important parts of communication between EMS personnel.

Tuesday, May 10, 2016

EMT Training: Mobile Communication Keywords

Communication among Emergency Medical Technicians and EMS is important. Without a way to communicate, teams would be left with a disability on the job. There would be no way to communicate with dispatch. There would be no way to call advance life support. There would be no way to contact the medical directive to assist a patient. I would hate to think of the scenario if one of our team members got injured on a call.

EMS communication is not perfect. In the future I do want to discuss some of the advantages and disadvantage of communication on a scene. For right now we'll be discussing the basic terminology and information.

Base Station
The base station is the central EMS dispatch and coordination area. In the city that I work in we actually have two dispatch centers. One is central dispatch where fire, ambulance and police can be contacted. The second one is direct dispatch to ambulance. In truth, I deal with three base stations. Campus dispatch, city dispatch, and ambulance dispatch.

Repeaters
As an EMT I have only seen one or two repeaters in the city. I'm sure there are many more. I just have not found them yet. Repeaters are devices that receive transmission from a low powered source and rebroadcast them to another.

Encoder
Device that breaks down sound waves into unique digital codes for radio transmission

Decoder
Device that recognizes and responds to certain codes imposed on radio broadcasts

Mobile data terminal
Devices mounted in an ambulance cab that receives and displays information on a screen.

SBAR
Acronym for situation, background, assessment, and recommendation. This is a method of organizing communications about a patient.

Communications
Using verbal and nonverbal expressions as messages that are received and interpreted by others.

Encoding
Process of converting information into a message

Decoding
Process of translating and interpreting a message

Feedback
Any information that an individual receives about his behavior

Defense Mechanism
Psychological coping strategies individuals use to protect themselves from unwanted feelings or thoughts.

Intimate Zone
In American culture, the space 1 1/2 inches between an individual

Gestures
Nonverbal body movements that convey meaning to others

Haptics
The study of touching

Open Ended Questions
Questions that allow the patient to answer in their own words

Close Ended Questions
Questions that cause for specific information from the patient

Leading Questions
Questions that suggest an answer

Culture
The thoughts, communications, actions and values towards racial, ethnic, religious and social decisions.

Monday, May 9, 2016

EMT Training: Patient Care Reports in review

Here is a short EMT review about documentation and patient care reports. The following questions help remind us why these reports are important in our career. It is my hope that these questions will help you on your EMT refresher and testing.

Explain the various uses of the documentation that the EMT generates after a patients contact?

Documentation can be used for continuous patient care, administration uses, as legal documents, educational documents, research, evaluation and improvement to the EMS system.

Describe two common formats for the Patient Care Report.
The two most common formats for a PCR is a written form or a computerized report. The computerized format is usually an electronic tablet or handheld device.

Explain the origin and purpose of the minimum data set.
The U.S. Department of Transportation has made an effort to standardize the information collected on a PCR. The purpose is to standardize reporting throughout the United States.

Explain what the phrase "accurate and synchronous clocks" meaning and its importance.
EMS systems should use clocks or time keepers that are accurately set and agreed upon.

Define Pertinent Negatives.
Pertinent negatives are signs or symptoms that might be expected base on the chief complaint but are denied by patient.

List the steps you should take if a patient refuses treatment.
A. Make sure patient is ration and not suicidal
B. Perform as much assessment as possible
C. Inform patient of risks for not obtaining medical care
D. Make last effort to have patient seek care
E. Have patient sign refusal of treatment form that is part of the PCR.

Explain the meaning and importance of the following document rules.
"If it wasn't written down, it wasn't done"
"If it wasn't done, don't write it down"
These two statements pertain to a patients care record. It's important to be exact on these reports. It may be easy to write something down to save face but this can be potentially harmful to the patient and your career.

Describe how errors on PCR should be corrected
An error on a PCR should be corrected by making a line through the mistake and then putting your initials next to it.

Explain how multiple casualty incidents can effect EMT documentation.
All the information may not be collected right at the scene of the incident. A multiple causality incident will cause the need for triage tags. Where name, age, and chief complaint is recorded.

Describe circumstances in which an EMT might be expected to file special reports with other agencies.
A. Child or Elderly neglect
B. Possible contact of diseases
C. Injury to EMS Team

Well I hope that you find these EMT training notes useful. I'll be adding additional notes as EMT classes go on. Please feel free to leave comments. I honestly believe that we can learn from each other.

Friday, May 6, 2016

EMT Training: Signs of adequate breathing

Adequate breathing is key to an EMT having a patient survive their medical illness or trauma. The question is "What are the signs of adequate breathing?" The signs are a little more then air going in and out of the airways. What should an Emergency Medical Technician be looking for?

An intact open airway
Normal respiratory rate
Normal rise and fall of the chest
Normal respitory rhythm
Breath sounds that are present bilaterally
Chest expansion and relaxation that occurs
No use of accessory muscles to aid in breathing
Normal mental status
Normal muscle tone
Normal pulse oximeter reading
Normal skin condition findings

Thursday, May 5, 2016

EMT In Review: Signs and symptoms of breathing difficulties

A Paramedic is called to a scene where there is a respitory emergencies. How does an EMT or person from the EMS team know? What sign and symptoms should he/she be looking for?

Abnormal breathing sounds such as wheezing, Rhonchi, and Rales.

There is trauma to the chest or lungs of the patient

Patient membranes are turning blue in color. This is near the eyes, nose, and mouth area of the patient.

The EMT will notice that the patient is sitting in a tripod position. This is a position where the patient is sitting upright. They will have their arms in front of them in a locked position.

Patients mental status is decreasing as the EMT, Paramedic, or Firefighter is talking to them.

EMT Training: Respitory emergency assessment based approach

Each time a EMT goes on scene they perform an assessment of the patient or patients. When the dispatcher says that it is a respitory emergency, what should the emergency medical technician be looking for when they arrive on scene.

An EMT should:
Form a general impression of the mental status of the patient, airway, breathing, and circulation.

Check patients position, face, speech and mental status.

Are they sitting in a tripod position? Are they using their neck muscles to breath? Is there a retraction of the muscles between the ribs? Does the EMT see Cyanosis, Diapharesis, and Pallor. Is the patients nasal passages flaring?

 

EMT Training: Geriatrics, Pediatrics, and Respitory Emergencies

Once you have been on a few scenes, you will find that there is always special consideration to Geriatric patients and Pediatric patients. One generation is still growing while the other generation is getting weaker. So there are a few things that Emergency Medical Technicians need to remember when assessing and managing these types of patients.

Pediatric Patients
Respitory failure is usually caused by both respitory arrest and cardiac arrest. The root cause is either upper airway blockage or a lower airway disease.

It's important to recognize early signs of respitory distress.

Because respitory distress can rapidly deteriorate into respitory failure, prompt intervention and transport is critical.

Geriatric Patients
Dyspnea is a common complaint.
Elderly already have a diminished respitory function so respitory distress will happen often.
Additional burden can overwhelm the respitory system causing respitory distress or respitory failure.

EMT Training: Respitory Emergency Medications

There are several medications that a patient can take when they are faced with a Respitory emergency. Some act differently than others. It is important for an EMT to know which one is appropriate to use and when.

So how does an Emergency Medical Technician differentiate between short acting beta 2 agonist and other respiratory medicines?

Medications that are for emergencies are fast acting. They are medications such as Buterol, Xopenex, and Bronkosol.

Medications that are not meant for emergency uses are long acting Beta 2 specific drugs (salmeterol xinafoate) that also contains a steroid (fluticasone propionate)

EMT Refresher: Abnormal breathing sounds

As an Emergency Medical Technician listens to a patients lungs they will either hear clear breathing or abnormal breathing sounds. There are three basic types of abnormal breathing sounds. They are wheezing, Rhonchi, and Rales (Crackling sound). So what do these three abnormal breathing styles sound like to a EMT?

Wheezing
High pitched musical whistling sound
Wheezing is usually heard in asthma, emphysema, and chronic bronchitis
What is causing the wheezing is a swelling and constriction of the bronchi

Rhonchi
Snoring or rattling noises coming from the nose or lungs
Obstruction of the larger conducting airways by mucus.
Rhonchi signifies chronic bronchitis, emphysema, aspirations and pneumonia

Rales (Crackles
Bubbly or crackling sound in the lungs
Fluid that has surrounded or filled the bronchioles
Indication of pulmonary edema or pneumonia

EMT Training: Where to assess breathing sounds

An EMT comes to a scene and they need to listen to a persons lungs. This is called assessment of breath sounds or assessing the lungs. There are four different locations where assessment of breath sounds can be made. I'm sure everyone has been to the doctors where the nurse, nurse practitioner, or doctor has taken a stethoscope to four different areas of your lungs.

One area is the second intercostal space, midclavical line
Sounds here represent airflow through the larger conducting airways.
Airway structures are still supported by cartilage.
Abnormal breathing heard here include stridor and rhonchi

Assessment can be made at the third intercostal space found near the anterior axillary.

Fourth intercostal space on the Midaxillary line. Sounds heard here represent airflow through smaller conducting airways (Bronchioles). You may also be able t hear some airflow into the air sacs (alveoli). Abnormal breathing sounds heard here are crackles (rales)

Midscapular Line
While patient sitting upright, the sounds heard here represent airflow into the alveoli. This is the best location to hear alveolar airflow. Abnormal sounds would be crackling sounds coming from the lungs. This is also known as rales.

Wednesday, May 4, 2016

EMT Refresher: Structure and function of the respitory system

The lovely lungs. For Emergency Medical Technicians it's the respitory system. What makes up the respitory system? What is the function of the respitory system. You will be surprised the respitory system is not just about breathing. Without breath there is no oxygenated blood and without oxygenated blood, there is no life.

The respitory system can be divided into three different sections.

Section 1 and 2
Upper and lower airways
The vocal chords being the medium between them both.
The upper and lower airways bring air into and out of the lungs.

Section 3
Consist of the lungs and accessory structures
Allow for the oxygenation of blood cells and elimination of carbon dioxide from the blood stream.

In the next EMT Refresher post, We will be discussion where to assess breathing sounds in a patient. It's important to listen carefully because certain breathing sounds will give an EMT clues to what the patient is dealing with.

Why is it important to recognize respitory emergencies

An EMT has arrived to a scene and the patient has a medical illness. Why is it important to be able to quickly recognize and treat patients with respitory emergencies.

It's important to recognize the signs and symptoms of respitory emergencies because if a patient does not receive emergency treatment it can ultimately lead to respitory failure and eventually cardiac arrest.

In the next couple of posts we will be discussing the structure of the respitory system, the function of the respitory system, how to assess breathing sounds, what is an abnormal breathing sound, medications, and how to assist in delivering medications to the patient.

If there is anything that you have questions about, please let me know in the EMT comments. Of course, I'm not perfect in the field. So if you are an Emergency Medical Technician and you think I missed something, please let me know. We are an EMS family. Family helps family even if we're EMS in another state.

Tuesday, May 3, 2016

Cardiac Conduction System Key Points

Every day we are given little tidbits of information. Here are some tidbits for Emergency Medical Technicians, Paramedics, Nurses, and Firefighters. These are some key points on the heart, veins, and Cardiac Conduction System.

The electrocardiogram is a graphic representation of the hearts electrical activity.

Agina Pectoris is a symptom of inadequate oxygen supply to the heart muscle or myocardium.

Diabetics, the elderly and women are more prone to an atypical presentation of symptoms when suffering a heart attack.

Coronary heart disease is now the single largest cause of death of females in the United States.

Patients suffering heart failure will say that they are taking a "water pill" or diuretic.

Some patients have chronically elevated blood pressures. The EMT should only elevate a patients current blood pressure in light of what "normal" blood pressure is for the patient.

Cardiac Conduction System Keywords

Squeeze, relax, squeeze, relax, electrical currents run through the heart. It's time to learn about the Cardiac Conduction System, Heart, and many other things that keep the patient alive during the struggles of the heart.

Circulatory System
System compose of the heart and blood vessels

Cardiac Conduction System
Contractile and conductive tissue of the heart that generates electrical impulses and causes the heart to beat.

Automaticity
The ability of cells within the cardiac conduction system to generate a cardiac impulse of their own.

Heart
The muscular organ that contracts to force blood into circulation through the body.

Atria
The two upper chambers of the heart

Ventricles
The two lower chambers of the heart

Venae Cavae
The two major veins that carry oxygen depleted blood back to the heart

Pulmonary Artery
Vessel carrying oxygen depleted blood from the lungs to the right atrium of the heart

Pulmonary Vein
Vessel carrying oxygen rich blood from the lungs to left atrium of the heart

Aorta
Major artery from the heart

Artery
Blood vessels that carries blood away from the heart

Arteriole
The smallest branch of the artery

Capillary
A tiny blood vessel connecting arterioles to venules

Vein
Vessels that carry blood towards the heart

Venule
Smallest vein

Coronary Arteries
Arteries supplying the heart with blood

Blood Pressure
The force exerted by the blood on the interior walls of the blood vessels

Perfusion
Delivery of oxygen and other nutrients to the cells resulting from the constant adequate circulation of blood through the capillaries.

Cardiac Compromise
Reduced heart function caused by any condition, disease or injury affecting the heart.

Acute Coronary Syndrome (ACS)
Signs and symptoms resulting from conditions in which the coronary arteries are narrowed or occluded.

Nitroglycerin
Medication that dilates the blood vessels, increasing blood flow and decreasing the workload of the heart.