EMT Lecture - Communications & Ambulance Operations

Communication in EMS

Importance of Communication

• Effective communication is crucial in Emergency Medical Services (EMS) as it directly impacts the ability to help others.

• Learning appropriate language and terminology for calls is essential; certain words can enhance or hinder communication.

Documentation Practices

• Proper documentation is vital, with a dedicated lecture planned to cover best practices at the end of the course.

Evolution of Communication Systems

Historical Context

• In the past, EMS relied on bulky communication devices, such as large phones in ambulances, which required manual operation.

Modern Communication Tools

• Today, cell phones are ubiquitous; however, radio communication remains integral to EMS operations.

• Analog systems are still prevalent despite a shift towards digital communications; simplex and multiplex systems have distinct functionalities.

Radio Communication Mechanics

System Functionality

• The transition from analog to digital systems varies by region; understanding local repeater systems is critical for effective communication.

• Repeaters extend the range of radio communications significantly compared to standard portable radios.

Dispatch Operations

• A centralized dispatch system manages communications across vast distances, ensuring that all messages are relayed effectively regardless of location.

Understanding Codes and Regulations

Use of Codes in EMS

• Different codes are utilized within Hatzolah compared to 9-1-1 services; familiarity with these codes is necessary for efficient operations.

Interagency Communication Challenges

• Each emergency service (EMS, Fire Department, Police Department) operates on separate channels and frequencies, complicating inter-agency communication.

Regulatory Considerations

FCC Guidelines

Understanding EMS Communication and Protocols

Overview of EMS Frequency Usage

• The FCC owns the frequencies used for medical dispatch, emphasizing their importance in patient information transfer to hospitals.

• Certain codes are commonly used in New York City EMS communication; familiarity with these codes is essential for effective dialogue among personnel.

Common EMS Codes Explained

• Code 63 indicates that an EMS unit is en route to a call. Miscommunication can occur if personnel are unfamiliar with specific codes.

• Code 82 signifies transport to the hospital, while code 98 means the unit is ready for the next call after completing a previous one.

Operational Procedures and Status Codes

• Each status code (e.g., 89 for being out of service or waiting) has specific implications for operational readiness and communication with dispatch.

• Units must maintain certain statuses during shifts, as failure to do so may lead to scrutiny from other departments like the fire department.

Fuel Management Protocol

• EMS units must not drop below a quarter tank of fuel; if they do, they go out of service until refueled.

• Different agencies have varying procedures for fueling vehicles, often involving specific gas stations and payment methods.

Hospital Communication Differences

• In major cities like New York, hospitals expect ambulances to bring patients without prior notification due to high volume.

• Outside urban areas, such as the Catskills, notifying hospitals before arrival is necessary due to lower patient traffic expectations.

Critical Patient Management

• For critical patients who cannot be stabilized on-site, calling ahead to notify the hospital may be required but can disrupt hospital operations.

Emergency Medical Response Protocols

Importance of Communication in Emergency Situations

• When responding to a STEMI (ST-Elevation Myocardial Infarction), it's crucial to call ahead for additional personnel, ensuring the hospital is prepared for the incoming patient.

• If arriving at a hospital with a critical patient, it’s essential to communicate effectively with staff rather than waiting in line; immediate attention may be necessary.

• The decision to wait for a medic or transport directly to the hospital should depend on the distance and estimated time of arrival (ETA); if the journey is shorter, proceed without delay.

Stabilization Techniques by Medics

• Medics are equipped to stabilize various conditions, including seizures and heart problems; they can manage tachycardia and bradycardia effectively.

• Specific conditions like strokes require specialized tools and protocols; understanding these nuances is vital for effective emergency care.

Effective Reporting Practices

• Clear communication during patient handoff is essential; avoid unnecessary radio chatter that could distract from critical information sharing.

• Prior preparation before contacting the ER ensures all relevant patient information is conveyed calmly and efficiently.

Communicating with Diverse Patient Populations

• Understanding how to communicate with hearing-impaired patients involves facing them directly so they can read lips instead of shouting louder.

• Language barriers can be addressed by utilizing translation services; having access to interpreters helps ensure accurate communication with non-English speaking patients.

Professionalism in Patient Interaction

• It’s important to engage patients respectfully, allowing them space to respond during assessments rather than rushing through questions.

Understanding Ambulance Operations and Protocols

The Role of Medical Professionals

• The speaker emphasizes the importance of remaining calm and confident as a medical professional during emergency situations, highlighting that for 20 to 30 minutes, you are the patient's doctor.

Ambulance Specifications in New York City

• Discussion on Part 800 regulations indicates that this knowledge is crucial for EMT training and may be included in assessments.

• In New York City, ambulances typically have either two EMTs or two paramedics; hybrid systems are not common here.

• Identification of ambulance types is simplified: A-R designates BLS (Basic Life Support) EMT ambulances, while S-Z indicates paramedic units.

Types of Ambulances

• There are three main types of ambulances:

• Type One: Non-walkthrough design primarily used by FDNY; features a box at the back.

• Type Two: Often resembles converted vans with walkthrough capabilities; more common outside NYC.

• Type Three: Typically associated with Hatzalah ambulances and private hospital transports.

Usage of Lights and Sirens

• Lights and sirens should only be used in two scenarios:

• When responding to a call (going "63").

• During patient transport to the hospital (going "82").

• While using lights and sirens, privileges come with responsibilities; drivers must ensure safety when navigating through traffic.

Legal Responsibilities While Responding

• Emergency vehicle operators can exceed speed limits, run red lights, and make illegal turns but must exercise caution.

Emergency Response Protocols

Parking Guidelines for Emergency Vehicles

• The most common locations for parking during emergencies are intersections. A course called "C fo" is available for further discussion on this topic.

• It’s important to understand that Good Samaritan laws do not protect individuals from liability in driving accidents, emphasizing the need for caution when responding to emergencies.

Hazmat Scene Protocol

• When parking an ambulance at a hazmat scene, it should always be positioned uphill, upwind, upstream, and up yours—these are critical safety measures.

• Personnel entering hot zones must have the appropriate protective equipment; only trained individuals can safely retrieve patients from these areas.

Required Documentation

• In New York State, every ambulance must carry the "orange book," which contains essential information about hazardous materials.

• Despite its outdated content (last updated in 2000), knowledge of the orange book is crucial as it frequently appears in test questions.

Protective Equipment Levels

• Understanding levels of protective gear is vital: Level D offers minimal protection (akin to changing a diaper), while Level A provides full encapsulation against toxic environments.

• The highest level of protection (Level A) is necessary for maximum toxicity situations, highlighting the importance of proper gear selection based on risk assessment.

Extrication vs. Disentanglement

• Distinguishing between extrication (removing a patient from a vehicle with accessible doors) and disentanglement (using heavy machinery when doors cannot be opened) is essential for emergency responders.

Understanding MCI and Triage in Emergency Situations

The Importance of Safety and Backup

• Emphasizes the need for safety at a scene, suggesting to call for backup before taking action.

• Discusses the importance of assessing exits (doors vs. windows) before breaking them.

Defining Mass Casualty Incidents (MCI)

• Defines MCI as a situation where there are more patients than available resources, using an example of a flipped school bus with 60 children.

• Highlights that an incident may be classified as MCI based on potential harm until confirmed otherwise, referencing events like 9/11.

Establishing Incident Command

• Explains how cities quickly establish MCIs during emergencies, especially in residential fires due to uncertainty about casualties.

• Introduces the concept of triage, derived from French meaning "to sort," which is crucial in managing patient care during MCIs.

Triage Process and Patient Categorization

• Describes how triage involves sorting patients into categories based on urgency for treatment.

• Mentions that state exams often include questions about prioritizing patients in emergency scenarios.

Identifying Patient Priorities

• Discusses the initial steps taken by responders to identify who needs immediate assistance among injured individuals.

• Introduces the use of colored tags (green for walking wounded, black for deceased), aiding in quick identification during triage.

Managing Resources During MCI

• Explains how responders can manage walking wounded by directing them away from critical areas to streamline care efforts.

• Clarifies that black-tagged patients are those who are dead or beyond help; they do not receive further attention due to resource constraints.

Finalizing Triage Decisions

• Reiterates that identifying red-tagged patients is essential as they represent those who can still be saved with immediate intervention.

Understanding EMT Roles in Emergency Situations

The Importance of EMT Interventions

• EMTs play a crucial role in preventing fatalities during emergencies, particularly heart attacks. They must prioritize resources effectively to manage multiple patients.

• EMTs are trained to assist with airway and breathing problems, including suctioning and administering oxygen, which can be life-saving interventions.

• Controlling severe bleeding is another critical function of an EMT. Proper techniques can prevent patients from entering hemorrhagic shock.

Recognizing Shock Types

• Understanding the difference between compensated and decompensated shock is essential for EMTs. Decompensated shock is defined by blood pressure dropping below 90 mmHg.

• Severe burns can be treated by EMTs; however, while they can mitigate damage, they cannot always prevent death from such injuries.

Patient Tagging System

• Familiarity with patient tagging systems (e.g., red tags for critical patients) is vital for effective triage during emergencies.

• New York City has introduced an orange tag system for non-trauma-related medical emergencies that occur during incidents, such as asthma attacks or chest pain.