Chapter 5- EMS Communications

Open-ended question

A question that does not have a yes or no answer, and that does not give the patient specific options from which to choose

Ten-code

A radio transmitter and receiver housed in a single unit; a two-way radio

Remote console

A terminal that receives transmissions of telemetry and voice from the field and transmits messages back, usually through the base station

34. Repeating the key parts of a patient's responses to your questions demonstrates: A) sympathy. B) active listening. C) passive communication. D) an exchange of information.

Ans: B Page: 133

75. Many _________ believe that touching the head may put their soul in jeopardy. A) Thais B) Asians C) Muslims D) Somalis

Ans: B Page: 141

74. What hand gesture is interpreted in many Arabic and some Latin American cultures as the equivalent of an extended middle finger? A) The OK sign B) A clenched fist C) Waving your hand D) The thumbs-up sign

Ans: D Page: 140-141

Wavelength

Distance in a propagating wave from one point to the corresponding point on the next wave

Interpersonal communications

Exchange of information between two or more persons

Noise

In radio communications, interference in a radio signal

Simplex

Method of radio communication using a single frequency that enables transmission reception of voice or an ECG signal but is incapable of simultaneous transmission and reception

Hertz (Hz)

Unit of frequency equal to 1 cycle per second

Emergency medical dispatcher (EMD)

A person who receives information and relays that information in an organized manner during the emergency

16. Radio transmission distances from a mobile transceiver are reduced: A) by fog or light rain. B) over mountainous areas. C) over water or flat terrain. D) with greater than 7.5 W of power.

Ans: B Page: 122

Multiplex

Method by which simultaneous transmission of voice and ECG signals can be achieved over a single radio frequency

Very high frequency (VHF) band

Portion of the radio frequency spectrum between 30 and 150 mHz

Ultrahigh frequency (UHF) band

Portion of the radio frequency spectrum between 300 and 3000 mHz

Trunking

Sharing of radio frequencies by multiple agencies or systems

Pervasive developmental disorders (PDDs)

A group of disorders that cause delays in many areas of childhood development, such as the development of skills to communicate and interact socially, and may include repetitive body movements and difficulty with changes in routine; includes autism and Asperger syndrome, among others

Encoded

A message is put into a code before it is transmitted

Closed-ended question

A question that is specific and focused, demanding either a yes or no answer or an answer chosen from specific options

Enhanced 9-1-1 system

An emergency call-in system in which additional information such as the phone number and location of the caller is recorded automatically through sophisticated telephone technology and the dispatcher need only confirm the information on the screen

2. A backup communication system is especially critical when dealing with: A) mass-casualty incidents. B) motor-vehicle collisions. C) simultaneous EMS calls. D) any critically injured patient.

Ans: A Page: 121

4. A _____________ receives a weak signal and retransmits it at a higher power on another frequency. A) repeater B) base station C) multiplex system D) duplex system

Ans: A Page: 122

8. The term "frequency," as it applies to radio communications, is MOST accurately defined as: A) how frequently a radio wave recurs in a given time. B) a predefined station designed for emergency use only. C) a relatively long wavelength that produces audible sound. D) the number of megahertz per cycle that the radio transmits.

Ans: A Page: 122

19. Which of the following statements regarding the use of cellular telephones and landline telephones is MOST correct? A) Cellular and landline telephones overcome problems caused by overcrowded EMS radio frequencies. B) Cellular phones are more expensive than radios and give a weaker signal. C) Landline phones are in a fixed location and transmit with a simplex system. D) Cellular phones do not rely on a repeater to increase the coverage distance.

Ans: A Page: 124

13. At minimum, sending the 12-lead ECG of a patient with chest pain to the emergency department physician via telemetry would: A) decrease the time from diagnosis to treatment. B) enable the paramedic to begin treatment in the field. C) decrease the likelihood of prehospital cardiac arrest. D) allow the physician to choose the appropriate fibrinolytic.

Ans: A Page: 125

21. The FIRST principle of communicating by radio is: A) clarity. B) accuracy. C) calmness. D) thoroughness.

Ans: A Page: 126-127

33. Using the NATO phonetic alphabet, how should you spell Dr. "Wilson"? A) WHISKEY-INDIA-LIMA-SIERRA-OSCAR-NOVEMBER B) WHISKEY-IDA-LIMA-SAM-OSCAR-NANCY C) WILLIAM-INDIA-LINCOLN-SIERRA-OCEAN-NOVEMBER D) WILLIAM-IDA-LINCOLN-SAM-OCEAN-NANCY

Ans: A Page: 127

24. Which of the following words would be the MOST difficult to hear over the radio? A) Yes B) Negative C) Affirmative D) Received

Ans: A Page: 128

27. When relaying medical information to a physician in person, you should: A) include information that you did not provide during your radio report. B) provide a lengthy, detailed report that includes all patient information. C) ensure that another physician or a nurse is present to avoid confusion. D) routinely give your report at the patient's bedside so he or she can hear.

Ans: A Page: 130

29. When a panicked person calls 9-1-1 for help: A) he or she needs immediate confirmation of having reached the right number. B) the emergency medical dispatcher must answer the phone within four or five rings. C) the dispatcher should not speak to the caller until the caller has calmed down. D) an ambulance should be dispatched before the nature of the problem is known.

Ans: A Page: 131

37. When functioning at a noisy scene, communication will be MOST effective if you: A) move the patient to the ambulance as soon as you can. B) tell noisy patrons or bystanders to be quiet or leave. C) yell into the patient's ear so he or she can hear you. D) find the source of the noise and remove it if possible.

Ans: A Page: 133

42. If a patient is reluctant to communicate because he or she feels threatened, the paramedic should: A) cautiously approach the patient and use open posturing. B) maintain a position that is at or slightly above the patient. C) ask a law enforcement officer to help obtain information. D) defer further questioning until the patient appears calm.

Ans: A Page: 133

43. All of the following are external factors that can affect communication with a patient, EXCEPT: A) lack of empathy. B) language barriers. C) a disruptive scene. D) sensory impairment.

Ans: A Page: 134

48. The purpose of a closed-ended question is to: A) elicit a specific response from the patient. B) enable the paramedic to gauge the patient's mentation. C) obtain reliable information about a patient's complaint. D) allow the patient to describe what he or she is feeling.

Ans: A Page: 134

59. Eye-to-eye contact with a patient reinforces: A) trust and honesty. B) passive listening. C) sympathy. D) professional courtesy.

Ans: A Page: 134

49. Which of the following questions would be appropriate to ask a patient who has no medical training? A) "Do you have any breathing or heart problems?" B) "Have you ever experienced a syncopal episode?" C) "Do you have any endocrine-related illnesses?" D) "Have you ever had an acute myocardial infarction?"

Ans: A Page: 134-135

65. If a patient is unable to tell you who he or she is, where he or she is, and what day of the week it is: A) you should suspect decreased blood flow to the brain. B) he or she is most likely scared and unable to remember. C) he or she likely has an intracerebral hemorrhage or lesion. D) you should ask him or her questions that require more thought.

Ans: A Page: 135-136

54. If a patient provides a confusing or disorganized response to your question, you should: A) rephrase the patient's comments with simpler terms and ask if he or she agrees with your synopsis. B) revisit the question later in your assessment and conclude that the patient's mental status is altered. C) attempt to obtain the most pertinent part of the patient's response and continue with further questioning. D) recognize that the patient is likely scared because of the situation and ask him or her to repeat the response.

Ans: A Page: 137

60. When touching a patient as a form of reassurance, the paramedic should: A) touch the patient on a neutral part of his or her body. B) touch the patient in the center of the chest or on the thigh. C) remember that most patients take offense to being touched. D) not touch the patient if he or she leans toward the paramedic.

Ans: A Page: 137

71. When the paramedic encounters a patient who has difficulty communicating, he or she should: A) enlist the help of a family member or primary caregiver. B) try to use sign language when asking a specific question. C) suspect that the patient may have a psychiatric condition. D) transport the patient and advise the hospital of the situation.

Ans: A Page: 139

73. Touching a conscious elderly patient in a nursing home without his or her permission: A) is nonverbally communicating, "You are not important enough or mentally competent enough to be asked for permission." B) is typically acceptable to the patient, because he or she is often frightened and desperately wants someone to help. C) may be necessary if the patient appears to have an altered mental status during your visual assessment of his or her behavior. D) is unprofessional and ethically unacceptable unless you have obtained consent from the patient's family or primary caregiver.

Ans: A Page: 140

9. Low-band frequencies: A) have a range of up to 500 miles and are not associated with skip interference. B) are unpredictable because changes in ionospheric conditions may cause losses in communication. C) function at 150 to 175 MHz and have a range that is nearly triple that of high-band frequencies. D) have a longer range than high-band frequencies, but are more readily absorbed by rain, trees, and brush.

Ans: B Page: 122

10. The ability of multiple agencies or systems to share the same radio frequency is called: A) a duplex. B) trunking. C) patching. D) telemetry.

Ans: B Page: 123

14. Cellular telephones are more advantageous than regular two-way radios in that cellular telephones: A) enable laypeople to call 9-1-1 for a minimal service charge. B) incorporate GPS technology to help rescuers find the patient. C) can transmit long distances with the use of a mobile antenna. D) do not utilize computer technology and are less likely to fail.

Ans: B Page: 124

22. When transmitting information via radio, you should: A) break long messages into 60-second segments. B) use a normal conversational tone of voice. C) speak with your voice slightly elevated. D) keep your mouth 1" from the microphone.

Ans: B Page: 127

32. Before you begin to transmit over the radio, you should check the volume and then: A) press the transmit key for 1 second before talking. B) listen to make sure that the channel is clear of traffic. C) turn the squelch setting to zero to ensure a good signal. D) key the microphone two or three times to reach the repeater.

Ans: B Page: 127

26. The use of ten-codes over the radio: A) should be carried out whenever possible to ensure effective communication. B) is not recommended by the National Incident Management System (NIMS). C) increases the likelihood of miscommunication during the radio transmission. D) is prohibited by the Federal Communications Commission and should be avoided.

Ans: B Page: 128

40. Which of the following statements regarding ten-codes is correct? A) All EMS agencies utilize a universal ten-code system. B) They should be avoided during a mass-casualty situation. C) The purpose of ten-codes is to ensure transmission clarity. D) Most services use ten-codes for regular day-to-day operations.

Ans: B Page: 128

3. Notification of EMS usually occurs when: A) EMTs contact an emergency medical dispatcher. B) a bystander notifies the dispatcher via telephone. C) a sick or injured patient presents to your EMS station. D) law enforcement requests assistance via two-way radio.

Ans: B Page: 131

31. If the EMD suspects that your patient has a life-threatening emergency, the EMD should make you aware of the situation and then: A) dispatch law enforcement to the scene. B) give prearrival instructions to the caller. C) ask the caller to put the patient on the phone. D) obtain the caller's name and physical address.

Ans: B Page: 132

38. If you want reliable answers to personal questions, you should: A) tell the patient that his or her responses to your questions are confidential. B) manage the scene so you can ask such questions quietly and privately. C) request law enforcement presence when asking a personal question. D) tell the patient that personal questions are a routine part of your exam.

Ans: B Page: 133

52. Which of the following questions would MOST likely reveal a hidden medical condition when communicating with a patient who has a severe headache? A) "Are you having difficulty seeing objects?" B) "What happened the last time you felt this way?" C) "Have you recently experienced any head trauma?" D) "Do you have a family history of severe headaches?"

Ans: B Page: 133, 135

45. Interpersonal communication is MOST accurately defined as the: A) ability to communicate while under extreme stress. B) exchange of information between two or more persons. C) dialogue that occurs between a paramedic and a patient. D) removal of an emotional barrier while communicating.

Ans: B Page: 134

47. It is important to remember that if a patient is not personally sensitive to modesty because of an impaired mental state: A) this will not influence your care. B) the patient's family likely will be. C) then he or she will not care about your treatment. D) protecting his or her privacy is of lesser concern.

Ans: B Page: 134

53. If a patient avoids answering a specific question, you should: A) conclude that the patient is trying to hide something. B) redirect him or her to the question to elicit a response. C) document that the patient did not answer the question. D) avoid repeating the question as this may upset the patient.

Ans: B Page: 136

58. A patient states, "I can't catch my breath," and the paramedic responds, "You say you can't catch your breath, ma'am'?" This is an example of: A) facilitation. B) reflection. C) confrontation. D) interpretation.

Ans: B Page: 136

63. After asking a patient a question about how he is feeling today, you sense that he is having difficulty putting his feelings into words. You should: A) ask another question and revisit the previous question later. B) be patient and give the patient time to express his feelings. C) repeat the question, but ask it differently the second time. D) offer suggested responses to facilitate the patient's answer.

Ans: B Page: 136

64. If a patient mentions something in passing or avoids answering a specific question, you should: A) assume that he or she is intentionally hiding something. B) politely redirect his or her attention to that question. C) ask the patient why he or she did not provide an answer. D) defer the question and continue with your interview.

Ans: B Page: 136

77. When attempting to interview a patient with a behavioral crisis, you should: A) use closed-ended questions to obtain his or her medical history. B) approach the patient cautiously, while maintaining eye contact. C) avoid eye contact with the patient, as this may agitate him or her. D) set "ground rules" regarding what you expect from him or her.

Ans: B Page: 137

69. When communicating with older patients, it is MOST important to remember that: A) many older patients lose the ability to understand simple terminology, thus requiring the paramedic to gear his or her questions accordingly. B) their illnesses may be more complex because they may have more than one disease process and may be taking several medications concurrently. C) the ability to hear and see is naturally impaired due to the process of aging, and the paramedic must accommodate these disabilities appropriately. D) older patients are generally poor historians regarding their medical history, and the paramedic should interview a family member or friend instead.

Ans: B Page: 138

78. During the course of your interview, your patient begins making sexual innuendos to you. You should: A) defer further questioning and simply transport the patient. B) ensure that another paramedic or EMT is present at all times. C) stop the interview until the patient's behavior is less aggressive. D) ask a paramedic of the opposite sex to interview the patient.

Ans: B Page: 138

70. If a parent insists on monitoring your conversation with his or her adolescent son or daughter, you should: A) suspect that the adolescent has been physically or emotionally abused and confront the parent. B) communicate the situation to the emergency department physician and document it accurately. C) refuse the parent's prerogative and move the patient to the ambulance to continue your conversation. D) explain to the adolescent that he or she is a minor and that you cannot converse without parental presence.

Ans: B Page: 139

76. Islamic and Hindu cultures avoid: A) touching the head. B) touching with the left hand. C) clapping their hands together. D) sitting with their legs crossed.

Ans: B Page: 141

17. A(n) __________ receives a weak signal and retransmits it at a higher power on another frequency. A) duplex B) simplex C) repeater D) encoder

Ans: C Page: 122

18. A base station decoder within the emergency department: A) amplifies the voice signal from the field transmitter. B) is used to increase the range of the radio transmission. C) translates a telemetry signal into an oscilloscope tracing. D) converts a low-band frequency to a high-band frequency.

Ans: C Page: 122

5. The combination of two or more signals, which allows the paramedic to talk and transmit an ECG simultaneously on one frequency, is called a: A) simplex system. B) trunking system. C) multiplex system. D) half-duplex system.

Ans: C Page: 123

7. Which of the following statements regarding 12-lead ECG telemetry is correct? A) Telemetry over UHF frequencies enables transmission and analysis of all 12 leads. B) Telemetry has never proven to increase diagnosis times for patients with a cardiac event. C) Most newer systems use facsimile technology to allow transmission of 12-lead ECGs. D) A decoder is required to ensure that voice communication does not filter out the ECG.

Ans: C Page: 124-126

12. All of the following factors may cause distortion of an ECG signal, EXCEPT: A) muscle tremors. B) loose electrodes. C) severe tachycardia. D) distant transmission range.

Ans: C Page: 125

23. When transmitting data over the radio, you should NOT disclose the patient's: A) vital signs. B) chief complaint. C) HIV status. D) age and sex.

Ans: C Page: 127

28. Which of the following patient data is NOT typically communicated during your radio report to the hospital? A) Brief, pertinent history B) Underlying medical conditions C) The patient's ethnicity D) ECG findings

Ans: C Page: 129-130

36. When a patient repeatedly apologizes to you because he or she is incontinent, you should say: A) "I understand your embarrassment, but it is okay." B) "Don't worry about it because we see this all the time." C) "You don't have to apologize; that's what we're here for." D) "Given the situation, your incontinence is understandable."

Ans: C Page: 133

41. Which of the following actions demonstrates that the paramedic has his or her emotions under control? A) Taking notes while repeating some of the patient's statements back to him or her B) Obtaining the patient's medical history while administering emergency treatment C) Speaking close to the patient's ear in a calm voice in an extremely noisy situation D) Frequently reassuring a seriously injured patient that everything will be okay

Ans: C Page: 133

46. Which of the following questions is the MOST effective when inquiring about a patient's chest pain? A) "Is the pain sharp or dull?" B) "Does the pain feel more like pressure?" C) "Can you describe the pain to me?" D) "Does the pain radiate to your arm?"

Ans: C Page: 134

51. It would be MOST appropriate to ask a patient a closed-ended question when: A) the question requires the patient to think. B) you are using complex medical terminology. C) you are trying to obtain medical history information. D) you are attempting to establish the quality of a patient's pain.

Ans: C Page: 134-135

57. If a patient provides an inappropriate response to a paramedic's question, it should be assumed that the patient: A) is frightened by the situation. B) does not wish to communicate. C) has impaired cerebral function. D) is not willing to cooperate.

Ans: C Page: 135-136

61. An elderly man states that he is sad and depressed because his wife recently died of cancer. Which of the following statements from the paramedic demonstrates empathy? A) "I understand why you are sad, and I am sad for you. Is there anything I can do to make you feel better?" B) "I'm sorry to hear about your wife, but you should take comfort in the fact that she is in a better place." C) "I'm sorry, sir. I don't know how I would feel in your situation, but I am sure it would be similar." D) "Your wife's death is very tragic, but perhaps going to the hospital will provide you with some relief."

Ans: C Page: 136

66. Stereotyping an elderly, very young, or hostile patient during your attempt to communicate with him or her: A) yields relatively accurate information. B) is proper under certain circumstances. C) works against effective communication. D) is an effective means of communicating.

Ans: C Page: 137

67. Which of the following statements is an example of providing false reassurance? A) "Your condition does not appear to be life-threatening at the present time, but that could change." B) "I can see that you are obviously upset, but I will provide the best care possible to you." C) "I'm sure that you will be fine, but let us take you to the hospital just to be on the safe side." D) "I don't see any abnormalities on your ECG, but you should be evaluated by a physician."

Ans: C Page: 137

72. When communicating with a patient whose cultural background differs from the paramedic's, it is MOST important for the paramedic to: A) agree with the patient's cultural differences. B) know the specifics about the patient's culture. C) treat the patient with the utmost respect at all times. D) use his or her own culture as the sole reference.

Ans: C Page: 139-140

15. In order for the paramedic to talk and transmit an ECG simultaneously on one frequency, a __________ system is required. A) duplex B) simplex C) low-band D) multiplex

Ans: D Page: 123

11. Biotelemetry is MOST accurately defined as: A) linking two frequencies together so that the paramedic and physician can converse directly. B) a common radio frequency assigned to EMS by the Federal Communications Commission. C) the ability of more than one public safety agency to share the same radio frequency during a crisis. D) the capability of measuring vital signs and ECG tracings and transmitting them to a distant terminal.

Ans: D Page: 124

20. When communicating medical information via radio, you should be: A) thorough yet rapid. B) comprehensive but brief. C) as expeditious as possible. D) simple, brief, and direct.

Ans: D Page: 126

25. When transmitting your radio report to the hospital, you should: A) use ten-codes whenever possible. B) allow the patient to hear the report. C) answer questions with the word "yes." D) not be sitting right next to the patient.

Ans: D Page: 128

1. When providing patient care, it is MOST important that you maintain effective communication with: A) the dispatcher. B) bystanders. C) medical control. D) your partner.

Ans: D Page: 130

30. Which of the following details is of LEAST importance for the EMD to obtain from the caller? A) The exact location of the patient B) An estimate of the situation's severity C) The caller's telephone number D) The patient's last known oral intake

Ans: D Page: 131-132

6. Under the instructions of a good EMD, a layperson should be able to: A) obtain a blood pressure. B) assess a patient's pupils. C) immobilize a person's spine. D) perform chest compressions.

Ans: D Page: 132

35. When a patient thanks you, your MOST appropriate response should be: A) "Any time." B) "That's okay." C) "No problem." D) "You're welcome."

Ans: D Page: 133

39. Conveying calm, unmistakable, genuine concern for someone you have never met before is the MOST essential challenge as a(n): A) sympathetic listener. B) competent paramedic. C) effective history taker. D) therapeutic communicator.

Ans: D Page: 133

44. Maintaining eye contact with a patient enables the paramedic to: A) rapidly gain any patient's trust. B) defuse a potentially violent situation. C) relay the seriousness of the situation. D) evaluate the patient's neurologic status.

Ans: D Page: 134

50. Which of the following is NOT an example of an open-ended question? A) "How did you feel when you awoke today?" B) "Can you tell me how this all started?" C) "Can you describe the pain you are feeling?" D) "Does the pain radiate to your arm or jaw?"

Ans: D Page: 134

62. Statements such as, "Please say more," or, "Please feel welcome to tell me about that," are examples of: A) reflection. B) clarification. C) sympathy. D) facilitation.

Ans: D Page: 136

55. If a patient asks for your advice regarding a treatment decision that his or her physician made, you should: A) only give advice if you disagree with the physician. B) give your opinion, but state that you are not a physician. C) obtain specific information about the physician's decision. D) advise the patient to consult with his or her physician.

Ans: D Page: 137

56. If the wife of a critically ill man asks you if her husband is going to die, the MOST appropriate response should be: A) "The situation appears grim, but you should not lose all hope." B) "It is possible, and you should prepare yourself for the worst." C) "That question is best answered by the physician at the hospital." D) "He is very sick, but we are doing everything we can to help him."

Ans: D Page: 137

68. If the paramedic is unable to defuse a hostile patient's anger, the paramedic should: A) restrain the patient and transport at once. B) administer Valium or Haldol for sedation. C) obtain a signed refusal and depart the scene. D) request law enforcement assistance if needed.

Ans: D Page: 138

Landline

Communications system linked by wires, usually in reference to a conventional telephone system

Federal Communications Commission (FCC)

Federal agency that has jurisdiction over interstate and international telephone and telegraph services and satellite communications, all of which may involve EMS activity

Emergency medical dispatch

First aid instructions given by specially trained dispatchers to callers over the telephone while an ambulance is en route to the call

Frequency

In radio communications, the number of cycles per second of a signal; inversely related to the wavelength

Cellular telephones

Low-power portable radios that communicate through an interconnected series of repeater stations called "cells"

Digital radio

Microwave transmission of digital signals through space or the atmosphere instead of transmission by radio waves

Repeater

Miniature transmitter that picks up a radio signal and rebroadcasts it, extending the range of a radio communications system

Duplex

Radio system using more than one frequency to permit simultaneous transmission and reception

Dispatch

To send to a specific destination or to send on a task