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Understanding Technical Communication Practices in Prehospital Healthcare Contexts

By Elizabeth L. Angeli

We generally associate “healthcare communication” with hospitals or clinics, but healthcare communication extends beyond these settings out into the field. It encompasses dispatch centers where people who need urgent medical attention are connected to prehospital care providers like emergency medical services (EMS) professionals.

Unlike hospitals or clinics, EMS professionals do not know where they will practice medicine. It might be on the side of the road, in a patient’s bedroom, or in a restaurant. This unpredictable environment can strain communication, which is pivotal in facilitating patient care beyond the prehospital setting. In this environment, effective instruction and training are essential.

While technical communicators can make meaningful contributions to these processes, this area remains underdeveloped in technical communication. To participate, technical communicators need to understand the dynamics and needs of the contexts in which EMS professionals work. This article examines these dynamics.

Emergency Response: Not Your Typical Healthcare Specialty

Most healthcare specialties are defined by bodily system (“neurology”), organ (“cardiology”), disease (“oncology”), or demographic (“gerontology”). Emergency healthcare, in contrast, is defined by a time and place: an emergency. Emergencies happen to patients in all demographics and across all bodily systems, organs, and diseases. Given the unpredictable nature of emergency situations, documentation needs to support an array of possibilities while allowing providers to take specific action tailored to a patient’s emergency situation.

To care for a patient, emergency healthcare professionals collaborate as a fine-tuned machine, and it starts with a 911 call to a dispatch center. Based on the nature of the emergency, EMS professionals travel to the patient’s location. EMS professionals then gather and transfer on-scene information to other agencies and stakeholders. For example, EMS professionals transfer patient information to emergency department (ED) healthcare providers so these providers can continue patient care.

Guided by sensory and situational awareness, training, and what some would call “intuition,” EMS professionals work with others to effectively care for and transport patients. The number of people on an emergency scene varies from two to eight or more. Events can move quickly and allow little time to take notes or refer to decision making aids.

During a response, the chain of information can change for reasons beyond an EMS professional’s control. For example, when en route to a scene, dispatch might tell the EMS professional, “Caller reports that the patient has no pulse and isn’t breathing.” When the EMS professional arrives on the scene, the patient might be sitting upright, never having lost her pulse or breath. It is in this context where technical communicators can make important differences in healthcare.

Written Communication in Emergency Response

Although much of the communication is verbal, written documentation is used throughout a response. EMS professionals refer to written protocols to support decision making in the field. At the end of every 911 response, EMS professionals also complete an electronic patient care report (ePCR), documenting the events that transpired. This documentation requires EMS professionals to input, synthesize, and narrate numerous data gathered from a response. This information encompasses a patient’s name, birthdate, social security number, relevant health and insurance information, and medications. It also includes the patient’s vital signs, medical interventions provided and related results, and other pertinent details. This information helps different audiences, like insurance billing agencies, to act. Addressing this situation effectively requires writing practices and materials that allow for the quick collection and effective transmission of medical information.

Documents used in the field need to support rapid, but not rushed, decision making and action. These materials need to be created specifically for emergency situations, not taken from other areas of healthcare. In the past, EMS documentation models, like SOAP and CHART, were borrowed from fields like hospital care. Although these workplaces share similar characteristics, like patient care and charting, they are different. Technical communicators can contribute to these processes by observing EMS professionals in the field and then using that information to design materials specifically for these professionals.

Get Out in the Field and Cultivate Partnerships

Hearing, watching, and reading stories on the news is different from witnessing emergencies firsthand alongside responders. Likewise, emergency medicine cannot be fully understood from only the ED or the field. It is best understood from all perspectives. These include the ED, the field, dispatch, billing and insurance agencies, and even medicolegal settings, like courts. These factors are key to getting necessary information to address the needs of EMS audiences when creating materials for them.

To do so, technical communicators need to build trust with EMS agencies and be open to partnering with them to develop long-term communication solutions. To create such relationships, technical communicators can contact a local EMS or fire agency to ride along (when a non-EMS provider joins an EMS agency on the ambulance on an emergency situation).

When riding along, technical communicators should listen to the providers’ stories and suggestions, be respectful, and ensure that they do not interfere with patient care. They should also:

  • Ask the crew where to sit on the ambulance. If they are allowed to sit in back with the patient, ask where to specifically sit to avoid interfering with patient care.
  • Bring snacks to share with the crew, being mindful of potential food allergies, like nuts.
  • Mentally and emotionally prepare to witness potentially traumatic scenes and to experience compassion, as well as physical, mental, and emotional fatigue. Also consider having a plan in place, such as speaking with a counselor afterward.
  • Avoid asking providers about the worst thing they’ve experienced. That can trigger post-traumatic stress symptoms.

When collecting EMS data in the field, technical communicators also need to be mindful of HIPAA guidelines to avoid creating problematic legal situations (to learn about HIPPA guidelines in emergency response, see Resources).

Design for Instability

When a situation changes, written documents, like protocols and ePCRs, are constants because they provide a predictable structure that providers use during high-stakes situations. Ideally documents should support—not add to—EMS professionals’ cognitive workload. To achieve that goal, documents should:

  • Help EMS professionals manage multiple, developing pieces of information from patients, dispatch, bystanders, and other emergency responders;
  • Support EMS professionals as they gather data from multiple sources, like a ten second preliminary visual scan of a scene and verbal information shared over the radio with dispatch; and
  • Account for unpredictability, such as a change in patient status that requires EMS professionals to assess and alter a course of action within seconds.

To help EMS professionals, technical communicators can create documents that prime recall when providers complete an ePCR. For example, a document might include visuals of items professionals observed on scene, like an oxygen tank or expired medications. These visuals can help remind providers to include those items in their ePCR narrative. This information tells ePCR readers important information about the patient, like that they might need in-home support to manage their medical care.

Technical communicators can assist with more than just documentation. They can help agencies think through design interfaces of ePCR programs, especially making design choices that prompt effective recall and support the writing process.

Design for Durability

Documents in this context must be easy to use and durable. Emergency response providers work in the field with multiple uncontrollable elements, including wind, rain, snow, fire, dark nights, sunny days, low lighting, and cramped spaces. They carry medical equipment, and they typically need both hands to work with a patient.

To design for this context, account for:

  • Providers not being able to use hands to hold materials
  • Limited space
  • Harsh environmental conditions
  • Mental and emotional stressors (burnout, post-traumatic stress, adrenaline) that contribute to a high cognitive workload

Technical communicators can help by creating pocket-sized or hands-free, voice-activated material that can be consulted at distances. For example, although EMS professionals might not be able to grab a smartphone to open a protocol app or to look at a paper document, they can say, “Hey, Google/Siri/Alexa, what’s the new protocol for albuterol?” while providing patient care. These kinds of document alternatives respond to environmental constraints and don’t remove the provider from care.

Conclusion

Clear communication helps emergency responders manage multiple moving pieces. It allows providers to treat and transport patients as effectively as possible. Successful documents in emergency contexts account for fast-paced, unpredictable, often space-constrained environments. Ideally, they are designed for and respond to the specific needs of an agency. By addressing such factors, technical communicators can make valuable contributions to greater healthcare practices and patient care.

Resources

“Emergency Situations: Preparedness, Planning, and Response.” U.S. Department of Health & Human Services. https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html.

ELIZABETH L. ANGELI, PhD, (elizabeth.angeli@marquette.edu) is an Assistant Professor in Marquette University’s English Department, where she studies technical communication in prehospital care. Liz’s book, Rhetorical Work in Emergency Medical Services: Communicating in the Unpredictable Workplace, details the underlying persuasive, cognitive, and collaborative processes that guide EMS communication and decision making. She is also the Principal of the Report Doctor, LLC, a consulting firm that provides documentation and education solutions for first responder agencies. Visit her website at http://lizangeli.com.

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