COMPETENCY BASED LEARNING MATERIALS

Sector : AUTOMOTIVE AND LAND TRANSPORT SECTOR

Qualification Title: DRIVING (Passenger Bus/ Straight Truck) NC III

Unit of Competency: PERFORM PRE-AND POST OPERATION

PROCEDURES VEHICLES CLASSIFIES UNDER LTO RESTRICTION
CODES 3 UP TO 5

Module Title: PERFORMING PRE-AND POST OPERATIONPROCEDURES

VEHICLES CLASSIFIES UNDER LTO RESTRICTION CODES 3 UP TO 5

ADOLPHUS INTERNATION TECHNICAL INSTITUTE INC

#222 Laguinbanwa West, Numancia, Aklan
HOW TO USE THIS COMPETENCY- BASED LEARNING MATERIALS

Welcome!

The unit of competency, “PERFORM PRE-AND POST

OPERATIONPROCEDURES VEHICLES CLASSIFIED UNDER LTO
RESTRICTION CODES 3 UP TO 5”, is one of the competencies of
“DRIVING (Passenger Bus/ Straight Truck) NC III”, a course which
comprises the knowledge, skills and attitudes required for a TVET trainer
to possess.

The module, PERFORMING PRE-AND POST

OPERATIONPROCEDURES VEHICLES CLASSIFIES UNDER LTO
RESTRICTION CODES 3 UP TO 5, this unit describes the outcomes
required in performing procedures before operating vehicles classified
under LTO restriction codes 3 up to 5.

In this module, you are required to go through a series of learning

activities in order to complete each learning outcome. In each learning
outcome are Information Sheets, Self-Checks, Operation Sheets and
Task/Job Sheets. Follow and perform the activities on your own. If you
have questions, do not hesitate to ask for assistance from your facilitator.

Remember to:
• Work through all the information and complete the activities in each
section.
• Read information sheets and complete the self-check. Suggested
references are included to supplement the materials provided in this
module.
• Most probably, your trainer will also be your supervisor or manager. He
is there to support you and show you the correct way to do things.
• You will be given plenty of opportunities to ask questions and practice
on the job. Make sure you practice your new skills during regular work
shifts. This way, you will improve your speed, memory and your
confidence.
• Use the Self-Checks, Operation Sheets or Task or Job Sheets at the end
of each section to test your own progress. Use the Performance Criteria
Checklist or Procedural Checklist located after the sheet to check your
own performance.
• When you feel confident that you have had sufficient practice, ask your
Trainer to evaluate you. The results of your assessment will be recorded in
your Progress Chart and Accomplishment Chart.

You need to complete this module before you can perform the next
module.
 (DRIVING (Passenger Bus/Straight Truck) NC III)
COMPETENCY-BASED LEARNING MATERIALS

List of Core Competencies

No. Unit of Competency Module Title Code

Perform Minor Performing Minor
Maintenance and Maintenance and
Servicing on Vehicles Servicing on Vehicles
1. ALT723349
Classified under LTO Classified under LTO
Restriction Codes 3 Restriction Codes 3 up
up to 5 to 5
Perform Pre-and- Performing Pre-and-
Post Operation Post Operation
Procedures Vehicles Procedures Vehicles
2. ALT832305
Classified Under Classified Under LTO
LTO Restriction Restriction Codes 3
Codes 3 up to 5 up to 5
Obey and Observe Obeying and Observe
3. Traffic Rules and Traffic Rules and ALT832303
Regulations Regulations
Observe Road Health Observing Road Health
4. and Safety Practices and Safety Practices ALT832308
Implement and Implementing and
Coordinate Acciden- Coordinate Acciden-
5. ALT832304
Emergency Emergency Procedures
Procedures
Drive Passenger Bus Driving Passenger Bus
6. ALT832306

Drive Straight Truck Driving Straight Truck

7. ALT832307
UNIT OF COMPETENCY : PERFORM PRE-AND POST
OPERATIONPROCEDURES VEHICLES
CLASSIFIES UNDER LTO RESTRICTION
CODES 3 UP TO 5

MODULE TITLE : PERFORMING PRE-AND POST

OPERATIONPROCEDURES VEHICLES
CLASSIFIES UNDER LTO RESTRICTION
CODES 3 UP TO 5

MODULE DESCRIPTOR : This unit describes the outcomes required in

performing procedures before operating
vehicles classified under LTO restriction codes
3 up to 5.

NOMINAL DURATION : 16 hours

QUALIFICATION LEVEL : NC II

SUMMARY OF LEARNING OUTCOMES:

Upon completion of this module, the trainees/students must be able

to:

LO1: Perform “BLOWAF” check

LO2: Perform Visual Check
LO3: Perform Operation Check
LO4: Perform post-operation procedures

ASSESSMENT CRITERIA:
 “BLOWAF” check is performed in accordance with standard
operating procedures.
 Deficiencies or findings in BLOWAF check are identified and
appropriate corrective measures are undertaken in
accordance with manufacturer’s specification.
 Abnormal conditions are noted in checklist and reported to
authorized person.
LO1. PERFORM “BLOWAF” CHECK

ASSESSMENT CRITERIA:

 “BLOWAF” check is performed in accordance with standard operating

procedures.
 Deficiencies or findings in BLOWAF check are identified and
appropriate corrective measures are undertaken in accordance with
manufacturer’s specification.
 Abnormal conditions are noted in checklist and reported to authorized
person.

CONTENTS:

 Parts of vehicle and its functions

 Basic principles of operation of vehicle system such as electrical
system, fuel system, cooling system, steering system, exhaust system,
tires and brakes.
 Diagnosis of vehicle faults and irregularities based on vehicle’s service
manual

CONDITIONS:

Students/trainees must be provided with the following:

 Vehicle unit
 Manufacturer’s service manual
 Coverall uniform
 Goggles
 Gloves
 Safety shoes
 Learning module

METHODOLOGIES:

 Self-paced learning
 Discussion
 Demonstration
 Individual practice

ASSESSMENT METHODS:

 Observation
 Written test
 Interview
  Learning Experiences

Learning Outcome 1 – PERFORM “BLOWAF” CHECK

Learning Activities Special Instructions
Read Information Sheet 2.1-1 on Read and understand the
Parts of vehicle and its functions information about the content. If
you can’t understand the
information, ask you facilitator
Answer Self-Check 2.1-1 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.

Participate in the discussion on

Parts of vehicle and its functions

Read Information Sheet 2.1-2 on Read and understand the

Basic principles of operation of information about the content. If
vehicle system such as electrical you can’t understand the
system, fuel system, cooling system, information, ask you facilitator
steering system, exhaust system,
tires and brakes.

Answer Self-Check 2.1-2 Compare answers with the

answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.

Participate in the discussion on

Basic principles of operation of
vehicle system such as electrical
system, fuel system, cooling
system, steering system, exhaust
system, tires and brakes.

Read Informaton Sheet 2.1-3 on Read and understand the

Diagnosis of vehicle faults and information about the content. If
irregularities based on vehicle’s you can’t understand the
service manual information, ask you facilitator
Answer Self-Check 2.1-2 Compare answers with the answer
key. You are required to get all
answers correct. If not, read the
information sheets again to answer
all questions correctly.

Participate in the discussion on

Diagnosis of vehicle faults and
irregularities based on vehicle’s
service manual

After doing all activities of this

LO, you are ready to proceed to
the next LO on
PERFORM VISUAL CHECK
 Information Sheet 2.1-1
PERFORM BLOWAF CHECK

Learning Objectives:
After reading this INFORMATION SHEET, the student will be able to
describes the outcomes required in performing procedures before operating
vehicles classified under LTO restriction codes 3 up to 5.

INTRODUCTION
Engines can come in several different varieties, with various parts depending
on the type of vehicle it is. For example, a truck engine would be different as
compared to the engine of a regular car due to the amount of power
required. Today, many vehicles make use of the internal combustion engine,
however with slight variations according to vehicle types, having some
added features or components. Developed in the 19th century, this type of
engine still remains a popular choice and it continues to benefit from the
technological advances in engineering. Today’s advanced engines may even
feature computerized controls and advanced systems to make them more
efficient, durable and powerful. With advances come several components
which all work together to allow the engine to perform the required tasks. In
order to be able to understand how an engine works, it is important to
understand what the different engine parts are. Many of the automotive
engines used in the industry today are four-stroke internal combustion
engine that use either gasoline or diesel as a fuel. These engines get their
name ‘four-stroke’ from the four distinct phases that occur in the engine
during operation. Being the first phase, fuel and air are taken into the
combustion chamber, earning this phase the name; intake phase. A piston is
then used to compress the fuel in the next phase. Thereafter a spark is used
to ignite the fuel to cause a controlled explosion. This explosion provides the
engine with the energy required to drive the car forward. The ignition of the
fuel varies in diesel powered engines and gasoline powered engines.
Gasoline powered engines make use of a spark to ignite the fuel. The spark
is generated through electrical components. On the other hand, the fuel in a
diesel engine is ignited through compression and does not require an extra
electrical component. After the ignition phase, the final part in the four-
stroke phase is the exhaust phase. During which, the unused fuel and carbon
emissions are let out of the combustion chamber to allow new fuel and gas
to enter the space, allowing the process to start over again.

The core component of an engine is the cylinder that houses the pistons. In a
regular car engine, it can have anywhere from four to eight cylinders. The
arrangement of the cylinder can pose different advantages and
disadvantages. Depending on the size and type of vehicle, manufacturers
opt for differing number of cylinders to match the requirements of the
vehicle. The movements of the pistons in the cylinders provide the engine
with power for the vehicle to function.

Components of an Engine

Spark Plug
As mentioned earlier, gasoline engines make use of a spark to ignite the fuel
and cause a controlled explosion in the engine. The spark plug in these
engines supplies the spark that is required to ignite the air and fuel mixture.

Valves
These engine parts allow for fuel and air to enter the combustion chamber
and later let the exhaust out. They remain sealed during the combustion
process and only open when required.

Pistons & Piston Rings

This is a cylindrical piece of metal that is located inside the cylinder of the
engine. Piston rings are located between the piston and the cylinder in which
the piston is located in. They provide a sealing edge between the exterior of
the piston and the interior of the cylinder. The purpose of these engine
parts is to seal the space and prevent the fuel and air mixture on one side of
the piston from leaking into the sump during the combustion or compression
process and also prevent the oil in the sump from leaking into the
combustion area as it would get burnt and lost, deterring the movement of
the piston.

Connecting rod and Crankshaft

The connecting rod connects the piston to the crankshaft. As the piston
moves up and down due to the controlled explosions, it causes the
connecting rod to move. This then cause the crankshaft to move as well as it
is connected to the connecting rod, in a circular motion due to the
configuration of the piston, connecting rod and crankshaft.

DIAGNOSIS
Cars may run on gasoline, but almost all automotive systems, from anti-
locking brakes to windshield wipers, are powered by electricity. Electrical
systems start the engine, power the headlights, provide climate control,
and run most of the safety systems on a vehicle. Compared with home
electrical systems, the electric systems in cars are generally pretty simple
and safe to work with, running on low-voltage direct current. However, this
does not mean automotive electrical systems never malfunction. Electrical
problems in cars are common, even in well-maintained cars, and can be
frustrating to diagnose. Luckily, many common issues, such as dead
batteries, blown fuses, corroded connections, and faulty relays, can be
diagnosed with a little know-how and a multimeter.. Knowing the basics of
electrical theory and how automotive electrical systems are set up can help
solve common issues, and will let drivers know when a problem needs to be
looked at in a shop.
The tools and components needed for automotive electrical diagnosis can
be found at hardware stores, auto-supply shops, or online.
Basic Electrical Theory
Electricity in a circuit runs in a loop, from a power source such as a battery,
through wires and electrical equipment, and back again. The basic
properties of electricity are voltage, amperage, and resistance. Voltage is
electromotive force, or electrical pressure, which causes electricity to flow.
Amperage is analogous to electrical volume, the measure of the strength of
an electric current. Electric power is a factor of voltage and amperage.
Resistance, measured in ohms, is the amount of electrical friction, and
resists flow.
Ohm’s Law

Ohm’s law describes the basic relationship between amps, volts, and ohms.
In any electric circuit, V = IR, where “V” is voltage, “I” is current measured
in amps, and “R” is resistance measured in ohms. This law can be used to
find any one unknown quantity; for instance, resistance is equal to voltage
divided by current, and current equals voltage divided by resistance.
Electric power is equal to voltage times amperage.
Automotive Electrical Systems
Many automotive systems, such as the headlights, starter, safety features,
electronic control unit, and sound system, run on electricity. In most cars,
the metal body of the car itself forms part of the circuit, grounding the
systems and connecting each component to the negative side of the
battery. Without a functioning battery and electrical system, a car cannot
start or function.
All electrical equipment and components in a car are powered by the
battery, which also regulates system voltage. Car batteries are 12V, as
automotive electrical systems run at 12V DC. The battery is charged by an
alternator, which generates electricity by putting electromagnetic friction
on the engine while it runs. The heart of an automotive electrical system is
the fusebox or power center, the central point from which every electric
circuit connects. Fuses protect each electrical circuit from damage, by
burning or blowing out in case of overcurrent. Each piece of electrical
equipment is connected to the fusebox and the battery by a system of
wires and connections, generally going through relays, switches, and other
components. Finding problems in these circuits, such as corroded
connections, blown fuses, broken wires, faulty switches, or broken
components, is the basic process of diagnosing automotive electrical
problems.
Troubleshooting Common Electrical Problems

Electrical systems are complex, and some problems, like issues with the
onboard computer, may need to be serviced at a repair shop or dealership.
Many common issues, however, are fairly simple to diagnose and repair at
home. With a few tools, most systems can be checked, and potential issues
can be narrowed down to find the true problem.
Safety Information

Working with the electrical system in a vehicle is generally quite safe.

Automotive electrical systems run at 12V, which does not pose a danger of
shocks or electrocution. However, many electrical components are easily
damaged, so care should be taken when handling them. Introducing
incorrect voltages or currents can break many systems. One part of the
electrical system that is potentially dangerous is the high-voltage side of
the ignition coil, which should not be serviced while power is applied.
Additionally, electric or hybrid-electric vehicles use many high-voltage
batteries and powertrains, which are dangerous and potentially fatal if
mishandled.
Tools Required

The simplest tool that can be used in electrical diagnosis is a 12V test light..
This light can be used to check if power is being received at any point in a
circuit, which can be handy for simple or quick tests. However, test lights
do not provide very much information. A digital multimeter,, or DMM, has
two probes that can be connected to a circuit to test voltage, amperage,
resistance, continuity, and more. With a DMM, most electrical problems can
be diagnosed. Basic electrical and automotive tools, such as wire cutters,
wrenches, and screwdrivers, are used to service automotive electrical
systems.

Checking the Battery

Battery problems are the most common cause of electrical issues in

vehicles. To test a battery, connect a multimeter in voltage mode across
the terminals of the battery. A fully charged battery should read 12.6V,
while a halfway-charged battery will be around 12.4V. A battery that shows
0V is dead and needs to be charged. One common problem is loose or
corroded connections at the battery post, which can cause intermittent
problems or prevent starting. Cleaning the posts and connections with a
wire brush and tightening them will solve these problems.
A battery that frequently goes dead might simply be old, and can be tested
at an auto-parts store. A good battery that still goes dead is an indication of
an electrical problem. With the car off, disconnect the negative battery
cable and connect the multimeter in amperage mode in between the
negative battery post and the cable. A reading of more than 50mA indicates
a parasitic load somewhere in the system that is draining the battery.
Disconnect fuses one by one from the fusebox while checking the reading.
When the system that is draining the battery is disconnected, the
multimeter reading will drop to below 50mA.
Grounding Problems

Another common problem in automotive electrical systems is improper

grounding connections. In a vehicle, the metal body of the car serves as a
ground, and connects each component back to the negative post on the
battery. Each component and system is connected to by a grounding
connector, which is generally an O-ring connected to a screw post. Vibration
from driving can cause these connections to become loose over time, which
opens the circuit, causing failure or intermittent issues. Cleaning and
tightening these connections solves most grounding issues.
Checking and Replacing Fuses

If a system, such as the radio or headlights, suddenly stops functioning, it is

likely that a fuse has blown. Fuses are located at the fuse box, underneath
the dash on the driver’s side, or in the power center under the hood. Each
should have a diagram showing which fuse goes with which system. Fuses
protect electrical systems and components by opening when too much
current is flowing in the circuit. When a fuse blows, the wire connecting
each side burns open, disconnecting the circuit. Replacing blown fuses with
a new fuse of the same amperage rating reconnects the circuit. If a fuse
has blown, it is likely that the problem is a short or overload in the circuit or
component the fuse is protecting. If this is the case, replacing the fuse only
fixes the problem temporarily.
Low Voltage

Dim headlights, slow starting, and other problems of degree are usually due
to low voltage. Undervoltage occurs when a component is still receiving
power, but not at the voltage it requires for proper operation. Undervoltage
is usually caused by a connection, switch, or ground wire using, or
dropping, more voltage than it should. Ideally, these circuit components
should have zero resistance and thus drop no voltage, but in reality, each
component drops a small amount. In proper condition, these voltage drops
are small, and do not add up to a significant problem. However, corroded
connections, undersized wires, worn-out switches, and other problems can
quickly add up to an undervoltage situation. Test voltage drop by placing
the probes of a multimeter on either side of a component.

The following table describes the maximum acceptable voltage drops for
automotive electrical system components.

Component Max. Acceptable Voltage Drop

Connection 0.00V

Wire or cable 0.20V

Switch or relay 0.3V

Ground connection 0.10V

If voltage drops exceed these levels, the component needs to be repaired

or replaced. For connections and grounds, this is usually as simple as
cleaning them with a wire brush and securing. Wires that drop voltage are
usually worn out, corroded, or undersized for their application. Switches and
relays that drop voltage generally need to be replaced.
Automotive Electrical Systems — Part 1: Basic Automotive Electrical
Theory

There's nothing difficult about electrical systems. The basic theory of

electricity is simple and easily understood if you are just a little patient and
curious. So, we're going to start off with a few definitions. Armed with an
understanding of the following six terms, you will quickly learn to "think like
an electron". Take your time and read these over until you understand the
concept fully:

Electron: The basic unit of electricity. Think of these little guys as

"bullets", traveling down the wire. It's the movement of electrons which runs
the devices which make our lives - and our cars - so comfortable and
convenient.

Voltage: This is the force (or pressure, if you like) of electricity in the
wire. If you think of your garden hose as the wire, the water pressure would
be equivalent to the voltage. Older cars run on six volt systems and newer
(most 1956 and later) utilize twelve volt systems. All vehicles' manuals
specify the system voltage.
 Current: This is the movement of electrons in the wire, expressed in a
unit called the [Link] greater the rate of movement through the wire, the
greater the number of amps. Think of this as the speed of the water coming
out of the garden hose. When you tighten the nozzle the water shoots out
further and faster.

Resistance: This is a restriction to the movement of electrons through

the wire or circuit. The unit of resistance is called the OHM and you can
think of it as a kink in that garden hose. The higher the resistance, the more
current must flow to overcome it. The more current which flows through an
area of high resistance, the hotter the wire will become, ultimately failing.
Corrosion, loose terminals and too-small diameter wires are three very, very
common causes of resistance.

IMPORTANT FACT! High resistance is the cause of ALL electrical

failures - with the exception of broken wires and lack of grounding - both of
which will be discussed later.

Watts: The unit of power in electricity and the product of Amps x

Volts. Why is this important? Because designers of circuits need to know the
amount of current required for a given device (such as a fan, horn, light, etc.)
in order to figure out which diameter wire to use. Example: a 50-watt brake
light, operating on 12 volts, will draw 4.1 amps (4.1 amps x 12 volts = 50
watts). The wire diameter must be large enough to carry the current without
heating up and melting off its insulation.

IMPORTANT FACT! This is the only formula you will ever really need
to understand basic electricity, be it in your car or in your house.

Ground: All electrical devices must be part of a circuit. That is,

electrons must flow from the power source through the device to a ground.
In cars, the metal chassis is the ground (that's why the battery's negative
lead is bolted to the engine or frame) and the power source is the positive
lead on the battery. Without a ground there is only a POTENTIAL circuit. No
electrons will flow — and therefore nothing will work — unless the circuit
ends in a ground. Note: Some cars and trucks utilized "positive ground"
electrical systems, where the positive lead from the battery connects to the
frame and the negative lead goes to the electrical wiring harness. This in no
way makes it more difficult to wire or troubleshoot; all that's required is to
remember that the system is the reverse of normal systems.

STOP! DON'T READ ANY FURTHER UNTIL YOU REALLY UNDERSTAND

ALL THE TERMS LISTED ABOVE!

Ready to go on? Okay, let's start with the fact that all cars run on Direct
Current (DC) electrical systems, as opposed to alternating current (AC) which
runs your home. DC is a "single wire" system. That is, the flow of electricity
always runs from the source of current through the device and then to
ground. It may do this through any number of connections and through other
devices, but tracing the path is straightforward if you always ask the
question:

"Where is the power coming from and is there a path to

ground?"

For practical purposes, the flow of electricity is now considered to be

from positive (voltage, designated by a plus sign +) to negative (ground,
designated by a minus sign - ). Therefore, your car's battery "negative"
terminal is connected to the metal framework of the car (some older cars —
mostly foreign — utilized 'positive ground' systems but this is no longer
done).

Tool Time!
In order to measure voltage, resistance, direction of current flow and other
electrical parameters you need a multimeter. These are devices which have
been around for many years and are available at electronics stores and even
most home centers. Inexpensive ($30 or so), reasonably high-quality meters
are all the average hobbyist needs, so don't overspend. All these meters can
measure DC, AC, resistance and even small amounts of current. Meters in
this price range are fully capable of measuring your car's components
accurately, as well as your household system and you can choose either
analog or digital types, depending upon whether you like to read a dial or
just a number display. After you purchase one, read the instructions and
practice measuring voltages and resistances with it. An hour's practice
should make you an expert. When you get accustomed to using a multimeter
you will quickly come to appreciate its enormous versatility.
 Battery:
Since the source of electricity in a car is the battery, let's see how one works:

A battery is an electrochemical device which converts chemical energy

into electrical energy. Cars use "lead-acid" batteries.
A lead-acid battery uses a series of lead dioxide plates for its positive (+)
terminal and porous, soft lead for its negative plates. All the plates are
arranged alternately and submerged in a solution of sulfuric acid and water.
The positive plate's lead oxide is a compound of lead and oxygen. Sulfuric
acid is a compound of hydrogen and the sulfate radical (SO4), so the acid's
chemical designation is H2SO4.

Chemically, when a battery is connected to an external load (a device

which uses electricity) it begins to discharge. As that happens, the lead in
the positive plate combines with the sulfate of the acid, forming lead sulfate
(PBSO4) in the positive plate. Oxygen in the positive plate combines with
hydrogen from the acid to form water (H2O), which reduces the
concentration of the acid in the electrolyte. Also, the pure lead in the
negative plate combines with the sulfate, forming lead sulfate and making
the positive and negative plates more alike in chemical composition.
Electrons are released during this reaction, creating electric current at a
specific voltage (2 volts per cell, with 6 cells in a 12-volt battery, described
below).

The battery voltage depends upon the chemical difference between the
two plate materials and the concentration of the acid. Because the plates
have become more chemically alike and the electrolyte concentration has
become weaker, the voltage output gets weaker and weaker until the
battery is "dead", or discharged.

However, the battery can be re-charged by passing an electrical current

through it in the opposite direction of the discharge. The chemical reactions
during a charge cycle are the reverse of those that occur during discharge.
As the battery is charged the positive plates become lead dioxide again, the
negative plates become pure lead again and the electrolyte returns to its
proper concentration. The charge-discharge cycle can be repeated over and
over again, until fatigue and erosion of the electrodes and corrosion of the
positive plates cause eventual failure.

Mechanically, batteries are composed of multiple "cells", each containing

the positive and negative plates. A single cell will produce two volts, so your
12-volt battery has six cells grouped together in one case, for efficiency. The
cells are connected in "series", or positive to negative to positive to
negative; and so-on. When you connect something in series you add up each
cell's voltage to get the overall battery's output.

So why does such a big, heavy thing like a battery only produce 12 volts?
Well, it's the current (remember?) which does the work and all those plates
immersed in that acid are capable of producing impressive amounts of amps,
at least for short durations. A typical battery delivers 500-1000 amps and
you need all that current to run the starter motor, not to mention other
things.

Batteries fail to provide sufficient current generally in only a few ways:

1. The electrolyte and plates "wear out". The life of a battery (36 months,
48 months, etc.) is determined by the thickness and number of plates and
you get what you pay for in that regard. Eventually the battery wears out
and can't hold a charge. To test for this, have a service station test the cells
with a hygrometer (a device which measures specific gravity ) or buy one for
yourself (they're cheap). If the hygrometer says the battery is shot and it
won't hold a charge, replace it.

2. The most common failure of batteries is loose or corroded cable

connections. In either case, the reason for failure is HIGH
RESISTANCE! (remember, a poor mechanical connection means that little
or no current can pass through). If the cables are loose, tighten them
thoroughly. If corroded, remove them and clean them with a file or
sandpaper (clean both the cable connectors and the terminals!) It's a good
practice to clean the connections at least once a year.

3. Overcharging, either through external chargers or faulty regulator,

kills batteries by creating so much heat (due to current flow) that the water
in the electrolyte is boiled off. In some cases the battery explodes. Of course,
connecting jumper cables incorrectly can result in a dead short, with
catastrophic consequences (A dead short is when all the current from the
voltage source is connected directly to ground without passing through any
device or resistance. In the case of a battery, it would be equivalent to
connecting both terminals together, causing a huge current flow through the
plates, in turn causing massive heating, then boiling, and finally the battery
will blow up).

In Part II of our Automotive Electrical Systems, we'll explain How

Generators and Alternators work.

Documentation Provided by the Developer

After construction, the developer must provide the strata council and strata
lot owners with reference documents about common property, new buildings
and other assets.

This information can include:

 architectural drawings and specifications (the “as built” drawings are

the most helpful)
 warranties, guarantees and service contracts
 information on replacement cycles for plumbing, flooring and other
items

Documents Acquired Over Time

The strata corporation (or section) will also acquire other maintenance and
renewals documents and materials over time. This documentation can
include:

 existing warranties, guarantees and service contracts

 information on replacement cycles for plumbing, flooring and other
items
 records of repairs and replacements
 records of items added, replaced, or removed since the strata
corporation was originally built. For example, perhaps a heat pump has
been added.
  equipment and supplies inventory
 any planned work, including contractors’ quotes
 any municipal work orders
 maintenance service agreements: over time the strata corporation (or
section) will often enter into agreements with various parties for
routine inspections, periodic maintenance and eventual renewal
services relating to the building and other shared assets such as
utilities and private roads
 safety and test certificates on items such as: elevators, roof anchors,
fire suppression systems, water systems, boilers and backflow
prevention valves
 relevant bylaws and written agreements with owners related to
common property, limited common property or strata lots that can
make either the strata corporation or the strata lot owner responsible
for the repair and upkeep of that property

Documentation for Doing Maintenance, Repair and Renewal Work

There is other documentation needed for doing repair and maintenance. This
can include:

Maintenance Plan: a maintenance plan is different from a depreciation

report. The maintenance plan outlines all maintenance and repair work that
needs to be done, both maintenance that is done once a year or more often
(and is an operating fund expense) and maintenance that is done less often
than once a year and is a contingency reserve fund (CRF) expense.

It is important to plan for routine or minor maintenance. The maintenance

plan works with the depreciation report to ensure that maintenance, repair
and renewal work is identified and completed.

Maintenance Manual: a strata corporation (or section) may have much, or

all, of its repair and maintenance documentation gathered in a maintenance
manual.

Maintenance Logs: the strata corporation (or section) and contractors

should use forms and logbooks to collect and record maintenance work
carried out on the assets. This documents work and helps to identifies any
trends in the behaviour of the building, assets or infrastructure over time.

Other maintenance and inspection records: these should be reviewed

regularly especially for anything that suggests repeat problems.

Maintenance Guidelines: an example of a maintenance guideline is: “The

strata corporation (or section) will wash the exterior of inaccessible windows
twice a year.”
Securing Documents

As strata councils and strata management companies change over time, it is

important for the strata corporation (through the strata council or executive
for the section) to have a system to gather, secure and update repair,
maintenance and renewal information.

As well, maintenance and renewal materials may be hundreds of pages so it

needs a system to keep it organized.

It is helpful to keep all documentation, including depreciation reports,

electronically for security, convenience, and easy updating. It is also good
practice to have backup securely stored in a separate location. Remember to
test the back up at least every six months.

Documents can also be stored in a simple filing cabinet. If using paper

storage, all originals should be kept and only copies signed out. Consider
scanning and storing paper documents in an electronic form as well for back
up.

Vehicle Systems Overview

The Car Care Council has developed a service interval schedule with general
guidelines for the regular maintenance of passenger cars, mini vans, pickups
and SUVs. Below is a breakdown of the vehicle systems that require regular
maintenance, as outlined in the council’s car care guide.

BELTS AND HOSES

What is it?
You car’s belts and hoses are essential to the cooling, air conditioning and
charging systems, and the engine. Don’t take these routine replacement
intervals for granted because they can break down and leave you stranded.

What does it do?

The timing belt keeps the crankshaft and camshaft mechanically

synchronized to maintain engine timing. Whether serpentine, V-belt or fan
belt (the belts on the outside of the engine), they all transmit power from the
front of the engine to accessories that need to be driven, such as the air
conditioning, the charging system and fans. Radiator and heater hoses carry
coolant to and from the engine, radiator and heater core.
 Typical Wear and Tear

Key items that affect the replacement interval for belts and hoses:

 Vehicle age
 Electrolytic corrosion
 Mileage
 Oil contamination
 Belt tension
 Failed hose clamps

Symptoms

 Squeaking noise from under the hood during start-up or operation

 Coolant leaks
 Dashboard light will illuminate
 A/C System may fail
 Engine overheating
 Smell of burnt rubber

BRAKE SYSTEM

What is it?
Your car’s brake system is its most critical safety system and you should
check it immediately if you suspect any problems. A properly operating
brake system helps ensure safe vehicle control and operation under a wide
variety of conditions.

What does it do?

When you push the brake pedal, the force generates hydraulic pressure in
the master cylinder. This pressure flows through the hydraulic lines and
hoses to the wheel cylinders and calipers, forcing the shoes against the
drums (drum brakes) and the pads against the rotors (disc brakes). The
resulting friction slows the vehicle and is relative to the amount of force
applied at the brake pedal.

Typical Wear and Tear

Brakes are a normal wear item for any car and eventually they’re going to
need replacement. Avoid letting your brakes get to the “metal-to-metal”
point, which usually means expensive rotor or drum replacement. Factors
that affect wear include driving habits and quality of brake pads and shoes.

Symptoms

 Car pulls to one side during braking

 Pulsating brake pedal or steering wheel shake
 Brake pedal feels “mushy”
 Unusual noise when you step on the brake pedal
 Repeatedly need to add brake fluid to the master cylinder
 Brake fluid sprayed onto outside of wheel
 Unusual odor or noise

EMISSION SYSTEM

What is it?
Your car’s emission system keeps the engine running cleanly and efficiently
in all sorts of operating conditions. A steady or flashing warning light on your
vehicle dashboard indicates a problem that is currently happening and may
require immediate attention. Failure to do so can reduce your gas mileage or
cause your vehicle to pollute.

What does it do?

Your car’s emission system controls the emissions, exhaust and pollutants
(including gasoline vapors escaping from the fuel tank), using an array of
sensors, computerized engine controls and the exhaust components. The
emission system substantially reduces harmful gases such as carbon
monoxide (CO), unburned hydrocarbons (HC) and oxides of nitrogen (NOx)
and, by law, must be maintained in operating condition.

Typical Wear and Tear

Some factors affecting the emission system include:

 Driving and atmospheric conditions

 Mileage
 Vehicle age
 Type of spark plug electrode material
 Poor vehicle maintenance
 Poor quality fuel
 Damaged or worn sensors
 Dry-rotted or cracked vacuum hoses

ENGINE COOLING SYSTEM

What is it?
The engine cooling system affects your car’s overall dependability and
engine longevity. Cooling systems have advanced over the years with new
coolant formulations and new radiator designs and materials. If you suspect
a problem with your cooling system, you should check it immediately.
 What does it do?
The key parts of the cooling system remove heat from the engine and
automatic transmission and dissipate heat to the air outside. The water
pump circulates coolant through the engine. The coolant absorbs heat and
returns it to the radiator where heat is dissipated. The thermostat regulates
the coolant temperature to keep it consistent for efficient engine operation.

Typical Wear and Tear

Factors that affect the replacement of cooling system parts include:

 Driving habits
 Operating conditions
 Type of vehicle
 Type of coolant
 Frequency of regular maintenance such as coolant changes

Symptoms

 Overheating
 Sweet smell
 Leaks
 Repeatedly need to add fluid

EXHAUST SYSTEM

What is it?
Your car’s exhaust system has come a long way from the old days of exhaust
pipes and mufflers. Today, the exhaust system is safety and emissions
control rolled into one. Have your car’s exhaust system inspected regularly
and check it immediately if you suspect any problems.

What does it do?

The exhaust system routes dangerous exhaust gas from the engine out and
away from the car to keep from affecting the occupants. Next, the exhaust
system reduces exhaust noise from the engine. The catalytic converter
reduces the level of harmful pollutants in the exhaust. The oxygen sensors
mounted in the exhaust system monitor the level of oxygen in the exhaust
gases to maintain efficient engine operation and to monitor the converter’s
operation.

Typical Wear and Tear

Maintain a safe car with regular exhaust system checks. Factors that affect
replacement requirements include:

 Driving habits (short trips take their toll on exhaust system life)
 Road conditions (salt, road spray, bumps)
 Vehicle type
 Age of exhaust system parts

Symptoms

 Loud noise
 Rattling noise when starting, accelerating or braking
 Drowsiness while driving
 Rotten eggs smell

FILTERS AND FLUIDS

What is it?
Your car’s filters are important to the longevity of your car and interior
comfort. Maximize your car investment by replacing filters regularly.

What does it do?

The oil filter traps contaminants, allowing the oil to flow through the engine
unrestricted. The fuel filter separates harmful contaminants that may cause
problems with carburetors or intricate fuel injectors. The air filter traps dirt
particles, which can cause damage to engine cylinders, walls, pistons and
piston rings. The air filter also plays a role in keeping contaminants off the
airflow sensor (in fuel-injected cars). The cabin filter helps trap pollen,
bacteria and dust that may find their way into a car’s ventilation system.

Typical Wear and Tear

Filters are normal wear items that require regular checks and replacement.
Factors that affect replacement intervals include:

 Mileage
 Driving habits
 Driving and road conditions
 Type of filter
 Vehicle type

Symptoms

 Poor gas mileage

 Hesitation while accelerating
 Musty odor in the cabin

FUEL SYSTEM

What is it?
You car’s fuel system works with the rest of the engine control system to
 deliver the best performance with the lowest emissions. Check your car’s
fuel system regularly or immediately if you smell gas or suspect a problem.

What does it do?

The fuel system transfers fuel from the fuel tank and passes it through a fuel
filter for straining before it arrives at the injectors. A pressure regulator
controls fuel pressure to ensure good engine performance under a variety of
speed and load conditions. Fuel injectors, when activated, spray a metered
amount of fuel into the engine. Some vehicles use a return line system to
return unused fuel back to the tank.

Typical Wear and Tear

Intervals for fuel system maintenance may be influenced by:

 Fuel quality
 Vehicle age
 Mileage/time
 Operating conditions
 Maintenance history

Symptoms

 Poor fuel economy

 Vehicle won’t start
 “Check Engine” light is illuminated

LIGHTING AND WIPERS

What is it?
Lights and wipers play a major role in safe driving – the chances for
accidents increase if you can’t see or be seen. Some states have laws that
require the headlights to be on with the wipers. If you detect any problems
with your car’s lights or wipers, have them checked out at once.

What does it do?

The wiper system keeps excessive water, snow or dirt from building up on
the windshield and removes them to maintain clear visibility through the
windshield. The lighting system provides nighttime visibility, signals and
alerts other drivers, and supplies light for viewing instruments and the
vehicle’s interior.

Typical Wear and Tear

Lights and wipers are normal wear items that require periodic replacement.
Factors affecting replacement intervals include:

 Operating conditions (winter conditions are tough on wiper blades)

 Frequency of use
 Material and type of lights and wipers
 Sunny weather – wiper blades can deteriorate faster and need more frequent
replacement in desert states

Symptoms

 Chattering or streaking wiper

 Rapid signal blinking
 Dimming lights

STARTING, CHARGING AND BATTERIES

What is it?
Your car’s starting and charging systems, and the battery, help ensure
dependable vehicle operation whenever you drive your car and in all sorts of
driving conditions. Make sure to check these systems regularly.

What does it do?

The battery stores electrical energy and the starter converts that energy into
mechanical force to turn the engine for starting. The alternator produces
electric current to replace what the starter used during start-up and to
support electrical loads when the engine is running. An ignition module turns
the low-voltage supply to the ignition coil on and off, and the coil produces
the high voltage for the ignition system. This creates a spark at the spark
plugs and ignites the air/fuel mixture in the engine. A belt transmits power
from the front of the engine to the alternator’s pulley, along with other
accessories.

Typical Wear and Tear

Driving habits such as frequent engine on/off cycles will cause more wear on
the starter than a simple trip back and forth to work. Other factors include:

 Driving and weather conditions

 Mileage
 Vehicle age
 Excessive electrical draws like in-vehicle entertainment systems

Symptoms

 Headlights and interior lights dim

 “Check Engine” and/or battery light may come on
 Accessories fail to operate

STEERING AND SUSPENSION

What is it?
 The steering and suspension systems are key safety-related systems that
largely determine your car’s ride and handling. Have these systems checked
regularly, at least once a year and usually with a wheel alignment.

What does it do?

The suspension maintains the relationship between the wheels and the
frame or unibody. The suspension system interacts with the steering system
to provide vehicle control. When working properly, the suspension system
helps absorb the energy from road irregularities such as potholes and helps
to maintain vehicle stability. The steering system transmits your input from
the steering wheel to the steering gear and other steering components to
control the car’s direction.

Typical Wear and Tear

Over time, steering and suspension components wear out and require
replacement. Regular checks are critical to maintain a safe car. Factors that
affect wear include:

 Driving habits
 Operating conditions (potholes in road)
 Vehicle type
 Type of steering and suspension system
 Frequency of regular maintenance such as chassis lubrication and wheel
alignment

Symptoms

 Car pulls to one side

 Uneven tire wear
 Excessive noise, vibration or bouncing
 Loss of control

TRANSMISSION

What is it?
The transmission works with the engine to provide power to you car’s
wheels. Whether automatic or manual, the transmission plays a major role in
the overall performance of your car. Make sure to check it at the first sign of
problems.

What does it do?

A transmission/transaxle keeps the engine’s output optimally matched to the

speed and load conditions. The torque converter, connected to the automatic
transmission/transaxle input shaft, connects, multiplies and interrupts the
flow of engine torque into the transmission. Universal and/or Constant
Velocity (CV) joints connect to the driveshaft to transmit output power from
 the transmission to the rear axle on rear-wheel-drive cars and the front axle
on front-wheel-drive cars. These joints also allow the driveshaft and/or CV
shaft to work at an angle. The several different types of automatic
transmission fluid serve multiple purposes: cleans, cools, lubricates,
transmits force, transmits pressure, inhibits varnish buildup and continually
protects the transmission.

Typical Wear and Tear

Wear and tear on the transmission can be influenced by:

 Driving habits
 Towing or excessive loads
 Operating conditions
 Condition of the transmission fluid
 Frequency of regular maintenance

 Slipping
 Hesitation
 Bucking
 Grinding gears
 Difficulty shifting

SELF-CHECK 2.1-1

I. Enumeration:

1. Components of an Engine

a.
b.
c.
d.

2. Key items that affect the replacement interval for

belts and hoses:

a.

b.
 c.

d.

e.

f.

ANSWER KEY 2.1-1

II. Enumeration:

1. Components of an Engine

a. Spark Plug
b. Valves
c. Pistons & Piston Rings
d. Connecting rod and Crankshaft

2. Key items that affect the replacement interval for belts and
hoses:

a. Vehicle age

b. Electrolytic corrosion
c. Mileage

d. Oil contamination

e. Belt tension

f. Failed hose clamps

COMMUNICATION
- Is the transmission of information to another person.
o Verbal
o Nonverbal (through body language)

Verbal communication skills – are important for EMS. It enables you to

gather critical information, coordinate with other responders, and interact
with other health care professionals.
Therapeutic communication – defined as the face-to-face process of
interacting that focuses on advancing the physical and emotional well-being
of a patient.
- 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

Factors and strategies to consider during communication

Age, culture and personal experience:
- Shapes how a person communicates
- Body language and eye contact greatly affected by culture
o In some cultures, direct eye contact is impolite.
o In other cultures, it is impolite to look away while speaking.
- Tone, pace and volume of language
o 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 unto others

Non Verbal Communication

Body language – provides more information than words alone.

Facial expressions, body language, and eye contact are physical cues.

– Helps 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

- Facilitation
o Encourage hesitant patients to provide more detail. The
technique involves pointing to letters on an alphabet board,
keyboard or other device so that the person with
the communication disability can communicate.

- Silence
o Silence is also used as total communication, in reference to
nonverbal communication and spiritual connection.
- Reflection
o Reflecting is the process of paraphrasing and restating both
the feelings and words of the speaker. The purposes of
reflecting are:
  To allow the speaker to 'hear' their own thoughts and to
focus on what they say and feel.
 To show the speaker that you are trying to perceive the
world as they see it and that you are doing your best to
understand their messages.
 To encourage them to continue talking.
- Empathy
o "the quality or process of entering fully, through imagination,
into another's feelings or motives." In the fullest sense, it
implies putting yourself into the other person's shoes, or even
getting into his or her skin, so that you really understand and
feel his pain, fear - or more positively -his joys.
- Clarification
o involves offering back to the speaker the essential meaning,
as understood by the listener, of what they have just said.
Thereby checking that the listener's understanding is correct
and resolving any areas of confusion or misunderstanding.
- Confrontation
o Helping the client become more aware of inconsistencies in
his or her feelings, attitudes, beliefs, and behaviors. Only to
be used after trust has been established, & should be done
gently, with sensitivity: “You say you’ve already decided what
to do, yet you’re still talking a lot about your options.”
- Interpretation
o is a communication process, designed to reveal meanings
and relationships of our cultural and natural heritage, through
involvement with objects, artifacts, landscapes and sites.
- Explanation
o Taking notice of a single idea expressed or even a single
word. An example is “On a scale of 0 to 10 tell me the level of
the pain you are experiencing in your great toe right now.”
- Summary
o Pulls together information for documentation. Gives a client a
sense you understand. It is a concise review of key aspects of
an interaction. Summarizing brings a sense of closure.
Example “It is my understanding that your arm pain is a level
1 since you’ve taken a Vicodin one hour ago. Taking your pain
medication before physical therapy seems to help you
complete the activities the doctor wants you to do for your
rehabilitation. Is this correct?” Client responds “Yes It really
helps to take the medicine before I do my physical therapy
because it helps reduce the pain in my arm.”

Interviewing Techniques
 When interviewing a patient, consider using touch to show caring and
compassion.
– Use consciously and sparingly.
– Avoid touching the torso, chest, and face.

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.
– 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.
SELF-CHECK 7.1-1

I. Identification. Identify the following (5pts)

1. _________________ it enables you to gather critical information,
coordinate with other responders, and interact with other health
care professionals.
2. _________________ is the process of conveying information
between two or more people.
3. _________________ shapes how a person communicates
4. _________________ provides more information than words alone.
5. _________________ Study of space and how distance between
people affects communication.

II. Enumeration (15 pts)

1. Shannon – Weaver Communication Model (In order)
2. Golden rules to help calm and reassure patient

ANSWER KEY 7.1-1

Identification
1. Verbal communication skills
2. Communication
3. Age, culture and personal experience
4. Body language
5. Proxemics

Enumeration
1. Shannon – Weaver Communication Model (In order)
- Sender takes a thought
- Encodes it into a message
- Sends the message to receiver
- Receiver decodes the message
- Sends feedback to the sender

2. 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.
- 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.
 Learning Outcome 2 – CONVEY AND RECEIVE INFORMATION USING
AVAILABLE MODES OF COMMUNICATIONS
Learning Activities Special Instructions
Read Information Sheet 7.2-1 Read and understand the
on information about the content. If
Exercise Effective you can’t understand the
Communication Techniques information, ask you facilitator
Answer Self-Check 7.2-1 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.

Participate in the discussion

on Exercising Effective
Communication Techniques
Read Information Sheet 7.2-2 Read and understand the
on information about the content. If
Relevant Guidelines and you can’t understand the
Procedures information, ask you facilitator
Answer Self-Check 7.2-2 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.

Participate in the discussion

on Exercising Effective
Communication Techniques
After doing all activities of this
LO, you are ready to proceed
to the next LO on
FOLLOW ROUTINE
INSTRUCTIONS
Information Sheet 7.2-1
Exercise effective communication techniques

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Use communication codes and equipment correctly
2. Acknowledge and/or clarify information received using active listening
3. Know how to make communication as efficient as possible

In Emergency Medical Services, communication, information must move

rapidly, efficiently and effectively.

In this unit, you will learn to exercise effective communication techniques.

COMMUNICATION COMPONENTS

Emergency Medical Dispatchers (EMD) – are communications personnel

responsible for receiving and transmitting pure and reliable messages,
tracking vehicles and equipment, and recording other important information.
Essentially, the dispatcher is the “conductor” of the force, and is responsible
for the direction of all units within it.
Base station – is a radio at a stationary site with superior transmission and
receiving capabilities, such as a hospital, mountaintop, dispatch center or
other public safety agency.
 Serve as dispatch and coordination areas
 Should be in contact with all other system elements
Repeater – is a remote receiver that receives a transmission from a low
power portable or mobile radio on one frequency and then transmits at a
higher power, often on another frequency. Through this, an EMS system can
communicate over a large geographical area.
 Miniature base stations
 Extend system range
Encoders and decoders – a process that blocks out radio transmissions not
intended for that unit. In some systems, this is called a private line or
channel guard, which uses a combination of encoders and decoders. This
method allows the system to reduce extraneous radio traffic.
Transcievers – two-way radios
mounted on vehicles
Portable transmitter/receivers
– handheld radios

Remote consoles
- Receives transmissions from field
- Send messages back
EMS Communication needed to:
- Call for resources
- Transfer care of the patient
- Interact within the team structure
- Communicate with other health care professionals
- Team communication and dynamics

EMS Communication Sytems

- Requires specialized equipment
o Systems are based on radio signals
o You need a reliable way to communicate with medical
direction
o Always have a backup system. Critical during disasters.

RADIO COMMUNICATIONS
- Radio transmits by electromagnetic waves
o When transmitted by waves, energy can be characterized by
length of wave it produces
o Frequency: how frequently the wave recurs
o Radio wavelengths are designated in cycles per second or
hertz.
- Radio waves occur from 3kHz to 3,000 GHz.
o Frequency bands are portions of the radio frequency spectrum
assigned to specific uses.
o Medical communications are usually VHF/UHF.
 UHF better in dense populations and buildings
 Shorter range, easily absorbed by rain
- 800 MHz is commonly used for EMS
o High penetration works well in cities
o Minimal interference
o Reduced channel noise
 o Allows trunking
 Trunking - is a method for a system to provide network
access to many clients by sharing a set of lines or
frequencies instead of providing them individually

Note: EMS systems must perform COMM CHECKs routinely

Modes of Radio Operation

Simplex – uses one frequency to either transmit or receive
Duplex – uses two frequencies to transmit and receive simultaneously
Multiplex – combines signals to transmit simultaneously on one
frequency

Digital Radio and Trunked Systems

• Digital radio helps clear up distorted or lost transmissions.
• Digital trunked radios have channels related by groups.
– Allow simultaneous exchanges on one channel
• Digital systems relay data from CAD.

Cellular Telephones
• Used in EMS
– Basically, low-power radios
– Be familiar with important/ commonly used phone numbers.
– Know the location of dead spots.
• Have a backup plan to prevent overload during an MCI.
• Most new cell phones have GPS.
– Many vehicles have similar features.
• In most cases, the caller’s call-back number and location are delivered
to the Public-Safety Access Point (PSAP).

Backup Communications Systems

• Landlines
– Link various fixed components of the system
– Calls can be patched into radio transmissions
– Less expensive
– Give clearer signals
– Allow communication with anyone with a phone
– Older systems may be used if a disaster occurs
Biotelemetry
• Measures and transmits
vital life signs
– Started with ECGs
– “Telemetry” for
short
• Signal must be encoded if
submitted over radio
channels used to transmit
voice.
• Over UHF, confined to one
lead
– For more complex
cases, all 12 leads
transmitted
• Noise may arise from a
number of sources.
• Allows doctors to supervise paramedics
– Helped gain acceptance for paramedic practice
• As paramedics have gained skill, the trend has been to rely on ECG
telemetry less.
• Recent research indicates telemetry still serves a purpose.
– Early diagnosis/treatment of AMI
– New technology allows instant data transmission

Factors that may affect communications

• You may experience:
– Equipment failures
– System problems
• Be prepared to troubleshoot quickly.
– If you cannot fix it, use planned redundancy.
• Follow protocols regarding radio failure

Communicating by radio
• Effectiveness depends on:
– Technical hardware
– People who use it
• You must:
– Know the rules.
– Understand the conventions
• Keep messages simple, brief, and direct.
– Practice effective communications skills.
– Know the required methods of communication.4
• You must effectively communicate with:
– Dispatch
 Receiving facility
SELF-CHECK 7.2-1

I. Identification. Identify the following (5pts)

1. _________________ Measures and transmits vital signs.
2. _________________ combines signals to transmit simultaneously on
one frequency.
3. _________________ is a method for a system to provide network
access to many clients by sharing a set of lines or frequencies
instead of providing them individually
4. _________________ is a remote receiver that receives a
transmission from a low power portable or mobile radio on one
frequency and then transmits at a higher power, often on
another frequency
5. _________________ is a remote receiver that receives a
transmission from a low power portable or mobile radio on one
frequency and then transmits at a higher power, often on
another frequency.

II. Enumeration (15 pts)

1. Common uses of EMS Communication
2. Modes of radio operation
3. Purpose of telemetry
ANSWER KEY 7.2-1

Identification
1. Biotelemetry
2. Multiplex
3. Trunking
4. Repeater
5. Base Station

Enumeration
1. Common uses of EMS Communication
- Call for resources
- Transfer care of the patient
- Interact within the team structure
- Communicate with other health care professionals
- Team communication and dynamics
2. Modes of radio operation
- Simplex
- Duplex
- Multiplex
3. Purpose of telemetry
- Early diagnosis/treatment of AMI
- New technology allows instant data transmission
TASK SHEET 7.2-1

Title: OPERATE AND MAINTAIN BUS

Performance Objective: Given the necessary tools, materials and

equipment, you should be able to:
 PERFORM PRE AND POST OPERATION PROCEDURES
 PERFORM EQUIPMENT OPERATION
 PERFORM OPERATION CHECK

Tools : BUS

Steps/Procedure:
1. Prepare the needed tools, equipment and materials
2. Follow the steps below :
- Be sure the radio is on
- Select the proper frequency
- Adjust the volume to a comfortable noise
- Listen to the frequency before beginning a transmission and
monitor the frequency for at least 5 seconds before
transmitting
- Press the push-to-talk button and wait for 1 second before
speaking
- Speak with your lips about 5cm to 7cm from the microphone
- Address the unit being called then give the name of the unit
calling
- Speak clearly and slowly
- Keep all transmissions brief
- Use clear, everyday language, not codes
- When giving a number it is best to say each digit
- Avoid words that are difficult to hear, such as “yes” and
“no;” instead say “affirmative” and “negative”
- Indicate when the radio transmission has ended, typically by
saying “over”
3. Clean the area and return the tools/materials to their
designated places.
Assessment Methods:
ORAL QUESTIONING, DEMO
Performance Criteria Checklist ______

CRITERIA
YES NO
Did you….
1. Operate a portable two-way radio following
standard EMS protocol and procedure?
2. Prepare the necessary equipment for the
operation of a portable two-way radio?
3. Did you observe safety procedures and
guidelines before operating the portable two-way
radio?
4. Accomplish the task in a timely and accurate
manner?
Information Sheet 7.2-2
Relevant guidelines and procedures

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Observe proper guidelines and procedures in sending transmission
2. Identify the regulating body for telecommunications

Communications problems have been considered the most common

operating problem facing emergency response personnel. The lack of proper
communications affects emergency medical personnel’s ability to initiate,
coordinate and complete on-scene operations. Common problems include
the lack of standard operating guidelines, lack of proper training,
organizational problems, equipment and communication techniques.
Understanding and using the following basic guidelines will improve fire
ground or emergency medical communications.

In this unit, you will learn to observe relevant guidelines and procedures
on telecommunication.

National Telecommunications Commission (NTC)

– Issues licenses
– Allocates frequencies
– Establishes technical standards
– Establishes/enforces rules/regulations for radio equipment operation
– Ensures frequencies for emergency medical use are confined to that
use
– The NTC forbids:
– Use of obscenities
– Transmission of nonmedical messages

Clarity of Transmission
• Basic model of communication
– Sender
– Clear message
– Receiver
– Feedback loop
• Communications equipment is designed to permit
communication.
 • Many guidelines can improve clarity, such as:
– Make sure the channel is clear.
– Speak clearly and distinctly.
– Keep calm and free of emotion.
– Keep transmissions brief.
– Use the NATO (North Atlantic Treaty Organization) phonetic
alphabet.

Content of Transmissions
• Be brief, to the point, and professional.
• Guidelines include:
– Protect the patient’s privacy at all times.
– Be impersonal.
– Use clear text.

Note: Question orders you did not hear/ understand.

• Some EMS services use radio codes to:

– Maintain security.
– Keep airtime brief.
– Prevent patient, etc, from understanding what is being said.
• To be effective:
– Everyone must learn them.
– Codes should be:
• Simple and standardized
• Posted
– Should not be used during MCIs
Response to the scene
• When a call is received, you should follow a standard method
of communications.
– Usually standardized for agency
• When first contacted by dispatch:
– Record location and call information
• After dispatch and recording information:
• Respond that you received information
• A standard sequence
– Tell dispatch you received the message and are responding to
the alert
– EMS unit begins its trip to the scene
• Next transmission is your arrival on scene
– After you treat your patient(s) and are ready to transport,
contact dispatch again to confirm
– Notify dispatch when you arrive at the hospital
– Contact to confirm call completion and establish status

Relaying information to medical control

• Communications with medical control should be concise and
accurate.
– Use a standard format.
• Going to a different facility than medical control is not
uncommon.
– Know protocol.
SELF-CHECK 7.2-2

III. Enumeration (15 pts)

1. Basic model of communication
2. Functions of NTC
3. Purpose of radio codes to EMS
4. A transmission should be
ANSWER KEY 7.2-2

Enumeration
 Basic model of communication
- Sender
- Clear message
- Receiver
- Feedback loop
 Functions of NTC
- Issues licenses
- Allocates frequencies
- Establishes technical standards
- Establishes/enforces rules/regulations for radio
equipment operation
- Ensures frequencies for emergency medical use are
confined to that use
 Purpose of radio codes to EMS
- Maintain security.
- Keep airtime brief.
- Prevent patient, etc, from understanding what is being
said.
 A transmission should be:
- Brief
- To the point
- Professional
 Learning Outcome 3 – FOLLOW ROUTINE INSTRUCTIONS
Learning Activities Special Instructions
Read Information Sheet 7.3-1 Read and understand the
on information about the content. If
Knowledge of communication you can’t understand the
skills, equipment and function information, ask you facilitator

Referral process of
organization
Answer Self-Check 7.3.1 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.
After doing all activities of this
LO, you are ready to proceed to
the next LO on
COMMUNICATE WITH PATIENTS
Information Sheet 7.3-1
Knowledge of communication skills, equipment and function
Referral process of organization

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Observe proper guidelines and procedures in sending transmission
2. Identify the regulating body for telecommunications

Dispatch is a procedure for assigning employees (workers) or vehicles to

customers. Industries that dispatch include taxicabs, couriers, emergency
services, as well as home and commercial services such
as maid services, plumbing, HVAC, pest control and electricians.
With vehicle dispatching, clients are matched to vehicles according to the
order in which clients called and the proximity of vehicles to each client's
pick-up location.

Emergency Medical Dispatch (EMD) refers to a system that enhances

services provided by Public Safety Answering Point (emergency) call takers,
such as municipal emergency services dispatchers. It does so by allowing the
call taker to quickly narrow down the caller's type of medical or trauma
situation, so as to better dispatch emergency services, and provide quality
instruction to the caller before help arrives. In most modern EMS systems,
the Emergency Medical Dispatcher will fill a number of critical functions. The
first of these is the identification of basic call information, including the
location and telephone number of the caller, the location of the patient, the
general nature of the problem, and any special circumstances. In most EMS
systems, the telephone remains almost a singular point of access for those
needing assistance.
In this unit, you will learn to
interpret instructions correctly and
carry out withing agreed time frame.

Emergency medical dispatcher

- Is a professional
telecommunicator, tasked with
 the gathering of information related to medical emergencies, the
provision of assistance and instructions by voice, prior to the arrival
of emergency medical services (EMS), and the dispatching and support
of EMS resources responding to an emergency call.
- Is a vital part of the paramedic team
o Obtains as much information as possible
o Directs appropriate vehicle(s) to the scene
o Provides caller with information
o Monitors and coordinates communication
o Maintains written records

Receipt of the call for help

• The EMD must:
– Answer the telephone promptly.
– Identify himself or herself and the agency.
– Speak directly into the mouthpiece.
– Observe telephone instructions.
– Take charge of the conversation.

Information gathering
• EMD should elicit, at minimum:
– Patient’s exact location
– Call-back number
– Caller’s perception of the nature of the problem
– Information about the patient’s condition to determine urgency
• For a motor vehicle crash:
– Kinds of vehicles involved
– Number of persons injured
• Estimate of extent
– Apparent hazards
• EMD may need to contact other agencies to assist.
Dispatch
• EMD decides which crew/vehicle to dispatch
– Depends on:
• Location and nature of call
• Availability of various units
• EMD may provide additional information en route

Advice to the caller

• EMD will tell the caller:
– What is being done
– Provide instructions in an emergency situation
• EMDs should undergo training in providing emergency care
instructions.
Ongoing communications with the field
• The EMD must monitor the communications of the ambulance.
– Coordinates communications between ambulance and medical
control
– Contacts other agencies who may be needed
• Use standard military time to document calls.
• 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

• Plan and organize your radio communication.
• Concise, well-organized patient report
– Usually follows standard format established by local EMS system
• Medical control must be readily available:
– On the radio at the hospital or
– On a mobile or portable unit when you call

Maintenance of radio equipment

• 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
– 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

Most common areas of responsibility as EMD

1. Identification of basic call information
 Location and telephone number of the caller
 Location of the patient
 General nature of the problem
 Any special circumstances
2. Triage of incoming calls
 providing expert systematized caller interrogation, using the
script provided by the Emergency Medical Dispatch system, in
order to determine the likely severity of the patient's illness or
injury, so that the most appropriate type of response resource
may be expedited. All calls are prioritized by medical
symptom/condition acuity.
3. Selection and assignment
 selection and assignment of the most appropriate type of
response resource, such as an ambulance, from the closest or
 the most appropriate location, depending on the nature of the
problem, and ensuring that the crew of the response resource
receive all of the appropriate information. The EMD is
responsible for the management and work assignment
(physicians and supervisors provide work direction) for all of the
response resources in the EMS system
4. Assist the layperson/caller
 provide and assist the layperson/caller with pre-arrival
instructions to help the victim, using standardized protocols
developed in co-operation with local medical directors. Such
instructions may consist of simple advice to keep the patient
calm and comfortable or to gather additional background
information for responding paramedics. The instructions can
also frequently become more complex, providing directions
over the telephone for an untrained person to perform CPR
5. Provide information support to the responding resources
 this may include callbacks to the call originator to clarify
information. It may involve clarifying the exact location of the
patient, or sending a bystander to meet the ambulance and
direct paramedics to the patient. It may also include requests
from the EMS crew to provide support resources, such as
additional ambulances, rescue equipment, or a helicopter. The
EMD also plays a key role in the safety of EMS staff.

6. Ensures that the information regarding each call is collected

in a consistent manner
 For both legal and quality assurance purposes.

SELF-CHECK 7.3-1

I. Enumeration (20 pts)

1. Most common areas of responsibility of EMD
2. Information to gather during a vehicle crash
3. During receipt of call, the EMT must:
4. Identification of basic call information
ANSWER KEY 7.3-1

Enumeration
 Most common areas of responsibility as EMD
- Identification of basic call
- Triage of incoming calls
- Selection and assignment
- Assist the layperson/caller
- Provide information support to the responding resources
- Ensures that the information regarding each call is
collected in a consistent manner
 Information to gather during a vehicle crash
- Kinds of vehicles involved
- Number of persons injured
- Apparent hazards
 During a call for help the EMD must:
- Answer the telephone promptly.
- Identify himself or herself and the agency.
- Speak directly into the mouthpiece.
- Observe telephone instructions.
- Take charge of the conversation.
 Identification of basic call information
- Location and telephone number of the caller
- Location of the patient
- General nature of the problem
- Any special circumstances
 Learning Outcome 4 – COMMUNICATE WITH PATIENTS
Learning Activities Special Instructions
Read Information Sheet 7.4-1 Read and understand the
on information about the content. If
Referral process of you can’t understand the
organization and relevant information, ask you facilitator
guidelines and procedures on
communication and
interpersonal skills
Answer Self-Check 7.4.1 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.
After doing all activities of this
LO, you are ready to proceed to
the next LO on
COMPLETE REPORTS AS
REQUIRED

Information Sheet 7.4-1

Communicate with patients

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Establish rapport through open, sensitive and confident manner
2. Obtain information from patient showing the firmness sensitivity and
respect for confidentiality demanded by the situation
3. Recognize and respect religious, social and cultural differences

Communicating with patients is partly about the science of gathering

medically relevant information and partly about the art of using good
communication skills to make people feel better and accept your care. It is a
challenge to achieve a balance between rapidly gathering critical information
and encouraging and empowering the patient to participate in their
treatment. Even experienced providers struggle to achieve this balance as
they improve and learn with every patient encounter. The EMS professional
must determine the underlying causes of communicaton difficulties and
when possible, help the patient “tell his own story.”
 This unit provides information regarding what is known about how
humans communicate, especially in the stressful setting of a medical
emergency. Is also provides information on overcoming barriers to
communicate that are encountered by EMS professionals.
Therapeutic communication – defined as the face-to-face process of
interacting that focuses on advancing the physical and emotional well-being
of a patient.
- Both verbal and nonverbal
- Encourages patients to express how they feel
- Achieves a positive relationship with patient
Your job will involve daily interactions with people at their most vulnerable.
At least half of calls involve going in someone’s home.
• See every invitation into a home as a personal honor
• Convince the patient you are listening:
– Give patients your undivided attention.
– Do not talk about someone in front of him or her.
– Listen.
• Never repeat a question.
– Use “active listening.”
– Repeat key parts of a patient’s response.
• Especially when taking notes
– Helps confirm the information patients are providing
– Try hard not to shout.
– Reduce noise when possible.
– Move the patient to a quiet area.
– Speak close to the patient’s ear in a calm voice.
– Complete all your history taking at once.
– Ask personal questions quietly and in private.
– Ask payoff questions.
– Communication is critical in challenging environments.

Rapport
- a close and harmonious relationship in which the people or groups
concerned understand each other’s feelings or
ideas and communicate well.

Developing Rapport
• Try to develop a good rapport as soon as you meet the
patient
– Set an atmosphere of trust and comfort.
– Convey calm, genuine concern.
• Obtaining information is a learned
skill
– Getting information can be difficult.
 • If patient is reluctant, explain why you need the information
– Remind them it is protected by law.
• If you can safely move a patient, do so
– For patients who cannot focus
• If a patient seems threatened:
– Approach cautiously.
– Use open posturing.
– Smile.
– Be calm.
– Reassure the patient.
– If possible, take things slowly.

• Tips for positive communication:

– Introduce yourself; get and use the patient’s name.
– Make and keep eye contact.
– Position yourself at or below patient’s level.
– Be honest.
– Use language the patient can understand.
– Be aware of your body language.
– Speak calmly/clearly.
– For patients with hearing deficits, ensure your lips are visible.
– Give the patient time to answer.
– Act confident and professional.

Even with the best techniques, communication may be difficult.

• Consider internal and external factors.
• Take good notes.

Modesty
- Behavior, manner, or
appearance intended to
avoud impropriety or
indecency
- Modesty matters.
o No matter how acute
the condition
o Especially for:
 Elderly
 Adolescents
 Children
- Even if patient is not
sensitive, family members will be.

Conducting an interview
• Two types of questions
– Open-ended, which allow:
 • The patient to give you feedback
• You to judge mentation
– Closed-ended
• Used to elicit specific answers
• Have a standard set of questions concerning medical history to
ask almost all patients.
– Avoid talking down to patients.
– Use terms people without medical training can understand.
• Know what to ask women of • Sample payoff questions include:
childbearing age. – Have you ever felt like this before?
• Most paramedics have additional – Have you been upset about anything
questions for patients in specific lately?
circumstances. – Are you afraid of someone?
– Called payoff questions • Do not use leading questions.

Strategies to elicit useful responses

• Reflection
• Repeat a word or phrase a patient used to encourage more detail.
• Empathy
• The ability to understand and accept another person’s reality, to
accurately perceive feelings, and to communicate understanding.
Example “It must be very frustrating to know what you want and
not be able to do it”
• Confrontation
• Make the patient aware that you know something is not “right” or
consistent without provoking them.
• Interpretation
• Vocalize what you think the patient said, and have him or her
correct you.
• Facilitation
• Encourage hesitant patients to provide more detail.
• Being quiet
• Time for the responder and client to observe one another, sort out
feelings, think of how to say things, and consider what has been
verbally communicated. Allow the client to break the silence.
• Clarification
• To check whether understanding is accurate, or to better
understand, the nurse restates an unclear or ambiguous message to
clarify the sender’s meaning. “I’m not sure I understand what you
mean by ‘sicker than usual’, what is different now?”
• Redirection
• Helps to keep communication goal-directed
• To get back on track
• Simplification and summarization
• Use when you receive a confusing/disorganized response.
Common interviewing errors

• Some errors can be considered “traps.”

– Never provide false assurance.
• “Don’t worry, everything will be all right.” .” When a patient is
reaching for understanding these phrases that are not based
on fact or based on reality can do more harm than good.
– Do not give advice.
• Giving advice takes away decision-making for the client.
Remember the problem and the solution belongs to the
patient and not the yours.
– Do not consider yourself an authority.
• You must not impose your own attitudes, values, beliefs, and
moral standards on others, while in the professional helping
role.
– Do not use avoidance language.
– Do not interrupt the patient or talk too much.
• It ends to block further communication, and seems to say that
you don’t really care about what they are sharing.

First impressions are important.

• Maintain a professional
demeanor/appearance.
• Be patient.
• Keep body language positive.
• Touch may provide comfort.
– Varies by patient
• Some situations require special
techniques.
– Remain nonjudgmental about your patients.
• Difficult patients are especially challenging.
– Consider why the patient is being difficult.
– Use patience, persistence, and persuasion.

General tips for caring for difficult patients

– Approach with caution; maintain eye contact.
– Introduce yourself; ask for the patient’s name.
– Use open-ended questions.
– Provide positive feedback.
– Make sure patient understands you.
– Continue to ask questions; rephrase if necessary.
People who are hostile
• Hostile or angry patients may present a threat.
– Approach with caution, maintaining eye contact.
– Try not to interview an angry patient alone.
• Have your partner stay a little farther back.
– Identify escape routes.
– Approach from the front, with hands visible/open.
– Ask permission to interact with the patient.
– Be wary for signs of impending attack.
– Be prepared to escape if necessary.

Sexually aggressive patients

• Follow your agency’s policies.
• Make sure someone else is always present.
• Communicate professionally and politely.
– Avoid sexually ambiguous words.
• Document your encounter meticulously.
– Get witness names and signatures on notes.

Special considerations of age

– Do not presume older patients are harder to communicate with
than anyone else.
• Illnesses may be more complex.
• May be differences in hearing, mobility, etc
– Children can be difficult patients.
• Practice skills to help improve these interactions
– With children:
• Maintain friendly eye contact.
• Smile
• Give calm, subdued, age-appropriate explanations.
• Minimize movements
• Lower your voice.
• Keep eye level at or below child’s.
• If possible, involve a parent with the care of a small child.
– For young children:
• Toys may be useful.
• Create a toy to connect with the child

– Adolescents:
• May not want their parents present
• An adult who insists on monitoring is disconcerting.
• Do not refuse, but inform ED physician.
• Offer options; honor their choices.
 • Modesty is especially important.

People who live with special challenges

• Family members and caregivers can
facilitate communication.
• Help patients access any devices to
aid communication or reduce fear.
– Touch and eye contact can
convey kindness or reassurance.
• Encountering patients with autism is
becoming more common.
– Autism is a PDD.
– PDD
• Pervasive Development Disorder
• This category is used to refer to children who have
significant problems with communication and play, and
some difficulty interacting with others, but are too social to
be considered autistic. It's sometimes referred to as a
milder form of autism.
• Patient may not be able to:
– Understand what you are saying
– Communicate nonverbally
• Children with autism who can speak may say things that have no
meaning or seem out of context.
• Caregivers are your best resource for communicating with patients
with PDDs.

Cross-cultural communication

Cross-cultural communication is a
field of study that looks at how people
from differing cultural backgrounds
communicate, in similar and different ways among themselves, and how
they endeavour to communicate across cultures.
Intercultural communication is a related field of study.

• You will interact with people of differing race, religion, gender, class,
and lifestyle.
– Always remain considerate and professional.
• Learn as much as you can about the languages and cultures of your
service area.
• Consider attending a cultural sensitivity or cultural diversity seminar.
– Be open to educating yourself.
• A patient’s views may differ from his or her family’s.
• Some cultures’ views about treatment may affect your care plan.
– Remain sensitive to the patient’s beliefs.
• Even if you disagree about the cause of the illness, the patient can still
accept treatment.
• Hand gestures can be
misunderstood.
– One gesture can have many
meanings.
• The most cross-cultural gesture is the
smile.
• – Use of
Examples it often!
body language that differ by culture:
– Touching the head – It is believed that the head is sacred
• Thailand, Laos
– Touching with the left hand – Left hand considered dirty
• Middle East
– Feet – Considered unclean and showing the heels considered
insulting
• Thailand, Laos
– Slouching – Sign of poor manners
• Germany, China
– Hands on hips - Arrogance
• Asian Country
– Nodding – Opposite meaning
• Bulgaria, Greece

SELF-CHECK 7.4-1

I. Identification. Identify the following (5pts)

1. _________________ A close and harmonious relationship with
people or groups.
 2. _________________ Defined as the face-to-face process of
interacting that focuses on advancing the physical and emotional
well-being of a patient.
3. _________________ Repeat a word or phrase a patient used to
encourage more detail.
4. _________________ Used when you receive a
confusing/disorganized response.
5. _________________ Encourage hesitant patients to provide more
detail.

II. Enumeration (15 pts)

1. Tips for caring for difficult patients
2. Tips with dealing with children
3. Tips for dealing with younger children

ANSWER KEY 7.4-1

Identification
1. Rapport
 2. Therapeutic technique
3. Reflection
4. Simplification and summarization
5. Facilitation

Enumeration
– Common uses of EMS Communication
- Call for resources
- Transfer care of the patient
- Interact within the team structure
- Communicate with other health care professionals
- Team communication and dynamics
– Tips for dealing with children
- Maintain friendly eye contact.
- Smile
- Give calm, subdued, age-appropriate explanations.
- Minimize movements
- Lower your voice.
- Keep eye level at or below child’s.
- If possible, involve a parent with the care of a small
child.
– Tips for dealing with younger children
- Toys may be useful.
- Create a toy to connect with the child

Learning Outcome 5 – COMPLETE REPORTS AS REQUIRED

Learning Activities Special Instructions
Read Information Sheet 7.5-1 Read and understand the
on information about the content. If
Organization hierarchy and you can’t understand the
standard operating procedures information, ask you facilitator
on reporting

Answer Self-Check 7.5.1 Compare answers with the

answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.
After doing all activities of this
LO, you are ready to proceed to
the next LO on
PRESENT A POSITIVE IMAGE OF
THE SERVICE TO THE PUBLIC

Information Sheet 7.5-1

Complete reports as required

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Complete reports as required to the standard expected in the workplace.
2. Complete reports correctly within identified time frames.
3. Prepare clear and accurate reports on time as required.

Your reporting responsibilities do not end when you arrive at the hospital.
An accurate record of the care provided in the field can play a critical role in
the subsequent treatment of patients in an Emergency Department (ED),
trauma center or other receiving facility. An effective EMS chart informs
subsequent caregivers of the patient's presenting signs and symptoms, the
caregiver's assessment of the patient's condition, attempted EMS
interventions, successful EMS interventions and the patient's response to
those interventions.

This unit provides information regarding standard operating procedures

on reporting and its significance.

• 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

When reporting patient information

– Patient’s age and sex
– Patient’s chief complaint
– A brief, pertinent history of present problem
– Other medical history relative to current situation
– Patient’s level of consciousness/ degree of distress
– Patient’s mental status
– Patient’s vital signs
– Physical findings in head-to-toe order
– ECG findings
– Treatment given so far and response
– Estimated time of arrival

Disorganized and incomplete communication is inefficient and

causes frustration.

To avoid ineffective dialogues:

– Gather and organize your information before reporting to
physician.
– Write reporting format on a card for reference.
– Continue to assess patient and report changes.

You will exchange information with many people.

• Especially your partner

Use terminology understood by the people you are communicating

with.
• Avoid slang.

Ambulance run report

– function's as a legal and billing document, a unit of database for
emergency medical service system quality improvement and
community resources allocation
Medical terminology
– Use it correctly.
– Learn established terms and abbreviations.
– Review anatomy and physiology and documentation chapters.

In-person report
– Be mindful of information relayed in front of patient.
• You may want to step away.
– Be brief.
– Share information not given on radio.
– Ensure continuity of care.

Patient Care Report (PCR)

- Also known as prehospital care report
- Legal document
- Records all care from dispatch to hospital arrival

Six Functions of PCR

- Continuity of care
- Legal documentation
- Education
- Administrative information
- Essential research record
- Evaluation and continuous quality improvement

Essential information collected on the PCR

- Chief complaint
- Level of consciousness or mental status
- Vital signs
- Initial assessment
- Patient demographics

Types of PCR Forms

a. Traditional written form with:

 Check boxes
  Narrative section

b. Computerized version
The narrative section of the PCR may be the most important. It includes:
- Time of events
- Assessment findings
- Emergency medical care provided
- Changes in patient after treatment
- Observations at the scene
- Final patient disposition
- Refusal of care
- Staff person who continued care

RECORD KEEPING

EMS SERVICE REPORT

1. A detailed service report must be completed and submitted into the
data collection system for each request for emergency medical
service. This report must include all data elements required by the
State.
2. Incidents that require a detailed run report include, but are not
limited to:
a. EMS incidents
b. Standbys
c. Mutual aid
d. Canceled runs (if the unit clears the station)
e. Refusal of service.

SERVICE RECORDS
3. All ambulance and medical rescue services are required to maintain
accurate and separate records of its services, including but not
limited to:
a. Driver records including current licenses, history of DOT
physical examinations or physician certifications, and
emergency vehicle operator training history;
b. EMS personnel licensure;
 c. Statement of employment or volunteer status, including
employment start and stop dates;
d. Records of equipment, such as reports, repair and
maintenance records, equipment lists, vehicle titles, and
registration certificates;
e. Complete accounts;
f. Organized records of all ambulance runs, including copy of the
patient care record.

REFUSAL OF SERVICE
4. A refusal form must be completed for all patients that are potentially
in need of emergency care, but refuse treatment and/or transport.

• 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.

The “Hand-Off”
– or transfer of
patient care from prehospital providers to emergency
department (ED) physicians, trauma surgeons or critical care
 physicians—represents one of the most important elements of
successful care for patients with serious injuries or illnesses
– involve the transfer of rights, duties and obligations from one
– person or team to another

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

Pnemonic for Hand-off Report

E: Events prior/why EMS was called

“We were called to the scene of this 72-year old woman who presented with
the chief complaint of left-sided weakness and slurred speech.”
S: Subjective Findings
“Her husband noticed that her speech was slurred and that she appeared to
have facial weakness. Over the next 30 minutes, she subsequently
developed left-sided weakness and was unable to stand on her own.”
T: Triage/time
“We transported her as a priority 1 patient under the suspected stroke
protocol;”
“Her husband noticed that the symptoms started at approximately 8:30 this
morning.”
A: Allergies/assessment
“She has a rash with penicillin and amoxicillin;”
“On exam, she was found to have left sided-weakness, 3/5 strength in the
left upper and lower extremities and slurred speech;”
“She has a past medical history significant for coronary artery disease, stable
angina, osteoarthritis and type I diabetes.”
T: Treatment
“En route, she was provided with oxygen by face mask at 10 Liters per
minute. Her symptoms didn’t improve en route.”
SELF-CHECK 7.5-1

I. Identification. Identify the following (5pts)

1. _________________ The transfer of rights, duties and obligations
from one person or team to another.
2. _________________ Also known as pre-hospital care report.
3. _________________Must be completed for all patients that are
potentially in need of emergency care, but refuse treatment
and/or transport.
4. _________________ function's as a legal and billing document, a
unit of database for emergency medical service system quality
improvement and community resources allocation.
5. _________________pnemonics for hand off report

II. Enumeration (15 pts)

1. Included in the narrative section of PCR
2. Types of PCR form
ANSWER KEY 7.5-1

Identification
1. Hand-off
2. PCR (Patient Care Report)
3. Patient Refusal Form
4. Ambulance run report
5. ESTAT

Enumeration
– Included in the narrative section of PCR
– Time of events
– Assessment findings
– Emergency medical care provided
– Changes in patient after treatment
– Observations at the scene
– Final patient disposition
– Refusal of care
– Staff person who continued care
– Types of PCR forms
- Computerized version
- Traditional written form
 Learning Outcome 6 – PRESENT A POSITIVE IMAGE OF THE SERVICE
TO THE PUBLIC
Learning Activities Special Instructions
Read Information Sheet 7.6-1 Read and understand the
on information about the content. If
Communication and you can’t understand the
interpersonal skills information, ask you facilitator
Answer Self-Check 7.6-1 Compare answers with the
answer key. You are required to
get all answers correct. If not, read
the information sheets again to
answer all questions correctly.

Participate in the discussion

on Communication and
interpersonal skills
After doing all activities of this
LO, you are ready to proceed
to the next MODULE on
CONTRIBUTE IN ON-ROAD
OPERATIONS

Information Sheet 7.6-1

Present a positive image of the service to the public

Learning Objectives:
After reading this INFORMATION SHEET, YOU MUST be able to:
1. Communicate with the public in a courteous manner and respecting
privacy
2. Present self in public according to agency standards of personal
presentation

Over the past 20 years, the field of prehospital medicine has undergone
impressive growth. As the body of knowledge continues to grow, as more
technology is introduced, and as research defines and refines the uniqueness
of prehospital emergency medical care, the challenges of the prehospital
setting are becoming more than operational and medical. Efficient response,
appropriate care, and safe, expeditious transport are the expectant
fundamental components of prehospital care. However, more and more
prehospital providers are facing challenging ethical dilemmas. The
prehospital provider must frequently interact and negotiate with reluctant
patients, counsel those patients who ask for advice or refuse care, address
requests for limitation of resuscitation, assume some degree of personal risk
in the care of agitated, uncooperative, or infectious patients, deal with social
and psychiatric challenges, and respond to a variety of unusual requests
which may not be medical in nature. Each of these situations presents
potential ethical conflicts.

In this unit, you will learn about ethics in communicaton and interpersonal
skills.
Ethics
- is the study of the distinction between right and wrong.
Who creates ethical standards?
– Professional groups and societies.
 National Association of Emergency Medical Technicians (NAEMT).
 World Medical Association (WMA).
– Laws and Treaties.
 Declaration of Geneva, 1948.
 Convention on Human Rights and Biomedicine, 1997.
• The Oath of Geneva • The Code of Ethics for EMS
• Drafted in 1948 by the World Practitioners
Medical Association. • Issued by the National
• Taken by Medical Students Association of Emergency
upon graduation from Medical Technicians.
Medical School. • Applies to all EMS Personnel.

• Apply three basic ethical concepts to the practice of

medicine:
• Do no harm.
• Act in good faith.
• Act in the patient’s best interest.
• Professional EMS Ethics require:
• A total commitment to act in the best interest of the
patient.
• Conduct yourself in a professional and ethical
manner at all times.

Scope of practice
• Care an EMS provider may perform according to:
• Licensure / Certification / Credentialing
• State Protocols
• Online / Offline Medical Control
 • Recognized training
Standard of care
• The degree of care, skill, and judgment expected under similar
circumstances by a similarly trained provider in the same
community.
• Did you do the right thing?
• Did you do it the right way?

Standard of Practice vs Standard of care

• Scope of Practice – What you can do.
• Standard of care – How you should do it.

Patient Autonomy
• A patient has the right to direct their own care.
• EMS Providers must respect and honor the patient’s rights.
• This includes:
• Consent of Treatment
• Refusal of Care

• Types of consent:
• Informed Consent - Required from every adult with
decision making capacity.
• Describe the problem and proposed treatment.
• Discuss the risks and alternatives.
• Advise the patient of consequences of refusal.
• Expressed Consent – Patient approves the treatment or
procedures.
• Implied Consent – The patient is unable to provide
expressed consent so implied consent is assumed.
• Unconscious / Unresponsive patient
• Altered mental status
• Minor - In Loco Parentis

• Transportation Decisions
• The patient has the right to be transported to a facility of their
choice, within reason, in accordance with existing Protocols.
• Refusals
• Must be informed.
• If Against Medical Advise – consider contacting Medical Control
and using “people skills”
• You are still the patient’s advocate.
• Do not judge any patient refusing care based on their personal
beliefs.
• Document!
 • Minors (Under 18 years of age)
• Generally need parental / guardian consent to treat.
• In Loco Parentis – assumes implied consent.
• Emancipation – gives minors the right to express consent.
• Emancipation in Maryland occurs by declaration of the
court when a minor:
• Marries
• Joins the Armed Forces
• Demonstrates they are supporting themselves and
living independently
• Emancipation is unlikely to occur unless the minor is 16
years of age.
• Emancipation requirements vary from state to state.

• Express Consent and Refusal may also be expressed by:

• Living Wills
• Advanced Directives
• Healthcare Power of Attorney
• Do Not Resuscitate (DNR) Orders
• Medical Orders for Life Sustaining Treatment (MOLST) Orders

SELF-CHECK 7.6-1

I. Identification. Identify the following (5pts)

1. _________________ complete words of DNR orders
2. _________________ gives minors the right to express consent
3. _________________ A patient has the right to direct his own care
4. _________________ Is the study of the distinction between right and
wrong.
5. _________________ assumes implied consent.

II. Enumeration (10 pts)

1. Express Consent and Refusal may also be expressed by
2. Application of implied consent
3. Tips for dealing with younger children
ANSWER KEY 7.6-1

Identification
1. Do not rescucitate
2. Emancipation
3. Patient autonomy
4. Ethics
5. In Loco Parentis

Enumeration
– Express Consent and Refusal may also be expressed by
- Living Wills
- Advanced Directives
- Healthcare Power of Attorney
- Do Not Resuscitate (DNR) Orders
- Medical Orders for Life Sustaining Treatment (MOLST)
Orders
– Application if implied consent
- Unconscious / Unresponsive patient
- Altered mental status
- Minor - In Loco Parentis
– Patients’ rights
- Consent of Treatment
- Refusal of Care