Accident · casualty · Education · first responder · paramedic · police · Trauma ·

Casualty Communication: A Critical Skill for First Responders

These show emergency responders attending to a patient on a yellow tarp or emergency blanket on grassy ground. Image 5 features the text "TACMED AUSTRALIA CASUALTY COMMUNICATION" overlaid on the scene.

Beyond your standard first responder kit, your most powerful tool in a crisis might be something you use every day—your voice. As first responders, we train extensively on tourniquets, wound packing, and airway management—but the way we communicate during these high-stress moments can be just as crucial for successful patient outcomes and scene safety. This blog post explores practical techniques for communicating with casualties when seconds count and conditions are far from ideal.

The Importance of Casualty Communication

Effective communication with casualties isn't just a nice-to-have skill—it's backed by research and real-world outcomes. Here's why it matters:

Calms and Connects

When you introduce yourself clearly and speak with confidence, you're not just exchanging pleasantries; you're establishing a relationship with your patient that primes them to trust you in what is most likely the scariest moment of their life.

As McCabe (2004) notes in her research, a patient-centred approach to communication significantly impacts the quality of care patients receive. Establishing this connection through proper communication techniques helps patients feel more secure during traumatic experiences.

Reveals Hidden Risks

Effective communication uncovers what your initial assessment might miss. Harmsen et al. (2017) conducted a Delphi study that highlighted the importance of communication in the identification of severely injured patients and proper handover. A conscious casualty who can communicate is an essential diagnostic tool—if you know what to ask and how to listen. The right questions, asked at the right time, can alert you to developing problems that weren't immediately apparent during primary assessment.

Two emergency responders wearing hard hats (one with "EMERGENCY 506" marking) are working closely together in what seems to be a tight space, possibly providing medical care or communication during an emergency response.

Boosts Compliance

Even the most medically sound intervention fails if the casualty resists treatment. Research by Deveugele (2015) emphasises that the relationship between doctor and patient significantly influences outcomes and compliance. This is especially important when applying tourniquets, performing needle decompressions, or initiating other painful lifesaving interventions. Casualties who understand what you're doing and why you're doing it are more likely to remain still, follow instructions, and actively participate in their own care.

Keeps You Sharp

High-stress environments tax cognitive resources severely. Sedlár (2020) reviewed cognitive skills of EMS crew members and found that situation awareness and decision making are critical for effective and safe performance. Formalised communication isn't just for the casualty's benefit—it provides responders with mental frameworks that conserve cognitive bandwidth when it matters most. With rehearsed communication templates in your toolkit, your cognitive resources remain available for critical medical decision-making rather than figuring out what to say next.

Secures the Scene

Scene safety begins and ends with communication. Harmsen et al. (2016) found that prehospital communication with Emergency Medical Services is often carried out in hectic situations. Clear, authoritative direction to casualties about movement, positioning, and potential hazards transforms them from potential risks into scene safety allies. In tactical or multi-casualty scenarios, a well-communicated plan prevents casualties from endangering themselves and others while allowing responders to maintain situational awareness.

An emergency responder in safety gear (helmet, high-visibility vest) is positioned in what appears to be a confined space or mine shaft, sitting against a rocky wall with equipment nearby.

The CLEAR Communication Technique

Drawing from both Tactical Emergency Casualty Care principles and frontline experience, the CLEAR Method offers a systematic communication approach that performs under pressure.

Step-by-Step Technique

C - Command Attention

  • Kneel at eye level if safe
  • Speak loud but calm
  • Say: "I'm a medic, I'll help you."
  • Touch a shoulder gently
  • Block gory sights with your body

L - Language Simplification

  • Use short sentences
  • Skip jargon: "I'll stop the bleeding," not "haemostatic agents"
  • Repeat key information

E - Expectation Setting

  • Say what's coming: "I'll check your chest"
  • Warn of pain: "This will hurt, but it will save you"
  • Describe feelings: "You might feel cold, that's normal"
  • Set timing: "30 seconds and done"

A - Active Listening

  • Ask simple yes/no questions: "Can you breathe?"
  • Watch for non-verbal cues
  • Acknowledge emotions: "I know you're scared"
  • Pause for answers

R - Reassess and Reassure

  • Update: "Bleeding's slowing now"
  • Provide encouragement: "You're doing great"
  • Continue communication even with unconscious patients
  • Adjust as they react

Special Communication Scenarios

Not every casualty fits the script. Here's how to adjust:

Noise Barriers

In high-noise environments like helicopter operations, industrial accidents, or chaotic mass casualty incidents, verbal communication can be difficult. Position yourself within the casualty's line of sight and use exaggerated mouth movements combined with universal hand signals—pointing to injuries, mimicking breathing, or indicating direction of movement.

Direct physical contact becomes crucial; maintain hand contact with the casualty's shoulder or arm to provide reassurance and a communication channel when auditory options fail. For critical information, bring your mouth directly to the casualty's ear, using simple, loud phrases with keywords repeated. 

Emergency responders with blue gloves are treating a person lying on the ground in what appears to be a confined space with red lighting. Medical supplies are visible nearby.

Paediatric Casualties

Children process information differently under stress, requiring specific communication adjustments. Ayub et al. (2016) found that providing emotional support and effective communication are important components in delivering patient and family-centred care in the prehospital setting. Physically position yourself at the child's eye level—kneeling rather than towering over them. Frame medical equipment and procedures in terms children understand: "This is a special sticker that tells me your temperature" or "This bandage has super-strong powers to stop bleeding."

A medical professional wearing gloves is administering oxygen to a young patient wearing an oxygen mask. The patient appears to be sitting in a vehicle while receiving care, with emergency personnel visible.

Language Barriers

Linguistic differences create significant challenges in emergency settings. When working through interpreters (human or tech), it's still important to maintain eye contact with your patient. Forsey et al. (2021) identified that clear and explicit language is a dominant conceptual grouping in effective physician-patient communication. These days we have the luxury of carrying a translator in our pockets, so don't forget to utilise your smartphone to bridge communication gaps.

A group of first responders, illuminated by a headlamp, provide emergency medical care to an injured person wearing a high-visibility vest. The scene is intense, with responders focused on treating the patient in a dark, high-stress environment, showcasing TacMed Australia's training and equipment in action.

Psychological First Aid

Effective communication serves as psychological first aid during the critical first minutes after injury. As Cook et al. (2020) noted, "We have an imperative to improve the communication for all patients" Use the casualty's name repeatedly to help combat dissociation common in trauma. Normalise physiological responses with simple explanations: "Feeling dizzy is normal after losing blood—your body is working hard to protect you."

Provide frequent orientation information, even to apparently alert casualties: "It's Tuesday afternoon, you're at Main Street, paramedics are helping you." Assign achievable tasks that give casualties a sense of control and purpose: "Focus on taking slow breaths with me" or "Can you wiggle your fingers when I count to three?" 

Two responders wearing gloves apply pressure to a simulated injury on a training mannequin, with fake blood visible on the mannequin's clothing. The TacMed Australia logo is displayed in the top left corner, highlighting their high-fidelity trauma trainers used for realistic first responder training.

Summary

Effective communication with casualties isn't just about bedside manner—it's a critical lifesaving skill backed by research. The CLEAR Method (Command Attention, Language Simplification, Expectation Setting, Active Listening, Reassess and Reassure) provides a structured approach that works even in high-stress environments. By establishing trust, uncovering hidden issues, boosting compliance, preserving cognitive resources, and enhancing scene safety, proper casualty communication can be as vital as any physical intervention. Remember: in a crisis, your voice may be the most powerful tool in your trauma kit.

Connect With Us

Your experiences matter. Have you used these communication techniques in high-stress scenarios? We'd love to hear how you made an impact. Share your experience with us on Facebook, Instagram, or LinkedIn @TacMedAustralia—your insights help us all improve.

Need advice on selecting the right trauma gear for your role? Reach out to us via phone 1300-862-633 or email info@tacmedaustralia.com.au and stay in touch on socials @tacmedaustralia.

Stay safe,

Team TacMed


References

  1. ANZCOR Guideline 9.1.1 - First Aid for Management of Bleeding - Available at: https://resus.org.au/guidelines/
  2. Tactical Emergency Casualty Care (TECC) (2023) - Guidelines. Available at: https://www.c-tecc.org/
  3. Waldrop DP, Clemency B, Lindstrom HA, Clemency Cordes C. "We Are Strangers Walking Into Their Life-Changing Event": How Prehospital Providers Manage Emergency Calls at the End of Life. J Pain Symptom Manage. 2015 Sep;50(3):328-34. doi: 10.1016/j.jpainsymman.2015.03.001. Epub 2015 Mar 28. PMID: 25828561. https://pubmed.ncbi.nlm.nih.gov/25828561/
  4. McCabe C. Nurse-patient communication: an exploration of patients' experiences. J Clin Nurs. 2004 Jan;13(1):41-9. doi: 10.1111/j.1365-2702.2004.00817.x. PMID: 14687292. https://pubmed.ncbi.nlm.nih.gov/14687292/
  5. Harmsen AMK, Geeraedts LMG Jr, Giannakopoulos GF, Terra M, Christiaans HMT, Mokkink LB, Bloemers FW. National consensus on communication in prehospital trauma care, the DENIM study. Scand J Trauma Resusc Emerg Med. 2017 Jul 11;25(1):67. doi: 10.1186/s13049-017-0414-9. PMID: 28693524; PMCID: PMC5504644. https://pubmed.ncbi.nlm.nih.gov/28693524/
  6. Deveugele M. Communication training: Skills and beyond. Patient Educ Couns. 2015 Oct;98(10):1287-91. doi: 10.1016/j.pec.2015.08.011. Epub 2015 Aug 11. PMID: 26298220. https://pubmed.ncbi.nlm.nih.gov/26298220/
  7. Sedlár M. Cognitive skills of emergency medical services crew members: a literature review. BMC Emerg Med. 2020 May 29;20(1):44. doi: 10.1186/s12873-020-00330-1. PMID: 32471352; PMCID: PMC7257132. https://pubmed.ncbi.nlm.nih.gov/32471352/
  8. Harmsen AM, Giannakopoulos G, Franschman G, Christiaans H, Bloemers F. Limitations in Prehospital Communication Between Trauma Helicopter, Ambulance Services, and Dispatch Centers. J Emerg Med. 2017 Apr;52(4):504-512. doi: 10.1016/j.jemermed.2016.11.010. Epub 2016 Dec 18. PMID: 27998633. https://pubmed.ncbi.nlm.nih.gov/27998633/
  9. Ayub EM, Sampayo EM, Shah MI, Doughty CB. Prehospital Providers' Perceptions on Providing Patient and Family Centered Care. Prehosp Emerg Care. 2017 Mar-Apr;21(2):233-241. doi: 10.1080/10903127.2016.1241326. Epub 2016 Nov 18. PMID: 27858502. https://pubmed.ncbi.nlm.nih.gov/27858502/
  10. Forsey J, Ng S, Rowland P, Freeman R, Li C, Woods NN. The Basic Science of Patient-Physician Communication: A Critical Scoping Review. Acad Med. 2021 Nov 1;96(11S):S109-S118. doi: 10.1097/ACM.0000000000004323. PMID: 34348382. https://pubmed.ncbi.nlm.nih.gov/34348382/
  11. Cook M, Zonies D, Brasel K. Prioritizing Communication in the Provision of Palliative Care for the Trauma Patient. Curr Trauma Rep. 2020;6(4):183-193. doi: 10.1007/s40719-020-00201-x. Epub 2020 Oct 29. PMID: 33145148; PMCID: PMC7595000. https://pubmed.ncbi.nlm.nih.gov/33145148/

 

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