Radio for Ambulance Service
The emergency medical communications network has been called the backbone of an emergency medical services (EMS) system. Its implementation ties together the various elements of the total EMS system, and its use requires interagency cooperation and coordination. Designing a communications system before an area emergency medical services plan has been developed can only result in a system that is either too costly, overequipped, or improperly designed to meet the actual emergency medical services needs of a community.
An affirmative answer to the question, “Is there an emergency services plan for the area to be served?” is a prerequisite to any discussion of emergency medical communications. Although various local groups may develop an emergency medical services plan, it is desirable that an area plan be designed under the auspices of an areawide comprehensive health planning agency with both professional and consumer input. Planning on an area basis allows for more effective utilization of limited medical resources and assures interjurisdictional determination and support on such matters as categorization of hospital facilities, ambulance service districts, command and control, financing, and training. Determining the level of sophistication of an emergency medical communications setup becomes a part of the planning process for the area’s emergency medical services system. As a minimum, answers to the following questions should be determined:
How will ambulances be dispatched?
Will there be a central dispatch for the total area to be serviced. If not, will individual hospitals dispatch ambulances?
Will the dispatch function be added to that of another public safety agency, such as police or fire service?
Will there be an emergency operating center for all emergency functions?
Will the ambulances be equipped to provide pre-hospital coronary care capability? If so, where will the fixed coronary care terminal or terminals be?
Does the hospital or hospitals with the fixed terminal(s) have adequate staff to provide a round-the-clock response to telemetered data?
Will provision be made for ambulance attendants to have the capability to talk by radio to hospital emergency departments, to central dispatch, to other ambulances, to physicians outside the emergency department, or to police, fire, or other civil units?
Who is going to provide the emergency medical transportation service?
To what extent will the fire department, police department, volunteer squads, and private enterprise be involved in the service?
Where will the ambulances be based?
Will the public be able to dial “911” toll free from anywhere in the area?
Will the public be educated to call a police or fire dispatcher, a hospital, or “911”?
Good management principles insist upon effective utilization of existing resources. Applying those principles to an emergency medical communications system requires interagency cooperation and multi-agency use of facilities, manpower, and other resources. One way of bringing about this coordination is through the establishment of an emergency operating center (EOC) which incorporates sharing and integration of services. A command post for emergency medical services exclusive of other emergency services required during major emergencies or disasters is economically unsound for most communities. And separate command posts for various public safety and service agencies make coordination difficult. By placing day-to-day command control functions for police, fire, rescue, and public works together in an emergency operating center, it is possible to overcome most of the coordination problems which arise during a major emergency or disaster. The importance of embedding the normal emergency medical services system in that which is planned for disaster response cannot be overemphasized. This approach assures a working system which needs only augmentation as necessary or possible to provide disaster response to the limit of its capabilities.
The following recommendation was made at the National Symposium on the Development of a System for Emergency Medical Services held in Philadelphia in 1972: “In general, it is not necessary to create a new communications system for medical purposes; instead the public, including the police and fire services, should join in integrating emergency medical communications within the community’s overall emergency response capability.”
The communications requirements for emergency medical care are similar where there is a single case of sudden illness or injury or a disaster involving large numbers of victims. After the emergency medical services system has been defined in terms of what services are to be provided as well as how these services are to be provided, functional communications system requirements may be determined.
The normal emergency medical services cycle consists of the following functions or stages:
- Incident—The occurrence which generates the need for emergency services. Patient(s) with acute illness or injury.
- Detection—The action which determines that the incident took place.
- Notification—The action which informs the emergency resource control agency where and when the incident took place and the nature of the incident.
- Dispatch—The act which orders emergency resources to the scene of the incident.
- Closure—The process which transports emergency resources to the scene of the incident.
- Action—The necessary acts which correct or alleviate conditions generated by the incident, including both immediate care and transport to a medical facility.
- Return to station—The return of all emergency resources to a state of readiness for a new cycle.
Once the incident is detected, communications are necessary complements to each successive stage of the emergency medical service cycle. For highway accidents notification is usually made by patrolling law enforcement vehicles, ambulatory surviving victims, or the casual passerby. The State of Nebraska has organized a voluntary highway accident surveillance system composed of state and county radio-equipped vehicles; department of roads vehicles; vehicles which operate in rural areas on a regular schedule such as R.F.D. mailmen, milkmen, milk tank trucks, bakery trucks, etc.; and citizen’s band volunteer groups. Some exploration has been made into the design of an automatic electronic alarm system built into vehicles which would alert appropriate authorities that an incident had occurred which might require aid. However, such a system does not appear to be imminent at this time. For the victim of a heart attack or other sudden illness, emphasis has been placed on early detection followed by immediate communication with the appropriate authority. In order to reduce the interval between the incident and initiation of definitive care, some communities have conducted educational programs aimed at alerting the public to symptoms that might be indicative of a heart attack.
Reducing the time between detection and notification has been given great impetus through the establishment of the universal emergency telephone number 911. From its inception in January 1968 until June 1972, approximately 230 communities have adopted the 911 system. Although the installation of this system may require considerable effort, the cost is usually nominal. The local telephone company is available to assist in planning the system for the individual community.
Communication needs during dispatch require channels by which the ambulance crew can be notified to proceed to the scene of the emergency. Dispatch can normally be made by telephone to reduce the radio air time. However, this does not eliminate the requirement for radio communications between the ambulance and the dispatcher. ‘Two-way radio communication is necessary during the closure and action stages. This permits the dispatch to supply supplemental information to the crew of the emergency vehicle and enables the crew to request assistance as needed.
Two-way radio communication between ambulance and hospital is necessary during the action stage of the cycle if optimum emergency medical care is to be provided. The voice channel to the emergency room from the scene of the incident enables the emergency medical technician at the ambulance to request advice to aid in stabilizing the condition of the casualty prior to transport. Communities should consider equipping ambulances with portable communication units for use where victims are beyond the point where the ambulance can travel. Ideally the portable unit should tie into the vehicle’s communications system so that the vehicle system can function as a relay station. The need for two-way radio communication between hospital emergency room and the emergency medical technician in the ambulance is important for the care of casualties during transport to the medical facility. It also permits the ambulance crew to advise the treatment facility of the patient’s condition, special requirements, estimated time of arrival, and other pertinent information.
The need for prompt communication continues into the return-tostation stage so that the dispatching center knows immediately when an ambulance is ready to begin a new cycle.
The use of two-way radio equipment is by no means limited to the dispatching center-ambulance-emergency department relationship. Other advantages provide:
The only operable communications system when the local telephone network is severely damaged, or overloaded during a major disaster;
The fastest mechanism for coordinating emergency medical activities with other disaster services in the community;
Rapid intercommunication among hospitals about the distribution of casualty loads;
Effective alerting of medical manpower’ to report to meet emergency needs.
Emergency medical technicians should be trained to use emergency medical communications equipment. If the system is to provide biomedical telemetry, then the technician must be trained in its use. If the emergency medical technician is not legally authorized to administer drugs and to defibrillate heart attack victims, then training in the use of the telemetry equipment would serve little purpose.
Ambulance dispatchers should have the same training as the personnel on the ambulance. The dispatcher needs this training in order to determine the true emergency medical needs of the victims and to function more intelligently with the ambulance personnel at the scene.
Training in the use of the communication equipment may be made part of the general curriculum emergency medical care or given separately. In many instances, police or fire departments can help arrange for the instruction of emergency medical technicians in the operation of communications equipment.
Adapted from HEW Publication No. (HSM) 73-2003, “Emergency Medical Services Communications, ” published by the U.S. Department of Health, Education, and Welfare, Health Services and Mental Health Administration, Division ot Emergency Health Services, 5600 Fishers Lane, Rockville, Md. 20852.