On February 22, 2012, the law authorizing FirstNet was enacted. FirstNet is tasked with building a nationwide public-safety broadband network, which will give first responders—now dependent on land mobile radio (LMR) systems—a data communications technology dedicated to public safety. Once in place, it will change EMS operations as markedly as did the introduction of advanced life support in the 1960s.
In EMS, we still depend on narrowband communications (such as VHF/UHF, 700/800 MHz voice systems). These are fine for voice communications, but they can't send text, pictures, video and other data fast enough to be useful. FirstNet's broadband network will do just that.
Paramedic services now send patient data and a few use video and other data-sharing apps via commercial or unlicensed broadband networks. But because these networks don't have a public-safety grade of reliability or priority access for EMS, among other issues, they aren't adequate for patient/mission-critical communications.
FirstNet, as a nationwide, interoperable data communications network for public safety, will provide that level of reliability and priority access. Its technology, LTE, however, doesn't yet support voice communication, direct communication between devices without going through a network, or push-to-talk. So, we must maintain LMR systems for patient/mission-critical voice communications for now.
Over the past several years, EMS expert panels and focus groups have identified four overarching communications needs, as well as dozens of apps that will improve patient care. The needs are:
- Situational awareness – real-time knowledge of resources and events affecting a call
- Common operating picture – all players, such as medics, extrication staff, flight crews and medical control, have the same expectations of next steps in a call
- Parallel processing of information from many sources instead of sequential processing through one or two sources, such as dispatch and medical control
- Ability to wirelessly support medical-technology devices, such as remotely interpreting an image sent from the field so medics don't need to be trained to do so
How would such apps work for EMS? Consider an example of a crashed car in a rural setting.
Today it may take 20 minutes or more to discover that a crash has occurred, another 20 minutes or more for an ambulance to arrive and determine overall crash severity and several minutes per patient to further determine the severity of injuries and communicate this to other responders and medical control. Add the time required for extrication and getting a helicopter to the scene and then to a trauma center, and the golden hour is jeopardized.
Advanced automatic crash notification (AACN) such as On-Star, automatic response protocols based on AACN prediction of severe injury in a crash and appropriate data communications through FirstNet and NG9-1-1 will change this picture dramatically.
A burst of data from the crashed car can, in seconds, simultaneously appear on the devices of responder and hospital staff who are on duty for crashes of that magnitude in that response area. At the same time, the first responder EMS and ambulance crews, extrication crews, medical helicopter, trauma center and local hospital teams are alerted and react according to protocol. Their device screens show the who/what/when/where/why status of the cars, vehicle occupants and those alerted.
The medic of the first ambulance on scene initiates head-worn streaming video and transmits it into patient database #1 (PDB1) while simultaneously starting a throat-mike voice-to-text app and dictating his car and patient findings and actions into PDB2. Using a standoff vital-signs monitor, he determines both patients involved are alive, but one has life-threatening vitals.
To the severely injured patient, he attaches a multi-vital signs mini-monitor and begins sending data to PDB3. Using the patient's health ID number, sent to a regional medical record repository, he transmits the patient's emergency health record into PDB4. Within 60 seconds or so, all four patient databases are populated and can be accessed by incoming responders or medical-control personnel.
The second patient has vague abdominal complaints with no visible injury or other issues. Medics use portable ultrasound and transmit the signal to trauma center personnel. Ruling out internal bleeding, they send the patient to the local hospital for further exam while the first patient is sent by medical helicopter to the trauma center.
The result: 40 minutes deducted from the golden hour, one patient sent efficiently to life-saving care and a second patient spared tens of thousands of dollars in unnecessary service.
That is what FirstNet can enable EMS to do. And the apps keep coming!