Talk to You Tomorrow
Kevin McGinnis began studying EMS systems in 1974, and has been a self-described "system builder" ever since. He earned undergraduate and graduate degrees from Brown and Cornell in healthcare delivery systems and hospital administration, and has held EMT, EMT-I and Paramedic licenses in New York and Maine. He has been a regional EMS coordinator, a hospital emergency department director and Maine's state EMS director from 1986–96 (also serving as interim state E9-1-1 director for a year during that time). McGinnis was the principal investigator/primary author of the Rural and Frontier EMS Agenda for the Future, has served NHTSA as a member of state EMS system technical assistance teams for five statewide evaluations and, for the past three years, has been a program advisor for the National Association of State EMS Officials. I recently spoke with Kevin regarding communications issues in EMS and some of the new technology impacting EMS systems.
Can you explain the concept of Radio over Internet Protocol (RoIP) and its potential impact on EMS?
RoIP establishes IP-based connections between existing radio and other communications systems (e.g., private branch exchange, landline and cell phones; data systems). Using wireless equipment such as microwave systems, fiberoptic lines, routers and servers connecting radio and other system base stations, as well as IP standards-based software solutions, previously noninteroperable systems can be made to work together without completely replacing radio systems or changing the frequencies being used. A good example is the Clallam County (WA) Olympic Public Safety Communications Alliance Network (OPSCAN). It connects radio base stations among local, state and federal public safety radio users in a redundant microwave/fiberoptic loop, making them interoperable without purchasing new radios.
In essence this is simply an alternative carrier system for communications that enables the output of one radio system to be translated and received and understood by the users of another communications system. This requires a dedicated IP, closed-carrier system between base stations. This is still thought to be much less expensive and disruptive than replacing radio systems. Importantly, because radio systems don't change, it is interoperability that's largely invisible to the user. It also provides dispatchers and radio system managers the ability to create permanent and ad hoc talk groups among users using disparate communications systems.
The importance for EMS will be in allowing greater interoperability among responders and, therefore, greater situational awareness individually and more of a common operating picture.
A recent report presented to Congress by the Joint Advisory Committee on Communications Capabilities of Emergency Medical and Public Health Care Facilities, of which you were a member, reviewed what is needed to solve communications issues for EMS providers. Can you summarize the most important points?
The future of EMS communications lies in augmenting voice communications, which will otherwise become a bottleneck between busy medics and doctors and others for the sharing of detailed patient information coming from the increasingly sophisticated diagnostic technology we will employ with broadband-supported data communications.
To do this we need to establish EMS resource and event monitoring systems (EMSREMS) in our response areas. These are databases accessed using a communications device such as a PDA, mobile data unit or desktop computer. Some databases would have information about resources (e.g., real-time data about the status of an ambulance, ED or cath lab). Others would have real-time information on events that impact the user (e.g., other EMS calls in the vicinity, DOT-based routing reflecting current roadwork, patient SOAP notes in a voice-to-text translated format, patient status from a multi-vital signs monitor and video cam). In this EMSREMS system, information is pushed out to a database and parked (until it is updated seconds, minutes or hours later, as appropriate to the type of data), where it can be accessed by those authorized.
To accomplish this we need radio channels that will support broadband data communications. Some of the most important data communications described above cannot be sent on current VHF, UHF or other EMS communications systems that can send data only as fast as old dial-up Internet access. So, in addition to maintaining our current voice frequencies, we need to start thinking about adopting the 4.9 GHz public safety system now available, or the 700 MHz public safety broadband network the FCC has proposed. The former is capable of only short transmission distances, so it's appropriate for urban operations and hot-spot connections to telemedicine fiberoptic and other systems in less urban areas. The 700 MHz system can have similar applications, and because it has greater transmission distances and would be based on a public/private partnership, would have wide geographic and population coverage and be less expensive, and yet more reliable, than current commercial wireless options employed by EMS providers.
Then we need to create these databases and the cooperative relationships among agencies and facilities that would allow colleagues to access them as appropriate and authorized. While operability and interoperability have technology components, these governance, protocol and other "intercooperability" pieces are often the most difficult and take the most time to overcome. So while EMS must start planning for how it will take advantage of 700 MHz and/or 4.9 GHz and/or telemedicine systems, it should start now to build relationships and start talking out how accessible databases may be created to build their own EMSREMS.
Last, EMS must get to the table at state and regional levels to secure the resources it needs. Every state and territory now has a statewide communications interoperability plan penned by its Statewide Interoperability Executive Committee or similar entity. These guide not only where current and future communications grant funding will go in the state but, along with regional planning committees, affect decisions on frequency allocation and coordination. Strong statewide EMS communications systems (Maryland's is a good example), will move in the direction of EMSREMS establishment locally, more regional-based medical direction, and perhaps coordinators of all medical and public health communications systems in the state.
What should EMS agencies be considering in the immediate future?
Some systems, such as the Richmond Ambulance Authority, have begun using a commercial wireless-based gateway system to allow patient data to be sent back to base data systems, if not to destination hospitals. Likewise, some urban areas have adopted 2.4 MHz unlicensed mesh hot-spot systems to do the same and send video as needed.
Also, the VHF and UHF frequencies have been ordered to go through a process of "refarming" or "narrowbanding" effective in 2013. By that time, equipment that cannot operate on narrowbanded frequencies will become obsolete. While this is primarily pre-1997 devices and systems, all radio systems should be inventoried, shortcomings addressed, and budgeted appropriately. The FCC and organizations like the National Public Safety Telecommunications Council, APCO International, NENA and others have information on narrowbanding on their websites. The National Association of State EMS Officials will soon release its new guide to information communications technology systems, which will also contain guidance on this subject.
Raphael M. Barishansky, MPH, EMT-B, is program chief of Public Health Emergency Preparedness for the Prince George's County (MD) Health Department. Reach him at rbarishansky@gmail.com.
