GPS Technology: Should You Be Online or Off?

This is the second in a six-part series examining the potential role of telemedicine and other advanced technologies in the emergency medical services.

The youngest Americans today take GPS for granted. Between in-car navigation systems and map programs on their smartphones, they don’t remember the need to visit the American Automobile Association before taking a long road trip or consult a Thomas Guide map book when getting around new areas of town.

But here’s a potentially dangerous downside the “old ways” avoided: Everyone who uses Google or Apple maps on a phone can tell of some instance when the Internet wouldn’t connect, so the map couldn’t find itself. Imagine being in the grip of such paralysis during a hurricane, tornado, earthquake or other mass-casualty incident.

In the world of situational awareness and the EMS documentation industry, there are two principal technology manufacturers: companies that design for offline operations and companies that build for online use. Both architectures carry pros and cons: Offline-capable ePCRs are more robust in the face of natural disasters; they also keep working when a vehicle is beyond cell signal coverage. By contrast, online systems are built for speed and are more affordable, enabling relatively inexpensive solutions that can be converted into apps for portable use on a phone or tablet. These connect to a network behind the scenes or via a Web browser, and generally work anywhere there is a network signal.

This discussion focuses on the distinction between 1) the Web-based GPS technologies built into many ePCR and automatic vehicle locator (AVL) systems, and 2) the satellite-based GPS that might accurately be called an “eye in the sky,” because a view of the heavens and horizon is all that is needed for the sensor to find its place on a map. (Disclosure: My firm, Beyond Lucid Technologies, Inc., produces the MEDIVIEW platform—the first stand-alone all-in-one ePCR system that integrates online/offline satellite-based GPS that is tied to the patient’s record, as well as telemedicine and data portability for streamlined handoff to the hospital.)

I often tell potential clients who ask, “Would it be possible for your system to do ______?” that we’ve reached the point of technical sophistication where we can assume computers will do almost anything we ask of them. EMS may have been slow to push the envelope, but not because medics don’t want innovation—on the contrary, most medics are happy to play with new toys! Rather, EMS has been deliberate and stepwise in its embrace of technology because the mission-critical nature of the lifesaving art commands a reliance on “what has worked for us,” even when new or potentially better solutions become available. After all, if something were to go wrong with a new system, the results could be dire.

At the same time, necessity remains the mother of invention. As cities get bigger and countryside is developed into condos and cul-de-sacs, EMS and fire agencies more frequently complain that their medics don’t know how to get to or from an incident simply because the scene is in a part of town that didn’t even exist just months earlier. Indeed, interviews with firefighters, medics and agency administrators across the U.S. reveal a fascinating finding: Among all the field innovations I presented in a survey, GPS was the single most-requested feature of the “ideal ePCR” by public safety professionals.

Online vs. Offline

Online GPS systems leverage platforms like the map programs of Google, Bing and Apple. They enjoy a unique benefit over satellite-based GPS in that they can tap into the vastness of the Web to gather augmented situational details—for example, street views for faster arrival to scenes, structural diagrams of buildings, access to municipal surveillance camera feeds, and especially in the case of rural rescue, weather and other environmental information. Medics can obtain turn-by-turn directions that often will incorporate traffic conditions as well as detour alerts.

Online GPS systems thus achieve their primary goal of being a flexible and affordable tool for navigation on the move, but they have an Achilles heel: They require an Internet connection. When a network connection is lost or unavailable—which still happens not only in rural areas, but even in the densest cities—the only information that will be accessible to the medic is what was entered before the connection was lost. In some instances, even rerouting via Web-based GPS becomes impossible.

While satellite-based GPS systems are free of that network dependency, their con is different from Web-based systems’: They are more expensive to deploy and demand more technical expertise to build into field-ready solutions. Users need a receiver to capture the satellite location and an ability to map offline.

The question then becomes this: Is reliability important enough to shoulder the added costs given the contexts in which a GPS system will be used? After all, many of us deal with cell phones that sometimes disconnect or fail to work as intended. In EMS and fire, though, lost connectivity could make it more difficult and dangerous for personnel to do their work. Hurricane Sandy highlighted the risk associated with assuming that infrastructure like network connectivity won’t be interrupted.

It’s a decision systems will have to make with one eye on their bottom line and the other on the potential costs of failure.

Jonathon S. Feit, MBA, MA, is cofounder and chief executive officer of Beyond Lucid Technologies, Inc., an IT firm committed to connecting first responders with the care facilities they serve using cutting-edge technology. For more see www.BeyondLucid.com.