Updated Jan. 5, 2015
The Middle Class Tax Relief and Job Creation Act of 2012 created FirstNet and made the concept of a Nationwide Public Safety Broadband Network (NPSBN) a reality. FirstNet, the governing authority created to oversee the planning and build-out of the network, encourages EMS and state representatives to participate in the process.
Much conversation has focused on how the network will help first responders and its potential role in major events, such as the Boston Marathon bombing and the Navy Yard shooting. But it is expected that EMS will see benefits from the implementation of this network day-to-day, with better information on scene and the ability to provide electronic patient records to hospitals while in transit. Here’s how it could work.
The scenario
Two cars are involved in a head-on collision at moderate speed in a remote part of an EMS response area. The crash is not witnessed, and the vehicles’ occupants are unable to call for help. However, both cars were equipped with and subscribed to an automatic crash notification (ACN) system. The 911 public safety answering point (PSAP) is alerted that a crash has occurred, notified how many occupants were in the vehicles and provided with GPS coordinates that are mapped to a location in the Master Street Address Guide in the computer-aided dispatch system. The PSAP is also told that additional information regarding vehicle speed, angle of impact, rollover and potential for serious injury is available.
Based on the analysis of data, the PSAP activates the emergency response, dispatching fire rescue, two ambulances and a helicopter. The area trauma center is notified to expect casualties. Analysis of the ACN data is simultaneously sent to the responding ambulance and the trauma center. The patients’ medical records are immediately made available to the first responders and the trauma center, giving the medical team valuable information on the patients’ “normal” vitals and potential complicating conditions.
The crash victims are located, extricated, treated, triaged and transported. As the paramedics check the patients’ blood pressure, apply the 12-lead ECG, use the portable CT to check for internal injuries and monitor other vitals, the data are seen in real time at the trauma center. The paramedics enter their findings into their electronic patient care reports, and the data are shared in an automatic burst to the trauma center. With two-way video in the back of the ambulance, the trauma physician can provide direction for patient care that’s beyond the paramedics’ basic trauma protocol.
The hospital trauma team is well prepared to take over patient care with no lag as soon as the helicopter and ambulances arrive.
Does this scenario seem far-fetched? It shouldn’t. The technology already exists, and an NPSBN is in the planning stages to make data sharing (and eventually mission-critical voice communications) a seamless process.
FirstNet benefits for EMS
“I want to emphasize how fundamentally important this network is to EMS,” says FirstNet Board member Kevin McGinnis, chief/CEO for North East Mobile Health Services, the largest paramedic service in Maine. He outlines several benefits, saying, “A lot more information will be available to help EMS providers make better treatment, operational and transport decisions.”
The result: EMS providers will have the ability to make more effective decisions in the field, and patients will receive definitive care more rapidly.
The ability to almost instantaneously share patient information and real-time monitoring of vitals while the EMS provider is talking with the trauma team will provide a common operating picture from which clinical and transport decisions can be made. The network will allow for:
- Audio/video/data interfaces with home monitoring, or “I’ve fallen” systems
- Automated dispatching based on monitored patients and vehicles
- Access to searchable patient records/images/data
- Real-time vehicle extrication hazards alerting, including video/images as necessary
- Syndromic surveillance and quick alerts to specific, at-risk populations
- Physician-mediated interface among EMS dispatch, EMS crews and nurse call centers to optimize patient disposition.
Getting EMS involved
FirstNet has held six regional meetings so far to solicit input from stakeholders, and it has received requirements documents from several groups, including the National Public Safety Telecommunications Council (NPSTC) and SAFECOM. Individual state meetings are also being planned.
“EMS needs to be at the table when the network is being planned and grants are discussed,” says McGinnis. “They need to know who the single point of contact for grants is.”
State and Local Implementation Grant Program (SLIGP) funds will enable states to perform research and data collection to provide FirstNet with information about available infrastructure and resources needed for the network build-out. Although the contact list has not yet been released, EMS leaders can call the governor’s office to find out who their single point of contact for grants is. The FirstNet staff can also be contacted to identify the point of contact in each state.
Many states have already been awarded grants to support state planning, consultation and outreach activities as these states prepare for the launch of the first nationwide public safety broadband network. Colorado, Connecticut, Delaware, New York and Ohio will receive a total of $13.1 million. All U.S. states and territories are eligible to apply for the grants, and a partial match is required. Future grants to the remaining states and territories will be awarded on a rolling basis.
Reaching out to other stakeholders
The input of states, tribes and local governments will be critical as FirstNet develops its plans for this historic network, as recently noted by Lawrence E. Strickling, assistant secretary of Commerce for Information and Communications at NTIA.
“NTIA’s State and Local Implementation Grant Program will give states the resources they need to consult with FirstNet on deployment of a nationwide public safety broadband network,” Strickling said.
McGinnis says there are many ways to ensure EMS benefits from the network. One opportunity: NPSTC has established an EMS Working Group to develop potential applications for EMS and funnel that information to FirstNet. McGinnis suggests EMS leaders contact NPSTC to see how they can get involved.
The network is still in the planning stages, and now is the time for EMS to act. The opportunity is here to improve patient care and save lives, and EMS leaders should make sure they speak up to make sure the nationwide broadband network meets the needs of EMS providers and their patients.
This article was adapted from the Office of EMS’ EMS Update Newsletter.
Report on EMS crashes in rural areas
According to national highway safety statistics, a disproportionate number of fatalities caused by motor vehicle crashes occur in rural areas. Roughly 40% of vehicle-miles traveled occur on rural roads, yet these rural trips account for 54% of all traffic fatalities. These rural crashes present a unique and complex set of challenges for EMS systems to provide adequate response times and care.
Toward that end, the Transportation Research Board—a division of the National Research Council, which serves as an independent adviser to the president, Congress and federal agencies on scientific and technical questions of national importance—recently released a comprehensive report on EMS response to rural vehicle crashes. The report provides a look into the current state of the practice, as well as an in-depth look into what is—and isn’t—working in rural EMS response.
Some of the information contained in the report includes:
- Measurable quality of care and outcomes
- Collection and analysis of response and transport times
- Evaluation of cost-effectiveness of EMS practices
- Integrated partnerships between key stakeholders
- Technology used to improve EMS performance
- Innovative training and recruitment strategies
- Compiled through a combination of literature review, agency surveys and follow-up interviews, this report is valuable for managers of EMS systems throughout the country—especially those who operate within a rural setting.
Download the report here.
Majority of super-frequent ed users have substance abuse addictions
A vast majority of “super-frequent users” of emergency departments have a substance abuse addiction, according to a Henry Ford Hospital study. A patient is considered a super-frequent user if he or she visits the ED at least 10 times a year.
ED physicians have long theorized that patients who frequent the ED have a substance abuse problem. Yet few studies have actually measured the rate of addiction of these patients. The study’s key findings:
- 77% of patients had a substance abuse addiction.
- 47% were addicted to pain-relief narcotics such as Vicodin or Dilaudid.
- 44% were addicted to other illicit drugs, such as cocaine or marijuana.
- 35% were addicted to alcohol.
Researchers also found that super-frequent users seeking pain-relief narcotics were more often women.
The findings were presented at the Society for Academic Emergency Medicine annual meeting in Dallas in May.
Nurses issue community paramedic policy statement
Community paramedics should have minimum standards for education and training beyond that of standard EMT or paramedic training, and clearly identify their role within the healthcare team as distinct from that of nurses, according to a policy statement on community paramedics released in March by the American Nurses Association.
Community paramedics are filling gaps in healthcare services such as home assessments and consultations typically performed by public health nurses or visiting nurses, according to he Silver Spring, Md.-based group.
According to the “Essential Principles for Utilization of Community Paramedics,” community paramedics and RNs need to cooperate to deliver safe, quality care. This includes making community paramedics accountable to a regulatory agency and promoting interdisciplinary communication and collaboration. The nurses’ group also called for more evaluation of community paramedics’ ability to reduce costs through decreased ED visits, hospital admissions and readmissions, as well as monitoring for patient satisfaction and reduced adverse outcomes.
Read the policy statement here.
American Telemedicine Association issues core standards
One more document worth perusing for EMS agencies interested in exploring telemedicine as part of mobile integrated healthcare or community paramedicine programs is a draft copy of “Core Guidelines for Telemedicine Operations,” released in January by the American Telemedicine Association. The document covers clinical guidelines for health professionals using telemedicine. It also covers technical guidelines for devices and equipment, connectivity and how to protect patient privacy.
Read the document here.
