Modern 911 system needed to improve EMS field care

A high-tech and effective EMS response depends on citizens being able to activate 911 and accurately describe their emergency

Not too long ago, I wrote about how technological progress continues to drive the evolution in field care. I very much want to see greater development in the area of emergency response activation; I strongly believe that a modern 911 call receiving system will greatly enhance how we respond to emergencies in the not too distant future.

According to the National Emergency Number Association, an estimated 240 million 911 calls are made to just over 5,800 public safety answering points annually in the United States. Approximately 96 percent of the geographic United States is covered by some form of 911. In other words, this system is truly a universal way of calling for help in an emergency. Many, if not most Americans, do not know of world where 911 did not exist.

Yet for all of its success, 911 is in danger of failing on a massive scale. The evolution of wireless cellular technology and the rapidly multiplying modes of telecommunications is putting tremendous pressure on an increasingly antiquated, landline based telephone system that is not up to current standards. Recent failures in Dallas, Fort Lauderdale and Portland, Ore. point to the challenges of incompatibility and upgrading live systems.

Meanwhile, EMS providers are at the mercy of well-meaning citizens who are unable to accurately describe the emergency that is happening in front of them. Using emergency medical dispatch protocols, 911 telecommunicators do remarkably well trying to determine the level of urgency of the incident. However, most field folks regularly put their lives at risk responding with lights and siren to a medical emergency that really wasn't. It's a frustrating situation.

At the root of the issue, it's the 1970s technology that hinders development. 911 uses a system of dedicated lines, relays and other switching equipment that is effectively isolated from the remainder of the U.S. landline telephone system. While it has its own redundancy built in, the emergency number system was really designed to operate on its own and to remain functional in major events.

The level of protection is also its chief nemesis. Today's Internet Protocol-driven digital phone services, common in many parts of the country, is not directly compatible with the existing 911 system. Mobile phones, introduced en mass in the early 1980s, have only recently been connected directly to local PSAPs. Texting and video calls aren't even in the picture yet for the majority of PSAPs.

The cost of upgrading 911 systems is also a major barrier. It cost New York City nearly 2 billion dollars to overhaul its emergency number system, only to see it crash on the first day. Most city managers would faint at the cost of implementing a modern day 911 system.

Many of today's EMS systems are sporting the latest technology in their mobile intensive care units. All of it is for naught if it can't be activated by the citizen in a timely, reliable manner. It's going to take a collaborative, intensive effort by local, state and federal government, as well as private industry, to bring 911 into the 21st century.

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