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Rural coverage: Communications challenges for EMS

Best practices include the strategic application of wireless communication systems to improve response capabilities and safety

Many find the serenity and quiet beauty of a rural area peaceful and comfortable. But the challenges of managing emergencies in such areas are significant for EMS personnel. How can leaders of rural fire and EMS agencies equip and then train their providers to improve response capabilities and safety in areas with lower populations and greater distances between emergency resources? Best practices include the strategic application of wireless communication systems.

Challenges for rural responders
A rural emergency incident requires the timely response of rescuers, response equipment, transport vehicles and coordination. The talents of on-scene EMS providers must be allocated to deliver the best response and the safest operation. There are generally fewer resources than could be applied in an urban or suburban environment.

Communication systems may be less available, less durable or even completely absent in many rural areas. Even with basic 911 service, delays in call center access and response are present; many personnel have a primary occupation that is not EMS-related, so when the primary responders request assistance, there can be a time lag, no matter how excellent the communication tools and services are.

Even in a rural environment, callers and patients have high expectations for EMS response. The activation of emergency services may or may not be available through a 911 system, and the responding rescuers may be many minutes away from the scene.

Anxiety over delays can be partially addressed using a good “script” from the 911 call center operator, but this usually requires an early explanation from the first responders that the closest aid is farther away in this environment.

That’s why the communication system is an integral component of safe rural emergency operations. Beginning with the activation of the emergency system through 911, a seven-digit number or a vehicle-based communication system, the location of the emergency must be pinpointed as accurately as possible. This will facilitate activation of appropriate emergency responders.

Call-locating technology is rapidly improving for mobile phones, and linkage of location to the emergency is an important first step.

Rural dispatch centers can use telecommunication devices for callers that cannot communicate verbally. Resources should be identified in a preplan, so that dispatching time is not taken searching for phone numbers, and access points for important resources. In a rural area, there may be only one dispatcher on duty to handle all incident communications and resource coordination for police, EMS and fire.

The potential of wireless solutions
Rural agencies are finding solutions to the communications challenges of these smaller systems. Wireless activation systems for in-station and out-of-station responders have been enhanced by paging, digital phone and satellite-based communicators.

Some novel systems allow a combination of devices to allow for one-step dispatching and return notifications about available responders that confirm an appropriate response.

The direct communication pathway of a rural call-taking system will allow rescue crews to prepare for the response needed on arrival at the scene.

In the past few years, there are many more options for communications equipment that function well in rural areas, and sometimes there are funding mechanisms to obtain those resources. This includes digital cell phone and radio networks.

In rural communities, the opportunities for excellent mutual aid relationships must be matched with communication systems that facilitate multiple agencies. Wireless systems can be interfaced so that radios can serve the needs of both EMS providers and the public they serve.

Managing incidents with fewer resources as well as relationships with law enforcement also must be incorporated in the plan for communication equipment and wireless networks.

In a rural setting, transport times to the hospital are longer, so EMS providers have longer to manage a patient encounter and to provide more care to the patient. With longer-range communication capabilities, they can use part of that time discussing the nature of the medical emergency with medical control, allowing the emergency department to prepare what will be needed on patient arrival.

Communication strategies for rural operations
Considering these challenges and opportunities, EMS providers can be equipped and trained to manage emergency incidents in rural locations.

Wireless communications capabilities for the first arriving crew must be flexible and durable, regardless of the location of the incident, so that an urgent rescue operation can take place without the crew having to give up a vehicle-based radio position.

Responding to vehicle accidents, rural providers must be capable of handling extrication, fire control, rapid patient removal and scene lighting with one or two vehicles. In appropriate medical circumstances, they should be capable of rapid extrication to begin the transport as soon as possible.

Where critical trauma patients are moved by air ambulances, the on-scene crews must have capabilities to communicate with the air crew, establish and maintain a safe landing zone and exchange any important patient information. This is most efficiently performed by the on-scene crew, and not through the public safety dispatcher, so wireless communication systems must accommodate two-way transmission.

With longer transport times, EMS providers must be prepared for longer patient interaction times. Rural basic-level EMS providers may be in a position to use “rendezvous” procedures with regional advanced life support services to improve pre-hospital care. This must be matched to communication resources.

Rural systems can establish networks to respond together through joint purchasing, grants to augment funding for major acquisitions, assurance that equipment works seamlessly across the different agencies and procedures that promote safe operations.

Wireless communication systems augment efficiency and safety, and new ones are being introduced at a rapid pace. Rural EMS agencies need efficient activation communicators; durable communication systems that work in large, open geography and onsite systems that make scene operations safe with smaller crews. Agency cooperation is a must for purchasing these sometimes expensive but lifesaving systems.

In summary, rural incidents of all types present communication challenges for all responders. Emergency personnel must be familiar with rural operations and scene priorities and utilize both pre-planned operations and on-scene incident command functions that facilitate safe prehospital operations and excellent patient care.

James J. Augustine is an emergency physician and Fire/EMS medical director, and a clinical professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio. He is chair of the National Clinical Governance Board for US Acute Care Solutions, based in Canton, Ohio. Dr. Augustine currently serves a medical director role with fire rescue agencies in Ohio and Florida.

In addition, he has been a member of national groups and organizations overseeing emergency medical services, emergency service quality improvement, benchmarking and best practices and disaster preparation.

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