A new wireless network stands to change the very nature of delivering emergency medical care in the field. The network is being developed by the First Responder Network Authority (FirstNet), an independent authority within the U.S. National Telecommunications and Information Administration that’s charged with its building, deployment and operation. FirstNet grew out of a 9/11 Commission recommendation calling for interoperable communications for all first responders nationwide.
FirstNet aims to “foster heightened situational awareness, a greater common operating picture among the patient care team, and the sharing of field data by paramedics with critical care facilities and receiving instruments,” said TJ Kennedy, FirstNet’s acting executive director and a former paramedic.
FirstNet and the technology it enables could “cut response times by providing real-time data about patients, in-place monitoring data from car systems and the ability for public safety entities to coordinate their response at the scene,” said Kevin McGinnis, FirstNet Board member, paramedic and communication technology advisor to five national EMS associations.
McGinnis says FirstNet intends to enable paramedics to communicate digitized scene and patient assessments, including video and vital signs, to the entire patient care team–including flight paramedics and ED doctors–to speed response and treatment.
According to McGinnis, FirstNet intends to “not only give the emergency dispatcher the ability to share clinical patient data before paramedics arrive on scene, it’ll enable additional resources to be automatically dispatched so paramedics have what they need.”
To illustrate ways FirstNet intends to enhance operations, McGinnis says if you assume it takes 30 minutes for a rural car crash to be discovered and 30 minutes for paramedics to arrive and assess the severity of patient injuries, an hour has already elapsed. “Today, it’s only at this point that paramedics call a helicopter and make other decisions about what the patient needs.”
However, FirstNet intends to enable capabilities like automatic advanced crash notification (AACN) introduced by car manufacturers to be integrated into emergency response scenarios to decrease response times, improve treatment and better equip responders. “In 60 seconds, data coming out of car systems, including the location of the crash, the speed at impact and the forces acting on the car and people in it, could be transmitted from the car to public safety answering points and communicated via FirstNet to response team smartphones.”
EMS could run AACN data from a wrecked car through an app enabled by FirstNet to determine the percentage likelihood of severe injury, according to McGinnis. If the chance of serious injury hits a predetermined threshold, the local medevac team would report to the helicopter and standby. If the chance of serious injury hits a higher threshold, the helicopter team would depart for the scene immediately and, because the car is assumed damaged enough to warrant extrication assistance, extrication equipment could automatically be dispatched.
According to McGinnis, when a paramedic exits the ambulance at the scene of a motor vehicle crash today, it can take 6–10 minutes to “approach the car, make sure the scene is safe, do an adequate patient assessment and history, write that information down, and report all that information to the ED and get treatment instructions.” In contrast, with the envisioned capabilities of FirstNet, paramedics could begin transmitting voice, text, video, monitoring and history data to the entire patient care team within 60 seconds of reaching the patient.
With FirstNet and the modern mobile technology it intends to enable, McGinnis anticipates paramedics will be able to exit the ambulance, turn on a body camera and a microphone, and start transmitting to the team. A voice-to-text app on the paramedic’s smartphone could translate the paramedic’s description of the damage to the car into text. Video from the body camera could confirm the amount of damage to the car as predicted by the AACN and show additional responders and the definitive care team how severe injuries are likely to be. “Video showing the patient’s skin coloration and the amount of blood loss, bruising and broken bones would be transmitted to the entire team along with an accompanying textual description,” McGinnis explained.
FirstNet would also facilitate sharing the patient’s vital signs and allow the paramedic to find and securely download the patient’s HIPAA-compliant medical record from the Web using his or her smartphone.
All the data collected during the 60 seconds it took to accomplish these activities would simultaneously be placed in the appropriate database, allowing doctors and other team members access to the information. The ability to put all information associated with an incident together in one data stream and transmit it to the patient care team while simultaneously populating appropriate databases will be an operational game changer, according to McGinnis.
EMS, along with their hospital counterparts (FirstNet legislation specifically includes hospital emergency services as FirstNet users), need to understand the capabilities of the network and should begin to imagine the apps it could facilitate. “EMS leaders should imagine the ability to bring devices to the field that can’t be brought there now, think how wireless connectivity can improve decision-making, and get involved in the FirstNet consultation process,” McGinnis said.
FirstNet is consulting with the states, territories and District of Columbia and will build an individual plan for each area so that the network meets the needs of their public safety communities. According to Kennedy, “The collaborative consultation process is an opportunity for stakeholders like EMS to participate in the planning process with the State Single Point of Contact (SPOC) and FirstNet so FirstNet understands and supports stakeholder needs.” Further, Kennedy said, “each consultation meeting is an important opportunity for stakeholders to directly inform the proposed plan for build-out of the network in their state.” To participate in consultation meetings, stakeholders should contact their SPOC. A list of SPOCs is available at www.firstnet.gov/content/single-points-contact-spoc.