Communications & Dispatch, Operations

FirstNet Brings High Quality, Efficient Care Directly to the Patient

Issue 2 and Volume 43.

FirstNet brings a high-quality, efficient communications network to the field

Photos courtesy FirstNet Senior Public Safety Liaison, Kyle S. Richardson

Ask any EMT or paramedic why they do what they do, and I can almost promise you they’ll all give some form of the same answer: They went into this field to help people. Quality patient care and positive outcomes are at the very core of EMS.

Today’s EMS responders have tremendous capabilities to provide care to our patients, and to a very limited degree that capability is enhanced using mobile broadband communication with our medical direction system.

Unfortunately, before FirstNet became a reality, public safety had no effective priority over public use of commercial broadband networks. Thus, we limited our use to a few text-based applications such as patient care reports (PCRs), 12lead ECGs and the occasional picture. Even sending those limited data files was often hampered by network congestion.

The result was that data was sent slowly or not at all, and that’s just not good enough for public safety use.

Real, dedicated mobile broadband offers much more capability, including full motion video, medical imaging (e.g., ultrasound or CT scans), and a host of other data-
intensive uses.

The FirstNet network, available today, gives public safety a dedicated network that enables us to make use of these new treatment technologies. It’s a network we can depend on with the capabilities we need.

Device manufacturers and application developers are moving rapidly to bring to market the tools we need to take advantage of this major new communications tool.

Today, we think of broadband communication only for use by our smart phone or tablet computer. Very soon we’ll see broadband communication devices tailored to specific public safety uses, designed for our needs and environment.

I joined FirstNet (the First Responder Network Authority) in 2015, after three decades as a paramedic and police officer in Michigan. I saw the great potential of the FirstNet network to significantly improve the care EMTs and paramedics provide in the field.

That was two and a half years ago, and only a few years after FirstNet was created by Congress in 2012. Today, the FirstNet vision is becoming a reality, and first responders have quality of service, priority access and pre-emption on the existing AT&T long-term evolution (LTE) network.

Let’s look at what FirstNet is, where it’s going, and what it can do for patient care.

Data shared over a robust, secure wireless network will improve situational awareness and response times across all public safety disciplines.

What is FirstNet?

FirstNet was established by Congress in 2012 after public safety stakeholders identified the need for a dedicated, nationwide wireless network for first responders, and the 9/11 Commission Report recommended the need for interoperable communications for all U.S.-based first responders.

Congress provided FirstNet with $7 billion in funding, 20 MHz of spectrum in the powerful 700 band, and the unique charge to create a public-private partnership that would allow the network to serve the needs of public safety in every U.S. state and territory.

In 2015, FirstNet was in its active consultation phase, traveling to meet with government and public safety officials and practitioners at every level from every part of the country. My job was to reach out and talk with the EMS community. I was, in part, sharing information about FirstNet, and at the same time I was asking EMTs and paramedics about the issues and challenges they experienced, and listening to EMS personnel tell me what they wanted from the network.

My FirstNet peers, who are experts in law enforcement, fire services and 9-1-1, were out doing the same thing, alongside a deep network of FirstNet regional staff who worked with public safety communications leaders
in each state and territory to define their unique needs.

FirstNet then took that input and issued an objectives-based request for proposal that would allow a private partner to be creative and flexible in its approach to meeting the network’s goals.

An Innovative Partnership

In March 2017, FirstNet announced a partnership with AT&T with a 25-year agreement to deploy and maintain the nationwide public safety broadband network. AT&T brings its current nationwide infrastructure and customer service experience along with a promised $40 billion investment in expanding the network.

After the award, FirstNet combined the consultation inputs and data gathered through years of interactions in states and territories with AT&T’s coverage and network offerings to issue a customized network build-out plan to each U.S. state and territory. States and territories then had an opportunity to provide comments and ask questions about the plan before FirstNet issued the revised State Plans and provided official notice to governors.

Governors received their official State Plan notice on Sept. 29, 2017, and had 90 days (until December 28) to opt in or opt out of the FirstNet plan. The final count of opt in and opt out states is available at FirstNet.gov. As of Dec. 29, all 50 states have opted in.

Choosing to opt in means the radio access network will be built out at no cost or risk to the states and territories. Opt in also offers subscribers within those states immediate priority access to AT&T’s entire network, with pre-emption being phased in as AT&T expands the network and brings the unique benefits of FirstNet to first responders. Whatever a state decides to do, it’s then up to each jurisdiction or department to decide whether to adopt FirstNet as a subscriber.

Benefits of FirstNet

Any discussion of FirstNet begins with an understanding of how this new communications capability differs from our traditional voice only radio networks. FirstNet brings high-speed, dedicated mobile broadband communications capability to the field. It’s not a replacement for the current two-way radio systems you use today, but is a major enhancement offering totally new capabilities.

Before FirstNet, our only option was to use commercially available cell phone networks, which offered no real priority or guarantee of network spectrum availability to public safety providers. FirstNet provides what public safety needs most: The network puts first responders first, by providing dedicated service to public safety users.

Dedicated service comes through something called “ruthless preemption” that automatically gives a FirstNet user the spectrum needed to send or receive data regardless of any congestion or slowing of the network due to high use by the public.

Public safety providers can depend on the network to carry mission-critical data including lifesaving data. That data can be in the form of pictures, video, medical imaging, monitor data including 12-leads, and a host of other data intensive uses that require dedicated high-
speed connections.

Seamless communication is a basic tenet of the FirstNet network and those within an EMS system of care are the primary users of the network. FirstNet recognizes EMS communications with police, fire, 9-1-1 centers, EDs, physicians and nurses as priority use.

FirstNet will be public safety-grade, meaning the network will be reliable, hardened and redundant. Unlike a land mobile radio system that operates off a limited number of towers, FirstNet’s LTE network offers many more towers and often considerable site overlap, which makes it easier to manage traffic across the network when one or two sites go down. FirstNet will also be secure and HIPAA-compliant, with end-to-end encryption and a dedicated security team.

Congress gave FirstNet a “rural mandate” to treat rural areas no differently than metro areas. To better serve rural areas, AT&T has made a commitment to build in places where public safety has identified a need for improved service. The network will be built through phased deployments, and AT&T will continuously upgrade and expand it throughout its 25-year contract.

AT&T has also provided 72 deployable assets that will be prepositioned across the U.S. for quick dispatch to large events, natural disasters, or response in wilderness settings. These deployable assets are mobile broadband “cells on wheels” that can provide connectivity and service to an area in which the traditional network towers or other infrastructure are damaged or not available.

A Powerful, Dedicated Network

The FirstNet network enhances the ability of field units to receive and send information. Information and communication are two of the most powerful tools you can give an EMT or paramedic in the field. It’s even more powerful in rural settings where the nearest hospital may be hours away.

Right now, when an EMS unit goes to a call, the default position is a trip to the hospital. With the right tools and information, EMS can provide far better treatment in the field. The more that is known on the scene, the easier it is to avoid expensive and unnecessary care.

FirstNet allows EMS providers to securely send large amounts of data, including pictures and videos, ultrasound images and CT scans across a robust and reliable network. Because only a physician can diagnose, these tools enable providers to bring the physician to the patient—which means patients may be able to get what they need at a tremendous cost savings. If we know that a patient who has fallen has a bruised arm rather than a broken one, her care ends on site rather than many hours later in an ED far from home.

These types of tools, along with the ability to securely send and receive patient records and files, can also assist in the delivery of community paramedicine, allowing us to bring quality care to patients in their homes to help manage chronic conditions.

The ability to communicate directly with physicians through streaming video and shared data will improve on-scene response and may prevent unnecessary and expensive trips to the hospital.

Driving Innovation

There are several powerful applications and tools on the market now, but commercial networks, with their congestion and limited availability in certain locations, hinder an EMS provider’s ability to make full use of those applications and tools.

FirstNet not only provides the network to run those tools without a lost signal or slow transmission, it also opens up the public safety market to technology firms and application developers who want to drive innovation and make new tools more affordable and accessible to public safety personnel.

It’s important to note that FirstNet is a nationwide network built on open standards, rather than the patchwork of systems most public safety customers rely on now. That fact alone has drawn in more players to the public safety arena. FirstNet is also working hard to foster relationships with developers, launching its App Developer Program and a public safety app store.

FirstNet has also designed and built a state-of-the-art lab in Boulder, Colo., to test applications, devices and tools. We’re working with partners at the National Institute of Standards and Technology (NIST) and the Public Safety Communications Research Division (PSCR) to bring the brightest minds in technology to address public safety’s most complex needs, such as location-based services and mission critical voice-over LTE.

Preparing for FirstNet

In states and territories that have opted in to FirstNet, the service is available now to individual and agency subscribers. Visit www.FirstNet.com for more information on coverage and pricing.

AT&T is working hard to expand the network to meet public safety’s needs and FirstNet is here as public safety’s advocate, providing oversight and ensuring AT&T meets promised goals and targets.

FirstNet’s website has more information on planning for and adopting FirstNet at www.FirstNet.gov/Prepare.

It’s been exciting to watch this network go from an innovative idea to a useable tool, and I can’t wait to see all the ways it makes the lifesaving work of EMS providers easier and more effective.