It’s been an exciting privilege to grow up professionally as the nation’s EMS system has also grown up, particularly in follow up to the 1966 white paper Accidental Death and Disability: The Neglected Disease of Modern Society and the EMS Systems Act of 1973. My forty plus years as a system builder and paramedic span the time of ambulances as horizontal taxicabs through the growth of EMS as a relatively sophisticated system of emergency mitigating–and occasionally lifesaving–service.
We truly have changed the practice of emergency medical intervention since 1966. Along the way, many distinct subsystem developments added to the changing shape of the EMS system.
The trauma subsystem concept of the early 1990s altered our clinical and operational thought processes in field care and transport—destination decision-making in serious trauma intervention. So too, more recently, has the development of subsystems of care for other time-dependent emergencies (e.g., stroke and ST-elevation myocardial infarction).
The 1996 EMS Agenda for the Future and the 2004 Rural and Frontier EMS Agenda for the Future finally allowed us to rethink the role of EMS in the overall healthcare system. They made the case for EMS involvement in meeting a community’s primary and preventive healthcare needs where other resources couldn’t. Concepts such as mobile integrated healthcare and community paramedicine (MIH—CP) and EMS 3.0 system building are the foundation of that initiative.
Rethinking Communications
In 2006, colleagues in public safety communications began to band together around the belief that first responders would greatly benefit from priority use of the power of broadband.
The ability to harness the use of real-time video, picture, text and other data sharing for such things as wireless telemedicine, crime center intervention and fire scene operations was seen an essential step in public safety and EMS growth.
Mobile radios, the staple of public safety voice communications for decades, still offer unparalleled voice communication, but can only support data transmission at one-fifth the speed of dial-up internet access.
Commercial wireless broadband, which is what’s primarily used for data in ambulances today, doesn’t give any priority in its use to EMS or other public safety systems, making it less than ideal for patient-critical communications.
In 2012, public safety colleagues, under the banner of the Public Safety Alliance, succeeded in having legislation passed to create the First Responder Network Authority, also known as FirstNet. This legislation created a major broadband bandwidth and $7 billion in funding to serve the needs of public safety.
An independent authority tasked by Congress to ensure the deployment of the nation’s first mobile broadband network dedicated to public safety use, FirstNet is taking steps to make the latest technological advances available and beneficial for public safety users.
A New Approach
Today, EMS is the most adventurous of public safety broadband users. We’re about to enter a new phase in our healthcare intervention efforts, and it will change how EMS is practiced. It will involve telemedicine and information sharing to help us bring greater clinical and operational decision-making into the field. It will increase situational awareness. It will allow us to work more efficiently, enabled by a nationwide broadband network that gives us more capabilities to benefit our patients.
FirstNet is a communications system developed by public safety, for public safety and those we serve. I’m honored to represent EMS interests as a member of the FirstNet board. In this role, I advocate on behalf of EMS practitioners to make the vision of an interconnected broadband communications network a reality.
In March, FirstNet partnered with AT&T to build and operate the mobile broadband network that will modernize the communications used by EMS and other public safety personnel around the country.
The announcement is a big step toward FirstNet becoming a reality and maximizing the potential of advanced emergency communications for public safety. This public—private partnership will deliver the broadband network that EMS personnel asked for, fought for and have needed for a long time.
As FirstNet’s network partner, AT&T is making a significant investment in public safety: approximately $40 billion over the course of the 25-year contract. Our public-private partnership will also leverage AT&T’s existing network infrastructure, valued at more than $180 billion, to build and operate this public safety network.
Having an existing network to build upon will speed up the delivery of specialized features, which means we’ll have better outcomes more quickly for patients in the communities we serve and protect.
For more than four years, FirstNet has worked closely with states and territories to gather input, feedback and data from the public safety community.
This is evident in the network solution FirstNet will deliver through its public—private partnership with AT&T: a superior, modernized and specialized service that isn’t available to
commercial customers.
The unprecedented connectivity that FirstNet plans to provide will open the door of innovation, putting technologically advanced devices and applications into the hands of public safety professionals. Based on AT&T’s economies of scale, the public safety community will have access to the newest equipment and accessories at a more reasonable price.
FirstNet is dedicated to delivering exceptional customer service with a network that’s tailored specifically for public safety.
For the first time, there will be a dedicated helpdesk for first responders that’s available when they are: 24/7/365.
What’s Next for FirstNet?
In June, FirstNet achieved a major milestone with the launch of the State Plan Portal and the delivery of customized state plans to states and territories. These state plans outline how the network will be built in the 56 U.S. states and territories.
The plans are based upon the feedback and input FirstNet received through consultation and outreach efforts with the EMS community and other public safety disciplines.
States and territories have been eager to get started, and FirstNet will continue consulting with the states and territories during this review period and beyond to ensure the network meets the needs of its users.
After review, governors will decide to either opt in to the FirstNet plan or opt out and develop their own radio access network (RAN) for that state’s portion of the nationwide network.
To expedite deployment, a state or territory can announce its intent to opt in at any time, as some already have. Once a state opts in, AT&T will immediately offer guaranteed priority and preemption service over its existing network–a full two years ahead of schedule–with preemption to follow by the end of the year.
If a governor opts out, that state is required to notify FirstNet, the National Telecommunications and Information Administration (NTIA) and the Federal Communications Commission (FCC).
After notification, the governor must develop and complete requests for proposals for the state’s construction, maintenance and operation of a statewide RAN. The state must then submit an alternate plan to the FCC–one that’s interoperable with FirstNet and complies with the minimum technical requirements.
It’s likely that this process will force a multi-year delay in services to public safety. Opt-out states will assume all technical, operational, political and financial risks and responsibilities related to building their own RAN for the next 25 years.
Technology Use
The benefits that a dedicated public safety network will provide are very real, lifesaving and becoming more fully realized with each passing day. FirstNet understands that emergency medicine, especially in the field, is one of the most challenging areas of medical care.
FirstNet will continue to learn about how first responders are using advanced technologies in the field to address unique challenges in their communities and help put those technologies into the hands of public safety to improve prehospital emergency care for physicians, paramedics and EMTs alike.
FirstNet will bring public safety agencies a robust set of features they’ve never had before–like priority access and improved coverage–that will allow EMS personnel the ability to provide the best prehospital care possible. It will help EMS systems and agencies:
- Exchange real”time audio/video feeds with hospitals and physicians while on scene and during transport;
- Send sensitive patient data securely;
- Use patient tracking and bed management software for real-time monitoring;
- Access new diagnostic tools, such as ultrasound; and
- Use CT scans in the ambulance to enhance stroke care decision-making and treatment capability.
FirstNet will support community paramedicine programs by providing mobile access to healthcare records and voice or video communications between providers in the field and hospitals.
FirstNet will increase an EMT’s or paramedic’s ability to transfer and receive medical imaging, video, photos and other medical data over a secure, prioritized network. This could enhance telemedicine–especially in rural areas or at large events, and it also affords EMS providers the opportunity to seek new applications that benefit them and their patients.
FirstNet Advocacy
As FirstNet becomes operational, many advocacy groups are already spreading the word about the new network and preparing to use it in their own systems and agencies.
The National Association of State EMS Officials (NASEMSO) and several other national EMS associations have been early supporters of FirstNet, and have been involved in the network’s planning and development, advising how the network can best serve
EMS providers.
Last year, NASEMSO passed a resolution calling on all EMS providers to “prepare for and support” the FirstNet network.
Additionally, the Association of Public-Safety Communications Officials (APCO) and the International Association of Fire Chiefs (IAFC) have lent support to the opt in option, encouraging governors to adopt the FirstNet solution.
Both APCO and IAFC note the key benefits of priority and preemption are reasons why states would reap enormous benefit from opting into the nationwide network.
EMS officials can contact their FirstNet State Points of Contact (SPOC) to get information about their specific state plans and provide input as their governors make a decision about adoption of the FirstNet build-out plan. Here are some suggestions to support the FirstNet solution in your state:
- Reach out to your SPOC and participate in your state’s process leading up to the governor’s decision to either allow FirstNet
to build out the network or opt out and build its own RAN. - Tell the governor if he/she decides to opt-out, the state will assume all technical, operational, political, and financial risks and responsibilities related to building their own RAN for the next 25 years.
- Make sure the governor understands that if they allow FirstNet to build out the network, one of the key benefits of the partnership will be the availability of priority services immediately after a governor makes the decision to stay in the network. Priority access will be made available over AT&T’s existing nationwide network and on all of its long-term evolution (LTE) bands. This is only available to states that opt in.
- Inform the governor that states building their own RANs won’t be able to make a profit. Any revenues made in a state may not be kept for general funds; the state must reinvest the revenue back into the public safety broadband network.
- As an EMS leader in your state, ensure that you express your views to the governor as they make the decision to opt in or opt out of the FirstNet state plan.
- Once the governor makes the decision, stay involved in the process.
The EMS community believes in FirstNet’s promise, that by providing dedicated, interoperable, mission-critical data communications, we’ll enhance emergency response operations for EMS for years to come.
As the voice of public safety, FirstNet will continue to ensure this promise is fulfilled.
