Field Operations and Medical Command Communications

1. Field Operations and Medical Command Communications But first…..Radio 101…..

2. Types of Radios • Base Radio • High power • Uses elevated antenna / tower • Mobile Radio • Intermediate power • Uses roof mounted antenna • May use in doors on AC power (e.g., ED) • Handheld Radio • Low Power • Integrated antenna • May use external antenna extension • Scanner

3. Options in Public Safety Radio Systems • Radio Spectrum • VHF, UHF, 700/800 MHz • Analog vs. Digital • Conventional vs. Trunked • Simplex – Duplex - Trunked

4. Radio Spectrum 4.9 GHz New Public Safety Broadband 150 MHz +/- 450 MHz +/- 700-800 MHz

5. Analog vs. Digital Networks • Analog • Translate an audio signal into radio frequency signals • Can also carry data by converting it to an analog signal via a modem • Digital • Translate an audio signal into a digital bit stream of ones and zeros using “vocoder” • Stream is sent over the airwaves and decoded at the receiving end • Receiving radio translates the digital stream into an audio signal equivalent to the original voice message

6. Analog vs. Digital Analog Signal Clear Signal Signal begins to degrade Signal unreadable with lots of static Digital Signal Clear Signal Clear Signal Computer cuts signal off when it becomes unreadable

7. Radios C and D Tx: 155.340 Rx: 155.340 Radio B Tx: 155.340 Rx: 155.340 Radio A Tx: 155.340 Rx: 155.340 Simplex Radio Systems • Transmits & receives on single frequency • “Talk Around” • Like family walkie-talkies

8. Base Radio B receives signal from Port. Radio A Port. Radio B too far away to receive signal from Port . Radio B Simplex Radio and Base Stations Base Radio B Tx:155.340 Rx: 155.340 Port. Radio C Tx:155.340 Rx: 155.340 Port. Radio A Tx:155.340 Rx: 155.340

9. Simplex Radio and Base Stations Base Radio B Tx:155.340 Rx: 155.340 Base Radio A transmits with strong signal that is received by both portable radios. Port. Radio C Tx:155.340 Rx: 155.340 Port. Radio A Tx:155.340 Rx: 155.340

10. Only radios with Tone A (or no tone squelch) will hear transmission from ambulance. Simplex Radio with Private Line(AKA Tone Squelch) Hospital A Tx: 155.340 Tone A Rx: 155.340 Tone A Hospital B Tx: 155.340 Tone B Rx: 155.340 Tone B Ambulance C Tx: 155.340 Tone A or B Rx: 155.340 Tone A or B

11. Base Radio B receives signal from Port. Radio A on 467.950 Base Radio B automatically repeats received signal on 462.950 with very strong signal received over wide area Duplex Radio System with Repeater Base Radio B Tx: 462.950 Rx: 467.950 Repeater Port. Radio B Tx: 467.950 Rx: 462.950 Port. Radio A Tx: 467.950 Rx: 462.950

12. Police Fire EMS Conventional Radio System One frequency = one user group

13. Trunked Radio System Defined “A pool of radio channels available to any user when required. Channels are removed from the pool when needed and returned to the pool when not in use”

14. Trunked Radio System • UHF Bands (450, 700, 800, 900 MHz) • Radio frequencies shared among all users • Computer Controls Radios and Base Stations • Each Radio Has Unique Address • Each radio affiliates with single tower • “Talkgroups” replace frequencies • APCO Project 25

15. Trunked Call Processing Push to Talk (PTT) Control Channel Voice Channels System Controller 1. Call Request

16. Trunked Call Processing “Assigns Channel 2” Control Channel Voice Channels System Controller 2. Call Set-Up

17. Control Channel Voice Channels System Controller Trunked Call Processing Receive Transmit 3. Transmission

18. Trunked Radio Network Radio set on EMS Talkgroup Radio set on Police Talkgroup

19. Trunked Radio Network Radio set on EMS Talkgroup Radio set on Police Talkgroup

20. Disadvantages Technically complex Requires new equipment Relatively expensive Fireground limitations Advantages Efficient spectrum use System redundancy Interagency communications Supports future growth Statewide / regional coverage possible Trunked Radio SystemsPros and Cons

21. EMS Operations / MEDCOMCommunications MEDCOM Communications Field Ops Communications Dispatch Communications 0 Min 5 Min 10 Min 15 Min 20 Min

22. EMS Field Operations Communications • Purpose • Provide mission critical communications between all responders and dispatch • Interagency Communications Between • 1st Responders – BLS – ALS – other Public Safety • Applications • Downgrade, upgrade, or cancel response • Scene safety / vehicle placement • Provide update on patient status • Determine status of hospitals

23. EMS Field OperationsCommunications • Communication modes • Radio • Cellular • Mobile data terminals • Challenges with multiple agencies • Use of multiple frequencies / bands • Proprietary frequencies • Unwilling to allow other agencies on their frequencies

24. MEDCOM Communications • Field to Hospital (MEDCOM Center) • Provide pre-arrival notification to hospital • Receive direct medical control • Pre-Arrival Notification • Enough info to find an ED bed • Direct Medical Control • Authorize certain medical treatments • Physician consultation • Physician “heads up” notification

25. MEDCOM Communications • Modes • Radio • Cellular • Web-based notifications • System should be highly reliable • Offer redundant capabilities • Need for recording • Maybe required • Essential component of retrospective CQI

26. Communications and CQI • EMS communications systems provides excellent means to monitor system performance in real time and retrospectively • Dispatch and Field Operations • Monitor response times / overall system function • Provides source for on-scene, concurrent CQI • MEDCOM • Monitor clinical performance • Provides source for case reviews

27. Recording Communications • Multi-channel digital recorder • Allows for electronic file transfers • Confidentiality of communications • May be subject to FOIA • MEDCOM should be considered confidential • Use in CQI • Random selection • Sentinel events • Selected cases

28. Radios and the Medical Director • Should Medical Directors have Radios? • Why? • Monitor system operations • Field response • Allows for “cherry picking” • MCI Response • What type of radio(s)? • Portable vs. mobile vs. scanner • May need permission from agency / state • How do you acquire the equipment?

29. Primary Rule for the Medical Director and Radios Listen instead of talk!!!

30. Disaster and Interoperable Communications

31. Disaster Communications • Ineffective communications most constant disaster response deficiency • Interagency Communications • Between field responders • Between EMS agencies / Between disciplines • Essential for effective ICS • Between field and hospitals • May use Regional Medical Coordination Center • Between field and Emergency Operations Center • Between local and state officials

32. Landline and Cellular Phones • Cellular phones not reliable in disaster • Landline systems may be overwhelmed • GETS / WPS • Priority systems for wired and wireless phones • www.gets.ncs.gov

33. US GOVERNMENT PROPERTY. If found, return to: NCS (N3), P.O. Box 4502, Arlington VA 22204-4502 WARNING: For Official Use Only by Authorized Personnel. The GETS Calling Card Calling cards are in widespread use and easily understood by the NS/EP User, simplifying GETS usage GETS priority is invoked “call-by-call” GETS USER GETS USER ORGANIZATION GETS is a "ubiquitous" service in the Public Switched Telephone Network…if you can get a DIAL TONE, you can make a GETS call

34. Web-Based Resource Tracking and Alerting Systems • Used during non-disasters to monitor hospital status • Connect all key resources • EMS – Hospitals – EOCs • Provides Real Time • Casualty care capacity • Bed availability • Alert hospitals and others of MCIs

35. Web-Based Resource Tracking and Alerting System

36. Health Alert Networks (HAN) • CDC Bioterrorism Cooperative Agreements • Goal: Provide a high-speed network to rapidly alert public health and emergency responders • Currently in all 50 states • Coordinated by each state • Alerting options • E-mail / Pager • Phone • Alerting by jurisdictions and by roles • Variable alerting based on event priority

37. Amateur Radio in Disasters • Amateur Radio (HAM) Support in Disasters • Highly knowledgeable volunteer operators • Extensive amateur radio network / infrastructure • Provides redundant emergency communications • Radio Amateur Civil Emergency Service (RACES) • Sponsored by Local / State Government • Volunteer operators certified, regularly train / exercise • Amateur Radio Emergency Service (ARES) • Non-government sponsored amateur radio operators • Organized in clubs • Often affiliated with RACES

38. 911 References • Federal Communications Commission 911 • E-911: http://www.fcc.gov/911/ • VoIP: http://www.voip911.gov/ • National Emergency Number Association • http://nena9-1-1.org/ • Assoc. of Public Safety Comm. Officials • http://www.apcointl.org/

39. EMD References • NHTSA EMD Program • http://www.nhtsa.dot.gov/people/injury/ems/Reorder%20files%20for%20CDRom1.htm • National Academy of Emergency Dispatch • http://www.emergencydispatch.org/ • APCO Institute • http://www.apcointl.com/institute/ • PowerPhone • http://www.powerphone.com • New Jersey EMD Guidecards • http://www.state.nj.us/health/ems/guidecard.htm

40. Disaster and Radio References • Government Emergency Telecommunications System (GETS) • http://gets.ncs.gov/ • CDC – Health Alert Network • http://www.phppo.cdc.gov/HAN/Index.asp • Radio Amateur Civil Emergency Services • http://www.races.net/ • Free radio frequency / system information • http://www.radioreference.com/