Stuck in the Mud

Prior to the early 1970s, an ambulance typically would get dispatched through a red-telephone system to a volunteer service out in the sticks, or you would call a hospital if it were a big-city hospital. The ambulance would arrive on the scene unannounced for the most part.

Then in 1973, the federal EMS Act created the modern system we know today. Using a big chunk of change that came along with that legislation, we started to put radios in ambulances and hospital emergency departments. You could be announced before you got there so they would be expecting you and knew what kind of patient you’re bringing in, and physicians could guide our care remotely.

In the ensuing 35 years, EMS has really gone from being horizontal taxicabs to being able to provide very sophisticated medical care in the field, guided by emergency room physicians. But the one thing that hasn’t changed is the communication system — the systems we bought in 1973 are, by and large, the same communications systems we are using today. They use UHF and VHF frequencies, and they’re 98% voice communications with a little bit of telemetry going on.

We’re starting to suffer, because technologies like multi-vital-signs monitoring means we can get some very, very sophisticated information about what’s going on with the patient. We need more and more guidance from the emergency room physician. But when you have two people — the paramedic in the field and the emergency room physician — who are both really busy at a given moment, each might not be ready to either receive or give information when the other is. Having to rely on voice communications between two very busy people is creating a bottleneck.

There’s a concept evolving called the EMS resource and event-monitoring system (EMSREMS), which is essentially a collection of databases on the status of a patient’s vital signs or the availability of an emergency department or medical helicopter.

Today, the databases that I use are basically in my head, which gets filled up pretty fast. What we end up doing is using the purple nitro glove on our hand, writing vital signs on the glove until it breaks — anything to organize information.

In the future, I envision talking into a microphone and saying that “a such-and-such-build male patient has been in a motor vehicle crash. He has lacerations to the forehead and apparent multiple fractures to the legs” — basically reciting a note. That information would be transferred to a PDA on my hip and also would be transmitted to the database in the ambulance computer and then translated into a text file. The patient’s information then would be transmitted to the hospital’s emergency room.

In a matter of two minutes, a database containing a description of the patient, a database containing all the vital signs, a database with the patient’s history and a database with video have been pushed out to the ambulance and the hospital. I notify the hospital that we have the patient’s description ready. When the doctor can get free, he or she will access those databases to see what is going on at the scene and perhaps push out — from yet another database — some orders for me to follow, which I can tap into when I’m ready to pay attention to them.

These capabilities exist today. What doesn’t exist is the communications system to adequately tie together the monitoring devices and the EMS system. The communications right now are clunky.

Multi-vital-signs telemetry requires 10 times the throughput that you get on UHF, VHF or trunked 800 MHz today. When you start talking about medical-quality video, you’re talking about 200 times the speed of the systems that we have.

Because we do not believe that commercial wireless is going to be able to serve our mission-critical communications needs, we’re looking to two sources for realistic broadband. One is 4.9 GHz for urban areas, and the other is the 700 MHz system. If we don’t have a 700 MHz system, we have no rural or suburban solution for bringing EMS into the 21st century. — as told to Donny Jackson

Kevin McGinnis is the program adviser for the National Association of State EMS Officials.