THE NATIONAL ASSOCIATION OF
State Emergency Medical Services Directors
PLANNING
EMERGENCY MEDICAL COMMUNICATIONS
STATE-LEVEL PLANNING GUIDE
VOLUME
ONE
THE NATIONAL ASSOCIATION OF
State Emergency Medical Services Directors
PLANNING
EMERGENCY MEDICAL COMMUNICATIONS
VOLUME
ONE
STATE-LEVEL PLANNING GUIDE
June 1995
Developed by:
THE NATIONAL ASSOCIATION OF
STATE EMERGENCY MEDICAL SERVICES DIRECTORS Under Contract DTNH22-94-G-05222
U.S. Department of Transportation National Highway Traffic Safety Administration
ACKNOWLEDGEMENT
The National Association of State Emergency Medical Services Directors extends a special thank you to the EMS Communications Committee and the EMS Communications Guideline Task Force for their efforts and cooperation in the development and review of this document.
The Task Force was comprised of:
Carl C. Van Cott, Chairman
EMS Communications Guideline Task Force
Assistant Chief-Engineering State of North Carolina
Office of Emergency Medical Service Raleigh, North Carolina
Paulette B. Newman Medical Health Program Analyst
State of Florida
Department of Health and Rehabilitative Services Tallahassee, Florida
Jack K. Pase Planning Officer
West Virginia Emergency Medical Services Technical Support Network
Elkview, West Virginia
Jeff Pegram Communications Engineer
Commonwealth of Virginia
Office of Emergency Medical Services Richmond, Virginia
Carlton W. Wells Supervisor
State of Florida Division of Communications Local Government Engineering Section Tallahassee, Florida
Andrew Szekely National Frequency Coordinator
IMSA/IAFC
Providence, Rhode Island
Mark S. Johnson, Chairman NASEMSD Communications Committee
Chief
Emergency Medical Services Section
State of Alaska Department of Health & Social Services Juneau, Alaska
TABLE OF CONTENTS
1 INTRODUCTION
... 1FIRST-TIER PLANNING... 1
EMS COMMUNICATIONS DESCRIBED... 3
2
EMS COMMUNICATIONS NEEDS
... 53
EMS COMMUNICATIONS SYSTEM COMPONENTS
... 11EMS COMMUNICATIONS SEQUENCE ... 11
4 PUBLIC
ACCESS
... 15IMPLEMENTING 9-1-1... 15
CATEGORIES OF PUBLIC SAFETY ANSWERING POINTS ... 15
CITIZEN ACCESS ... 16
9-1-1 SYSTEM DESCRIPTIONS ... 17
FEATURES AVAILABLE TO 9-1-1 SYSTEMS... 18
9-1-1 ENHANCED FEATURES... 19
SPECIAL TELEPHONE METHODS FOR PSAPS ... 20
PROBLEMS WITH CELLULAR ACCESS TO 9-1-1... 21
5
DISPATCH & COORDINATION
... 23EMS VEHICLE DISPATCH ... 23
CENTRAL MEDICAL EMERGENCY DISPATCH FUNCTIONS ... 23
INTERDISCIPLINARY COMMUNICATIONS... 25
EMD-TRAINED TELECOMMUNICATOR... 25
CMED PLANNING... 26
6
MEDICAL CONTROL COMMUNICATIONS
... 29MEDICAL CONTROL AND COORDINATION... 29
TELEMETRY ... 29
PLANNING EMERGENCY MEDICAL COMMUNICATIONS
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7
STATE COMMUNICATIONS PLANNING
... 33PLANNING TERMINOLOGY ... 33
GOALS FOR EMS COMMUNICATIONS... 33
8
EMS COMMUNICATIONS HISTORY
... 59HISTORY OF REFARMING THE MOBILE RADIO SPECTRUM ... 61
9
EMERGENCY MEDICAL COMMUNICATIONS PLAN
... 63THE CURRENT STATUS... 63
MIGRATION ISSUES FOR EMS COMMUNICATIONS... 67
10 EMS RADIO FREQUENCY PLAN
... 69THE FEDERAL COMMUNICATIONS COMMISSION... 69
RADIO LICENSING AND FREQUENCY COORDINATION... 70
OPERATING UNDER AUTHORITY OF ANOTHER LICENSEE ... 74
RADIO COVERAGE AND RANGE ... 75
11 THE REGIONAL SYSTEM
... 77COORDINATED RADIO COVERAGE... 78
WIDE-AREA RADIO COVERAGE ... 79
FREQUENCY SPECTRUM AND SERVICE REQUIREMENTS ... 80
RADIO FREQUENCIES FOR EMS COMMUNICATIONS ... 81
ELIGIBILITY CRITERIA... 81
EMS RADIO FREQUENCIES ... 81
12 COMMUNICATIONS SYSTEM COMPONENTS
... 82RADIO SYSTEM EXPLANATIONS... 82
EMS RADIO PATHS... 82
BASIC RADIO SYSTEM EQUIPMENT... 83
STANDARD HIGH BAND VHF FREQUENCIES... 87
DUPLEXED RADIO STATION ... 88
RADIO RELAY STATIONS ... 88
BASE-STATION REPEATER... 89
PATIENT-SIDE COMMUNICATION ... 91
UHF MEDICAL COMMUNICATIONS ... 91
220 MHz Systems... 94
TRUNKED RADIO SYSTEMS ... 94
800 MHz SYSTEMS ... 97
NETWORK RADIO FREQUENCIES AND IDENTIFIERS ... 98
RADIO EQUIPMENT GUIDELINES... 104
UHF MED RADIO STATIONS... 106
EKG TELEMETRY STANDARDS... 107
13 SYSTEM
CONCEPTS
... 109STATE CALLING CHANNEL ... 110
AREA WORKING CHANNEL... 110
LOCAL WORKING CHANNELS ... 110
AREA SYSTEMS OPERATIONAL DESCRIPTION... 110
APPENDIX A RADIO FREQUENCIES - PAGING
... 113APPENDIX B RADIO FREQUENCIES - EMRS
... 114APPENDIX C - SPECIAL EMERGENCY RADIO SERVICE
... 117APPENDIX D - STATE EMS COMMUNICATIONS PLAN
... 121APPENDIX E - SAMPLE DESIGNATION LETTER
... 125APPENDIX F - SAMPLE SUPPORT LETTER
... 126APPENDIX G - SAMPLE FREQUENCY PLAN
... 127SELECTED REFERENCES
... 134SUPPLIERS OF FCC LICENSE DATA
... 136ACRONYMS
... 137GLOSSARY
... 141= iv <
PREFACE
Planning Emergency Medical Communications is presented in two volumes. Volume One contains general background information and information regarding the two-tiered approach to EMS communications planning. The first-tier plan focuses on factors necessary to ensure proper compatibility, interface and coordination of local EMS communications within a statewide system.
Volume Two, the Regional-Level Planning Guide, provides more specific information and directions for use by local planners in preparing detailed second-tier local emergency medical telecommunications plans.
It is impossible for a document such as this to convey all of the information needed regarding emergency medical communications or to keep up with continuous change in communications technology and regulations. Changes to the Federal Communications Commission's Rules directly influence the system configurations and use of the radio frequency spectrum. The types of equipment offered by manufacturers constantly change, and there also are frequent changes in funding and federal, state and local policies. These all influence the EMS communications-system-design philosophy. EMS communications, as with most modern communications, are being constantly developed and improved. Throughout this document, references are made to the "state office of emergency medical services" (state OEMS). This generic term refers to the appropriate official agency responsible for regulating emergency medical services within state government.
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PLANNING
EMERGENCY MEDICAL COMMUNICATIONS
Volume
One
STATE-LEVEL PLANNING GUIDE
1 INTRODUCTION
FIRST-TIER
PLANNING
Volume One of this planning manual is concerned with development of emergency medical communications systems and state plans, and the role that a state office of emergency medical services (state OEMS) plays in developing these plans. This approach to planning is patterned after the ASTM Standard Guide for Emergency Medical Services System
(EMSS) Telecommunications Standard F1220-891. The ASTM standard sets state
planning goals and objectives and advocates applying a two-tiered approach for EMSS communications planning.
Under the two-tiered approach, a general guide or overall first-tier state plan identifies the communications goals and factors that need to be coordinated statewide. Local second-tier EMSS communications plans are then prepared in accordance with the statewide guideline plan. The local plans are tailored to satisfy local system needs while providing communications compatibility and interoperability with other emergency medical services within the state. This is accomplished by adhering to the compatibility factors provided in the statewide plan.
The definition of "local" changes with each geographic area under consideration. In some cases, "local" implies a city. In others, "local" implies a county or larger geographic regional division or planning area. Whatever fits for each locality or circumstance is considered "local." If the geographic division works, it should be used. Planners should avoid developing arbitrary areas that do not logically function together. Existing boundaries and situations should be used. If a "regional" planning agency or administrative body exists, its use should be considered. If political subdivisions are present, their use should be
1
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considered. In this planning guide, the terms "local" and "regional" are used interchangeably.
The communications concepts expressed in the first-tier "state" plan should be expressed in basic terms. Efforts should be made to avoid technical language whenever possible so that non-technical planners will feel comfortable using the document.
This Volume One planning guide will be useful as a reference. Various communications techniques are included that can be used in a variety of settings for EMS communications system planning. The techniques form a foundation of system elements and design approaches that can be investigated. Each approach to EMS communications has strengths and weaknesses. The communications user and the communications system planner must understand the basics of the complete EMS system and each communications element so that a set of common expectations can be developed. These understandings are used to formulate a final system design for local/regional implementation.
Technical system designers acquainted with conventional communications equipment also must become familiar with some of the unique requirements of EMSS communications before proposing a system design, so that they do not overlook any of the requirements of EMS communications systems. These requirements include EKG and medical telemetry, full-duplex radio operation, and vehicular repeater systems operating in conjunction with mobile relay stations. Advanced and future systems may include trunked system operations, picture and video transmissions, computer and data interface, computer report generating systems, satellite and geo-positioning interface, and access to multiple public and private wireless communications systems and paging systems.
The system ideas are not restrictive to the development of local EMS communications systems and are not intended to dictate any particular design approach or system configuration. The statewide plan should consider compatibility factors and allow system planners and communications system users to develop local and regional systems from common system elements. The state-level plan should lead to a more standardized statewide emergency medical communications network that will help provide effective EMS communications by giving direction on common frequency use and system-design parameters.
Guidance for developing EMS communications plans and systems, technical assistance, engineering and financial involvement are essential for successful implementation of the systems. Communications planners must foster a design concept to implement communications systems meeting their unique sets of requirements and circumstances. Local requirements are always best understood and addressed by local EMS system
planners working within their own systems. Detailed EMS communications systems planning and engineering is the responsibility of the local planners. Guidance for developing local or regional plans is included in Volume Two of this series.
Compatibility must exist among EMS communications systems. Personnel in each EMS communicating agency must realize that their system is actually part of a larger system that will interact with the other communications systems and other EMS operations around it. For local planning to be effective, a larger-scale plan and-wide-area guidance must be included. Without compatibility, system development becomes counterproductive because of interference between systems and deficiencies in required communications linkages. In the past, EMS communications systems may have developed on a localized or fragmented basis. This happened when no larger-scale direction or guidance for system development was available. EMS providers were left on their own to conceive and implement communications systems by whatever means might be available to them. This approach, or the lack of an approach, can result in not having an organized emergency medical communications system.
Information about local EMS communications systems and communications plans should be collected by the state as a means of assuring uniformity and compatibility of the statewide system. Ideally, the state OEMS or state telecommunications office should have technical and engineering assistance available. These offices should provide technical assistance to the local EMS providers within the state. The state OEMS must also provide liaison with contiguous states or nations for coordinating cross-border EMS and EMS communications systems. The state OEMS must maintain liaison with its own state department or division of telecommunications (if applicable) for coordinating EMS operations with other telecommunications services.
EMS COMMUNICATIONS DESCRIBED
EMS planners and providers understand that communications are necessary for an EMS system to function. Even though communications is vital to the functioning of the EMS system, it remains a confusing and elusive component.
EMS communications is sometimes mistakenly simplified to the purchase of two-way radio equipment to be placed in an ambulance vehicle or hospital without any insight into how the radio equipment will be used or how it fits into the overall communications and emergency medical system. It is often thought of as only an ambulance talking to a hospital, rather than in the sense of communications as a whole. For planning purposes, EMS communications should be contemplated in a more classical meaning of communications: that is, as exchanges required to convey information and to respond to
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medical emergency situations, rather than as just equipment required for communication. In its broadest sense, EMS communications are the exchanges of information necessary for the emergency medical system to function. The need to communicate commences with the occurrence of an emergency medical incident and continues through all of the phases of the incident, including detection, reporting, response, medical direction, and coordination with other agencies necessary to effectively handle the situation. EMS communications end only with the full resolution of the emergency situation.
While information exchange between ambulance and hospital personnel is important to EMS communications, EMS communications involves much more. EMS communications must be integrated into the aggregate of public safety communications and be capable of responding to a wide variety of communications needs.
EMS communications should not be forced into the obscure and sometimes esoteric language of the communications engineer. The daily vernacular of non-technical system designers should be used. EMS communications are simply those exchanges of information needed to support the EMS system. EMS communications planners should not be overwhelmed by thinking of EMS communications in terms of frequencies, FCC Rules, mobile radios, walkie-talkies, base stations and complex technology. Instead, they should identify the people in the EMS system who need to exchange information. Consider who needs to communicate, where they will be located when they communicate, on which occasions they need to communicate, what equipment they need in order to communicate, and with whom they will need to communicate. Planners should try not to initially consider "how" they will communicate. The "how" part will be added later and is left to the technical wizards. They can come up with many answers and different approaches to "how." However, technical wizards are not adept at developing the "who, when, where, why, and what" part of the communications. This is communications planner’s job, planning within the EMS system.
2
EMS COMMUNICATIONS NEEDS
The following EMS communications needs were derived from a U.S. Department of Transportation planning guide. They show how the concepts of this discussion fit within the larger-scale (first-tier) plan to satisfy the national requirement of coordinated EMS communications.
1. Human health emergencies must be reported immediately to appropriate
community agencies that manage and control EMS resources and services.
2. Appropriate EMS resources must respond to human health emergencies at
any time and place.
3. Recognition of the need for and immediate response by EMS resources to
life-threatening and serious human health emergencies must be provided quickly enough to maximize lifesaving and prevent serious, long-term disabilities.
4. EMS and other health organizations and professionals must marshal their
individual and collective resources (staff, equipment, supplies, and facilities) and coordinate their responses in the shortest effective time to meet individual and mass human health emergency needs.
5. Personnel with special EMS training must provide guidance and direction via telecommunications to persons at the scenes of human health emergencies pending arrival of trained prehospital EMS personnel.
6. EMS must be coordinated with other public safety emergency response
services within the community through emergency operation centers or other means.
7. Special medical facilities--such as emergency departments, intensive care
and coronary care units, and burn and trauma facilities--must be used as effectively as possible.
8. All appropriate vital human physiological information necessary during any health emergency must be transmitted from the site of the emergency to the proper monitoring and decision-making emergency medical professionals, and the medical facility should be notified of the number, condition, and estimated arrival time of patients.
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9. Information on human health emergencies must be collected, recorded, and
documented for EMS system managers to review, revise, and reorganize to meet changing conditions and needs.
10. Safe transfer between health care facilities must be provided for acutely and chronically ill patients.
11. Best use must be made of EMS and other medical resources in preventing
or mitigating adverse effects of human health emergencies.
From this national EMS needs list, the following EMS communications requirements can be extracted:
EMS Access - Messages related directly to public access for reporting
emergency medical situations to appropriate EMS-response organizations.
EMS Dispatch and Control - Messages related to response, such as alerting,
dispatching and controlling the movement of EMS units as well as providing direction to persons calling for help. Medical Communications - Messages related to patient care, transmission of physiological
information and the exchange of patient assessment and treatment information among EMS personnel at the scene and medical personnel and physicians.
EMS Resource Coordination - Messages necessary for effective EMS resource
coordination relative to care and transportation of the patient.
Interdisciplinary Coordination - Messages related to the coordination of EMS activities with police, fire, government, and other agencies or resources (such as public utilities and private contractors) that are required to handle EMS emergencies.
Disaster Coordination - Messages related to the coordination of EMS, health,
and medical activities with those of local, state and national disaster-response authorities.
EMS communications begins with emergency medical incident detection and continues through personnel and equipment dispatch to respond to the emergency scene. The communications extend through the treatment of the patient at the scene and during the transportation of the patient to the hospital. The emergency response also must be coordinated with other public safety services, such as law enforcement and fire services, and with other agencies involved in the emergency response. Therefore, EMS communications broaden to these other services as well and include hazardous materials units, public works, gas and electric utilities, auto towing services, public transportation systems, disaster-relief services, and public administration as a whole.
The information exchanges essential to effective EMS communications are consolidated into the following five general categories or key points:
1. PUBLIC ACCESS to the EMS system
2. DISPATCH AND COORDINATION of the resources, vehicles, equipment,
and people required to respond to the emergency
3. MEDICAL CONTROL COMMUNICATION, including information exchange
between the field EMS personnel and the hospital, and the application of EKG telemetry when appropriate or required
4. INTERAGENCY COMMUNICATION, consisting of those information
exchanges necessary to coordinate the response of EMS personnel with those of the other public safety services
5. EDUCATION OF COMMUNICATIONS USERS in communications equipment use; language and terminology standardization; medical dispatcher education and certification; and standard emergency medical dispatch protocol development and use. Education also extends to citizens so they know whom to call, when to call, how to call, and what to expect when they call for emergency medical assistance.
These five key points are explained in detail in later sections. They are presented as an easily managed outline for surveying, reporting and planning EMS communications. If each of the five key points is understood within a geographic area, a concise plan can be created. Each key point should to be considered in two modes--"day-to-day" communications and the "disaster" mode.
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The "day-to-day" mode is defined as routine. The "disaster" mode is used for tornados, hurricanes, floods, earthquakes, volcanos and other such events. In these situations, communications systems that survive will be stressed and may be called upon to operate in an extraordinary manner. When possible, the disaster mode should be a natural extension of the day-to-day mode and not require a communications system reconfiguration. Untested equipment or communications schemes should not be relied on during a disaster--they usually don't function as anticipated and the people involved will not understand how to operate the equipment. Radios should not be hidden away just for use in the disaster. The radios, batteries, generators and other equipment should be tested, maintained and used regularly. Users should become familiar with the equipment and system. The system should be kept operational. Following these basic guidelines should help to ensure that when the unexpected happens, the system will be better prepared to cope.
Consideration also should be given to supplementary communications resources that are available and identified in other disaster and emergency plans. The EMS community must be familiar with these alternatives and consider their functions and compatibility factors during the planning process.
In April 1992, the Federal Emergency Management Agency (FEMA) adopted the Federal Response Plan (the Plan), which describes the mechanisms and structures by which the federal government will mobilize resources and conduct activities to augment state and local response efforts. The Plan is applicable to natural disasters such as earthquakes, hurricanes, typhoons, tornados and volcanic eruptions; technological emergencies involving radiological or hazardous material releases; and other incidents requiring federal assistance. The Plan uses a functional approach to group the types of federal assistance which a state is most likely to need. The Plan consists of the following 12 emergency support functions (ESFs). The twelve Emergency Support Functions are:
1. Transportation
2. Communications
3. Public works and engineering
4. Firefighting
5. Information and planning
6. Mass care
7. Resource support
8. Health and medical services
9. Urban search and rescue
10. Hazardous materials
11. Food
To parallel the federal structure, some state and county emergency management departments have adopted the federal approach. Although a state OEMS may interface with many ESFs during a disaster, this EMS communications guideline only addresses ESF 2 (communications).
In a presidentially declared disaster or emergency in which state and local resources have been destroyed or overburdened, ESF 2 will coordinate the establishment of required temporary telecommunications in the affected area. Support will include government-furnished telecommunications, commercially leased communications and telecommunications services provided under provisions of the National Security and Emergency Preparedness (NSEP) Telecommunications Services Priority (TSP) system procedures for expediting requirements.
During a disaster, any of the federal resources must be requested through the state office of emergency management (OEM). Requests should be made for specific types of equipment for specific missions. A good working relationship with state and local emergency management agencies will be beneficial.
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3
EMS COMMUNICATIONS SYSTEM COMPONENTS
EMS COMMUNICATIONS SEQUENCE
In developing an EMS communications system, the function of the EMS system and the needs of the EMS communications system must be identified prior to developing specific hardware or frequency allocations. There must be a clear determination of who needs to communicate with whom and why, when, and from where they need to communicate. Only after these parameters are understood can one address how the equipment system will operate. The communications system should be developed as integral to the overall county and regional EMS system, not as a free-standing communications system element.
EMS communications must take place between the people who operate and use the EMS system. To communicate effectively, they must know what information needs to be exchanged, whom to exchange the information with and how to exchange the information. During the delivery of emergency medical services, communications are necessary between diverse groups of people who are at various locations.
From the scene where an emergency occurs, the people involved need quick access to emergency help without added confusion. The people involved need to talk to people who dispatch the field medical resources. The dispatchers should routinely monitor the field teams and vehicles to coordinate their rapid dispatch and direct them to the scene. The dispatcher may also advise the people at the emergency scene about how to take additional actions necessary to help preserve life or reduce suffering. This advice, sometimes referred to as "pre-arrival instructions," should be delivered by trained telecommunicators using a medically approved protocol.
During the response, a dispatcher may need to communicate and coordinate with law enforcement, fire, or other agencies to coordinate EMS activities with these agencies. Interagency communications sometimes consist of requests from other public-safety agencies for emergency medical services.
After arriving at the scene, the field medical team needs to establish communications with hospital medical personnel for medical control communications. The team also needs to send to send patient condition or status information to the hospital or request medical direction and authorization. The situation at the scene may necessitate additional communications requirements. This is particularly true in-large-scale emergencies that involve several responding agencies.
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When departing the emergency scene with a patient, the field team must notify the hospital of the patient’s condition as well as and the estimated time of arrival (ETA) so that the hospital can be prepared for the patient. While the patient is en route to a hospital or during emergency treatment, the hospital receiving the patient may need to contact another medical facility for additional medical information or to arrange for transfer of the patient to a facility that provides a higher level of care.
When a field medical team travels outside of its normal service area to transfer a patient to a medical facility or to assist another area during a disaster, communications are necessary among that field team and medical facilities for coordination, notification and medical direction. These communications can provide assistance for the field team having difficulties (e.g., becoming lost or breaking down) or assistance in establishing necessary radio contact or frequency information. This communication can additionally extend to regionwide medical direction or control.
When the field medical team has completed its response and leaves the hospital or medical treatment facility, it must report its operational status to the dispatcher. This action completes a typical EMS response cycle.
This brief overview of EMS communications and system operation shows the nature of communications involving five basic groups of people. These include: (1) the public needing emergency assistance, (2) the dispatcher or telecommunicator, (3) the field medical teams, (4) the hospital personnel and (5) other agencies involved in the emergency response.
This planning guide has addressed who and where the people are and what they communicate to one another without yet addressing how the communications take place. This format should be typical of the considerations necessary for effective EMS communications system planning before equipment considerations are made. After these design parameters are established, the hardware and methods of communications may be considered. For EMS communications, these typically include telephone, radio and microwave, recording and computer equipment.
For the EMS communications system to function, the field teams, dispatchers, hospital personnel, and the system users must know how to operate the telephone and radio equipment required for their communications. For example, the system users who use public telephones to call for emergency assistance must know which number to call. The field teams, dispatchers, telecommunicators and hospital and medical personnel must know how to operate their radio equipment and know the procedures for establishing and maintaining radio contact. If the people who must operate EMS communications
equipment do not understand how the equipment or the system should function and how to maintain it, they will not use it. This lack of understanding leads to interference, miscommunication, confusion and frustration and could result in system failure.
Education is the final key point of EMS communications for system planners to consider. Education is perhaps one of the most important points. Knowledge and understanding lubricate the independent parts of the EMS system so they function smoothly and freely. These independent parts of the EMS system are the people--including the system users-- who administer EMS from their various locations. They must exchange information from these locations to coordinate their activities.
The nature of EMS communications addressed in this section can be summarized in the following required five key points:
1. Public access to the EMS resource delivery system 2. Dispatch and coordination of the response
3. Medical control communications, including: A. Hospital notification communication
B. ALS medical direction and telemetry communication 4. Interagency communication
5. Education for communications users
Each EMS communications system plan must consider all of these key points for effective communications among the public, the field medical teams, the dispatchers, the hospital personnel, and the people at the scene of an emergency incident.
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4 PUBLIC
ACCESS
IMPLEMENTING
9-1-1
Before emergency services can be rendered, the emergency service providers must be aware of the requirement for the service and the location where it is needed. In most cases, the request for service comes from the public citizen by telephone. Two problems exist with public access by telephone: delays or difficulties due to multiple emergency telephone numbers, and the inability of the callers to effectively convey their needs or location.
Multiple numbers--Problems due to multiple numbers may be caused by boundary or jurisdiction questions that create confusion about the proper number to call, and by misdirected calls due to regionalized telephone boundaries.
Sometimes callers are unable to communicate effectively because of their lack of familiarity with an area, or because of communications barriers, which can exist with persons who are blind, deaf, mute, or who speak a language other than English.
Some of the multiple emergency telephone number problems can be remedied by establishing a public safety answering point (PSAP) with a single number to call for all emergency services and districts in a given area. The PSAP can be part of an existing dispatch center or may be an autonomous agency established for this purpose.
CATEGORIES OF PUBLIC SAFETY ANSWERING POINTS
There are four general categories of public safety answering points (PSAP).
Referral - Personnel at the public safety answering points answer the phone, ask
pertinent questions, such as the nature of the emergency and location, and then advise the calling party of the proper number to call. The referral method is the least time-efficient and is not encouraged or recommended for any system. The system should be avoided unless there is no other option.
Relay - The PSAP answers the phone, acquires all necessary information from the
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does not interact or speak directly with the responding or dispatching agency and is not always available to answer further questions, in case they develop during a response.
Transfer - The PSAP answers the phone, asks pertinent questions and transfers the call directly to the appropriate responding agency. This method is more time-efficient and allows direct communications between the caller and the dispatching or responding agency.
Direct - The PSAP answers the phone, acquires all information from the caller, and
then directly dispatches the necessary response units.
CITIZEN
ACCESS
The 9-1-1 PSAP system must be able to receive and process incoming calls that report emergencies and request emergency medical services. All citizens must be able to summon help rapidly in an emergency situation. A citizen must be able to call for police, fire, emergency medical service, rescue, and other emergency aid promptly, without confusion, and without having familiarity with a particular community. A system that is uniform locally, statewide and nationwide will enable a citizen to do these things.
In areas in which a 9-1-1 system has not been implemented, citizens must search through telephone directories for one of several separate police, fire, ambulance, and hospital emergency department numbers when a medical emergency occurs. The lack of a 9-1-1 system delays emergency medical assistance, and in life-threatening and serious medical emergencies, can contribute to loss of life and permanent disabilities. There is no technical reason why a basic or 9-1-1 Enhanced emergency telephone number cannot be planned and implemented by any telephone company. (9-1-1 Enhanced systems can determine the telephone number and location from which an emergency call is made.) The universal national 9-1-1 emergency telephone number should be implemented without delay in areas in which new or improved communications systems are being implemented.
In 1994, the National Emergency Number Association (NENA) estimated that about 75 percent of U.S. households, mostly in urban areas, have access to public safety services through some type of 9-1-1 system. Many rural households and roadways fall outside of existing 9-1-1 system coverage areas.
and effective alternative means of access to public safety services for the remainder of the nation's population. Enhancement of 9-1-1 systems permits automated use of computerized databases listing pre-designated law enforcement, fire, and EMS primary and secondary responders for each location in the 9-1-1 service area.
Existing 9-1-1 systems may not be totally effective for various reasons. Some households do not have public telephone service due to financial limitations or non-availability of services, particularly in rural areas. Even with public telephone service, some households may not have 9-1-1 services because there has been no local government initiative to provide such services. Effectiveness of 9-1-1 services may be increased by upgrading basic 9-1-1 systems to 9-1-1 Enhanced systems. With-9-1-1 Enhanced, the time required for processing individual 9-1-1 calls is decreased, permitting processing of a greater volume of calls per unit of time. This enables a system to handle the demands of a larger population and a greater volume of emergency calls during "busy hours."
Existing 9-1-1 systems may not be sufficiently coordinated with EMS dispatch services. In uncoordinated systems, information on incoming calls may be sent to the wrong response agency or unit. Emergency response crews may be sent to the wrong locations, they may become lost or delayed en route, or the may be directed to an inappropriate or unprepared medical facility. Such problems may be reduced through close coordination and cooperation of EMS and 9-1-1 centers. Dispatch services may be further enhanced by co-locating facilities, cross-training personnel, and by completely integrating 9-1-1 and dispatch services.
A single telephone number should be assigned for the service area. Where practical, that number should be 9-1-1. The emergency number should be available at all telephones throughout a service area, and pay telephones used to dial the emergency number should not require a coin to operate. Other telephone linkages into the Central Medical Emergency Dispatch (CMED) should be considered where feasible, including street and highway emergency telephones or call boxes.
9-1-1 SYSTEM DESCRIPTIONS
Basic 9-1-1 is the least expensive of 9-1-1 systems and is generally easy to implement if a telephone company's switching equipment can accommodate the change. Smaller telephone companies are frequently unable to absorb the cost of making necessary changes in switching equipment, and unless an organization is willing to absorb the costs, people in the area have to wait until the switching equipment becomes outdated and must be replaced. When new equipment is installed, it is usually able to accommodate 9-1-1. Basic 9-1-1 can contain such features as Called Party Hold, Forced Disconnect, Ringback
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and Dial Tone First.
Note: there is an effort to use the terminology "nine one one" rather than saying "nine eleven." Also, the "E" for enhanced is commonly being moved to after the numbers to prevent confusion with members the calling public, who sometimes attempt to dial the "E" on the telephone. It does not matter which digits are pressed after 9-1-1 is dialed.
9-1-1 Enhanced includes additional features beyond the basic 9-1-1 service, such as selective routing, which brings 9-1-1 calls into the appropriate center, depending on the area from which they originated. The calls then can be handled by a telecommunicator assigned to calls from a specific area. 9-1-1 Enhanced also includes the capability for automatic number identification (ANI) and automatic location identification (ALI), which flashes the caller's telephone number and address on the screen in front of the dispatcher. These features increase the reliability of a response, since they enable the dispatcher to send help even when the caller is unable to speak. They also serve to reduce false or prank calls to the 9-1-1 center.
It is usually possible for a basic 9-1-1 system to convert to a 9-1-1 Enhanced system. It is less expensive when all municipalities agree to one public safety answering point (PSAP) and central dispatch, rather than maintaining separate dispatch centers, because of the lower costs created by reducing duplicated personnel and equipment.
Emergency care providers have traditionally been plagued by abuse calls (e.g., continual calling and hanging up). Additionally, calls that may include bomb threats or false claims are often made. The agencies receiving these calls must respond until such calls are proven to be hoaxes. Such necessary policies place personnel and equipment in high-risk situations or in non-emergency situations that reduce the resources available to respond to confirmed emergencies. By including features available in 9-1-1 Enhanced, these occurrence of these situations can be lessened.
FEATURES AVAILABLE TO 9-1-1 SYSTEMS
Forced Disconnect - The capability of a PSAP attendant to disconnect a 9-1-1 call to prevent jamming of the incoming lines.
Idle Tone Application - Idle Tone indicates by the presence of a tone that a caller has hung up, or by the absence of a tone that the distant telephone is still off the hook.
central telephone office and allows calls to be "patched" or transferred to another location by dedicated phone lines.
Direct Trunking - Direct trunking refers to dedicated incoming lines that connect
the telephone central office of the calling party directly to the PSAP. Tandem trunking refers to non-dedicated trunk lines that connect the central office of calling parties to a single central office, where they are passed to the PSAP by a small number of dedicated lines. Tandem trunking is less costly but is susceptible to unavailability during system overloads or busy periods
Dial Tone First - The provision of dial tone to enable a caller to originate and
complete 9-1-1 calls from public telephones without inserting a coin or any other device. Sometimes referred to as "coin-free dialing."
Called Party Hold - This allows the Public Safety Answering Point (PSAP) to hold a telephone circuit open when the calling party hangs up. This allows the call to be traced and can prevent subsequent calls for as long as the line is held open by the PSAP.
Ringback - Ringback allows the PSAP to ring the telephone that is being
held by called party hold, even with the phone off the hook.
Switch Status - Switch status allows the PSAP call-taker to determine visually
whether a caller has gone "on hook" or hung-up without the call-taker listening or monitoring the line.
9-1-1 ENHANCED FEATURES
9-1-1 Enhanced replaces many of the features of basic 9-1-1 with more effective features. The new features can help with some of the communications problems that might be encountered once the call is made. Some of the features available are:
Automatic Number Identification (ANI) -
Immediately and automatically provides the PSAP with the telephone number of the calling party. This replaces called party hold and ringback service, since the PSAP has the correct number to call back.
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Automatic Location Identification (ALI) -
Provides the PSAP with the street address and telephone number of the calling party. If the number corresponds to a nonresidential location, the subscriber’s official (business) name is also shown. Other information such as handicapped status, emergency or utility service district designations, also can be included in some ALI systems.
Selective Routing (SR) -
Can route a call to one of several PSAPS as determined by the telephone number of the calling party.
SPECIAL TELEPHONE METHODS FOR PSAPS
Foreign Exchange (FX) -
This telephone service provides the PSAP with a telephone number corresponding to an exchange that would not normally provide service in its geographic area. The FX service can prevent the necessity for long distance calls within a geographic area, regardless of the location of the PSAP in that area. The telephone line is switched in an exchange or central office other than the exchange or central office in which the telephone is located.
Enterprise (WX) -
This service allows a telephone operator to assist callers that would normally be classified as long distance. The calling party dials zero and asks to speak to the "enterprise operator" by dialing a three-digit number. The operator can connect the caller to the desired party. The cost of WX calls are billed to the called party, and constitute a previously agreed-to collect telephone call. Enterprise service is not recommended for emergency reporting, because it delays reporting of the emergency.
Inwats (area code 800) -
This service allows incoming calls to be received from callers in a specified geographic area at no charge to the caller. The calling party dials a "1-800 number." The cost of the call is billed to the called party. Inwats lines can provide a single areawide access number that is toll-free to the calling party.
Teletypewriter (TTY) -
These services allow deaf or mute persons to communicate with the PSAP. In order to communicate, the PSAP must connect the telephone line to a teletype machine, or have a dedicated TTY telephone number. The TTY system connects two
teletypes so everything typed on one is printed at both locations. TTY systems are sometimes called "text telephones."
PROBLEMS WITH CELLULAR ACCESS TO 9-1-1
To service cellular 9-1-1 emergency calls, it is necessary for the PSAP telecommunicator to revert to time-consuming basic 9-1-1 answering procedures. This degrades the 9-1-1 Enhanced services for everyone, not just for the cellular callers. In some states, the concept of using cellular phones to call 9-1-1 has been exploited as a marketing tool by cellular service providers. This marketing strategy has adversely affected wire-line 9-1-1 services. In those states with statutes and regulations on 9-1-1, there have been efforts toward requiring cellular service providers to cease what some consider to be false advertising claims regarding the effectiveness and reliability of the cellular interface with 9-1-1. As a consequence, there is no uniformity in the posting of emergency telephone numbers for emergency highway use.
In some states (e.g., California, New Jersey, and Connecticut) where state 9-1-1 legislation has been enacted, provisions exist for all cellular 9-1-1 calls to be received by the state highway patrol. After the caller telephone number, nature and location of the emergency are determined by the highway patrol communicator, the call is transferred to the appropriate local 9-1-1 PSAP. At that point, the call can be handled the same as other basic 9-1-1 calls to the PSAP. This procedure is costly and puts an extra burden on state law enforcement resources. National uniform standards regarding the interface of wireless services with basic and enhanced 9-1-1 systems are needed. To accomplish this, there is a need to bring about appropriate FCC rulemaking on this subject.
FCC rule changes needed for current and future integration of wireless telephone communications services with 9-1-1 are in process.
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5
DISPATCH & COORDINATION
EMS VEHICLE DISPATCH
On notification of the need for emergency medical service, the system must promptly dispatch EMS units to the emergency scene. The EMS system must keep track of the units and provide guidance that expedites vehicle movement to the scene, transportation to appropriate emergency medical facilities, and return to availability for further assignment. The lack of coordination between the various groups required to provide assistance in an emergency has been a weakness of EMS communication systems in the past. Ambulance and rescue services, hospital emergency departments, and other emergency services provided by the fire service, law enforcement and other public services have traditionally operated independently in many areas. Often, the only available communications link for this interagency contact has been the public dial-telephone system. Thus, emergency-response agencies have been poorly prepared to select and coordinate appropriate responses. They react much like the citizen who opens the telephone book to find a multitude of emergency numbers for various jurisdictional areas and types of services. This results in inefficiency, delay and unreliable coordination in emergency response.
The procedures and equipment for communications between agencies must be regularly used and tested to ensure that the hardware functions properly and that personnel are familiar with and capable of operating the system.
CENTRAL MEDICAL EMERGENCY DISPATCH FUNCTIONS
The primary function of central medical emergency dispatch (CMED) is service coordination. The CMED receives requests for emergency medical assistance and coordinates the response of the emergency medical resources with the response of other emergency agencies, such as police, rescue, sheriff and fire departments. An emergency assistance request and the response coordination requires communications linkages or paths for: (1) access to EMS from the scene of the incident, (2) dispatch and coordination of EMS resources, (3) coordination with medical facilities and (4) coordination with other public safety and emergency services such as law enforcement and fire services.
A trained dispatcher at the CMED should continuously monitor the total emergency reporting system. On notification of an emergency, the dispatcher obtains information
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concerning the location and type of emergency and may provide advice on medical treatment for the victim before the arrival of a field medical team. The dispatcher also initiates and coordinates response by all agencies that are necessary to cope with the emergency.
The CMED may directly dispatch emergency ambulance and rescue vehicles to the scene of an emergency in its service area or it may transfer necessary information to a dispatch authority. A dispatcher will make the decision as to the number of ambulances and type of emergency vehicles needed and dispatch these to the scene of the emergency. Dispatchers must have the capability of activating a response by all EMS personnel and vehicles within their areas. The mode of activating this response or dispatch may be either by a direct telephone line to the emergency vehicle base or by radio on an appropriate frequency. Where volunteer personnel are part of the system, some type of radio alerting capability may be required. Dispatchers should have two-way radio communications to the EMS vehicles to facilitate additional responses as the emergency is assessed by the medical team at the scene, as well as to dispatch additional EMS vehicles, wreckers, fire, or law enforcement, or to request special hospital preparation. Dispatchers must also continuously monitor the status of all EMS vehicles and field teams in their service areas so the most rapid and effective response to emergencies can be initiated. Dispatchers must be able to determine the emergency’s location, provide direction and assistance to responding units, and monitor their progress.
The CMED should have direct communications with other emergency response agencies, including law enforcement, fire services, adjacent area CMEDs, and other local emergency support services. Communications with adjacent area CMEDs allows mutual backup and transfer of vehicles if necessary for emergency or disaster operations. The CMED also can be the receiving center for fire, police, and medical emergency requests. However, if this is not the arrangement, then the CMED must have direct telephone lines or other continuous communications to the fire and police agencies for coordination of an emergency response. This communication must take place rapidly, and without the possibility of confusing, losing portions, or not obtaining complete location, call-back or location information.
The CMED should have direct communications to all medical facilities involved with EMS in its service area and should maintain current data on EMS treatment capabilities of all medical facilities and emergency support services in the service area. When requested, the dispatcher will use available hospital resource information to direct the EMS vehicles to the nearest appropriate medical facility and notify that medical facility of the emergency type and estimated arrival time of patients.
INTERDISCIPLINARY
COMMUNICATIONS
Medical emergencies often involve the response of various public safety and emergency service agencies that must be able to communicate and coordinate operations. Although the various services may operate on different radio frequency bands, mechanisms such as cross-band operations, cross-frequency patching at radio consoles, interservice use of common radio frequencies, and other measures should be included in the EMS communications system design. Co-location of communications centers or telephone lines among communications control centers for various emergency response agencies can also provide a coordinated response. Such communications are needed to support daily EMS operations and mutual aid agreements, and are also essential for mobilization and command and control of all emergency response units during disasters or large-scale emergencies.
EMD-TRAINED
TELECOMMUNICATOR
The emergency medical dispatcher (EMD) is the principal link between the public caller requesting emergency medical assistance and the EMS resource delivery system. As such, EMDs play an important role in the ability of the EMS system to respond to a perceived medical emergency. With proper training, program administration, supervision and medical direction, EMDs can accurately query callers, select appropriate methods of response, provide pertinent information to responders and give appropriate aid and direction for patients through the caller. Through careful application and reference to written, medically approved, emergency medical dispatch protocols, sound decisions concerning EMS responses can be made in a safe, reproducible and non-arbitrary manner. These benefits are realized by EMS systems when appropriate implementation, sound medical management and quality assurance/quality improvement (QA/QI) at dispatch are provided within the EMD/EMS system. This document assists in establishing these management and administrative standards.
The EMD’s function is to promptly and accurately process calls for emergency medical assistance. The training and practice gained through the use of a written or automated medical dispatch protocol is not sufficient to ensure continued medically correct EMD functioning. Their dispatch-specific medical training and focal role in EMS has developed to such a complexity that only through a correctly structured and appropriately managed quality assurance environment can the benefits of their practice be fully realized. The philosophies of emergency medical dispatch have established new duties to which the emergency medical dispatch agency must respond. It is important that their QA/QI activities, including initial hiring, orientation, training and certification, continuing dispatch
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education, recertification and performance evaluation be given appropriate managerial attention to help ensure the ongoing safety in the performance of the EMD. This standard establishes functional guidelines for these managerial, administrative and supervisory functions.
The CMED should be staffed with EMD-trained telecommunicators. The telecommunicators should be highly skilled in mobilizing all necessary extrication, rescue, transportation, and treatment resources required in providing optimum treatment for an emergency patient. They must have a good knowledge of the service area, including landmarks useful to directing field teams to emergency scenes. Also, because of the medical coordination required of these telecommunicators, they should have a working knowledge of the medical community. They must be able to speak clearly, hear well, make sound decisions and stay calm in emergency crisis situations.
All medical dispatch protocols, pre-arrival instructions and quality assurance/quality improvement programs must be supervised by a physician EMD medical director.
CMED
PLANNING
Necessary communications links to and from the CMED may be accomplished in many ways. Radio communications should be used only where other means, such as telephone, ringdown or intercom, are inadequate or not technically or economically feasible. The radio frequency spectrum is shared by many users; therefore, when radio systems must be used, operational procedures must be developed to limit radio use to that required for efficient coordination. The inventory of existing area communications systems should be reviewed to determine whether they can play a part in the CMED communications. In some areas, many emergency response agencies use the same frequency band, such as high-band VHF, which can permit inter-agency communications by allowing one agency to monitor the other agency's radio frequency. This is a relatively inexpensive method that can facilitate the coordination of activities necessary for a CMED system.
It may be possible to achieve substantial cost savings to the area by eliminating duplicated functions or facilities. For example, in an area in which three 24-hour dispatch centers for fire, police, and EMS units are combined into a single center, savings may accrue due to reduced facility costs, the need for fewer dispatchers, and reduced costs and improved reliability for interagency communications and coordination. However, this approach may occasionally result in opposition from interagency partisan interests.
Planners must also consider whether using an existing communications link or system would impair the ability of the system to change or grow in the future. In some cases, the
benefit of using existing communications links would not be lasting. For example, designing an EMS communications system around an extensive, but aging, single-channel radio communications system or existing ambulance radio system might not be wise. Effective interagency coordination requires multichannel capability, so if an inadequate existing system was used, daily internal system operation might be difficult, and interface difficulties and adjacent evolving EMS systems could soon render the system obsolete.
Every type of communications link has a reliability level associated with it. Radio communications links may be more reliable than telephone lines, whether they are dedicated or public dial-up circuits. Planners should be cautious about designing around any one type of system or device. For example, the cellular telephone has several benefits for some types of communications but it has drawbacks that must be considered when assessing possible emergency communications system approaches. The cellular telephone works well for one-on-one communications, such as between a paramedic and a physician medical adviser for medical-control communication. However, the cellular telephone does not work satisfactorily for dispatch communications in which contact and communications must be made with several individuals or units simultaneously. Direct two-way radio works better in such a situation. Even one-two-way "alert dispatch paging" is preferable for dispatch operations, as it facilitates simultaneous information transmission to many individuals.
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6
MEDICAL CONTROL COMMUNICATIONS
MEDICAL CONTROL AND COORDINATION
The EMS communications system must provide the field medical personnel with a communications channel that permits the exchange of treatment information while the patient is at the scene of the emergency and while en route to a medical care facility, permits alerting of the medical facility prior to the patient's arrival, and allows coordination among medical facilities and services. With the advent of advanced life support (ALS) trained EMS personnel within an EMS service area, medical control communications between the administering physician or hospital providing medical direction and the field medical team has been mandated in most jurisdictions.
TELEMETRY
To administer advanced cardiac life support, especially when an ALS program is early in the evolution of its system, biomedical telemetry from the EMS field team to a hospital physician is occasionally desired or is mandated in some areas. Eight of the UHF MED radio channels may be used for telemetry. The transmission time required by telemetry is one of the reasons the FCC allotted 10 UHF channels for planned sharing of the medical channels in order to minimize interference and channel congestion. Standards are included in this planning guide for telemetry equipment. There is currently no consensus on non-proprietary standards for exchange of digital EKG (telemetry) data. Twelve-lead, simultaneous EKG transmission may be required for some of the new treatment drugs such as TpA. Future guidelines and standards need to be developed to address such issues.
CELLULAR TELEPHONE USE IN EMS FIELD OPERATIONS
Cellular telephone systems have been available in most areas of the United States since the mid-1980s. The concept of cellular radio/telephone systems is to limit the actual coverage to the smallest possible area, which will allow the frequencies to be reused more often.
Early mobile telephone systems were designed so that each fixed site provided the maximum possible coverage to mobile radio/telephone units. These stations transmitted
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their signals at full power, regardless of the location of the associated mobile unit being served. With the improvements in control and switching technology, many stations may be implemented, with each having greatly reduced coverage. As mobile telephones move through their coverage areas, they may handle or pass the call off to another station (or cell).
Cellular service is provided by one of two categories of carriers--wireline-, or non-wireline-based. Their category depends on whether they provide conventional (wireline) telephone service to the same population. There are 832 cellular channels available, with 333 channels allocated to each category and an additional 166 channels available to either group.
Cellular systems may provide supplemental communications coverage for EMS operations. System coverage is provided over large areas, channel availability is high and operation is relatively simple. However, there are several advantages and disadvantages that govern when cellular telephone use is acceptable in EMS systems.
Some of the advantages of cellular radio telephone are:
< Good coverage is provided within the service area.
< Excellent voice quality is provided within the service area. < A large number of channels are available for use.
< Mobile equipment is low-powered (0.6 - 3.0 watts).
< Communications are not usually monitored by other users. < Full duplex communications are possible.
< They can be used to provide biomedical telemetry operation. Some disadvantages of cellular radio telephone are:
< There is no broadcast capability that allows the same message to be
simultaneously sent to several parties.
< It is necessary to be registered within the system in order to use the
< It is necessary to know the telephone numbers of the parties with which you wish to speak.
< It is not possible to temporarily interrupt an ongoing conversation (except with call-waiting-type features).
< Substantial fees are charged for system use.
< Cellular telephones are vulnerable because they rely on the existence and proper operation of fixed radio equipment, switching systems, and (when calling landline telephones) proper operation of the public switched telephone network.
< Central documentation (such as log recording) is more difficult to accomplish. < The systems are subject to unavailability during periods of peak demand.
Examples would be during traffic jams, rush-hour traffic, or during catastrophic events that attract media attention.
< No standard system has been established to ensure priority access to public-safety users.
< Equipment that provides biomedical telemetry capabilities must be approved by the federal Food and Drug Administration (FDA). There is a limited availability of FDA-approved biomedical telemetry equipment is limited.
< The coverage area for the cellular system may be unfamiliar to the system user.
< Rural service areas are usually not covered or receive only limited or
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7
STATE COMMUNICATIONS PLANNING
PLANNING
TERMINOLOGY
Goals - Planning statements of broad direction, general purpose or intent. A
goal is general and timeless and is not concerned with a specific achievement within a given period of time.
Objectives - Planning statements of a desired accomplishment that can be
measured within a specified time frame and under determinable conditions. Attaining an objective moves the system toward a directly related goal.
Tasks - Planning statements that include the small increments of achievable
work that are identifiable, assignable and measurable within an immediate time frame.
GOALS FOR EMS COMMUNICATIONS
GOAL 1 - EMS communications systems should meet the needs of emergency
medical systems and nationally accepted standards of functional performance.
GOAL 2 - Local EMS communications systems should be compatible with, and
should not interfere with, EMS communications systems in neighboring or adjacent areas and within the state or in other geographic areas.
GOAL 3 - Local EMS communications systems should be compatible with, and
should not interfere with, other types of communications systems.
GOAL 4 - EMS communications systems should make maximum use of state
and other common resources, where this approach is appropriate and cost-effective.
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GOAL 5 - The state OEMS acts as the representative of local EMS systems in
dealing with federal agencies and national organizations.
Objectives for planning statewide EMS communications should be based on these goals. EMS communications must meet the performance goals and objectives specified by those who use and are served by the systems. Ideally, the systems should satisfy every conceivable need. Realistically, constraints such as cost, political considerations, demographics, geography, social preferences, existing legislation and time will limit what actually can be achieved.
In situations in which EMS communications require coordination among several political subdivisions that affect the health and safety of the population, it is appropriate for state government to take a coordinating role. Additionally, statewide planning for coordinated use of radio frequencies for EMS communications is necessary so individual efforts do not become counterproductive to the system. The new FCC Emergency Medical Radio Service (EMRS) Rules require that frequency coordination complies with state EMS communications plans where they exist.
As a governmental unit, the state OEMS should have the statutory and regulatory responsibility for planning EMS communications. State planning for emergency medical systems provides the authority to accomplish coordination in use of the available radio frequencies and promotes multiagency cooperation necessary to serve the public needs. Communities, counties, and multicounty regional planning agencies are thereby provided with the guidance to achieve the performance goals and objectives for their EMS communications systems.
The performance goals and objectives should be considered by each EMS region for evaluating, planning and implementing acceptable EMS communications systems. Determining the goals and objectives for an EMS communications system requires defining the specific role for each agency involved in the EMS communications system.
With few exceptions, states do not own or operate EMS systems or EMS communications. Instead, the state OEMS acts as a regulator, coordinator and facilitator for local EMS and EMS communications systems.
EMS communications regions may be thought of as collections of smaller local EMS communications systems or areas. The state is not involved with the daily operation of these individual local communication systems, but it is concerned with the interfaces and
interactions among them and the other elements that form a complete EMS system.
The first interface is between a local EMS system and the population it serves. The concern of the state OEMS is that the local system meets appropriate functional standards for performance. The state OEMS should focus on the result, including the character and quality of service provided to the population, rather than on the mechanics of how the service is provided. Items of interest include EMS communications training standards, and the degree to which the communications systems provide public access, medical communications for basic and advanced life support and radio coverage.
A second interface is between local EMS communications systems and neighboring EMS service areas. There are two specific concerns. First, the various communications systems must not interfere with one another. This requires consideration of coverage boundaries, allocation of frequencies, and real-time coordination of common frequencies. Second, systems should be able to cooperate const
