EMERGENCY MEDICAL COMMUNICATIONS

Transcription

1 THE NATIONAL ASSOCIATION OF State Emergency Medical Services Directors PLANNING EMERGENCY MEDICAL COMMUNICATIONS STATE-LEVEL PLANNING GUIDE VOLUME ONE June 1995

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3 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 U.S. Department of Transportation National Highway Traffic Safety Administration 1947 Camino Vida Roble Suite 202 Carlsbad, CA /

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5 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 Paulette B. Newman Jack K. Pase Jeff Pegram Carlton W. Wells Andrew Szekely Assistant Chief-Engineering State of North Carolina Office of Emergency Medical Service Raleigh, North Carolina Medical Health Program Analyst State of Florida Department of Health and Rehabilitative Services Tallahassee, Florida Planning Officer West Virginia Emergency Medical Services Technical Support Network Elkview, West Virginia Communications Engineer Commonwealth of Virginia Office of Emergency Medical Services Richmond, Virginia Supervisor State of Florida Division of Communications Local Government Engineering Section Tallahassee, Florida National Frequency Coordinator IMSA/IAFC Providence, Rhode Island Mark S. Johnson, Chairman NASEMSD Communications Committee Charles Glass Chief Emergency Medical Services Section State of Alaska Department of Health & Social Services Juneau, Alaska Contracting Officer Technical Representative National Highway Traffic Safety Administration Washington, D.C.

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7 TABLE OF CONTENTS 1 INTRODUCTION... 1 FIRST-TIER PLANNING... 1 EMS COMMUNICATIONS DESCRIBED EMS COMMUNICATIONS NEEDS EMS COMMUNICATIONS SYSTEM COMPONENTS EMS COMMUNICATIONS SEQUENCE PUBLIC ACCESS IMPLEMENTING CATEGORIES OF PUBLIC SAFETY ANSWERING POINTS CITIZEN ACCESS SYSTEM DESCRIPTIONS FEATURES AVAILABLE TO SYSTEMS ENHANCED FEATURES SPECIAL TELEPHONE METHODS FOR PSAPS PROBLEMS WITH CELLULAR ACCESS TO DISPATCH & COORDINATION EMS VEHICLE DISPATCH CENTRAL MEDICAL EMERGENCY DISPATCH FUNCTIONS INTERDISCIPLINARY COMMUNICATIONS EMD-TRAINED TELECOMMUNICATOR CMED PLANNING MEDICAL CONTROL COMMUNICATIONS MEDICAL CONTROL AND COORDINATION TELEMETRY CELLULAR TELEPHONE USE IN EMS FIELD OPERATIONS = i <

8 7 STATE COMMUNICATIONS PLANNING PLANNING TERMINOLOGY GOALS FOR EMS COMMUNICATIONS EMS COMMUNICATIONS HISTORY HISTORY OF REFARMING THE MOBILE RADIO SPECTRUM EMERGENCY MEDICAL COMMUNICATIONS PLAN THE CURRENT STATUS MIGRATION ISSUES FOR EMS COMMUNICATIONS EMS RADIO FREQUENCY PLAN THE FEDERAL COMMUNICATIONS COMMISSION RADIO LICENSING AND FREQUENCY COORDINATION OPERATING UNDER AUTHORITY OF ANOTHER LICENSEE RADIO COVERAGE AND RANGE THE REGIONAL SYSTEM COORDINATED RADIO COVERAGE WIDE-AREA RADIO COVERAGE FREQUENCY SPECTRUM AND SERVICE REQUIREMENTS RADIO FREQUENCIES FOR EMS COMMUNICATIONS ELIGIBILITY CRITERIA EMS RADIO FREQUENCIES COMMUNICATIONS SYSTEM COMPONENTS RADIO SYSTEM EXPLANATIONS EMS RADIO PATHS BASIC RADIO SYSTEM EQUIPMENT STANDARD HIGH BAND VHF FREQUENCIES DUPLEXED RADIO STATION RADIO RELAY STATIONS BASE-STATION REPEATER PATIENT-SIDE COMMUNICATION UHF MEDICAL COMMUNICATIONS MHz Systems TRUNKED RADIO SYSTEMS MHz SYSTEMS NETWORK RADIO FREQUENCIES AND IDENTIFIERS SELECTIVE SIGNALING = ii <

9 RADIO EQUIPMENT GUIDELINES UHF MED RADIO STATIONS EKG TELEMETRY STANDARDS SYSTEM CONCEPTS STATE CALLING CHANNEL AREA WORKING CHANNEL LOCAL WORKING CHANNELS AREA SYSTEMS OPERATIONAL DESCRIPTION APPENDIX A RADIO FREQUENCIES - PAGING APPENDIX B RADIO FREQUENCIES - EMRS APPENDIX C - SPECIAL EMERGENCY RADIO SERVICE APPENDIX D - STATE EMS COMMUNICATIONS PLAN APPENDIX E - SAMPLE DESIGNATION LETTER APPENDIX F - SAMPLE SUPPORT LETTER APPENDIX G - SAMPLE FREQUENCY PLAN SELECTED REFERENCES SUPPLIERS OF FCC LICENSE DATA ACRONYMS GLOSSARY INDEX = iii <

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11 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. = v <

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13 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 F 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 Available from ASTM, 1916 Race Street, Philadelphia, PA Telephone: 215/ = 1 <

14 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 = 2 <

15 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 = 3 <

16 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. = 4 <

17 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. = 5 <

18 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 - EMS Dispatch and Control - Messages related directly to public access for reporting emergency medical situations to appropriate EMSresponse organizations. 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 - Interdisciplinary Coordination - Disaster Coordination - Messages necessary for effective EMS resource coordination relative to care and transportation of the patient. 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. Messages related to the coordination of EMS, health, and medical activities with those of local, state and national disaster-response authorities. = 6 <

19 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. = 7 <

20 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 12. Energy = 8 <

21 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 governmentfurnished 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. = 9 <

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23 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. = 11 <

24 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 = 12 <

25 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. = 13 <

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27 4 PUBLIC ACCESS IMPLEMENTING 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 caller and then relays the message to the appropriate agency. The caller = 15 <

28 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 timeefficient 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 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 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 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 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 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 system. Many rural households and roadways fall outside of existing system coverage areas. Ideally, there should be Enhanced coverage for at least 90 percent of the households = 16 <

29 and effective alternative means of access to public safety services for the remainder of the nation's population. Enhancement of systems permits automated use of computerized databases listing pre-designated law enforcement, fire, and EMS primary and secondary responders for each location in the service area. Existing 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 services because there has been no local government initiative to provide such services. Effectiveness of services may be increased by upgrading basic systems to Enhanced systems. With Enhanced, the time required for processing individual 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 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 centers. Dispatch services may be further enhanced by colocating facilities, cross-training personnel, and by completely integrating and dispatch services. A single telephone number should be assigned for the service area. Where practical, that number should be 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 SYSTEM DESCRIPTIONS Basic is the least expensive of 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 Basic can contain such features as Called Party Hold, Forced Disconnect, Ringback = 17 <

30 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 is dialed Enhanced includes additional features beyond the basic service, such as selective routing, which brings 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 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 center. It is usually possible for a basic system to convert to a 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 Enhanced, these occurrence of these situations can be lessened. FEATURES AVAILABLE TO SYSTEMS Forced Disconnect - The capability of a PSAP attendant to disconnect a call to prevent jamming of the incoming lines. Idle Tone Application - Call Transfer - 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. This requires special electronic equipment at the PSAP or = 18 <

31 central telephone office and allows calls to be "patched" or transferred to another location by dedicated phone lines. Direct Trunking - Dial Tone First - 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 The provision of dial tone to enable a caller to originate and complete 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 - Switch Status - 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 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 ENHANCED FEATURES Enhanced replaces many of the features of basic 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. = 19 <

32 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 = 20 <

33 teletypes so everything typed on one is printed at both locations. TTY systems are sometimes called "text telephones." PROBLEMS WITH CELLULAR ACCESS TO To service cellular emergency calls, it is necessary for the PSAP telecommunicator to revert to time-consuming basic answering procedures. This degrades the Enhanced services for everyone, not just for the cellular callers. In some states, the concept of using cellular phones to call has been exploited as a marketing tool by cellular service providers. This marketing strategy has adversely affected wire-line 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 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 legislation has been enacted, provisions exist for all cellular 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 PSAP. At that point, the call can be handled the same as other basic 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 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 are in process. = 21 <

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35 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, emergencyresponse 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 = 23 <

36 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. = 24 <