First Responders, Hospitals Need More Bandwidth

A recent report on the state of U.S. emergency management and hospital systems found that they were lacking in modern communications and that little or no information sharing existed between first responders, hospitals and the military.

The United States’ emergency medical communications and computer networks are on life support. This is the conclusion of a recent report to Congress by a committee of experts from the telecommunications and emergency response industries. Although hospitals and first responders use many modern technologies, the document found that their communications systems are antiquated and unable to utilize the full advantages of modern network-centric information systems.

Researched and written by the Joint Advisory Committee on Communications Capabilities of Emergency Medical and Public Health Care Facilities (JAC), the report found the nation’s emergency communications capabilities were outdated, limited to voice and unable to adequately respond to a major disaster. It stated that first responders and health care professionals “…must practice 21st century medicine with 20th century communications technology.” The document added that modern broadband networks and applications have the potential to radically improve how health officials share emergency information.

Established by Congress to implement the recommendations of the 9/11 Commission, the JAC is a bipartisan task force of experts from the communications, emergency medical and public health care sectors. It comprises representatives from federal, state and local governments; industry and nonprofit health organizations; academia and health institutions.

The JAC identified the need to develop integrated, interoperable broadband networks, both wired and wireless, to allow critical health care-related information to move rapidly, reliably and securely. It also stressed the need to improve interoperability through better interagency coordination and through the use of common protocols, mobile broadband services and applications to create virtual hospitals at the scene of accidents and disasters. The paper also advocated advancing life-saving capabilities such as telemedicine, remote monitoring and telecommuting by encouraging network and application innovation and deployment.

To advance these goals, the committee offered a range of recommendations. Key among these was the need for policy makers to encourage the deployment of interoperable, standards-based broadband networks built on common standards and protocols that can transmit bandwidth-intensive information. Also needed is enhanced coordination between existing systems to share real-time data across systems and to allow common patient and emergency vehicle tracking for better situational awareness for all emergency medical and public health care facilities. “By taking advantage of modern communications technologies, we can begin laying the foundation for a mobile, digitally connected health care system,” the report states.

The document recommends a systematic strategy to improve emergency communications from first responders to public health care facilities. The strategy covers all parts of the emergency response chain, from an initial 911 call, through emergency dispatch, onsite communications, transport communications, hospital communications, interagency communications and coordination, treatment of victims and identification of disease outbreaks.

“For the first time we have an official report saying the issue is all emergency communications—all on broadband, all on IP [Internet protocol], everybody linked together,” says David Aylward, director of the ComCare Alliance, a nonprofit organization dedicated to improving emergency response with modern communications and information systems. ComCare was one of the advisory groups to the JAC. He adds that this is an important step because previous reports and policies only focused on silos.

Although the report stresses a network-centric approach, Aylward notes that the report does not condone tearing out existing networks and technologies. Instead, the document advocates supporting the core of the network by using open-software architectures to link groups and organizations. These networked technologies would permit applications such as common personnel and vehicle tracking for improved situational awareness, he says.

The report notes that new networks are not necessary, stressing that the goal is connecting emergency management service (EMS) and health care organizations to existing infrastructure. “There are already lots of networks out there. What you need to do is connect the ones that exist,” he says.

Outdated technology is a key weakness in the nation’s EMS chain. The report found that first responders and hospitals use technologies that are now mostly obsolete in the private sector. The lack of modern communications has several consequences. It not only limits EMS and hospitals’ ability to save lives and money, but it also reduces communications with patients, their families and other health experts. The report’s authors state that the emergency response and public health sectors have not benefited from the productivity improvements driven by IP networks and investments in information technology that drive the rest of the national economy.

Among the deficiencies listed by the JAC report were a lack of integrated, interoperable communications; insufficient broadband spectrum, and the lack of a common operational picture. Public health organizations also suffer from an inability to communicate between different institutions, no comprehensive means to track patients or their records and insufficient disaster communication planning.

Aylward shares that a key network-centric aspect missing from U.S. emergency response systems is a directory of members. “The absence of a registry of organizations involved in emergency response and the absence of a federated rights management system are two key missing links,” he says.

Individual communities host a number of health care institutions such as hospitals, clinics, urgent care facilities, multidoctor practices and offices of public health services. There are also emergency medical services such as paramedics, airborne medical services and military medical organizations. Alyward notes that the Washington, D.C., metropolitan area alone hosts 31 separate 911 facilities, a poison control center, a number of traffic management centers, homeland security entities and dozens of police forces. “There are a lot of organizational players, each of which has its own membership,” he says.

But there is no directory of these entities. Even if some hospitals and groups are on directories, there are few if any electronic links to them, and there is no database of operational standards. Aylward notes that no system is in place for an organization such as a local police force to send out a regional public health alert. “Today it would have to be done by a series of phone calls. Rights management is currently based on paper and voice. But in an electronic world, you’d need a system that could assign those rights and identify messages,” he says.

These common, shared tools are called core service. Aylward notes that groups such as the Network Centric Operations Industry Consortium (NCOIC) and ComCare are working on projects such as Net Enabled Emergency Response (NEER) to provide this piece of the EMS network that the report says is lacking. NEER focuses on two service gaps, the lack of a national electronic directory of response organizations and no corresponding system to confirm user identity and authorize information transfers.

Data transport is a key weakness because many health and EMS organizations are not connected to redundant high-speed data networks. “They’re not all hooked up that way, and if they are, they aren’t necessarily connected redundantly. The Internet is unbelievably architecturally redundant and sound, but if you’ve only got one connection to it, you’re the weak link,” he says.

Another issue is the need for standards. Although the JAC report does not provide any specific details about the standards, it notes that they are lacking and necessary. However, the report notes that networked IP systems offer the potential for applications such as automated crash notification technology for 911 calls; systems to route patients from a mass casualty event to hospitals based on available beds; and tools that provide emergency managers with real-time maps showing 911 caller locations, available EMS resources, deployed first responders and patient status.

Military support also is important for major disasters and emergencies. The report notes that although the military is not usually involved in emergency response beyond major disasters, an efficient standards-based communications and data system would allow the services to plug into it during disaster relief operations. “If the military comes in as they did in Katrina, and there’s no system, they’re not plugging into anything,” Aylward says.

Even in events such as Hurricane Katrina, where the communications infrastructure of entire communities was devastated, there is always some capability at the edges of the disaster zone and in the region. The goal is to move resources from undamaged areas into the emergency space.

But lacking a directory of regional EMS groups and officials can hamper and delay disaster relief. For example, a National Guard unit sent to the Gulf Coast to support post-Katrina command and control operations first needed to know who were the responsible agencies in its area of operation. The unit learned this by driving around the region and asking residents for the locations of local officials such as the sheriff’s department.

Besides standards, functional core services such as domain name servers will become important because all network users rely on them for data access, says Aylward. On the Internet, the equivalent of the directory proposed for the NEER project is a domain name server. “There’s a registry of everyone who’s in .com and everybody who’s in .net. They are operated by different entities, but they’re operated according to a standard,” he says.

For example, when a person conducts a Web search for a specific name, standards allow the search engine to look in the correct area of the Internet. Aylward explains that this is what the NEER project hopes to do for emergency response. But this system relies on standards working on existing architectures. “That’s very different than putting out an RFP [request for proposal] to build a national network. On one level, it’s much cheaper and faster. On another level, it’s more complicated because it involves a level of cooperation. It’s not a federal problem. It’s not a local problem or a state problem. It’s an everybody problem,” he maintains.

Again using the example of the Washington area, Aylward explains that there are 30 to 35 different emergency management centers in the region. “Four years ago they had each other’s phone and fax numbers, and to some degree some of them were on public safety radio systems. But they couldn’t share data, and they couldn’t do voice very well,” he says.

These groups purchased the same emergency management data product. After they installed the software, they immediately were able to send messages to each other on their own internal crisis management software. “The only problem was that they couldn’t share data with anybody who wasn’t on the system,” he observes. The network stovepipe prevented these emergency management centers from sharing data with hospitals or other groups.

Instead of chastising organizations or requiring them to obtain new software, Aylward says what is necessary is an interface to interoperability standards and for the centers to register on the directory. What is also needed is a tool allowing authorities to connect the rights of the various parties and to link the tool to the same application used by the 911 system.

Despite the challenges facing the nation’s emergency communications infrastructure, the JAC report described several promising projects promoting next-generation IP-based networks. These efforts include Washington’s Capital Wireless Integrated Network, a state-of-the-art wireless IP network providing integrated data, images and conferencing linking EMS and first responders in the region; Virginia’s Commonwealth Link to Interoperable Communications project leveraging voice over IP technology to allow a variety of radios from different agencies and jurisdictions to communicate; and Tucson, Arizona’s video-based EMS telemedicine system, ER-Link, which provides patient data and real-time video on trauma patients before they arrive at the hospital.

Web Resources
Joint Advisory Committee on Communications Capabilities of Emergency Medical and Public Health Care Facilities, report to Congress: http://energycommerce.house.gov/Press_110/JAC.Report_FINAL%20Jan.3.2008.pdf
ComCare: www.comcare.org
Network Centric Operations Industry Consortium: http://www.ncoic.org