Ryan Stanton, MD, an emergency medicine physician in Lexington, Kentucky, and Brent Williams, a first responder who spent more than 30 years in emergency medical services, both have a firsthand understanding of how communication between emergency departments and those out in the field can affect patient care in day-to-day and disaster situations.

Over the last several decades, most of this communication occurs over either two-way radios or public communications networks. The problem: These methods don’t optimally empower first responders and hospital clinicians to work together toward the best possible patient outcomes.

The need for inter-jurisdictional communications leads to numerous frustrations. Variations in interoperability between two-way radio networks used in different communities, for instance, is a debilitating limitation. “Most radios don’t communicate with each other, and this is especially frustrating in disaster situations. Our police radios don’t communicate with our fire radios, and our fire radios don’t communicate with our EMS radios, and our EMS radios don’t communicate with hospital radios,” said Stanton, who serves as the medical director for Lexington Fire/EMS and is a member of the American College of Emergency Physicians.

Public wireless networks offer the interoperability needed, but they risk becoming overwhelmed and unavailable as a result of a dramatic public communications surge during a disaster.

“We’ve all been to a sporting event, a stadium, and tried to use our cell phone. It just won’t work. There are just too many people for the bandwidth that’s available. It’s a bad situation when somebody’s post on Facebook keeps an ambulance from communicating with the hospital,” Stanton pointed out.

Pre-emption for highly valuable data-rich images and video calls are needed between first responder and trauma center staff to exchange an immediate look at what is happening with patients in the field.

A new and improved public safety network

“The ideal solution is a completely separate network or bandwidth for fire, EMS, police, hospital and other public safety teams. The network also needs to allow cross communication across agencies in a protected manner,” Stanton said.

Created as a result of 2012 legislation, FirstNet, the nationwide public safety broadband network, provides just what Stanton is looking for. FirstNet is a dedicated network for public safety that offers prioritized communication separate from commercial traffic. FirstNet gives first responders priority and preemption on their own “fast lane.” As such, first responders move ahead of consumers when trying to access the network, and the consumers can be shifted onto other bands or off the network, if necessary.

Such a network could help emergency department clinicians work more closely with first responders to provide better care. For example, emergency medical technicians could use connected devices to send vitals and use mobile ultrasound equipment to send images to ED physicians, who could then make transport or treatment decisions while patients are still in the field.

“Having the ability to send images back and forth during disasters would mean that emergency department physicians would be able to perform triage remotely and better manage the capacity of their departments. They could then advise the first responders on who needs to be transported immediately and who doesn’t,” Stanton said.

The ability to share images could also help in day-to-day situations. “If a person has a fall of more than 20 feet, the guidelines say that he or she has to go to a Level 1 or 2 trauma center. That trauma center could be an hour or two away in some parts of the country,” said Williams, who now serves as the EMS advisor at FirstNet Authority. “If EMTs, however, could communicate with hospital doctors and remotely conduct a FAST exam, which looks for blood in the belly and chest, then it might be possible to determine which patients do and do not need to receive care in a trauma center. If there is no blood, then the patients could easily be treated at their local community hospital, which would result in huge time and money savings.”

Indeed, with a network that supports robust communication between emergency departments and first responders, it would be possible to get “that total picture that is crucial for ED physicians to help guide responses and care before patients arrive in the ED,” Stanton said. “By doing so, we can help improve patient outcomes.”