CHAPTER 8. Communications
Reneé Semonin Holleran
Competencies
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1. Demonstrate knowledge about communications systems and their use in patient transport.
2. Apply appropriate communication skills before, during, and after transport.
3. Demonstrate the use of appropriate communication equipment to provide safe and competent patient transport.
Communication encompasses more than the use of a radio or telephone; it is a total system that ensures the smooth operation of routine daily patient transports while guaranteeing optimal patient care and transport team safety (Figure 8-1). No one perfect communications system exists for all transport programs. The communications system must meet the present and future needs of the program it serves.
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| FIGURE 8-1 Communications Center, University Air Care, Cincinnati. (Courtesy Rose DeJarnette and John Robinson.) |
All transport team members must have good communication skills and know how to operate any equipment they may use for communication. 5 Communication equipment is influenced by the geographic location of the program and the education and training of those who use the equipment.
All communication needs to be HIPAA (Health Insurance Portability and Accountability Act of 1996) compliant. Team members must remember that radio and verbal communications can be easily overheard and cause a breach of patient confidentiality. 1,5
COMMUNICATION CENTERS
Communication centers are an integral part of all transport programs. Multiple models are currently used for transport programs and include a dedicated center that is a part of a transport program; local emergency medical services (EMS) or fire dispatch centers that may coordinate transports and communication; security personnel or unit personnel at hospital-based programs that may provide communication services; and the transport service that may have a centralized dispatch center, which may actually be in a different state than the program. The Commission on Accreditation of Medical Transport Systems Standards dictates that a communication specialist must be assigned to receive and coordinate all requests for the medical transport service. 2 The Federal Aviation Regulation (FAR) 135.79 requires that the Part 135 certificate holder must have procedures established for locating each flight for which a Federal Aviation Administration (FAA) flight plan is not filed. 3
THE COMMUNICATIONS SPECIALIST
The complexities of organization of a communications system are unique with respect to its operation. Beyond dealing with electronic hardware and computer software, the program is faced with one of the most challenging of tasks: dealing with people.
Humans are both the strongest and the weakest points in a system. People represent a broad spectrum of personalities and opinions, and no two individuals are quite the same. A communications center, communications specialist, and communication skills are mandatory to ensure a safe transport operation.
Roles and Responsibilities
The communications specialist (CS) is designated to coordinate requests for aircraft and ground responses. The title assigned to the person with the CS function varies from program to program. The only limitation is that the FAA uses the term dispatcher to designate a person who has the decision-making role of whether or not an aircraft takes off. Unless this is the case with a program, another title should be used.
The CS is responsible for coordinating intraagency and interagency communications that pertain to any phase of a transport, from a request to hospital admission. The role of the CS is to serve as a facilitator for the smooth integration of all the resources at the program’s disposal, with the dual objectives of program safety and excellent patient care.
The CS must perform a variety of tasks. These include the following7:
▪ Listening intently.
▪ Asking appropriate questions.
▪ Accurately confirming what was said.
▪ Reading maps (including using computer mapping software).
▪ Using spelling and professional grammar skills.
▪ Using medical, aviation, and EMS terms.
▪ Setting, evaluating, and resetting priorities.
▪ Providing customer service and good public relations.
Selection
Applicants for CS positions should be screened as thoroughly as applicants for transport team positions. Just as all persons who desire to be part of a transport team are not suited for the work, all persons who desire to be a CS may not be suited to the type of stress inherent in the job. 8,10
The decision about whom to hire as a CS must be determined by each individual program. Certain minimal educational requirements must be met in any case, but some controversy has arisen about background requirements. Areas of controversy include the following:
1. Should the CS have medical field experience? If so, at what level and how much?
2. Should the CS have communications center experience? If so, what type of experience is acceptable, and how much experience is necessary?
Neither medical field experience nor communications center experience alone qualifies a person to be a CS; neither does being a friend or relative of someone employed by the program.
The Commission on Accreditation of Medical Transport Systems (CAMTS) recommends that certifications, such as emergency medical technician (EMT), emergency medical dispatcher (EMD), and National Association of Air Medical Communication Specialists (NAACS) Certified Flight Communications Course, be encouraged and actually required by some transport programs. 2
Training
Regardless of the background of the CS applicant, the person must be trained as a communications specialist. The CAMTS standards that address communications state that the training of the designated communications specialist be commensurate with the scope and responsibility of the Communications Center personnel. Box 8-1 contains a summary of the initial training.
BOX 8-1
Summary of CAMTS Initial Training of Communication Specialists
1. Medical terminology and how to obtain patient information.
2. Knowledge of emergency medical system, including roles and responsibilities of various levels of training.
3. State and local regulations that govern the EMS systems in which the transport service operates.
4. Familiarization with equipment used in the prehospital environment.
5. Knowledge of Federal Aviation regulations and Federal Communications Commission regulations pertinent to medical transport services.
6. General safety rules and emergency procedures pertinent to medical transportation and flight following procedures.
7. Navigation techniques/terminology and flight following and map skills.
8. Weather interpretation.
9. Radio frequencies used in medical and ground EMS.
10. Assistance with hazardous material response.
11. Stress recognition and management.
12. Customer services.
13. Quality management.
14. Air medical crew resource management.
15. Computer literacy and software training.
16. Postaccident incident plan (PAIP).
The NAACS has developed a specific course to train and educate the CS. The components of this course are summarized in Box 8-2.
BOX 8-2
Summary of the NAACS Training Course
Postaccident incident plan (PAIP)
Flight following
Radio communications skills
Aviation weather
Aircraft emergencies
Medical terminology
Navigation and map usage
Customer service/public relations
Air medical crew resource management
Stress management
FAA
Training must be an ongoing process to ensure currency and proficiency. During training, the CS should be given a variety of situations, be allowed to make decisions, and discuss why decisions were made. Just as many transport teams use their “worst transports” to teach others, the “worst communication situations” presented and discussed with new CSs may assist them in future work.
Testing
The CS should undergo periodic testing on all elements of the position. The CS has the responsibility to know everything about the program and be able to use that information at a moment’s notice with a high degree of accuracy. In terms of communications procedures, the goal is 100% accuracy. For example, many programs periodically practice downed aircraft or communication loss exercises.
Dress Code
Proper attire for communications personnel is a matter of preference for each program. Wearing of a uniform provides an appropriate display to the public and ensures that the CS is viewed as a part of the transport team.
COMMUNICATIONS OPERATIONS
Operational Control
Operational control (OC) requires that the certificate holder be responsible for all aspects of flight operations. The FAA recognized the challenge of maintaining Part135 operational control with different companies joined together to provide separate services. The responsibility and authority of operational control should never be in question, and the FAA provided guidance with order 8900.4. Flight operations consist of crew member training, currency and certification, aircraft maintenance and airworthiness, “weather minimums, proper aircraft loading, center of gravity limitations, icing conditions, and fuel requirements,” and flight locating requirements. 11
Roles and Responsibilities
The FAA has compartmentalized operational control duties into two tiers. The OC responsibilities for tier I consist of “assignment of crew and release of aircraft to revenue service.”3 Tier I also requires management to verify and maintain the level of quality of employees. Tier II represents the daily operations or how a specific flight is conducted. Generally, these duties are performed at a management level, but they may be delegated without removing responsibility from the certificate holder.
COMMUNICATION ENVIRONMENT
A major aspect of any communications program is the physical environment of the communications center. 6 Following are some major considerations in the planning process for a communications center.
Location
Whether located in a hospital, at an airfield, or within a separate facility, the communications center should be in an area with little pedestrian traffic. Physical inaccessibility and program policy discourage casual visitors. A system should be in place to ensure that the communication specialist is not disturbed while involved with a medical mission. A signal device or even locking the door during dispatch may assist.
Seismic Stability
In some areas of the United States and the world, the structural and functional integrity of the facility in the face of a major seismic disturbance is a very real concern and should be discussed with the facility’s architect. That seismic stability is part of the design of the facility should not be taken for granted.
Security
The level of security needed for a given communications center varies considerably, depending on its location. A steel door with a deadbolt lock should be considered the minimal level of security. Numerous high-technology security systems may be acquired; the level of security attained ultimately is a function of the budget.
Security does not end with a locked door. Additional security issues are fire alarm and fire suppression systems. Although the communications center may meet current local fire codes, one must remember that most fire codes are minimal, not maximal, requirements for protection. Stricter safeguards than those required by the code are permissible. For more detailed information, one should contact the local or state fire marshal.
Emergency Electrical Power
Each communications center should have its own emergency power supply. Although an independent source of electrical energy is preferable, hospital-based communication centers commonly receive emergency power from the hospital’s emergency generator. However, independent communication centers must be sure that they have a back-up power source and be aware of its location.
An electrical generator of sufficient capacity for a given communications center should be located nearby. This generator may be powered by diesel fuel, gasoline, or natural gas, depending on which type of fuel is most economic in a given locale. Consideration should also be given to the use of alternative energy sources abundant in the region, such as sunlight, wind, or hydroelectric power. The technology for these alternative energy sources is available, and calculation of economies for the program is possible when these energy sources are used.
Emergency power must also be instantly available for remote transmitter/receiver sites.
Wiring Access
Each communications center includes enough wiring and cables to stretch the length of several football fields. These wires, which are vital to the operation of the system, should be readily accessible, and the function of each wire should be readily identifiable. This may be accomplished either by running all wiring underneath a raised floor or by terminating all wiring into a utility room behind the wall where the console is located.
Lighting
Whether the communications operations center has the appearance of an office or resembles a combat information center on a ship is a matter of preference. The CS must be able to clearly see everything that must be done. Emergency lighting must come on the instant that power is lost, even if this is only for a short duration.
Heating, Ventilation, and Air Conditioning
Heating, ventilation, and air-conditioning systems should be engineered with local geographic weather conditions in mind. 4 These systems not only keep personnel comfortable but also help prevent equipment from malfunctioning.
Console Layout and Design
Once a custom console is built and installed, it is costly to alter; therefore, consoles should be designed carefully, with use of full-scale plans and even cardboard mock-ups. In addition, a console should be designed to be ergonomically functional. The CS must be able to see and reach all portions of the console without twisting, craning, stretching, or squinting. The seat for a console must roll, swivel, tilt, and be comfortable while providing good lumbar support.
The communication area should be ergonomically designed. Information is available, and experts can assist with the design of a communication center to prevent work-related injuries.
Acoustic Insulation
The amount of insulation necessary to render the communications center oblivious to the external environment varies with the location of the center. Enough insulation should be used to deaden the noise from an aircraft engine 100 yd away at ground level. A communications center located deep within a building or above or below ground level is probably not as sensitive to external street or airfield noise.
Restroom Facilities
Each communications center should be equipped with full restroom facilities, including a toilet, sink, and shower. Depending on the schedule and program volume, the CS may not have the time to go elsewhere to use restroom facilities and certainly should not have to leave the communications center during a tour of duty.
Lounge Areas
A room adjacent to the operations room of the communications center that the CS may use during down time is useful. This room may contain a couch, chair, coffee table, television, and multimedia player. The CS should not be in this room while a transport is underway. Whether such a lounge area is available in a given program depends both on policy and space constraints. The lounge might also contain the kitchen area or dormitory area, or both.
Crew Rest Area
The existence of a crew rest area with lounge chairs or bedrooms depends on program policy, shift schedules, program volume, and the number of personnel on duty. Sleeping while on duty is a controversial topic, and its appropriateness for specific types of personnel must be evaluated by each individual program.
Kitchen Equipment
A small kitchen and pantry area is necessary to have in communications centers in which the CS is not able to leave. This area should include a small refrigerator and freezer, a small microwave oven, a coffee maker, and cabinet and counter space.
Storage
A secure storage area should be provided for communications center supplies, backup equipment, and archives. This space should not be shared with other departments. Some communication centers are also used to store disaster supplies because of their central location.
Decoration
The decor of the communications center should be pleasant, easy to maintain, and in keeping with the character of the organization. An excellent idea is for the personnel who work in a given area to have input into its decor. Some communication centers have windows that allow viewing of the transport aircraft.
Alternative Sites/Backup Equipment
An alternative site and backup equipment should be identified and prepared by every transport program. A plan of action to deal with such a scenario should it ever occur should be annually reviewed. Each communications center must be able to continue operations at an alternative site with backup equipment if for any reason the primary communications center becomes inoperable.
Plans should also be in place for rapidly repairing or replacing any piece of essential equipment in the communications center.
EQUIPMENT
Selection of equipment for a communications center should be made on the basis of the mission of the transport program, present and anticipated needs, functions, durability, reliability, expendability, serviceability, and, last but not least, cost.
For a decision about a given piece of equipment, a program should prioritize these factors, add any others that are applicable, and then determine the most cost-effective choice. The most costly item is not always the best item. However, also worth noting is that you get what you pay for.
Telephones
Each communications center must have at least one dedicated line for the medical transport service.
Emergency telephone lines should not go through a switchboard; instead, they should be dedicated central office lines, so that if the switchboard fails, the communications center still has telephone communications. The number of incoming local and wide area telephone service lines should be based on the size of the service area and the projected volume of calls. Phone lines can be added relatively quickly when needed.
All calls made with use of emergency phone lines should be recorded, as should any outgoing call that pertain to requests for assistance or notifications.
Telephones today are available with a wide variety of features that may prove useful in a given operation. These features include speed dialing, memory banks of phone numbers, call queuing, hands-free operation, automatic redial, and so on.
Today, both wired and wireless communication systems are routinely used. Cellular phones are used by many transport services. However, their use should be guided by Federal Communications Commission (FCC) regulations on air medical transport vehicles. The FCC prohibits the use of cell phones in flight per FCC Code of Federal Regulations, part 22, subpart H, section 22.925. Cell phone use during ground transport should never interfere with patient care or safe driving.
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