In search of the ‘wireless’ ambulance

When disaster strikes how vital would it be for paramedics to use Wi-Fi networks from their ambulances? Dr Dave Sloggett investigates

In search of the ‘wireless’  ambulance

Terrorism returned to the streets of London on 7 July 2005, when 52 people and four terrorists died in a series of four attacks on the transportation system. Another equally spectacular event outside the Tiger Tiger club in Haymarket, which at the time was full of 1,700 revellers, was only prevented by the incompetence of the attackers. 

With terrorism on the increase in the international security arena since then and the latest Home Office figures showing a 21% increase in arrests of people for terrorism-related offences in 2012 over the figures derived for 2011, the emergency services have to be constantly prepared for another attempt to bring carnage to the streets of London. 

Exercises are one way in which the members of the emergency services can maintain their skill levels in how to react to such an attack. In formulating the scenarios for these events insights gained from recent events overseas, such as the barbaric attack on the Westgate shopping mall in Nairobi, are invaluable. 

Coping with disaster

When a man-made disaster of this scale strikes the emergency services can rapidly become overloaded. On 7 July 2005, the London Ambulance Service deployed 101 ambulances, 25 Fast Response Units and a total of 31 officers to what were scenes of utter chaos. 

In the various enquiries that were held after the bombings the London Ambulance Service came under some criticism for the speed of its response. Questions were raised as to whether or not some of those that died could have been saved if the communications systems used at the time had operated more effectively. 

Those suspicions were unequivocally rejected by the Coroner Lady Justice Hallett when she published the results of her investigations into the overall response of the emergency services. 

The doubts that were raised are understandable. As a result of dramatic improvements in initial treatment of critically injured military casualties in places such as Iraq and Afghanistan, it was obvious that questions would be raised over the possible survival of those closest to the epicentres of the blasts. 

Situational assessment

For the emergency services one of the crucial problems they faced that day was simply getting to the attack sites. The initial situational assessment in the crucial moments when patient’s lives might have been saved was understandably confused. 

At the time, with the Airwave TETRA two-way radio network still several years away, the communications systems did come under pressure with first responders unable to communicate when they went forward into the tunnels to help survivors. 

Since that dreadful day the Airwave system has been introduced and it has clearly improved the ability of the various elements of the emergency services to communicate. But its’ TETRA-based technologies are rapidly becoming dated. New networking technologies offer a range of advanced capabilities and increased bandwidth. 

They also offer the prospect of being able to transmit imagery from the scene of a disaster directly into a control room. In the event of a terrorist attack this could provide greatly improved situational awareness and help commanders manage the rapid deployment of their assets. 

Next gen comms

So how might these contemporary technologies have an effect upon the ways in which the Ambulance Services respond to future major incidents? In trying to answer this question Wireless has been fortunate to be able to have discussions with Chris Lucas from the National Health Service, who is currently part of the team developing the next generation of communications systems for the Ambulance Service and their colleagues in the Police and Fire and Rescue services. 

Lucas is enthusiastic about the potential for the next generation of communication system known as the Emergency Services Mobile Communications Program (ESMCP). But he notes that the Ambulance Service is “quite forward thinking with regards to the benefits of using data”. 

Already ambulance services use data messaging to alert hospitals about inbound patients. Specialist teams, such as the Hazardous Area Response Team (HART), also are able to upload data from an incident via satellite links. This also helps increase situational awareness amongst the teams operating at the Gold, Silver and Bronze levels of command. 

Real-time data

Lucas sees the new technologies as being able to “provide a big enough pipe to put whatever data the emergency services want (individual pictures, video streaming etc.)”. Of course not all of the requirements for moving data can be clearly delineated at the moment. But he does see the potential for mobile data services to be installed on ambulances. 

Lucas develops this point further as he opines that “Without doubt a ‘wireless’ ambulance is the way forward”. This would have a single communications gateway from the ambulance to the nearest network in its vicinity as it responds and removes patients to hospitals. 

This fits in with the vision emerging from the latest Home Office deliberations on the architecture for ESMCP. Given the sensitive nature of the information being passed Lucas also acknowledges that “security will be a very important issue”. 

The aim would be to bring patient records forward to the paramedics and also forward information to the designated receiving hospitals. At the moment any solution would require integrating a number of different technologies on the ambulance into a single data stream, such as the Bluetooth on defibrillators, with other forms of digital data. 

Secure transmissions

The increased bandwidth of the next generation of networking systems does provide some seductive capabilities. “Could”, Wireless asked, “images of casualty’s wounds be sent over the network to enable surgeons to be better prepared to receive critically injured patients?” Lucas takes a pragmatic line on this subject. “The main area we consider from a health aspect is patient confidentiality. Security of any system conveying any such imagery or data is paramount.” 

That said, Lucas concedes that the idea of transmitting such images is not out of the question and could indeed prove useful. Warming to the idea he also suggests that such a capability might be really helpful for road traffic crashes where being able to transmit data showing the mechanism of injury could be helpful to the receiving hospitals. 

“Live streaming of video images might also help some paramedics discuss with their health care professionals options and guidance on specific treatments,” he says. This would, he notes, “help reduce patient admission procedures into acute wards”. It is an area that has already been identified in the requirements definition work associated with the ESMCP. 

This kind of mobile video conference and image data exchange would be specifically useful if terrorists where ever to conduct an unusual attack such as one involving the kind of chemicals used in Syria. Irregular events such as a Chemical, Biological, Radiological or Nuclear (CBRN) attack that involve treatments that are not part of the run-of-the-mill activities of the ambulance service could gain serious benefit from being able to harness a range of skills and expertise, even drawing on expert scientific support from outside the National Health Service. 

Ambulance to hospital

On the move any mobile data services enabled ambulance would be able to link outputs from equipment monitoring the patient’s vital signs directly into the receiving hospital. 

Any quick changes in those vital signs below pre-determined thresholds are already alarmed by the equipment to help trigger intervention by the on-board crew. Making that data available to the receiving hospital would allow the surgeons involved to be fully aware of the recent history of the patient’s vital signs. 

While this differs from the medical evacuation procedures used in military theatres where medical teams are flown forward to the point of wounding to tend the casualty, it is the next best thing that can be done to help improve survival rates from major disasters. 

If the deployment of these mobile data services technologies were to help improve this one important element of the way the ambulance service currently responds to major incidents, it would be a very worthwhile outcome from the ESMCP.

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