Development of a Communications Center

A communications center should coordinate all activities related to an interfacility transport request and should have the following essential features:

1. Operations 24 hours a day, 7 days a week

Communications specialty-trained personnel

3. Administrative transport policies and procedures; including a post incident accident plan

4. Information about local and regional emergency care resources

5. Communications technology and equipment, including the ability to record all transport-related calls

6. Communications space that is designed with consideration of security, acoustic, ergonomic, and equipment positioning needs

Space for the dispatch center should be chosen to permit operations 24 hours per day. Secure access and proximity to cafeteria and restroom facilities are important, because the center might be staffed by only one communications specialist during low volume times. The location of the dispatch center should take into account the need to monitor ambulance and helipad activity, either directly or indirectly. If indirect observation is favored, video monitoring of the remote areas should be available in the dispatch center. Furniture should be chosen with the understanding that the communications specialist may be seated for the majority of a shift and needs ready access to manuals and reference materials. Ergonomics is an important consideration, especially when there are multiple communication specialists using the same space. Systems and equipment that allow variability in chair height and maneuverability, the ability either sit or stand while working, adequate and adjustable lighting, adjustable temperature control, access to food and drinks and adequate workspace, will help the communication specialists maintain healthy work habits. Opportunity for periods of rest away from the communication center throughout the work shift can also support the communication specialist’s ability to perform expertly his or her duties.

Security of the communications center is also an important consideration. In the event of an emergency or disaster situation, the communications specialist must be able to lockdown the communications center. Flow through the center must be controlled, as the communication specialist may be overwhelmed with emergency calls and implementation of any disaster or emergency policies and procedures. Even everyday considerations include management of high volume of calls while dispatching and tracking transport teams while coordinating calls with medical control and other administrative personnel. Therefore, it is not a good idea to locate a communication center in the middle of a busy or chaotic department.

A phone system is a critical component of any communications system. The plan for the phone system must be comprehensive and organized. It is best to have not only a plan A but also plans B and C. The decision of customers to use or not use a service is many times based on how they are treated and their calls are managed over the phone. Most hospital-based programs can link to existing digital phone services. Headset and speaker phone capabilities give the communication specialist ergonomic options in which to communicate. Multiline units are a necessity, as is the ability to conference three or more parties at a time. It is imperative that a plan is developed to manage calls the dispatcher is unable to answer during high volume times. An example is call-park or transferring the call to a backup number or person. A unit that is capable of programming frequently dialed numbers improves efficiency. A toll-free number can be established for instate or multiple-state calls. If possible, request a phone number that is easy for the referring providers to remember (eg, the last 4 digits represented by “KIDS” or “HELP”). The communications center should be included in the institution’s emergency plan for phone system outages.

Many emergency medical services (EMS) systems use 2-way radios in addition to cellular phones.

Radios permit instantaneous contact without dialing and can serve as a backup in case there are problems with the phone system. Many bands are available, including UHF (ultra high frequency) and VHF (very high frequency). Many hospital services (eg, engineering) already might be using 2-way radios; the hospital’s vendor will likely offer the use of another rented frequency to suit the transport system’s needs. Alternatively, the transport program can apply to the Federal Communications Commission for a license to operate its own frequency (http://www.fcc.gov). Radios are linked to the dispatch center by use of a console, which can also monitor other frequencies such as local emergency medical services (EMS) providers, fire and police agencies, and the local C-MED (central medical emergency dispatch) system. The console will usually permit the radio operator and the phone user to be patched into the same call. Many hospitals are equipped with a radio system that is part of the nationwide Hospital Emergency and Administrative Radio, or HEAR, system. This could be monitored in the communications center as well.

It is strongly recommended that all communications pertaining to an interfacility transport be recorded. There are many advantages of recording, including the opportunity to review intake conversations for educational and quality improvement purposes, the ability to review conversations when there are questions or concerns related to the transport process or patient management, and the availability of recorded information in case there is a regulatory or legal inquiry about an emergency transport. Many facilities already have a means to record calls, so this may not pose added expense to the communications center. In this model, calls are readily accessed through the hospital’s intranet. If not, a digital recording device is preferred. Most recording devices need to be kept within a certain range of the main phone system, although some can be remote.

The advantage of having recording hardware located within the communications center is that tapes or digital video discs (DVDs) from previous periods can be easily accessed for review. A disadvantage is the need for physical space for recording equipment. Computer-based digital recording alleviates the need to have equipment other than a personal computer in the communications area and eases distribution of recorded conversation for quality review. A variety of media are available for recording and storing conversations and sources of communication, including cassette tapes, VHS (video home system) tapes, and DVDs. DVDs have the advantage of holding the most data per disc and are easy to store. All stored copies should be remotely located from the originals in case of fire, flood, or other catastrophe. Although the time for retaining recorded materials is not mandated, it is important to have a policy that is similar to the institution’s policy for storage of medical records and images. The hospital’s legal counsel should be consulted to develop a clear policy. Software to operate the recording system can be loaded directly onto the communications center’s computers, and most systems will allow for supervisor or manager access from the desktop. Separate software can be purchased to permit last message or last time interval playback for use by the communications specialist during a call.

Policies and procedures pertaining to the communications center should be comprehensive with consideration to related hospital or agency policies and procedures. A postaccident incident plan (PAIP) is a critical resource for the communication specialist in the management of the transport team in an emergency or disaster situation. This plan outlines specific procedures to be followed in the event of a transport incident. Because the plan is rarely initiated, it is important to perform frequent drills with transport and dispatch personnel. Also, when drafting policies, it is important to know state and federal regulations that may pertain to the communications center.

Certain states, such as Indiana, have regulations surrounding emergency medical dispatch. Section 3 of the Indiana code states, “After December 31, 2009, a person may not furnish, operate, conduct, maintain, or advertise services as an emergency medical dispatcher or otherwise be engaged as an emergency medical dispatch agency unless certified by the commission as an emergency medical dispatch agency” (IC 16-31-3.5). In Ohio, the State Board of Emergency Medical, Fire and Transportation Services enforces regulations surrounding documentation by dispatch personnel such time of call, dispatch time, arrival at referral, etc (http://codes. ohio.gov/orc/4766). Related to recording of calls, federal regulations permit the recording of telephone conversations as long as at least one party consents; in other words, recording conversations by third parties is illegal. The Federal Communications Commission has more specific requirements for interstate and foreign calls, during which recording can be performed only under one of the following circumstances:

• Preceded by verbal or written consent of all parties to the telephone conversation

• Preceded by verbal notification that is recorded at the beginning and as part of the call by the recording party

• Accompanied by an automatic tone warning device, sometimes called a beep tone, which automatically produces a distinct signal that is repeated at regular intervals during the telephone conversation when the recording device is in use

For in-state calls, regulations vary by state and might require 1-party or 2-party consent. A list of state-by-state regulations can be found at http://www.callcorder.com/phone-recording-law.htm.

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Source: AAP. Guidelines for Air and Ground Transport of Neonatal and Pediatric Patients. 4th edition. — American Academy of Pediatrics,2015. — 488 p.. 2015

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