Models for Communications Systems
There are multiple models for emergency medical communications systems: (1) 911 dispatch centers, responsible for public safety and emergency dispatch; (2) centralized, hospital-based communications centers (also known as dispatch centers), usually affiliated with an emergency department; (3) freestanding communications centers dedicated to one or more transport programs; and (4) decentralized communications sites, typically within a hospital unit that uses on-duty nursing or medical staff to coordinate transport services.
Each model has advantages and disadvantages that should be considered when a transport program is designing a communications system (Table 5.1). For example, 911 dispatch centers are usually governed by agencies such as law enforcement and fire services. Therefore, they might not be as responsive to the needs of an interfacility transport program. Stand-alone communications centers are often desirable, but they are costly to equip, staff, and operate unless multiple programs or users are interested in combining resources. Unit-based communications centers use clinicians to coordinate the transport process, which could save money, but may interfere with patient care responsibilities and potentially delay the transport team's response. Additionally, this model may pose safety risks if the caregiver is too busy to continually track the status of their transport teams.There is no standard formula to determine the volume of calls necessary to justify the development of an independent communications center. Justification is typically a challenge, because many times there is no revenue associated with a communications center unless the center is managing communications and dispatch for other services that contract with them to do so. Additionally, most expenses are fixed, such as personnel salaries, equipment, and facility.
Therefore, qualitative and quantitative metrics including a business plan that optimizes its use will help to achieve the most favorable costbenefit ratio. For instance, justification for a centralized communications/Table 5.1: AdvantagesZDisadvantages of Various Communication Systems Models
| Communication Systems Option | Advantages | Disadvantages |
| 911 emergency center | • Personnel specifically trained in emergency dispatch, information gathering • Dedicated to dispatch • Usually have up-to-date dispatch soft and hardware • Link to real-time weather, community resources | • May not have the medical background necessary to dispatch critical care teams • Priority may be 911 calls • May be regulated by EMS, therefore limited quality control • Usually off-site location |
| Centralized hospital based | • Dedicated to dispatch center • Control maintained by hospital • Personally know transport personnel, medical control, etc • Familiar with policies and procedures of their facility • Utilize technology that interfaces with their facility | • Expense • Requires dedicated space and resources • Personnel frequently not trained as communication specialist, but come from other professions such as EMT, RN |
| Free standing | • Can be located central to bases, satellites • Opportunities to service multiple transport organizations • Distractions typically minimized | • May be viewed as a totally separate function • May seem impersonal • May not be familiar with the region the transport team services |
| Decentralized hospital based | • Cost efficient; little expense • Productivity tends not to be an issue • For a small team, may be the only way to keep dispatch internal | • Various personnel may be assigned to dispatch • Usually little training in dispatch • Typically requires decisions around prioritization of tasks • May be easily distracted • May pose safety risks to the transport team |
EMT indicates emergency medical technician; RN, registered nurse.
dispatch center may be strengthened by identifying other areas in an institution that would benefit from coordination of communications, especially in emergency and/or disaster situations.
Establishment of a freestanding or centralized communications center has certain fixed expenses for hardware and software, in addition to necessary renovations. A list of equipment and representative estimate for equipping a communications center is shown in Table 5.2.
Table 5.2: Estimated Technical Equipment Costs for a Communications Center
| Item | Estimated Cost |
| Dispatch database (may including associated licenses and management fees) | $30 000 + monthly fees for vendor licenses/manage- ment per computer |
| Dispatch software (global positioning system, maps, flight following, telemedicine) | $500 month per workstation |
| Recording system | $13 500 |
| Radio system and console | $21 500 |
| Computers (hardware) | $10 000 per workstation |
| Fax machine, copier, printer | $2500 |
| Telephone (multiline) | $4000 |
| Telephones (wireless base) | $1500 |
| Total | $89 000 + |