Public Safety Answering Point Research Articles

Technical and Regulatory Issues of Emergency Call Handling

The paper presents selected technical and regulatory aspects of emergency call handling in communication between citizens and authorities in case of distress. Among the most important technical aspects of emergency call handling are recognition and treatment of emergency call by originating network, routing of such call to the appropriate public safety answering point (PSAP), delivering call-related information to the PSAP as well as architecture and organization of PSAPs. From the legal point of view, of importance are the obligations for the Member States and stakeholders involved in the E112 project included in the EU directives, actions of European Commission related to providing access to the location information as well as obligations concerning emergency call handling included in Polish national law.

A Smart Building Fire and Gas Leakage Alert System with Edge Computing and NG112 Emergency Call Capabilities

Nowadays, the transformations of cities into smart cities is a crucial factor in improving the living conditions of the inhabitants as well as addressing emergency situations under the concept of public safety and property loss. In this context, many sensing systems have been designed and developed that provide fire detection and gas leakage alerts. On the other hand, new technologies such edge computing have gained significant attention in recent years. Moreover, the development of recent intelligent applications in IoT aims to integrate several types of systems with automated next-generation emergency calls in case of a serious accident. Currently, there is a lack of studies that combine all the aforementioned technologies. The proposed smart building sensor system, SB112, combines a small-size multisensor-based (temperature, humidity, smoke, flame, CO, LPG, and CNG) scheme with an open-source edge computing framework and automated Next Generation (NG) 112 emergency call functionality. It involves crucial actors such as IoT devices, a Public Safety Answering Point (PSAP), the middleware of a smart city platform, and relevant operators in an end-to-end manner for real-world scenarios. To verify the utility and functionality of the proposed system, a representative end-to-end experiment was performed, publishing raw measurements from sensors as well as a fire alert in real time and with low latency (average latency of 32 ms) to the middleware of a smart city platform. Once the fire was detected, a fully automatic NG112 emergency call to a PSAP was performed. The proposed methodology highlights the potential of the SΒ112 system for exploitation by decision-makers or city authorities.

Motion Shield: An Automatic Notifications System for Vehicular Communications.

Motion Shield is an automatic crash notification system that uses a mobile phone to generate automatic alerts related to the safety of a user when the user is boarding a means of transportation. The objective of Motion Shield is to improve road safety by considering a moving vehicle’s risk, estimating the probability of an emergency, and assessing the likelihood of an accident. The system, using multiple sources of external information, the mobile phone sensors’ readings, geolocated information, weather data, and historical evidence of traffic accidents, processes a plethora of parameters in order to predict the onset of an accident and act preventively. All the collected data are forwarded into a decision support system which dynamically calculates the mobility risk and driving behavior aspects in order to proactively send personalized notifications and alerts to the user and a public safety answering point (PSAP) (112).

Mass shooting incidents: evolution of preventive procedures, preparation, treatment, and medical care supply

"Abstract: Mass shootings incidents occur with increasing frequency over time. Studying these cases proved that, despite their diversity, several common features could be taken into account in the early detection and possible prevention of certain future cases. Accepting that such incidents may occur anywhere and anytime, societies need to be prepared for their more effective response. Informing citizens about the best way to react to a mass shooting event is considered crucial and essential. The ""Run-Hide-Fight"" guideline/directive seems to be the most appropriate guideline given to the public. Proper training, of both the Suppression Forces and the emergency medical care providers, is considered of utmost importance. The role of the Incident Commander, regarding the incident management, as well as the external bleeding control of the injured people, are factors of paramount importance in trying to mitigate the casualties from such an incident. The alertness of both citizens and organizations/structures may lead to early detection of potential perpetrators and thereby averting a mass shooting incident. To achieve increased survival and a reduced number of casualties from a mass shooting event it is vital proper education be present at all levels. The response to a mass shooting event should be imprinted in an Emergency plan. Such a plan should have been decided and made, by the Security and Suppression Forces, the Healthcare Institutions, and the Public Safety Answering Point. Keywords: mass shooting incident, first responder, active bleeding, tourniquet, Incident Commander"

Rapid reorganization of the Milan metropolitan public safety answering point operations during the initial phase of the COVID-19 outbreak in Italy.

ObjectiveTo quantify how the first public announcement of confirmed coronavirus disease 2019 (COVID‐19) in Italy affected a metropolitan region's emergency medical services (EMS) call volume and how rapid introduction of alternative procedures at the public safety answering point (PSAP) managed system resources.MethodsPSAP processes were modified over several days including (1) referral of non‐ill callers to public health information call centers; (2) algorithms for detection, isolation, or hospitalization of suspected COVID‐19 patients; and (3) specialized medical teams sent to the PSAP for triage and case management, including ambulance dispatches or alternative dispositions. Call volumes, ambulance dispatches, and response intervals for the 2 weeks after announcement were compared to 2017–2019 data and the week before.ResultsFor 2 weeks following outbreak announcement, the primary‐level PSAP (police/fire/EMS) averaged 56% more daily calls compared to prior years and recorded 9281 (106% increase) on Day 4, averaging ∼400/hour. The secondary‐level (EMS) PSAP recorded an analogous 63% increase with 3863 calls (∼161/hour; 264% increase) on Day 3. The COVID‐19 response team processed the more complex cases (n = 5361), averaging 432 ± 110 daily (∼one‐fifth of EMS calls). Although community COVID‐19 cases increased exponentially, ambulance response intervals and dispatches (averaging 1120 ± 46 daily) were successfully contained, particularly compared with the week before (1174 ± 40; P = 0.02).ConclusionWith sudden escalating EMS call volumes, rapid reorganization of dispatch operations using tailored algorithms and specially assigned personnel can protect EMS system resources by optimizing patient dispositions, controlling ambulance allocations and mitigating hospital impact. Prudent population‐based disaster planning should strongly consider pre‐establishing similar highly coordinated medical taskforce contingencies.

Management of Emergency Services in Lombardy during COVID-19 epidemic using Business Intelligence

BackgroundIn Italy on the 20th of February, the first Italian patient was tested positive for Coronavirus Disease 2019 (COVID-19) in the Lombardy region. The Regional Emergency Medical Services (EMS) Trust (Azienda Regionale Emergenza Urgenza, AREU) of the Lombardy region decided to apply a Business Intelligence (BI) System to take timely decisions on the management of EMS and to monitor the spread of the disease in the region in order to better respond to the outbreak.MethodsSince the beginning of the COVID-19 outbreak, AREU developed a BI System to track the daily number of first aid requests received from 1.1.2. (Public Safety Answering Point 1). BI evaluates the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI analyses the pattern of the epidemic, identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). Currently, AREU is still implementing the BI as the epidemic is still ongoing.ResultsIn the Lombardy region on the 20th of February the number of the first aid requests for respiratory and/or infectious episodes were 314. This figure increased sharply during the month of February and March reaching its peak on the 16th of March with 1537 episodes. In the area around Bergamo, this number experienced a greater rise compared to the rest of the Lombardy territory, going from 74 episodes on the 20th of February to 694 on the 13th of March. Therefore, AREU decided to reallocate in the territory the resources (ambulances and human resources) based on the real-time data elaborated by the BI system.ConclusionsThe BI System has been of paramount importance in taking timely decisions on the management of EMS during the COVID-19 outbreak in the Lombardy region. Indeed, BI can be usefully applied to promptly identify the trend of the COVID-19 epidemic and, consequently, make informed decisions to improve the response to the outbreak.Key messages The Emergency Medical Services Trust of the Lombardy region applied a Business Intelligence System to promptly respond to the outbreak of COVID-19 and reallocate the resources based on real-time data.AREU used a Business Intelligence System to track the daily number of first aid requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview.

Dispatcher Identification of Out-of-Hospital Cardiac Arrest and Neurologically Intact Survival: A Retrospective Cohort Study.

To date, there are no published data on the association of patient-centered outcomes and accurate public-safety answering point (PSAP) dispatch in an American population. The goal of this study is to determine if PSAP dispatcher recognition of out-of-hospital cardiac arrest (OHCA) is associated with neurologically intact survival to hospital discharge. This retrospective cohort study is an analysis of prospectively collected Quality Assurance/Quality Improvement (QA/QI) data from the San Antonio Fire Department (SAFD; San Antonio, Texas USA) OHCA registry from January 2013 through December 2015. Exclusion criteria were: Emergency Medical Services (EMS)-witnessed arrest, traumatic arrest, age <18 years old, no dispatch type recorded, and missing outcome data. The primary exposure was dispatcher recognition of cardiac arrest. The primary outcome was neurologically intact survival (defined as Cerebral Performance Category [CPC] 1 or 2) to hospital discharge. The secondary outcomes were: bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, and prehospital return of spontaneous return of circulation (ROSC). Of 3,469 consecutive OHCA cases, 2,569 cases were included in this analysis. The PSAP dispatched 1,964/2,569 (76.4%) of confirmed OHCA cases correctly. The PSAP dispatched 605/2,569 (23.6%) of confirmed OHCA cases as another chief complaint. Neurologically intact survival to hospital discharge occurred in 99/1,964 (5.0%) of the recognized cardiac arrest group and 28/605 (4.6%) of the unrecognized cardiac arrest group (OR = 1.09; 95% CI, 0.71-1.70). Bystander CPR occurred in 975/1,964 (49.6%) of the recognized cardiac arrest group versus 138/605 (22.8%) of the unrecognized cardiac arrest group (OR = 3.34; 95% CI, 2.70-4.11). This study found no association between PSAP dispatcher identification of OHCA and neurologically intact survival to hospital discharge. Dispatcher identification of OHCA remains an important, but not singularly decisive link in the OHCA chain of survival.

Out-of-hospital management of acute coronary syndromes

In Europe, the biological and healthcare costs of acute coronary syndrome (ACS) are extremely high. For this reason, the Emergency Medical Service of the Lombardy Region (AREU Lombardy) has defined a "mission" that can partly resolve this issue, through an accurately balanced clinical/organizational plan of territorial medical rescue. The territorial and housing complexity of the Region has conditioned the recent strategic choices, that have foreseen the alignment to Europe with the introduction of the 1st level Public Safety Answering Point (NUE 1.1.2.), for the exact localization of the event, and its subsequent management by the Operations Centers of the Emergency Medical System with the dispatch of the most suitable rescue vehicles, all of which are capable of carrying out a 12-lead ECG for cardiology diagnostics. Furthermore, in order to meet the European quality requirements, all the rescuers are specifically trained to treat ACS, the healthcare professionals employed in the rescue are all "specialists", and a standard pharmacological treatment is administered prior to arrival at the hospital. As a result of this rescue organization, 78 425 12-lead ECGs were performed in Lombardy in 2018, subsequent to emergency calls; of the 52 528 cases of chest pain, the potential ACSs detected in the area were 41 220, of which 4980 confirmed in the emergency departments through the subsequent refined instrumental and laboratory diagnostics. The diagnoses of ST-elevation myocardial infarction at the territorial point of care were 1833, and all the events were pharmacologically pretreated in the territorial setting, according to the AREU procedure. In Lombardy, the out-of-hospital management of ACS is strictly aligned with the standards of the Ministerial Decree no. 70 of 2015 and follows a well-defined track, aimed at meeting the current quality goals and the performance indicators of this pathology. This track surely needs to be improved through the concerted effort by all the healthcare stakeholders in order to univocally define the outcome indicators, which at present are not yet perfectly defined.

ECall for Heavy Goods Vehicles

eCall is the European in-vehicle emergency call system. The functionality required for an in-vehicle emergency call service for heavy goods vehicles (HGVs) is largely similar to eCall for cars and vans. The specific requirements for HGVs include communicating information about the cargo carried by the vehicle to the public safety answering point (PSAP) and finding a suitable triggering mechanism for automated eCall for HGVs. The paper summarises the requirements for HGV eCall and drafts three architectural solutions for providing the PSAP access to information on cargo carried by the vehicle: a multi-party approach, a proxy approach, and a distributed system with authentication and authorisation of the HGV Information Service (HGV IS) and PSAP by trusted third parties. Finally, the paper examines the possibilities for interoperability with Next Generation eCall (NG-eCall) and ERA-GLONASS. The challenges to implementing the service and the needs for further research are also reviewed briefly.

Multiple Correspondence Analysis of Emergencies Attended by Integrated Security Services

A public safety answering point (PSAP) receives thousands of security alerts and attends a similar number of emergencies every day, and all the information related to those events is saved to be post-processed and scrutinized. Visualization and interpretation of emergency data can provide fundamental feedback to the first-response institutions, to managers planning resource distributions, and to all the instances participating in the emergency-response cycle. This paper develops the application of multiple correspondence analysis (MCA) of emergency responses in a PSAP, with the objective of finding informative relationships among the different categories of registered and attended events. We propose a simple yet statistically meaningful method to scrutinize the variety of events and recorded information in conventional PSAPs. For this purpose, MCA is made on the categorical features of the available report forms, and a statistical description is achieved from it by combining bootstrap resampling and Parzen windowing, in order to provide the user with the most relevant factors, their significance, and a meaningful representation of the event grouping trends in a given database. We analyzed the case of the 911-emergency database from Quito, Ecuador, which includes 1,078,846 events during 2014. Individual analysis of the first-response institutions showed that there are groups with very related categories, whereas their joint analysis showed significant relationships among several types of events. This was the case for fire brigades, military, and municipal services attending large-scale forest fires, where they work in a combined way. Independence could be established among actions in other categories, which was the case for specific police events (as drug selling and distribution) or fire brigades events (as fire threats). We also showed that a very low number of factors can be enough to accurately represent the dynamics of frequent events.

Statistical, Spatial and Temporal Mapping of 911 Emergencies in Ecuador

A public safety answering point (PSAP) receives alerts and attends to emergencies that occur in its responsibility area. The analysis of the events related to a PSAP can give us relevant information in order to manage them and to improve the performance of the first response institutions (FRIs) associated to every PSAP. However, current emergency systems are growing dramatically in terms of information heterogeneity and the volume of attended requests. In this work, we propose a system for statistical, spatial, and temporal analysis of incidences registered in a PSAP by using simple, yet robust and compact, event representations. The selected and designed temporal analysis tools include seasonal representations and nonparametric confidence intervals (CIs), which dissociate the main seasonal components and the transients. The spatial analysis tools include a straightforward event location over Google Maps and the detection of heat zones by means of bidimensional geographic Parzen windows with automatic width control in terms of the scales and the number of events in the region of interest. Finally, statistical representations are used for jointly analyzing temporal and spatial data in terms of the “time–space slices”. We analyzed the total number of emergencies that were attended during 2014 by seven FRIs articulated in a PSAP at the Ecuadorian 911 Integrated Security Service. Characteristic weekly patterns were observed in institutions such as the police, health, and transit services, whereas annual patterns were observed in firefighter events. Spatial and spatiotemporal analysis showed some expected patterns together with nontrivial differences among different services, to be taken into account for resource management. The proposed analysis allows for a flexible analysis by combining statistical, spatial and temporal information, and it provides 911 service managers with useful and operative information.

Abstract TP306: Mobile Application, “WeTrain911” to Decrease Stroke Mortality by Enhancing Emergency Dispatcher Training

Background: In rural states there are shortages of medically trained public safety answering point (PSAP) 911 answering stations. Dispatchers in these rural states risk leaving out vital Medical Priority Dispatch System (MPDS) determinants on patient stability and location to emergency medical systems (EMS) paramedics. We developed a smart phone medical education application for PSAP operators in underserved rural areas with a high deficiency of medical training. In Arkansas, as a rural stroke belt state there are 120 PSAP locations and 75 do not require any medical information training from state agencies. Twenty-six of these sites have limited medical training in cardio-pulmonary training. Only five counties have medically trained dispatchers and use MPDS. Following training, certification of dispatchers in any of the remaining underserved 70 counties that provide medical information will be regarded as a success. Hypothesis: The PSAP personnel serving as dispatch operators who utilize a medical dispatch training application will provide training based medical information, and reduce mortality due to stroke, trauma, and ST-elevation myocardial infarction (STEMI). Methods: In our data analysis, we are identifying whether the app intervention training influences telecommunication transition of information such as patient condition and caller location information to emergency medical service (EMS) providers. Other variables include paramedic impression/observation coding and response time to the scene. Baseline data from 2012 to 2014 will be used to compare pre- and post-training and state mortality data for stroke, trauma, and STEMI. Dispatcher to EMS agencies for dispatcher/caller information pre- and post-training will be compared for stroke, trauma, and STEMI mortality data. Results: App downloads have been noted in states across the US and as far as South Africa. At this time, we are still acquiring data for app downloads and user completed course training. Baseline mortality in 2012 to 2014 due to stroke, trauma, and STEMI were 140, 234, and 277 per 100,000, respectively. Conclusion: Currently, non-trained PSAP operators do not provide medical information on 911 calls and risk delayed EMS response time, jeopardizing patient safety.

Abstract TP219: Can Pre-hospital Intervention Improve Rural Stroke Care?

Background: In the stroke belt, local rural hospitals have reported 29 - 32% tissue plasminogen activator (tPA) treatment within 60 minutes for ischemic strokes. Since 2008, telemedicine has improved the door to treatment time from 120+ minutes to 70 minutes. A six month pilot program was initiated to determine the feasibility of a pre-hospital intervention to reach the American Stroke Association (ASA) target of 50% treatment within 60 minutes. Nine rural hospital sites were designated as Stroke Ready Hospitals (SRHs). Local emergency medical service (EMS) providers to these sites received additional education to evaluate and transport suspected stroke patients to the SRH in their area. The study also evaluated the early acute hospital patient care for improvements in treatment rates and data reporting at each SRH site. Hypothesis: Within six months, the SRHs will have 30-50% improvement rates in pre-notification by their local EMS providers and these will correspond to decreased triage time. Methods: This study assessed the benefit of early pre-notification by local EMS providers on decreased time to treatment and improved triage time as an improved process of care after implementation in nine SRH designated sites. To measure improvements in time to treatment and treatment rates, we compared time and treatment rates before (baseline was 11 months pre-study) and after study implementation in the same hospital sites. Results: A total of 6,049 transports were made by the EMS services with 117 patients suspected as strokes. A medical public safety answering point (PSAP) communication network provided stability in EMS data acquisition and stroke code notification to SRHs. The study showed improvements in mean triage and transport time vs. baseline (30.7 vs. 74 min, n=48 and n=22, respectively), Door to CT time vs. baseline (21 vs. 26 min, n=151 and =218, respectively) and Door to tPA time vs. baseline (65 vs. 78 min, n=13 and =22, respectively). While the ASA goal of 50% was not met, the % of treated ≤ 60 min increased from baseline at 24.8 to 38%. Pilot study code stroke % pre-notification increased from 38 to 69%. Conclusions: Pre-hospital intervention with local EMS providers improved pre-notification, first medical contact to CT time and the arrival time to treatment.

Estimate of mortality reduction with implementation of advanced automatic collision notification

ABSTRACTObjective: Advanced Automatic Collision Notification (AACN) is a system on a motor vehicle that notifies a public safety answering point (PSAP), either directly or through a third party, that the vehicle has had a crash. AACN systems enable earlier notification of a motor vehicle crash and provide an injury prediction that can help dispatchers and first responders make better decisions about how and where to transport the patient, thus getting the patient to definitive care sooner. The purposes of the current research are to identify the target population that could benefit from AACN, and to develop a reasonable estimate range of potential lives saved with implementation of AACN within the vehicle fleet.Methods: Data from the Fatality Analysis Reporting System (FARS) years 2009–2015 and National Automotive Sampling System–Crashworthiness Data System (NASS-CDS) years 2000–2015 were obtained. FARS data were used to determine absolute estimates of the target population who may receive benefit from AACN. These estimates accounted for a number of factors, such as whether a fatal occupant had nearby access to a trauma center and also was correctly identified by the injury severity prediction algorithm as having a “high probability of severe injury.” NASS-CDS data were used to provide relative comparisons among subsets of the population. Specifically, relative survival rate ratios between occupants treated at trauma centers versus at non-trauma centers were determined using the nonparametric Kaplan–Meier estimator. Finally, the fatality reduction rate associated with trauma center care was combined with the previously published fatality reduction rate for faster notification time to develop a range for possible lives saved.Results: Two relevant target populations were identified. A larger subset of 6893 fatalities can benefit only from earlier notification associated with AACN. A smaller subgroup of between 1495 and 2330 fatalities can benefit from both earlier notification and change in treatment destination (i.e., non-trauma center to trauma center). A Kaplan–Meier life curve and a multiple proportional hazard model were used to predict the benefits associated with transport to a trauma center. The resulting range for potential lives saved annually was 360 to 721.Conclusions: This analysis provides the estimates of lives that could potentially be saved with full implementation of AACN and universal cell coverage availability. This represents a fatality reduction of approximately 1.6% to 3.3% per year, and more than double the lives saved by earlier notification alone. In conclusion, AACN is a postcrash technology with a promising potential for safety benefit. AACN is therefore a key component of integrated safety systems that aim to protect occupants across the entire crash spectrum.

150 Dispatch Accuracy Effect on Neurologically Intact Survival: A Retrospective Cohort Study

The effect of public-safety answering point (PSAP) dispatch accuracy on Out-of-Hospital Cardiac Arrest (OHCA) neurologically intact survival is not well documented in the scientific literature. The goal of our study is to determine if OHCA dispatcher accuracy will correlate with neurologically intact survival. We analyzed data from the San Antonio OHCA Database from January 2014 thru June 2015. Exclusion criteria were: traumatic arrest, no dispatch type recorded, and EMS witnessed arrest. The primary variable was accurate PSAP dispatch. The primary outcome was neurologically-intact survival (cerebral performance category (CPC) 1-2) to hospital discharge. The secondary outcome was prearrival CPR (defined as any CPR given prior to ambulance arrival). Of 1770 cases, 1447 met the inclusion criteria. 1063 cases (73.5%) were dispatched as OHCA, upgraded to OHCA, or suspected dead on arrival. 384 cases (26.5%) were dispatched as another chief complaint. Unconscious/Faint (34.3%) and difficulty breathing (22.9%) were the most common inaccurate dispatches. The accurate vs inaccurate dispatch groups had no statistical difference in racial composition, age (62.0 vs 62.3) or initial shockable rhythm (15.2% vs 18.7%). Neurologically-intact survival occurred in 4.7%, 95% CI[3.5,6.3] of the accurate dispatch group and 4.3%, 95% CI[2.6,7.2] of the inaccurate dispatch group (p=0.88). Prearrival CPR occurred in 76.1%, 95% CI[73.5,78.6] of the accurate dispatch group vs 52.7%, 95% CI[47.7,57.7] of the inaccurate dispatch group (p<0.001). OHCA dispatch accuracy is not associated with neurologically intact survival in our fire department-based, urban, EMS system.

The Benefits and Tradeoffs for Varied High-Severity Injury Risk Thresholds for Advanced Automatic Crash Notification Systems

Objectives: The objectives of this study are to (1) characterize the population of crashes meeting the Centers for Disease Control and Prevention (CDC)-recommended 20% risk of Injury Severity Score (ISS) > 15 injury and (2) explore the positive and negative effects of an advanced automatic crash notification (AACN) system whose threshold for high-risk indications is 10% versus 20%.Methods: Binary logistic regression analysis was performed to predict the occurrence of motor vehicle crash injuries at both the ISS > 15 and Maximum Abbreviated Injury Scale (MAIS) 3+ level. Models were trained using crash characteristics recommended by the CDC Committee on Advanced Automatic Collision Notification and Triage of the Injured Patient. Each model was used to assign the probability of severe injury (defined as MAIS 3+ or ISS > 15 injury) to a subset of NASS-CDS cases based on crash attributes. Subsequently, actual AIS and ISS levels were compared with the predicted probability of injury to determine the extent to which the seriously injured had corresponding probabilities exceeding the 10% and 20% risk thresholds. Models were developed using an 80% sample of NASS-CDS data from 2002 to 2012 and evaluations were performed using the remaining 20% of cases from the same period.Results: Within the population of seriously injured (i.e., those having one or more AIS 3 or higher injuries), the number of occupants whose injury risk did not exceed the 10% and 20% thresholds were estimated to be 11,700 and 18,600, respectively, each year using the MAIS 3+ injury model. For the ISS > 15 model, 8,100 and 11,000 occupants sustained ISS > 15 injuries yet their injury probability did not reach the 10% and 20% probability for severe injury respectively. Conversely, model predictions suggested that, at the 10% and 20% thresholds, 207,700 and 55,400 drivers respectively would be incorrectly flagged as injured when their injuries had not reached the AIS 3 level. For the ISS > 15 model, 87,300 and 41,900 drivers would be incorrectly flagged as injured when injury severity had not reached the ISS > 15 injury level.Conclusions: This article provides important information comparing the expected positive and negative effects of an AACN system with thresholds at the 10% and 20% levels using 2 outcome metrics. Overall, results suggest that the 20% risk threshold would not provide a useful notification to improve the quality of care for a large number of seriously injured crash victims. Alternately, a lower threshold may increase the over triage rate. Based on the vehicle damage observed for crashes reaching and exceeding the 10% risk threshold, we anticipate that rescue services would have been deployed based on current Public Safety Answering Point (PSAP) practices.

Universal Access to eCall System

eCall is a car system which automatically calls for help in case of a car accident. The system sends a minimum set of data containing information about the occurrence, such as the geographic location and the vehicle identification. Simultaneously, a 112-voice connection is established. Therefore, the operator at the Public-Safety Answering Point (PSAP) is able to hear what is happening in the vehicle and actually communicate with the occupant(s). However if the occupant(s)’s are deaf or has earing impairments he will not be able to describe the situation using the voice channel established. This paper proposes a solution for this problem extending the SOSPhone concept, developed for enabling universal access to emergency services. A prototype of an application integrated with the eCall that enables the communication with deaf people or earing impaired people is presented. The solution makes use of touch interfaces, embedding the emergency protocols in the user's device, gathering information with an iconographic interface.

Emergency Medical Dispatch Codes Association with Emergency Department Outcomes

Background. Emergency medical dispatch systems are used to help categorize and prioritize emergency medical services (EMS) resources for requests for assistance. Objective. We examined whether a subset of Medical Priority Dispatch System (MPDS) codes could predict patient outcomes (emergency department [ED] discharge versus hospital admission/ED death). Methods. This retrospective observational cohort study analyzed requests for EMS through a single public safety answering point (PSAP) serving a mixed urban, suburban, and rural community over one year. Probabilistic matching was used to link subjects. Descriptive statistics, 95% confidence intervals (CIs), and logistic regression were calculated for the 107 codes and code groupings (9E vs. 9E1, 9E2, etc.) that were used 50 or more times during the study period. Results. Ninety percent of PSAP records were matched to EMS records and 84% of EMS records were matched to ED data, resulting in 26,846 subjects with complete records. The average age of the cohort was 46.2 years (standard deviation [SD] 24.8); 54% were female. Of the transported patients, 70% were discharged from the ED, with nine dispatch codes demonstrating a 90% or greater predictive power. Three code groupings had more than 60% predictive power for admission/death. Subjects aged 65 years and older were found to be at increased risk for admission/death in 33 dispatch codes (odds ratio [OR] 2.0 [95% confidence interval 1.3–3.0] to 19.6 [5.3–72.6]). Conclusions. A small subset (8% of codes; 7% by call volume) of MPDS codes were associated with greater than 90% predictive ability for ED discharge. Older adults are at increased risk for admission/death in a separate subset of MPDS codes, suggesting that age criteria may be useful to identify higher-acuity patients within the MPDS code. These findings could assist in prehospital/hospital resource management; however, future studies are needed to validate these findings for other EMS systems and to investigate possible strategies for improvements of emergency response systems.

Wireless emergency routing on empirical data: shaving time saves lives

PurposeThe purpose of this paper is to illustrate the outcomes of the RED (Routing on Empirical Data) Project, a three year cross‐jurisdictional collaborative undertaking in the State of California that significantly improved the efficiency of the State's wireless 9‐1‐1 emergency communications system.Design/methodology/approachThe Project's approach looked at historical wireless call data over a three‐year period and created accurate jurisdictional shapefiles to identify actual call origination and determine statistically which Public Safety Answering Point (PSAP) should receive wireless 9‐1‐1 calls routed to a particular wireless sector.FindingsThe findings or outcomes of the project were that busy signals previously in the 9‐1‐1 system were dramatically reduced to 2.3 per cent of total call volume in 2011 from 42.4 per cent of total call volume in 2007. This occurred with a concurrent 29 per cent increase in call volume over the same time period.Practical implicationsThe practical and social implications for improvement in public safety are significant given the improvements in emergency response time that the project's outcome provides. Exponential increases in wireless phone usage over the past decade makes review of emergency communication infrastructure essential to ensure expeditious delivery of emergency services to the 9‐1‐1 calling public. Whether fire, ambulance or law enforcement response is required, when delay is inserted into the process of answering 9‐1‐1 calls, a reduction in the likelihood of a positive outcome occurs.Originality/valueThe outcomes of the RED Project show that Local and State government collaboration using empirical data studies can ensure emergency communication systems are optimized and ready for Next Generation technologies.

와이브로 망에서 긴급 서비스 지원을 위한 구조

우리나라 주도의 와이브로 기술은 가장 먼저 4G 고지에 도달한 무선 인터넷 기술로, 유망한 차세대 이동통신 기술 중 가장 유력한 주자 중 하나이다. 모바일 와이맥스로 국제 표준화 되었으며 우리나라를 비롯해 해외 많은 나라에서 구축되고 있다. 와이브로 망에서 긴급 서비스 지원은 대국민 기반 서비스일 뿐 아니라, 번호 이동을 통해 다른 통신망의 음성 가입자를 유인하는데 전제가 되는 긴요한 서비스가 될 것이다. 본 논문은 모바일 VoIP 서비스를 제공하는 와이브로 망에서 긴급 서비스 지원을 위한 네트워크 구조를 제안한다. 제안된 구조는 국제 호환성을 위해 WiMAX Forum (WMF)에서 표준화한 구조를 기반으로 하되, PSAP (Public Safety Answering Point)과의 인터페이스는 우리나라 긴급 교환망 구조 및 현 긴급 서비스 시스템과 무리 없이 연동되도록 고안되었다. WiBro network technologies developed mainly by Korea are one of very promising 4G technologies. WiBro has been standardized as international standard called Mobile WiMAX, and has been deployed in many countries. Emergency Services in WiBro networks are infrastructure services and will be very essential to induce subscribers from other types of networks. This paper proposes a network architecture for supporting emergency services for WiBro mobile VoIP networks. The proposed architecture is based on WMF's architecture for international compatibilities, and reflects national considerations on interfacing PSAP for domestic compatibilities.