The 700MHz D Block: What It Means for EMS

On Friday February 17, 2012, Congress officially allocated 10 MHz of the700 MHz radio band to public safety. Known as the D Block, this spectrum had been much sought after by wireless carriers for commercial service. But in a move that could restore one's faith in politics, Congress put public service over profit and gave the D Block to police, fire and EMS; along with $7 billion to build a national first responder broadband network.

Once in place, this network will provide EMS, fire and police agencies with broadband, interoperable two-way communications nationwide. When equipped with the right equipment likely hardened smartphones and tablets built to the commercial wireless carriers' 4G/LTE standard EMS staff will be able to send and receive data video, audio, and medical instrument readings from their ambulances directly to receiving hospitals. The system lacks voice capability, but this may be overcome with VOIP or mixed broadband/voice bandwidth in the same device.

"The significance of this leap in EMS communications capability cannot be overstated," says Kevin McGinnis; communications technology advisor with the National EMS Management Association (NEMSMA) and four other national EMS associations. "It can be compared to what happened when ambulances were first equipped with two-way radios back in the early 1970s. It is that big a jump."

The 700MHz D Block network will be built by, licensed to, and managed by the First Responder Network Authority (FirstNet); an independent authority to be formed under the federal National Telecommunications and Information Administration (NTIA). FirstNet's 15-member Board of Directors will include the Secretary of Homeland Security, the Attorney General, and the Director of the Office of Management and Budget; plus three members representing/tribal/state governments, and three public safety professionals (active or retired). The other six members will likely include representation from wireless manufacturers and carriers. Under H.R. 3630 the Middle Class Tax Relief and Job Creation Act' that included the D Block decision FirstNet's board must be established by August 20, 2012.

"Once FirstNet's Board is in place, the process of building out the nationwide broadband network will begin," says Chief Jeff Johnson, CEO for the Western Fire Chiefs Association. "There will a lot of work to be done before we actually see broadband equipment in the nation's first responder vehicles, but at least we will finally be on the right course."

Imagining the Potential

It is easy to rhyme off technical platitudes regarding 700 MHz's capabilities for EMS. But what will it really mean for an EMS technician responding to a two car crash? Kevin McGinnis offers a tangible scenario.

"Let's say you're the first EMS responder on the scene, approaching the scene of the collision on foot," McGinnis tells EMS Responder. "You are wearing a small camera and lip microphone; both connected by your LTE first responder handset to your state's FirstNet network. As you approach the first car, you start giving a voice description of your impressions. Beyond going to Dispatch, your audio is automatically converted to text and begins to be compiled in an accident
database."

The EMS tech gets to the first victim. After assessing their vitals they are injured but conscious, breathing, and not bleeding the tech connects a multi-vital sign monitor to their body. The data from this unit is relayed through the FirstNet network to a second database. It is also reviewed by Dispatch for use in assigning a receiving hospital, and is set to alert the EMS tech if the vitals suddenly drop. Meanwhile, live video of the victim and their condition is captured and stored on a third database; for immediate or later access by medical processionals, as need be.

Onto the second car. Again, the EMS tech describes what they see with the information being stored automatically in the first database. A second multi-vital sign monitor is activated, and live video is shot. Again the data streams are received at Dispatch, and stored in the right databases while being also assessed in real-time.

Meanwhile, Dispatch has been using this time to access the victims' medical records, and to send this data to the EMS tech to help them make the best treatment decisions. "In some cases, patients may be wearing Medic Alert-type necklaces, except that their medallions contain USB drives or chips with their medical information right at hand," McGinnis says. "With modern RFID technology, it is possible to equip EMS responders with devices that will actively query the immediate area for patient-worn RFID-capable storage drives loaded with such information -- and to download that data wirelessly to the EMS tech's own handheld."

The result: In the space of one minute, rather than 5- 10 minutes, a patient's advanced assessment and clinical note-taking, diagnostic data collection, and history are made accessible to the hospital and all responders arriving on scene and authorized access to the data.

Fast forward: The victims have been assessed -- a second ambulance having arrived on scene -- and the victims are being take on board for transport to hospital. While this has been happening, their medical information, vital signs and conditions are being assessed by physicians at the receiving hospital. In the ambulances, the EMS techs are able to videoconference in real-time with these physicians, and conduct further tests to provide more data.

By the time the victims get to the hospital, they have already begun to receive treatment under the physicians' direction. This is a fundamental paradigm shift, as far as EMS is concerned: First responders will be able to move from administering first aid and maintaining life support, to beginning the healing process while enroute. Put another way, this shift will give the Golden Hour' an enhanced and even more important meaning.

The Nitty-Gritty

Everything you have just read represents the potential of 700MHz for EMS. However, there's a lot of work to be done to translate this potential into reality.

The work begins with getting FirstNet up-and-running. That's where H.R. 3630 comes in: "Under the Act, FirstNet will present each state governor with a plan for constructing their state FirstNet network," says Chief Johnson. "If the governor has plans of their own to make it happen, then they can do so. But if the governor does not respond, FirstNet has the authority to proceed and build the state network itself. This provision should prevent these buildouts from becoming mired in state politics."

This said, many issues will have to be tackled to launch these buildouts. This includes creating a functioning, qualified bureaucracy to get the process moving; getting plans drawn up, and hiring contractors and equipment suppliers to actually build the infrastructure.

Before shovels go into dirt, there's a fundamental decision that has to be made: Should FirstNet build its own 700MHz LTE network, or work with commercial carriers to tap into and expand their existing networks?

This is not a slam-dunk decision: Building a separate system ensures that it can be built to public safety standards, but could take years to accomplish. In contrast, working with commercial carriers would make it possible to get FirstNet on air sooner. But the network no matter how hardened and customized would be a public safety/commercial hybrid at best; a poor compromise at worst.

"This is a fundamental strategic decision that has to be made by the FirstNet board once it is in place," says Chief Johnson. "There are pros and cons to each option; neither one is perfect. But the choice made will dictate not just how FirstNet rolls out, but how its equipment evolves and is deployed; from handsets to transmitter sites and network design."

Time to Get Involved

Earlier in this article, the comment was made about H.R. 3630 restoring one's faith in politicians. Maybe so; but as Ronald Reagan liked to say, "Trust, but verify." Given that $7 billion is on the table and many billions more through subsequent equipment sales to first responders there will be a lot of competing interest groups trying to steer FirstNet's decisions to their own advantage. (Nothing gets the blood flowing faster in Washington than money.)

"This is the time for EMS and fire and police to make their voices heard in the FirstNet process, and to make sure that the decisions being made truly serve the public interest," says Chief Johnson. He's right: The choices that will be made will truly dictate the face of public safety communications for the 21st century and just how much can be done.

Here's are some of the issues that EMS agencies need to think about, take positions on, and then lobby hard for.

Interoperability: The creation of a national broadband first responder network is specifically intended to avoid the radio incompatibility issues that prevented fire/EMS and police being able to talk to each other on 9/11. That said, there is always the temptation for radio manufacturers to create some form of proprietary features that gives their product preference over the competition, by making such features unavailable to other radio systems. Remember, there's billions of dollars at stake.

If FirstNet is to truly achieve its goals, then public safety agencies must be on the lookout for such potentially incompatible features, and insist that every piece of equipment on the network no matter who makes it is truly interoperable. Function must trump profit.

Equipment Design: Given the 700MHz band's suitability for 4G LTE traffic, it will be very tempting for equipment manufacturers to adapt commercial 4G smartphones for use by public safety. (Should FirstNet decide to work with commercial wireless carriers, this temptation will be almost overwhelming.) The danger for EMS and other public safety agencies is that this equipment may lack sufficient ruggedness and mission-critical functionality, while offering features from the consumer space that really don't matter.

To keep this from happening, public safety agencies must make their voices heard at FirstNet, and at every forum where they deal with equipment manufacturers. It is vital that the broadband equipment that is sold to public safety be designed for public safety; not adapted from a mass-market consumer design simply because it can be. Again, function must trump profit.

Coverage: The concept of FirstNet is to provide a national broadband footprint. For the sake of first responders in rural and remote areas the people who need remote access to expert support the most the network must be truly nationwide.

There will doubtless be horse-trading on the part of some players in the process. They will argue that, there's so few people in that part of the state, that the expense is not justified for extending coverage there'.

The problem with this argument beyond the fact that applying business arguments to first response is not logical, since government is a cost-center by its very nature is that the FirstNet buildout is a unique and perhaps singular opportunity to remedy such gaps. Congress doesn't allocate $7 billion to public safety every day. In fact, chances are that it never will again; on the ground that FirstNet was funded to fill the holes, and that's that. So if coverage gaps are not addressed now, they may never be.

Ongoing Funding: It is one thing to build a brand-new, high-tech shiny network. It is another to pay to keep it maintained and upgraded, when the sheen has worn off the technology and the ADHD attention spans of politicians have been diverted elsewhere.

It will be vital for public safety agencies to demand and ensure that FirstNet is funded on a long-term, sustainable basis and that the network is built to be modernized and expanded as populations grow and technology advances. Make no mistake: The time will come when today's 4G LTE technology will be as quaint and inadequate as current LMR radios are with their 9.6k bandwidth capability. (Remember how slow Internet downloads were over a telephone dial-up connection? That ran at 56k; LMR's data speed is almost six times slower.)

"The D Block and FirstNet represents a historical opportunity for EMS and other first responders to get communications right, for the first time in our history," says Chief Johnson. "Yes, there will be a lot of work to be done to make FirstNet happen, and much effort required to make it happen to the public's benefit. But the potential for lives saved in the future is incalculable. As first responders, we have a chance to make a profound contribution to public safety, for decades and generations to come."

James Careless is a freelance writer with extensive experience covering computer technologies.