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Guest Editorial: The Risks of Computer-Aided Everything

The state of emergency medical services in the United States prior to the millennium may have been more stable than we see today. Paper charts, VHF/UHF radio systems, and hand-billing are things of the past, but the demise of these artifacts may have eroded our ability to continue services during even a minor disaster.  

In 2020 computers have taken over care of our patients whether we like it or not. They provide many benefits but are also vulnerable—computer-aided dispatch, ePCRs, vehicle hotspot systems, and push-to-talk radio are all subject to failure at any time. Even a small crash or malfunction of any of these systems could potentially be catastrophic for your organization. 

I challenge EMS directors to walk into their main station tomorrow and pull the plug on the Internet server. If there aren’t detailed, step-by-step backup plans in place, problems will begin immediately. 

Without Internet your CAD will stop functioning and dispatchers won’t know where units are. VoIP phones won’t ring, leaving crews and office personnel stranded. Without working phones, calls for assistance from the public will stop, at least until backup systems turn on. Some private companies won’t be able to roll calls to a separate old-fashioned system.

Billing will also stop without PCR access. In fact, even your current patient care reports will be halted without any finalization or transmission. Without rollover phone systems, lives will be at stake without the CAD, and revenue will suffer without PCRs and operational billing. 

The problem is not the computers, the Internet, or the optimization of services they allow us, but rather dependence on those systems. Younger providers may know no other way of charting than the click boxes and typing abilities allowed by a laptop or tablet; an older provider may have adapted and now be unused to writing the narratives they used to. 

It’s easy to have contingency plans but harder to use them under duress. During an Internet blackout many things must occur in a matter of minutes: The dusty old map books have to be dug out of the dispatch center closet; people have to remember numbers to punch into wired phones; crews have to find clipboards with the paperwork in the ambulances and pens to write with; and the list goes on. 

That STEMI Medic 1 just responded to? They won’t be able to transmit a 12-lead, either, and in many systems that means no STEMI alert can be called. That lack of Internet just delayed a STEMI from the cath lab. 

Hours following a break in connectivity with the World Wide Web mean ambulances are traveling more slowly to destinations, billing may be behind for days as they merge PCRs with dispatch copies, and operations will work more slowly through the learning curve. Calls may be missed; e-mails won’t go through. Dispatchers will be blind to unit locations, and turn-by-turn directions will not occur. 

When we look at the wonderful things that have occurred in EMS over the last two decades, we see the Internet has played a huge role in making our lives easier and streamlining both ambulance responses and patient care. It has increased revenue, reduced documentation mistakes, and made electronic communication the norm. However, when we lose that operability without forethought, we will lose our ability to sustain. Agencies need competent, trainable, bulletproof plans for sustainability during an outage. 

Training is of the essence, and everyone from the director to the newest EMT must be well-practiced on how to overcome such challenges. Every biller, dispatcher, and member of the support staff must know what to do. Train continuously and test and maintain backup and redundancy systems scrupulously. Be ready to adapt as circumstances change and training reveals weaknesses. 

In the big scheme of things, the Internet seems a small part of our environment as operators in EMS systems. We have been engrained to adapt, improvise, and overcome every obstacle thrown in our paths. But without proper training and safeguards, a loss of service won’t be something we can adapt to in an instant. 

Jason D. Cooke, MBA, NRP, is vice president of operations for Priority Ambulance in South Carolina. Contact him at jcooke@priorityam 

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