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I was wondering, do the east side fire medics and aid units communicate at all with hospitals when en route or on scene? If so do they use the 800Mhz system or something else. If it is the 800Mhz system what TGs would I need to listen too?

I guess what I am really after here is what would I listen to to hear more information about whats going on while medic units are working besides the TAC channels? Also do they ever communicate with the AMB units from AMR via radio?

Thanks.

-G

I was a FF/EMT with an agency on the Eastside for over 10 years, but recently moved out of the area. I can tell you that this is what I observed:

If the call was a medical related issue at a home, the medics frequently requested the use of the homeowner land line. Even at a business, they attemted to gain access to a land line.

If out "on the road" like at a car accident, their defaulted to the second choice, which was cell phone, usually a "mobile" phone rig mounted. Not sure what they are currently using, but they were older Analog 800 MHz cell phones - on commercial carriers - not on the trunked 800 MHz system.

last resort would be the 800 MHz Radio system. Each Hospital has an 800 MHz trunked mobile in the ER (multiples at Harborview). each Hospital is on it's own talk group - Look at IDs 60XXX to 61XXX

My experience in the Swedish and Harorview ERs, is that the radio is not used very often.

On communications with AMR, that was a very sore topic for me, as there was no communication with AMR. A public safety unit gets on-scene and the request a Private AMB - Dispatch center calls the Private AMB Companies and requests a unit. If you wanted to update them enroute, you would have to give the information to dispatch, then the pub safety dispatcher would call an AMR dispatcher on the telephone and then the AMR dispatcher relays the information to the incomming ambulance. The same communications path was used if you wanted an updated ETA.

I have been told AMR in Seattle may have a talk group on the public safety system now, but I'd doubt it. I find it odd that the Garbage trucks, and all the workers over at Key arena can have radios on the system, but not AMR - if the public knew, and knew that it was decreasing the quality of care, they would be outraged.

Even worse, my prior agency kept VHF radios in all the rigs as a "backup," but doesn't use the radios to communicate with AMR.

When I was in the D.C. area, the FD's definetly have direct communications with the private AMBs.

Here's the deal on FD to Hospital communications.

Medic units, MSO's (Medical Service Officers) and aid units often use three methods to communicate with the hospitals.

Quite often, medic units(in King County, but outside of Seattle) will use the landline to call the hospital that they're going to transport to. They will ask the patient or patients family if they use the phone in the residence. If they don't have access to a landline, then they will use their digital phone in the medic unit. They call the receiving hospital and ask to speak to the medic one doctor at that hospital. They call a special line at that hospital, that's reserved for that type of communication. They tell the doctor what they have, what they've done or what they plan to do--and ask for permission for procedures outside of standing orders.

Now sometimes the county medic units (KC, Bellevue, Shoreline, Vashon & now Redmond) will use TG 2032 to talk to the Harborview "Trauma Doc". This is when they are going to transport a critical trauma patient to Harborview. This is actually a Seattle Fire TG that's programmed into their radios. They also have TG-2000 (Medic One Doc) in their radios. They don't use that very often. They would only use that if they didn't have a landline or they couldn't get the doc on their mobile phone.

Now, what about Seattle Fire? Well, things are just a bit different. They use their radios a whole lot more when communicating with HMC(Harborview). You see, they contact HMC EVERY TIME regardless of what hospital they transport to. You might hear this, "Dispatch form Medic 10, have the Trauma-Doc use medcom( or phone) for Medic 10." Or you might hear, "Dispatch from Medic 18, have the Medic One Doc use phone(or medcom) for Medic 18.

Then the dispatcher at the SFD Fire Alarm Center will alpha-page the appropriate doctor at HMC. Then the doc will go to the radio room at HMC and communicate with whatever unit made the request.

Even if the SFD medic unit is going to transport to say Swedish, they still talk to HMC to give patient information. Then HMC calls the receiving hospital and tells them they have a patient headed there way. The SFD Medic One sub-group is a little more strict when it comes to hospital control.

So what about the eastside and the rest of the county? Well, I pretty much summed it up in the beginning. If Bellevue M-14 was on a medical call and had to relay patient info, they would simply call the receiving hospital by phone and tell them what they've got. The same is true with other county medic units. They individual hospital TG's are used infrequently. In fact, one time I was transporting a patient to a south-county hospital and couldn't reach them by phone. I told our dispatcher to have the hospital talk to us on their hospital TG. Well, I never did raise them on that TG. Turns out, their 800 MHz base radio was off and buried under a bunch folders and papers. I asked them what the deal was and they said they never use the 800 MHz radio and that they only use it to give space availability information to HMC or when communicating with EOC's. Then they told me NEVER to try and contact them again on that channel and that it wasn't meant for FD to hospital communition. I basically told them that was a bunch of BS and that why in the world would we have those TG's programmed in our radios?!?!?! And that we were told that using those TG's was an acceptable method to contact medical facitities. Whatever...

Lastly, what about the AMB's? Well they have their own dispatch. When we need a AMB whether from AMR or TriMed or whatever, we ask our dispatcher to get one for us. They call the AMB dispatch and then one is sent our way (code-yellow now). SFD does have a 800 MHz TG that they can switch to, to order-up an AMB. Because they have an exclusive contract with AMR, they have this link. That will never happen ANYWHERE else in KC. Ambulances have no business on the fire radios. There is no need to relay patient information to them. If a patient is transported by AMB, is't because the patient is NOT seriously/critically sick or injured. Therefore, we tell the AMB what we've got when they arrive on scene. So to answer you question, the medic/aid units don't communicate with the AMB's. This is in response to "waltd's" response. The pubic wouldn't care one bit about the lack of communication between AMB's and the public agencies. Like I stated above, there is NO need. Patient care is not decreased. End of story...

The AMB's do communicate with the hospitals using the VHF HEAR radio channels. These are not 800 MHz. This are really old VHF frequencies that have been in use for decades.

So, that is the long version of how medic units, aid units and MSO's contact the hospitals.

Let me know if there is someting that I left out.

Later,

CAR

I guess since there are always plenty of Medic Units available, and since Private AMBs always transfer non-critical patients, then we should just take the lights and sirens off of the Private AMB Units. . .

I guess I go back to when we used to be able to talk to the private AMBs directly on the radio, and things worked a lot better. Situations where it would be nice to talk to the private AMBs, not necessarily to relay patient information, but rather directions, best approach, ETA, etc. Here are some examples:

Large Car Wreck - might be nice to tell them the best approach to the incident, especially if things change while the incident progresses

Incident Requiring that the private AMB be upgraded to Lights and Sirens, as the patient may not need a medic unit, but may need more rapid transport than a unit sitting in SR520/I-90 traffic may be able to provide. Example is certian types of Stroke paitents - they need to get to the hospital in a timely manner for time critical treatments, but no medic intervention will help them.

No Medics available - If there are no medics available, then a private AMB with lights and sirens is better than nothing (been there - done that - we were an engine company at a car wreck out on SR 203 or SR 202) - and in this rare situation, they might need to know what type of patient they are transporting and where they will be transporting to.

What if you are an Engine Company and the patients condition all of a sudden gets worse and you want to upgrade the Private AMB to lights and sirens, because Private AMB rapid transport to meet the Medics in the middle is a better choice, according to the Medic Unit that you talk to on the radio. Unfortunately the call to get the Private AMB upgraded takes at least 5 miutes.

What about the situation where the Private AMB arrives prior to the FD, like at an MVA, just because they were in better position. Wouldn't it be nice for the Private AMB to be able to give a scene size up to the FD? This has happened to us, and we knew the Private AMB was on scene, as we could see thier flashin lights at the scene about a mile away.

Sorry, but I disagree that patient care is not compromised by not being able to communicate with the Private AMBs - If the patient basically needs a taxi cab, then I'll buy the arguement, but there are just too many times I have sat on scene waiting for an AMB, with a patient who could benefit from being at the hospital sooner, even if it is just for relief of pain, but they weren't medic criteria. Communicating with the AMB would have got them to the Hospital quicker.

Walk in he paient's shoes for a minute - a patient with a broken arm and some minor cuts and bruises - not a medic call, but they are sitting there waiting to go to the hospital, and the private AMB gets lost or misses a turn in route to the incident out on some remote road in Fall City (I know this would never happen!) - the patient's care is being compromised. If you don't think so, trust me you'll change your mind when it is your mother, daughter, or nighbor who just got hit by some drunk driver and they have to sit there waiting for an AMB.

I also attended one of the MCI drills on the Eastside where they had FD AMBs and Private AMBs in the staging area - for whatever reason the Staging manger wanted the AMB (FD and Private) to stay with their aid cars - then they decided for some reason that inside a parking garage was not a realistic place for a staging area at an Earthquake MCI Drill, so they decided to moving the staging area - there was no way to talk to the Private AMB units on radio, so a runner had to be sent - now that is communications efficiency and could never lead to delayed transport at an MCI... Oh, but I forgot, we'll just transport all 16 critically injured kids from the Junior High School bleacher collapse via Medic Units...

Look, I agree that on a day to day basis, it isn't critically necessary, but I think letteing AMR have 2-3 talk groups on an 800 MHz handheld could only help. I am not suggesting that the Private AMBs be transmitting needlessly on all of the public safety talk groupsm, but if the dispatcher told the requesting FD unit something like "Engine 99, you have AMR622 from Eastgate - they will be on AMR TG3 if you want to contact them." I guess I just can't see it hurting anything.

I appreciate your response, and there was some great information in there, but I respectfully disagree that not having the capability of direct communications with private AMBs until they get on scene is best. The solution is not necessarily to put them on the 800MHz system - but some solution would be nice.

Very Respectfully
Walt

WOW! Thanks for the overwhelming response guys.

-G

"waltd", you make some good points. However, I still disagree. Patient care is NOT compromised. AMB's have the ability to run "code-red" IF needed. In your example, you said if the patient's condition worsened while enroute to the hospital--then yes turn the red lights on and go. BUT, they are only authorized to do that IF it would take more time to call out for a medic eval than proceed on to the hospital. That is the rule--according to King Count Patien Care Guidelines.

Now about all this "routing information" business. There's no problem with relaying routing information through dispatch. Again, time is not a factor with patients that are not seriously sick or injured. There are some exceptions. Strokes, major bone fractures, pain issues, etc. These are all situations where timeliness is important. In many of those cases, FD's will have the aid units transport the patient to the hospital.

So, should we take the lights and sirens off of the private AMB's. No, but if you consider what King County EMS did in response to a fatality MVA involving an AMB, you'll understand why there is few reasons why AMB's need to run code-red. KC EMS revised the conditions on how AMB's respond. They are only to proceed(code-yellow) to the call, unless the on-scene fire department unit specifically requests the AMB to respond code-red. The on-scene FD unit MUST have compelling reason(s) have the AMB respond to the scene. Those reasone are listed above. If the AMB is stuck in traffic, then yes, it MAY be appropriate to have them respond.

Now for your MCI example. Your argument doesn't wash. I too have personally been involved with many MCI drills. The way it works is this:

The Medical Group Supervisor, under the direction of the Incident Commander, sets up their medical branch of the incident. Under the Medical Group Supervisor is the Transport Team Leader. That persons two main responsibilities are:

1. Remain in constant contact with Hospital Control at HMC--usually via phone or by 800 MHz radio (TG 2032 sometimes). HMC then gives patient destination information to the Transport Team Leader. They in turn tell the medic units, aid units AND the AMB's what hospital to take the patient to. The AMB supervisor or designee is SUPPOSED to be right beside the transport team leader to help facilitate the coordination of private tranport vehicles. WHEW!

2. The other job of the TTL, is to track all patients. That means their color (red, green, yellow, white, etc), their number and their destination (and what unit they're going in).

Now, I can't comment on your experience with the MCI drill on the eastside--I wasn't there. Coordination is CRITICAL on MCI's. That is why your don't do anything until directed by the person or person(s) in charge. I have been witness to a handfull of very successful MCI's (actual calls), where AMB coordination went extremely well. The AMB supervisor was right where they were supposed to be--next to the Transport Team Leader, and all the transport vehicle were in a well organized procession--waiting to load their patients.

So, that is my experience and information regarding AMB's. I still feel there is no complelling reason to have the AMB's on our radio's. Now I know things are a bit different in oher counties. I can only give you my experience in King County.

Thanks for your response!

CAR

Thurston County still uses the fire freqs to dispatch fire units and private amb responding on F1 154.430 and the appropriate fireground channels--however, AMR and Olympic dosent respond to BLS as much as they used to, the districts were getting tired of long reponse times from Olympia or Centralia after the different depts tried to get them to keep units local at stations
or at least have a better response.

They talk to each other a lot as far as updates or getting cancelled. Most of the westside districts, 1,5,9,11went to a Dept based BLS transport in which daytime career and nightime reserve FF's live at the station and pull a 12 or 24 hr shift The Chief I know down here likes the fact that the public gets a far cheaper bill and that the response times are less than 5-7 mins.

5 paramedic based transport units ( Medic 2 Yelm, 3 Lacey, 4 Oly, 5 Tumwater and 10 Oly) work the cities and outlying areas with a "Sprint 14", a first responder paramedic in a Expedition based at dist 1working the west side and Tenino. I hear the "code 12's" (ambulances) in the cities or when the fire transport rigs are backed up.

CAR,

Thanks for your insight. I can appreciate that your situation closer into the core may allow for more resources and may negate the need for direct communications with AMB units.

I think the story gets a little bit different when you get out on Snoq. Pass, Carnation, Norht Bend, Highway 18, etc. The departments out there are thin on manpower, and sometimes there are no dept aid cars within reasonable response.

I also can't argue that we need to be talking to them on a regular basis cluttering up the system, but I did think that in the rare cases when we do, going through two dispatch centers is a waste of resources and a time consumer, especailly now that we will be asking them to upgrade rather than downgrade (which we did do in the past, since we had really long response times from them). I guess if you have never been on a wreck in SR-203 with no medics available (closest was medic 19 from Kirkland), 4 red patients, airlift giving you a big negative becasue of low ceiling, and well ... there you are.

Back when this happened AMR was responding red already, but I emphatically agree with new policy of Private AMBs being directed to respond Code-Yellow - I agree with this more than you can imagine. AS far as the incident where a red AMB got in an accident and killed someone, I guess my arguement for direct communications held back then as well - if the releated FD would have had direct comm with that unit, maybe they would have requested a downgrade to yellow before the accident, saving a life. The on-scene FD Unit likely didn't bother to request a downgrade to yellow, becasue they were providing pt. care or it was too much trouble to bother the dispatchers.

Again, we don't necessarity need to have them on the 800 system (as pointed out, I think it has too many users already) - but maybe the units in those outlying areas need VHF Radios with Private AMB freqs and agreements with the Private AMB's on appropriate communications.
That is all I am saying...

Again - Thanks for your responses - I realize this is a fine point, if you want to discuss further, just email me directly - waltd@nospam.msn.com (remove "nospam." from my email name)

Walt

WOW I did not know it was that complitcated over there with private ambulance. Here in the Conconully-Riverside-Omak-Okanogan-Malott area we have Lifeline Ambulance that provides transport and BLS/ALS care. The 5 fire departments listed above provide initial patients care because all Ambulance are dispatch out of omak (omak and okanogan fire dept are not dispatched unless lifeline reqeust it unless its a motor vehicle accident and its automatic dispatch. we have continus contact with lifeline because the are dispatch from okanogan county sheriff dispatch. I hope this does not confuse anyone :?: some of the firefighters/emt also work parttime for lifeline so the lines of communications are always open and we have lifelines freq 155.280 and they have ours. so here it how it works over here.
mike

AMEN!

And the reason you see them driving like nuts without the appropriate training is that they get requested "red" by a good number of fire departments.

Many times, this is to save the time an engine or aid unit is out of service while waiting for a transport bus.

I know that in the Bonney Lake, Lake Tapps and Buckley areas of Pierce County fire department engines and medic units are able to communicate with the Paramedic unit that comes from AMR. The AMR paramedic unit is dispatched at the same time that the fire units are because they monitor the dispatch frequency for calls in their service area. I believe it is AMR 95 that serves Bonney Lake/Lake Tapps/Fire District 24(East Pierce Fire and Rescue) all the way to Buckley,Carbonado,South Prairie,Wilkeson,Fire district 12 and maybe as far as Greenwater and Crystal Mountain. AMR 94 covers the Sumner area and responds in place of AMR 95 if they are on a call already.