Wireless technology's effects on emergency response systems in rural areas

¶ … treatment of traumatic injuries and emergencies brought about by sudden health conditions. In urban areas response time is rarely a significant problem. In rural areas it is a significant problem. In an emergency, extra minutes can mean the difference between life and death; the difference between a serious injury and a disabling injury.

Statistically, there are a variety of reasons why the delivery of emergency services in rural areas is important. 1) Travel on rural roads increased by 27% between 1990 and 2002 by all vehicles and by 32% by large commercial trucks; 2) the traffic fatality rate on non-Interstate rural roads in 2003 was 2.72 deaths for every 100 million vehicle miles of travel, compared to a traffic fatality rate on all other roads in 2003 of 0.99 deaths per 100 million vehicle miles of travel; 3) Accidents on the nation's rural, non-Interstate routes resulted in an average of 22,127 fatalities annually from 1999 to 2003, accounting for more than half -- 52

percent -- of the nation's traffic deaths; 4) the fatality rate on rural, non-Interstate routes has actually increased from 2000 to 2003, from 2.65 fatalities per 100 million vehicle miles of travel to 2.72 in2003; 5) in about 30% of fatal rural traffic accidents in 2002, victims who died did not reach a hospital within an hour of the crash, whereas only eight percent of people injured in fatal, urban traffic accidents did not reach a hospital within an hour. (the Road Information Program, 2005).

Even a cursory review of the above cited statistics should reveal that prompt response by emergency personnel is vitally important in the saving of lives and the minimizing of the effects of accidents. It is equally true in the case of emergency situations such as heart attack, strokes, and severe bleedings situations. (Fisher, 2003). People in life-threatening circumstances need immediate help.

Adequate preparedness in rural communities is highly dependent on the public health departments, hospitals and emergency medical service providers available in the area. Unfortunately, rural medical providers are usually underfunded and undermanned. Rural medical facilities are technologically inferior; lack the same level of professional staffing; and often not centrally located. Additionally, the emergency personnel providing on-site service to emergency victims are often volunteers. Rural areas lack the necessary funding to employ fulltime, professional emergency staffs. Instead, volunteers whose primary occupation is something other than emergency care staff most rural EMS services. As a result, in most rural accident or emergency situations, the victims are relying upon the skills of individuals who are untrained. Add in the fact that the volunteers are working with equipment that is likely dated as well and you have a situation that is less than optimal.

Because of the unique situation presented by emergency conditions in rural settings, the need for good communication is heightened. Again, the rural setting raises unique problems and concerns. Communication technology has eased the problems inherent in the delivery of emergency services in urban areas; decreasing response time and allowing more efficient delivery of emergency services. Rural areas, however, have not been the beneficiary of the same results.

Historically, rural areas provide only basic telephone services and are only rarely suitable for effective data access. These conditions create problems in the delivery of emergency services in rural areas but improvements in communication technology have brought new hope.

The first major improvement in communication related to the delivery of EMS services was the establishment of the 911 system in 1968. (National Emergency Number Association) Under the 911 system individuals in need of emergency services were able to use the telephone, the traditional wired type, to use a dedicated line to contact a dispatcher specially trained to contact EMS personnel. The use of this system was intended to expedite the delivery of the EMS services and also remove any potential confusion. The 911 system has worked effectively but the proliferation of the use of cell phones has caused the system to become strained. Although a successfully placed 911 call can save valuable minutes the system that exists today is in danger of becoming obsolete.

As effective as the 911 system has arguably been there have been widely disseminated incidents when the system failed to operate as effectively as it was intended. As a result of these breakdowns, lives have been lost and injuries have been intensified due to delays in the delivery of EMS services. These breakdowns have occurred in calls never being received; calls being delayed; or the transmission of the calls being either interrupted or misunderstood due to static or outside interference. These problems and their effects are even more crucial in rural areas due to the inherent distances involved and the already referenced seriousness of the injuries.

Recent years have witnessed a remarkable improvement in business and personal communication. One of the major changes in this communication revolution is the introduction of wireless technology. Wireless technology has opened up new and improved avenues of communication and will likely in the near future change the entire face of all communication. Today wireless has removed nearly all need for traditional wired devices and this move toward an all wireless society has had its impact on the delivery of the emergency services. (Chapman)

The increased use of wireless technology has served to minimize some of the problems that have caused 911 failures in the past but wireless technology is not without problems of its own. In many urban areas the effectiveness of wireless communication has caused these areas to develop highly sophisticated wireless networks that enhance the ability of emergency responders to both transmit and receive valuable information in emergency situations. In rural areas, however, the development of the infrastructure necessary to support this widespread reliance on wireless technology is not as easily implemented. (Habib)

Although the introduction of wireless services has increased the availability of modern communication devices to rural areas there remain pockets of rural America where internet access and wireless phone use is still not available. Sometimes this is due to the limitations in technology in that residences can be so far apart that the base station necessary for the transmission of the wireless is impossible, or the service providers cannot justify the expenditure of the money necessary to provide the service because the number of users are too sparsely located. Because it is much more profitable to provide service in densely populated areas rather than spread out rural areas it only makes sense that service providers will concentrate on the more profitable options. There are, however, rapidly developing options that may soon obviate these problems.

The first major improvement in wireless technology that had major impact in rural areas was the introduction of WiFi. WiFi provided rural areas was an inexpensive alternative for rural areas and provided many rural areas with their first access to internet and cell phone usage but it lacked the range and power necessary for serving the vast expanses of many rural areas. Additionally, security was an additional concern When WiFi was first introduced, there were limited number of security protocols available. This has changed significantly over time but other products are now available that make wireless technology even more available in rural areas.

Three other wireless technologies are available similar to WiFi that can operate to provide service to rural areas. These technologies, WiMAX, satellites and balloons, have strengths and weaknesses but their value lies in their capacity to expand wireless services to rural areas. Other technological advances are being worked on that may soon make wireless service available throughout all rural areas but, in the meantime, it is incumbent on EMS service providers to begin developing their services based on the increased availability

Presently 36% of people living in rural America still do not have Internet access and there remain significant dead zones where cell phone access is limited as well. (Placeholder4) This segment of the population need to speak out so that service can be expanded to their areas and the advantages inherent in their use can be forthcoming. This need for action has taken on increased importance as a new Federal Communications Commission proposal may result in a slowdown in the building of much needed cell phone and internet towers in rural areas. A federal program identified as the Universal Service Fund has been actively building the towers to help build reliable communication networks in rural areas but the FCC has decided to place a cap on the wireless portion of their funding. Further, the FCC is considering cutting the funding in half which would greatly endanger the progress that has been made.

As indicated earlier, the 911 system has been the backbone of the emergency response system for over 40 years. The system was designed when dial-up, wired lines were the state of the art. With the introduction and widespread use of cellular phones, the FCC has designed a new system with new regulations identified as E-911. (Federal Communications Commission) Rural areas have had a problem in not only finding the funding necessary to upgrade to the new system they have also had a problem deciding how to most efficiently do so. As cellular phone usage has increased the emergency response systems in rural areas has found itself being jammed with over use while the traditional wired trunk lines go unused. Unfortunately, balancing the cost of adding new wireless trunks line in order to meet the new demand has to be balanced against the cost of maintaining the old wired trunk lines. Due to the fact that cell phone coverage is not universally available in rural areas, traditional wired phone access is still needed so rural areas must still adequately meet the needs of both technologies, the old and the new. (Kurtis)

The new E-911 system is an enhanced version of the old 911 system. The advance of wireless technology has allowed the transmission of more information in a much more efficient manner. Under the E-911 system, the 911 operator can easily identify the telephone number of the person calling and any stored information regarding the location of the caller. The addition of this information makes the dispatch of the emergency response team much quicker and more accurate.

Enhanced 911 service is a wonderful addition to the arsenal of emergency response teams everywhere but it is particularly beneficial to the teams located in rural areas. The new system will allow for more rapid and accurate location of motor vehicle crashes in areas where locating the site was often difficult and will also provide enhanced transmission of crash information that should serve to help emergency responders predict the seriousness of injuries.

The implementation of the new E-911 system has raised significant concerns across the board, in the wake of the events of 9/11, security concerns have become of paramount concern. Maintaining domestic preparedness and the consequential process of providing emergency services has received extensive interest among the public and private sectors. This resulting interest and concern has caused additional financial pressure on rural areas. One additional wireless device, however, the increased use of GPS mapping systems has allowed rural areas to improve their services at little additional cost.

Due to improvements in technology and the wide scale availability of worldwide satellite enabled navigation GPS use has become a very inexpensive method for dispatching emergency responders. This has been a godsend to the emergency management and response industry particularly in rural areas. Unlike cell phones and the internet, GPS tracking devices are not dependent on the construction of new towers and do not need integration with a centralized system. With GPS emergency response teams can quickly find crash sites and emergency need locations in areas that often lack signs, street names and house numbers. With the properly installed software a GPS system can guide emergency vehicles to any legally defined land location in a fraction of the time under the old system of using maps and/or directional assistance from the witnesses or victims and for rural areas already strapped for funding the cost of a fully equipped GPS system is minimal.