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(Initial Work Shift Tasks)
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|
|
|
-
|
| -
NOTE: An Acknowledgment message from each recipient is required to be sent back to the sender of any message regardless of whom or what system originated the message (e.g. AACN, PSAP, dispatcher, 1st responder unit) and regardless of the type of message sent (e.g. whether the message provided alerts, notifications, situation information or updates to any information), to verify that the content of the message has been received by the recipient system.
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-
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0600
|
A paramedic and an emergency medical technician (EMT) partner report for their shift at BEMS. After being assigned to ambulance A-1 and receiving the day's situation updates from the crew going off-duty, they go to their ambulance and begin the daily unit check-out.
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Ambulance Team
|
EMS Service , Direct Supervisor
|
Shift change information - Vehicle / vehicle type, new shift / staff names, staff credentials / EMT levels.
Depends on Region – RMCC may be in place to manage regional resources
|
1a
|
|
|
EMS Service
|
County Dispatch
Local and Regional Medical Communications Center (e.g. RMCC)
|
Ambulance shit staff status/ on duty… (same info as above)
|
-
|
|
The crew performs the daily unit check-out using RFID readers that identifies that all the medical supplies needed are onboard, all medical equipment and monitors are functioning within specification, and “Vehicle Status” is operational (Every vehicle system, fluid level, and tire inflation level)
|
Ambulance Team information capture Equipment (the readers)
|
Role e.g.: Direct Supervisor. Role: e.g. RMCC also receives Vehicle Status. Technology recipients may be ambulance crews PDA and an ambulance central server – waiting for anyone to pull the information
|
Verify or request Medical supplies, medical equipment and monitors diagnostics (against spec), Vehicle operation status information
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-
|
0625
|
The A-1 crew automatically reports to the dispatcher that it is active and available for calls. The dispatcher acknowledges that A-1 is active
|
Ambulance Team EMS SErvice
|
Local dispatcher
|
Shift change information - Vehicle / vehicle type, new shift / staff names, staff credentials / EMT levels, Ambulance and crew active and available.
|
|
|
(Response to Car Crash)
|
|
|
|
-
|
0839
|
County dispatch receives a call from an Advanced Automatic Crash Notification (AACN) (e.g. GM On-star or Mercedes Benz TeleAid) call center about an airbag deployment on Rte. 1-A, 12 miles southwest of Bayport. The AACN operator is unable to establish voice contact with the occupants. The AACN data feed indicates a 50 MPH head-on collision and roll-over. The AACN indicates three occupants, with two occupants still in the vehicle and one ejection. There is a belted driver who remained in the front seat and a passenger now in the back seat. The AACN center advises that there is an “urgency” alert derived from the onboard sensors for one severely injured patient, while the other occupant is likely less injured.
(NOTE: SEE GENERAL REQUIREMENTS SECTION BELOW - “Open Issues” #1 and scope statements)
|
AACN / service provider monitoring / call center checks validity and relevance before sending
|
PSAP
|
** For initial analysis, the team will focus this use case / standard on interoperability FROM PSAP / 911 centers out to others…
NOTE 1: the future requirement is for the AACN data feed to go directly to the telematic service provider, who will screen the call and then electronically provide the information to Dispatch / 911 centers (PSAP) (today it’s a phone call). A more forward-thinking and aggressive requirement is for real-time automated receipt of vetted AACN data by PSAP’s and any others who are “registered” to receive this information per a defined protocol (e.g. an alert).
NOTE 2: Although this is clearly “Situation Reporting” data, this is a scope issue under discussion (NASEMSO, HITSP, others) to determine the appropriate process and forum to define standard message(s) from these devices
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5a
|
|
Based upon this information, Bayport police, Fire first responders and Bayport ambulance A-1 is dispatched
NOTE: Contact could be made directly from PSAP to 1st responders, or from PSAP to local dispatch to 1st responders. Paid responders normally are directly called while volunteers are contacted through a local dispatcher.
|
PSAP
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Local dispatcher
|
Message 1 = Incoming 911 call information reporting the crash (info from the AACN service provider call center - to the PSAP - which is then provided to local dispatch)
|
5b
|
|
|
Dispatcher
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EMS Service
|
Message 2 = (Same info as 5a)
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5c
|
|
|
Dispatcher
|
1st responders
|
Message 3 (or combined with message 2) = Resource Request / local responders needed at crash site. (EDXL-RM “Request Resource” message? Define info here, in order to match with RM and confirm?)
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6a
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0840
|
The 911 center also begins to receive cell phone calls reporting the car crash, but providing more information about a third victim outside the car.
(NOTE: SEE GENERAL REQUIREMENTS SECTION BELOW - “Open Issues” #1 and scope statements)
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Citizens / 911 callers
|
911 call center
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Voice call from citizen.
Similar issue to Step 2. Assume for now that information coming into the PSAP is out of scope.
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6b
|
|
|
PSAP
|
Local dispatcher
|
Message 1 = Incoming 911 call information reporting the crash (same / similar information as in step 5a, but additional situation information – the third victim outside the car.)
|
6c
|
|
|
Dispatcher
|
1st responders
|
Message 2 = Additional information about the third victim outside the car
Message 3 = Resource Request / local responders needed (additional?) at crash site. (EDXL-RM “Request Resource” message? Define info here, in order to match with RM and confirm?)
NOTE: Different information may need to go to different responder organizations (Fire, LE, EMS etc.) Where applicable, break out to define each set and then determine gap / overlap
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7a
|
0841
|
Bayport police are the first to arrive on the scene and verify a single vehicle crash involving three victims; two of which are entrapped in the vehicle and a third which has been ejected and decapitated.
|
Police on-scene
|
Dispatch / Responders
|
Message: Status update – now on scene - time of arrival etc.
Message: Confirmation / revision of situation report information
|
7b
|
|
|
On scene police
|
County Coroner
|
Message: Notification of decapitated individual
|
8a
|
|
Bayport police indicate patients meet trauma triage criteria, and request a second Bayport ambulance, A-3, as well as fire department extrication and manpower
|
Police on-scene
|
Dispatch
|
Message: Notification that trauma criteria are met…
|
8b
|
|
|
Police on-scene
|
Dispatch
|
Message: Resource Request - additional resources
(EDXL RM?)
NOTE: In an alternative scenario branch, Fire Department extrication resources may have already received AACN info and dispatched immediately
|
9a
|
|
Area Hospital status and availability information is requested
2 steps – 1 requestig status and another where hospitals provide that status.
|
dispatch
|
Area Hospitals
RMCCs
|
EDXL-HAVE (Hospital Availability Exchange) standard?
Verify whether HAVE incorporates a request; otherwise where / how a HAVE request is defined?
|
9b
|
|
Area Hospital status and availability information is provided
|
Area Hospitals
RMCCs
|
Dispatch
|
EDXL-HAVE (Hospital Availability Exchange) standard
|
10
|
|
The PSAP tone alerts Med Flight-1, which prepares for departure but awaits dispatch. It also triggers notification of the Trauma Team (Central City Hospital). This information is entered automatically into the “COMMON SYSTEM OR SHARED DATABASE” (a regional medical database)
|
PSAP
|
Central City (others too?) hospital directly?. “COMMON SYSTEM OR SHARED DATABASE” system? Other hospitals notified through “COMMON SYSTEM OR SHARED DATABASE”?
|
What’s the info? Trauma center needed / alert…? Decision that hospital air transport is needed?
NOTE: For our purpose, I would like to assume the messaging provides all notifications and information updates in order to identify all requirements; rather than rely on “COMMON SYSTEM OR SHARED DATABASE” to provide info.
|
11
|
0842
|
As the ambulance A-1 approaches traffic lights along the route, the onboard signaling system changes the lights to the ambulance's favor
|
|
|
A message or signal is sent to the light system commanding the light to turn to “green”. Likely out of scope of this standard.
|
12
|
|
Fire and Ambulance A-1 arrive directly after Bayport police.
|
EMS on-scene
|
Dispatch
|
Message: Status update – now on scene - time of arrival etc.
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13a
|
|
Based upon AACN information, EMS observation / verification and trauma protocols, County Dispatch requests Med Flight-1 be dispatched to scene.
|
EMS on scene
|
Dispatch
|
Message: Resource Request – additional resources
(EDXL RM?)
|
13b
|
|
|
Dispatch
|
Med Flight-1
|
Message: Resource Request - additional resources (same / similar message relayed)
(EDXL RM?)
|
14a
|
|
Fisherville Hospital ER is the closest to the crash site and is Bayport's local medical direction facility. EMS notifies Fisherville ER to prepare / be on alert
|
EMS on scene
|
Dispatch
|
Message: Notification of incoming patients
NOTE: This step was questioned as redundant – that the facilities were alerted by the AACN. Above does not specifically call this out, but the alternative flow for more automated regions does assume receipt of alerts by registered entities.
So, keep this step to ensure no information exchance requirements are missed.
|
14b
|
|
|
Dispatch
|
Fisherville Hospital ER & Central city Hospital
|
Message: Notification of incoming patients
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|
|
|
|
|
|
16a
|
|
Bayport police begin traffic diversion around the crash scene.
|
Police
|
Dispatch
|
Message: Notification of traffic diversion
Message: Resource Request (Sign boards…)
|
16b
|
|
|
Dispatch
|
DOT / Traffic administration / Media
|
Message: Notification of traffic diversion
Message: Resource Request (Sign boards…)
|
17a
|
|
The paramedic identifies a helicopter landing site which is a mile from the crash scene.
|
EMS on-scene
|
Dispatcher then to Med flight
|
Location of landing site
|
17b
|
|
|
Dispatcher
|
Med flight-1
|
Location of landing site
|
18.
|
|
All units provide their response status, which is automatically received by County Dispatch and by other responding units.
|
Responding units / resources
|
Dispatch
|
Many to many exchange?
What info is passed to provide “response status”?
|
-
|
|
Additional status updates from County Dispatch are automatically received by responding units
|
Dispatch
|
Responding units / resources and support orgs
|
Many to many exchange?
What info is passed to provide “response status”?
|
-
|
|
The Central City Hospital Trauma Center, the Med Flight-1 crew and the lead trauma nurse check their “COMMON SYSTEM OR SHARED DATABASE” screen on the computer/communications device that is beeping an alert tone
At the same time, the triage nurse at Fisherville Hospital checks “COMMON SYSTEM OR SHARED DATABASE” in response to an audible alarm on the desktop computer/communications device from the PSAP alert. She notes that one ambulance (A-1) arrived on scene at (time), and one ambulance is responding,10 minutes from the scene. She sees that the Trauma Center has been put on alert for this crash and that Med Flight-1 has been requested to dispatch and is currently launching to the Bayport scene
|
Potential many to many exchange (need to identify senders)
|
Potential many to many exchange (need to identify recipients)
|
NOTE: May be a bit futuristic
Message: Response / resources status update. (One ambulance on-scene (tim), one ambulance is responding with 10 minutes from the scene. Trauma Center has been put on alert for this crash.
Med Flight-1 has been requested to dispatch and is currently launching to the Bayport scene
(EDXL “Report Resource Deployment Status” message?)
|
-
|
0900
|
A-3 arrives on scene simultaneously with a paramedic and EMT
|
EMS on-scene
|
dispatch
|
Message: Status update – now on scene - time of arrival etc.
|
-
|
|
The paramedic examines the patients and verifies a single vehicle crash into a tree with roll-over. There are three victims; two of which are seriously injured, including a male (the driver) and female, both approximately 50 years old and a deceased male, approximately 20 years old. The 50 year old male victim is semi-coherently responding to voice, has no visible injuries, and is complaining of chest and shoulder pain. The paramedic determines that there is no tenderness to touch in the chest area and suspects cardiac pain. The female patient is trapped in the back seat with doors pinned by a collapsed roof, is unresponsive but breathing, and appears to have an open head injury with possible skull fracture
|
EMS on-scene
|
|
Message1: Initial assessment - Observations, diagnostics, treatments of patients / victims on scene (e.g. I have triage patients, 2 reds and a black…?)
NOTE: See “General Requirements” section
Message2: “Initial assessment” (Non-EMS responders are also on-scene making observations and assessments – define this information set also)
|
23
|
|
The paramedic designates that this (female) patient will go to the Trauma Center via the helicopter, and provides his observations, diagnostics and treatments directly to the trauma center (Central City)
|
EMS on-scene
|
To Trauma center
|
Message: Initial assessment (updated / additional information) - Observations, diagnostics, treatments of patients / victims on scene
This is updated/additional info on decisions made based on initial assessment – info on where folks are being transported.
(2 red patients (names etc.) en-route to “X” and the black (name etc.) en-route to “x”…
|
24
|
|
On-scene EMS (or EMS in transit during a later step?) confirm that hospital resources are still available
NOTE: Status could change as time passes. Must reconfirm before designating where patients go, or can happen en route.
|
|
|
EMS re-checking again to confirm hospital status and availability - HAVE?
ETA and other information also passed etc.
|
-
a
|
|
Bayport police dispatch Bayport Coroner to the crash scene to confirm death of male crash victim and removal of the body from the crash scene
Figure out steps here and add (JEFF SEXTON check this)
|
Police
|
Dispatch
|
Alert Coroner
Dispatch of coroner
Provide Info from previous exchanges / updates
|
31b
|
|
|
Dispatch
|
Coroner
|
Alert Coroner
Dispatch of coroner
Provide Info from previous
|
-
a
|
|
To assist with the identification of crash victims and expedite next-of-kin notification and family member reunification, Bayport police utilize their in-vehicle mobile data system to run a National Law Enforcement Telecommunications System (Nlets) query on the crash vehicle Registration Plate and Vehicle Identification Number (VIN#) to return vehicle owner data and associated ‘emergency contact information’.
|
Bayport Police
|
Nlets system
|
Query on the crash vehicle Registration Plate and Vehicle Identification Number (VIN#)
|
33b
|
|
|
Nlets system
|
Bayport Police
|
Vehicle owner data and associated ‘emergency contact information’.
|
-
a
|
|
For those crash victims that Bayport police has confirmed identity, a patient ID security token is sent to EMS personnel enabling EMS to query for an electronic Personal Heath Record (PHR).
|
Police
|
EMS personnel
|
Message: Patient ID security token and related information
NOTE 1:
Police need to be able to pass some ID (identity of the person) to EMT’s, so they can query a personal health record. This is a future concept providing info about past care (captured and stored somewhere) and a master ID provides access. Need to know who the person is before any of this could be done.
|
25
|
|
Coroner arrvies and determines need for scene evaluation
|
coroner
|
ECC/RMCC and State coroner
|
Confirms death and cause
|
26
|
|
Police begin to notify next of kin
|
Police
|
Next of Kin System (or organization / contact?)
|
|
-
|
|
The helicopter continues and the Trauma Team sets up the trauma bay in the OR and notifies the OR of potential need for neurosurgery in particular.
|
|
|
No exchange for this step
|
28a
|
0905
|
the paramedic’s assessment clearly indicate that the male patient has suffered a heart attack and alerts the Faith Hospital cardiologist who issues an immediate alert to the cardiac catheterization lab at Fisherville.
|
EMS on-scene
|
Dispatch
|
Message: Male patient assessment update & redirecting of patient to Fisherville
|
28b
|
|
|
Dispatch
|
Faith Hospital & Fisherville
|
|
-
|
|
To confirm the absence of any severe injuries (for the second patient – female - targeted for transport by Med Flight-1) the paramedic to performs a head to toe trauma assessment and notifies the Trauma Center of the absence of major traumatic injury.
|
|
|
|
-
|
|
Based on consultation among the paramedic, the Fisherville Hospital ED physician, the Faith Hospital cardiologist, and the Trauma Center surgeon, to bypass Fisherville Hospital, and transport the patient by ground to the Faith Hospital for cardiac catheterization
|
|
|
|
-
|
|
Med Flight-1 nearing landing zone. Landing site needs to be secured and ensure the safety of the landing site for the crew and the public
|
Dispatch
|
DOT, Police, On-scene responders
|
Med Flight-1 ETA, request / confirmation that landing zone is secured and cleared for landing
|
34b
|
|
|
EMS personnel
|
PHR system
|
Query for electronic Personal Health Record PHR)
|
34c
|
|
|
PHR system
|
EMS personnel
|
Message: Person specific HEALTH information including past care info…
|
34d
|
|
|
EMS personnel
|
PHR system
|
Provide update to the PHR system record
|
35a
|
0910
|
A fire department heavy rescue vehicle arrives. The “COMMON SYSTEM OR SHARED DATABASE” indicates that the helicopter is on the ground at the landing site. The car’s doorposts are cut and the roof is removed.
|
On-scene Fire
|
Dispatch
|
Message: Status update – now on scene - time of arrival etc.
Message: Status update – landed at designated site - time of arrival etc.
|
35b
|
|
|
Dispatch
|
All 1st responder units, hospitals, etc.
|
(same)
|
-
336
|
0920
|
A-1 heads to Faith Hospital, 40 miles away. The paramedic performs a 12 lead EKGs to monitor progression of the heart attack and treatment being administered. This on-board information is sent to the hospital (which does in fact happen today). Medications administered en route seem to have improved the patient’s condition.
|
Ambulance system
|
Faith Hospital, others?
|
Message: Patient condition and care information, medications / treatments administered
|
37
|
|
The female patient is collared, boarded and removed from the car to unit A-3. EMT-Intermediate accompanies the patient and EMT crew to the helicopter landing site. The patient receives two IVs and a breathing tube en route to the helicopter landing area.
|
|
|
Message: Patient condition and care information, medications / treatments administered
Message: Time of departure, ETA
|
38
|
|
Bayport Police dispatch towing company to the crash scene for removal of crash vehicle and restoration of crash scene
|
Bayport Police
|
Towing company
|
Request Resources (EDXL-RM?)
|
39a
|
|
The Fisherville Hospital ED physician and the Central City Hospital trauma surgeon request a verbal patient update and order additional treatments to be given en rout to the landing zone (female patient). Patient care is transferred to the flight crew for transport to the Central City Hospital Trauma Center. ETA and other updated information is provided to the ER.
|
Hospital
|
Ambulance
|
Message: Request for patient update
|
39b
|
|
|
Ambulance
|
Hospital
|
Message: Patient condition and care information, medications / treatments administered
|
39c
|
|
|
Hospital
|
Ambulance
|
Message: Order additional treatments
|
39d
|
|
|
Ambulance
|
Med-Flight-1 system
|
Message: Patient condition and care information
|
-
|
|
|
Med-Flight-1 system
|
Hospital
|
Message: Patient condition and care information
Message: Departure time and ETA
|
-
|
|
A private towing company arrives at the scene removing vehicles and debris
|
|
|
|
-
|
|
Bayport Police restore the roads to normal operation
|
|
|
|
-
|
|
|
|
|
|