Monthly Archives: May 2011

Trading GPS Navigation for Wireless 4G Access

LightSquared, a hedge fund-backed start-up viewed as a major enabler of wireless competition in the US, was granted control over a portion of the US spectrum by the Federal Communications Commission (FCC) in order to build and wholesale 4G-LTE wireless broadband service through a nationwide network.  According to their own website, “LightSquared will unleash the boundless opportunity of wireless broadband connectivity for all.”   But unfortunately this presumed advantage comes at a serious known cost for popular navigation systems used by aviation and first responders.

During initial tests of the network conducted last month, there was significant interference with the Global Positioning System (GPS) receivers used by ambulances and state patrol.  These tests were conducted at Holloman Air Force Base in New Mexico where both sets of first responders experienced outages due to the LightSquared cell towers.  Bill Range, Director of the state E911 program, stated in a letter that the results of the April tests, “substantiate concerns that the LightSquared network will cause interference to GPS signals and jeopardize 911 and public safety nationwide.

The problem is that the LightSquared system operates using bands between 1525-1559 MHz and 1626.5-1660.5 MHz while GPS signals operate in the intervening bands of 1559-1610 MHz.  Making matters worse, the strength of the LightSquared signal is many orders of magnitude greater than the GPS signal.  As a result, the GPS receivers of Otero County ambulances could not establish any connection with the GPS satellites within 60 yards of a tower during testing.  The Federal Aviation Administration (FAA) also warned of potential GPS outages within 300 miles of the LightSquared tower in Boulder City, NV.  The US Department of Defense (DoD) and Department of Transportation (DOT) also have serious concerns about the impact that the 40,000 cell towers proposed to make up the LightSquared national network will have on GPS receivers.  These agencies complain that they “were not sufficiently included in the development of the LightSquared input” and the result is to effectively put commerce before public safety.

Consequently, LightSquared, along with the GPS industry and other federal agencies are conducting additional tests through June to determine the extent of interference between the cellular network and GPS receivers.  As your advocate, the Coalition to Save Our GPS is working to minimize the threat to applications and devices that leverage the Global Positioning System.  Their website also provides links for contacting your congressional or FCC representatives.

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Celebrate EMS Week

The dates for National EMS Week 2011 are May 15 thru May 21.  Thank a Paramedic or EMT today, but also consider going a step or two further with the following suggestions:

  • Become a “Fan” on the “National EMS Week” Facebook page at: http://www.facebook.com/National.EMS.Week.
  • “Like” our own Facebook presence for High Performance EMS where we are looking to help communicate news regularly about advanced pre-hospital care with a special focus on high economic efficiency to that community.
  • You can also follow @hp_ems on Twitter to keep up with news at no more than 140 characters at time throughout the year as well.
  • Consider adding to the conversation on this page by leaving comments to articles of interest encouraging others seeking to improve the EMS profession through EMS2.0 and NG911.

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Quick Thoughts from the Zoll Summit2011

Great talk on Risk Management by Gordon Graham to start the day yesterday at the Zoll #Summit2011: “Predictable is preventable”- always strive to do better was his primary mantra. Lots more of his advice at www.lexipol.com. Gordon also advises: “Everyday has got to be a training day” – directing participants to www.emsclosecalls.com to share experiences and learn from each other.

In another wonderful session, Jerry Overton pointed out that “EMS is the practice of medicine and needs to focus on ‘care integration’ being a part of the larger healthcare system.” As EMS, we must focus on the “Right Response, Every Time, and On Time” to become a High Performance EMS. He also pointed out that the EMS Chiefs of Canada (EMSCC) reported that the implementation of technology can improve EMS performance and efficiency reinforcing the point with several interesting examples of appropriate technology providers. “Good is the Enemy of Great”, Jerry reminds us of the book by the same title, saying that continuous improvement is critical and that “you can Expect more if you Inspect more” as a manager.

This morning started with a talk on Leadership from Erin Denholm of Centura Health at Home.  She started with some interesting facts and thoughts on healthcare reform and its affect on EMS delivery.  “Healthcare Reform is changing the financial model for ambulatory care and emergency medicine” she said.   The “old model” for EMS systems could be summarized as (volume * revenue) – cost but will need to be replaced with a newer model that is more complex being based on financial penalities for recitivism leading to new rules and partnerships.  Erin stressed that the old business model was very “militaristic” (command and control oriented) but that the future will require a more “cooperative” model (based on engagement and encouragement.)

Follow thoughts like these here in summary or by following our @hp_ems Twitter feed live.  Also check out the “High Performance EMS” community page on Facebook and hit “Like” to get any updates there as well.

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The Cost of Saving Money

There are two fundamental ways to save money: either cut your budget and make do with less resources or invest in process efficiency to cut future expenses while continuing to provide at least the same level of service.  These are important considerations as the costs of doing business clearly continue to increase, whether we consider the expenditures on goods used in providing a service or the price of fuel used to deliver that service.  At the same time, the ability to effectively raise the price of the delivered service in order to recoup those additional expenditures is not typically possible.  This paradox leaves many ambulance services in a quandry.  If your decision is to continue operating at a diminshed capacity to reduce spending, there is probably little advice I can offer.  But if cutting service is not a prudent long-term option, then we can look at how an agency looks to improve performance.

A good case study may be the Lexington County (SC) EMS, a service directed by Brian Hood responding to roughly 30,000 calls per year.  As a growing county outside one of the largest cities in South Carolina, Lexington has seen their call volume grow at an annual rate of about 7.5%.  To keep pace with this growth in demand, they would likely have needed to add one new vehicle per year at a cost exceeding $3M for an ambulance, crew, station, equipment, etc.

Additionally, one of the ongoing, and rapidly growing expenses, for any service delivery organization is the rising cost of fuel.  Controlling mileage can often be a great option for managing expenses.  Of particular interest to some services is also the incurring of fines for exceeding response times.  This is a particularly good area to control costs for affected services since this type of expenditure does not lead to any revenue nor does the payment itself provide any service.  But to achieve these goals, performance must improve.

High Performance EMS is about doing things better – specifically providing advanced pre-hospital care with a focus on higher economic efficiency.  The result of better performance is patient satisfaction with cost savings.

For Lexington County, the more efficient posting of ambulances based on predicted demand and time-based routing using MARVLIS has allowed the service to actually improve response in the face of rising demands while foregoing the acquisition of additional resources and the commitment to ongoing costs associated with them.  Over the 4 year period since implementing MARVLIS, the projected cost savings of $3M per year is compounded by the avoidance of recurring staff costs and therefore totals closer to$16M for that period.  The initial investment required to make that savings was less than $400K in hardware and software systems.  As a result, satisfaction has improved for both the patients (who experience quicker service), and also staff (who endure fewer post moves while being closer to incoming calls.)  This is not just a promise or hope of what might happen, but a real world experience of leveraging county GIS services and an experienced High Performance EMS consultant, Bradshaw Consulting Services.  Watch for a more detailed article soon from Esri Press.

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