Research already undertaken has highlighted deficiencies with the current Victorian communication process and system and has considered components of the optimal system and improvement strategies (CCRTF, 1997; NRTAC, 1993). There are five key communication time points in the management of major trauma and other time-critical patients. These are:
The purpose of improving communication at these key time points is to streamline information transfer, in turn aiding compression of time from injury to definitive care.
The Taskforce is mindful of the current saturation of available ambulance communications channels and is aware of the development of digital communication systems that will increase available channels in the near future.
Currently, a clinician managing the patient may be required to make several calls
The current communication system involves multiple links. Every sequence before, between and within hospitalsadds time to the process of care (McDermott, 1997). Prehospital notification currently proceeds sequentially through ASV dispatch to the receiving hospital. An interactive notification system that allows direct field-to-hospital communication is desirable but not technically possible at this time.
Replication of data for transfer of the patient by both hospital and prehospital providers adds to links and time in delivering the patient to a definitve care location. Standardised, comprehensive transfer documentation capturing data for prehospital and hospital providers should be developed in consultation with the Victorian Ambulance Clinical Information System project and the STC.
The communication system must be reliable and be perceived to be so. Dedicated phone lines in trauma designated emergency departments and at any other key communication points are required (CCRTF, 1997).
Ambulance personnel operate under the obligation to avoid unnecessary delays in delivering a time-critical patient to definitive care. Timely prehospital notification calls to the receiving hospital allow for valuable preparation time in the emergency department, however compliance with notification will largely depend on the technical and human reliability of the communication system.
Medical consultation in the prehospital setting is currently provided by consultant level physicians employed by ASV. Clinical consultation by ambulance personnel in the prehospital setting is infrequent. Medical advice for paramedics undertaking interhospital transfer is supplemented by the small pool of coordinators at the Office of the Coordinator, Emergency and Critical Care Services (OCECCS). In the future it may be possible for prehospital providers to seek advice from a trauma consultant at a MTS regarding clinical management and triage destination in marginal cases.
Interhospital transfer communications, especially in rural areas, may be initially managed by inexperienced and junior physicians, resulting in inappropriate and/or multiple information hand-over before reaching senior staff. This may result in inappropriate designation of transfer priority.
Medico-legal and internal auditing considerations for ASV require triage and clinical management discussions between field personnel and others to be securely recorded and retained. This should continue in any communication system improvements.