Communications

Introduction

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:

• Prehospital provider link for early hospital notification.
• Trauma team alert and notification.
• Prehospital provider and trauma team hand-over upon reception.
• Trauma team and intrafacility communication, for example with OR/ICU/HDU.
• Interfacility communication regarding referral and transfer to a MTS.

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.

Principles

The following principles will underpin future improvements to the communication system in both the prehospital and interhospital phases.

Simplicity

Currently, a clinician managing the patient may be required to make several calls
to activate a transfer, or several sequential calls occur involving 'too many hands'.
Both result in delays. The current communication system does not encourage the referring hospital clinician to liaise directly with the receiving senior clinician or consultant. Instead, clinical information often passes through unnecessary 'hand-overs' as the patient moves to definitive care. One call is all that should be required by the hospital clinician immediately managing the patient to activate a trauma system response.

Speed

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.

Reliability

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.

Seniority

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.

Security

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.