Wednesday, April 1, 2009

Individual Interests Need to Support Inclusive Emergency ICT

Here is an exchange today between me and my valued colleague Sheri Ann Farinha, a leading activist for access by deaf and hard of hearing people to the emergency response system. She had circulated the announcement of the new Advanced Emergency Communications Coalition (AECC) on the ListServ “E911 for Deaf and Hard of Hearing”. I commented on why the members of her group should support the broader emergency response ICT agenda represented by AECC, COMCARE’s advocacy successor. I repeat it here because the thoughts apply far beyond the needs of this particular group. Like all email chains, it is in reverse order.

David Aylward

Farinha: Agree with you David, time to work with others and think outside the box to help us find solutions which may or may not be solutions everyone else is needing as well. Esp with the discussion abt the recent independent rate ctrs, smile. Rob said he would be sending me a revised membership form which I will be sure to share with all here once I get it. Thanks for including us with this new network!

De, por, e para, as pessoas!


Aylward: I hope all the members of this group will also join the Advanced Emergency Communications Coalition (AECC). This is the successor to COMCARE in advocating for all hazards, all emergency domains, interoperable, modern emergency information and communications systems.

COMCARE had devoted attention to both advocacy and efforts to cause specific implementation of our ideas. We have turned over the advocacy to AECC, and will be focusing on the latter: getting Next Generation architecture deployed.

Why do you care when the advocacy is for broader solutions, not just solutions for the deaf and hard of hearing? Because getting where you want to go is very expensive and very slow --the upgrades are only for you, a relatively small percentage of the population, rather than being mainstream. Similarly, the Brain Injury prevention and similar people who care about car crashes, getting that data into the emergency response system, and enriching it with expert protocols, have been frustrated for years. There just aren't enough car crashes to force 9-1-1, EMS and the rest to upgrade to take data in from the outside. Suicide prevention folks? Same thing. And the list goes on.

But if you look at the emergency response system wholistically, persons with disabilities need the same "architecture" and essentially functions as these other uses. A couple of years ago, after detailed conversations with groups such as this, COMCARE held a terrific workshop we called "Common Requirements: Common Solutions" on exactly this topic.

If we are all pulling for the same basic system, we are far more likely to get it, for a lot less. NENA has been very supportive of this approach in its Next Generation policy and technical work.

So join AECC, join with the car crash and other folks, and advocate for common solutions! Rob Martin runs the new group and is a great guy.


Farinha: Dear E9-1-1 Stakeholder Council,

Wish to make you aware of this exciting new Coalition which this Council was asked to have a representative on and attend its first meeting last Wednesday.

Unfortunately there wasn’t an interpreter available at the last minute for me to attend while I was in DC. The information below explains its mission, who, and further information. It’s membership list is being developed, and a press release will soon be going out. Will keep you all posted on new information shared with this network. Patrick Halley/NENA and David Aylward/COMCARE here (who I believe are whom asked for this Council to be

added) are also members of this new Coalition and may have more to add should anyone have questions. :)


Advanced Emergency Communications Coalition <>


To advocate for the adaption and improvement of advanced emergency communications technologies. WHO WE ARE:

We are an international advocacy organization to promote cohesive and collaborative approaches to improve “end-to-end” emergency communications services and advance public policy and awareness. We encourage the development and availability of potentially lifesaving services, procedures, training, and tools that maximize safety and value for emergency responders and healthcare providers.


Advocating for the improvement of emergency communications services is critical now and in the years ahead as multifaceted, compound issues and choices are being made regarding transitioning all emergency communications services to a new IP-based infrastructure. Global coordination efforts are developing rapidly and all stakeholders need to not only be aware of these efforts, but involved.

By combining the widely diverse membership of more than 100 organizations connected with the COMCARE Emergency Response Alliance, together with other interested stakeholders, the Advanced Emergency Communications Coalition was organized in early 2009 to carry forward COMCARE’s vision of encouraging cooperation across professional, jurisdictional and geographic lines through collaboration with government, the emergency response professions, the public, and private industry.

Coalition members have a strong interest in improving the environment of emergency response and applying modern “next generation” technologies.

Membership includes many leading non-profit organizations, corporations, agencies, and individuals in numerous interconnected industries that impact emergency communications and response. These include, but are not limited

to: telecommunications, emergency management, public safety, first responders, social services, healthcare and medicine, transportation, telematics, government, academia, as well as other groups that have a vested interest in making our communities safer and more secure through the promotion of advanced emergency communications networks and services.


Thursday, February 26, 2009

Innovation in Emergency Medical Response

Here is an interesting article about innovation in 9-1-1 response. Sue Hoyt, our former Chairman for many years and former President of the Emergency Nurses Association, brought it to my attention.

Right now, when someone calls 9-1-1 and says they need emergency medical help, we often under resource (do nothing), and more often over resource (send an ambulance), when the situation calls for something in between. The English emergency medical response system began experimenting with using their 1-1-2 (their 9-1-1) system as a gateway to a range of medical services several years ago, using nurses as triage experts. Richmond EMS, led by Jerry Overton, was the first in the US to try it. Now Louisville, Ky and COMCARE member Priority Dispatch are trying it there.

With budgets tightening, and technology making it easy to pull in expert resources, we can expect more pressure for more informed response.

February 22, 2009
Lexington Herald-Leader

Louisville looks to ease emergency room backlogs

Officials in Louisville are looking at a new screening system for 911 calls as a way to reduce overcrowding in emergency rooms and limit ambulance runs.

Metro EMS recently received a $50,000 grant to look into how best to filter out lower priority calls that don't require an ambulance.

Dr. Neal Richmond, director of Metro EMS, said hundreds of ambulances are sent out each year in Louisville to respond to ailments that might not require one. Those calls are taxing the city's emergency response system.
Many of them go to 911 operators either because the patients making the calls have limited health insurance or they have no doctor or one who is unavailable.

"If there's an alternate way to handle 911 calls and get people the care they need, we're all about that," said Debbie Fox with MetroSafe Communications. "It's very innovative."

If the system is enacted, The Courier-Journal reported that 911 calls deemed low priority would be rerouted to a registered nurse, who would determine what care is needed. That could range from recommending treatment at home or making an appointment for the patient to visit a doctor or clinic.

This month, EMS officials talked about potential new software with doctors, nurses, hospital administrators, emergency dispatchers, social service agencies and others.

Greg Scott with Priority Dispatch, the company that developed the software, said only Richmond, Va., has incorporated it fully in the United States. A few other American cities have tried it, and the system is prominent in Britain.

Implementation won't happen overnight. It will take a significant network of resources, including requirements for medical providers to keep appointments open and assistance from transportation companies in providing taxi vouchers or bus rides.

"It's a vast effort," Richmond said.

Steve Heilman, a doctor with Norton Healthcare, said he expects the program could help reduce hospital crowding but warns it will take some education for the public to catch on.

"Community perception is going to be a very difficult area to address,"
he said. "People call 911 expecting to get an ambulance."

Sunday, February 8, 2009

Next Generation Emergency Communications and Cloud Computing

[The following comment was written to a list serv of persons interested in 9-1-1 access and response for persons who are deaf or hard of hearing. I wrote it in response to a notice of an upcoming FCC summit on 9-1-1, and a request for questions for the panel.]

David Aylward, February 6, 2009

The clearly stated emergency communications concerns of the deaf and hard of hearing community (along with those of lots of other constituencies, use cases, etc) will get properly addressed, with a mainstream solution, when and if Next Generation Emergency Communications gets installed everywhere a person calls from, or needs help.

I think a critical question for the FCC to ask at these two safety summits, and all of us to ask and answer, is how system-wide solutions can be deployed rapidly and efficiently, rather than the current excruciatingly slow and expensive method of upgrading PSAP by PSAP, 6500 times over (and the same for every other emergency agency). How can we have the equivalent of a “software upgrade” downloaded to emergency agencies rather than the equivalent of driving out to each office, tearing out custom electronics and replacing them with new equipment on site, which is what we do now, even though it is the most expensive way to do it, whenever each agency can scrape together the money to make a big purchase.

Solving this is not a question of money or technology -- in the first instance (although those are very relevant secondarily). It is first a question of architecture (what is the best way to construct a modern emergency information and communications tech system to meet public needs?), and then of a political governance system (or new business model) to implement that architecture.

The Problem: It has taken 13 years from the date of the E9-1-1 requirement by the FCC to get to a point where at least one PSAP in counties including 90% of the population can accept and display the trivial amount of data required to do automatic location of wireless 91-1 callers: latitude/longitude and call back number. It has been almost 10 years since the time OnStar agreed to send crash data to PSAPs, and not one is getting it today. There are some large, sophisticated PSAPs and emergency response organizations. But the vast majority is small, underfunded organizations, with very limited IT expertise. There are very, very few purchasing aggregations (i.e. buy for a whole state or region all at once). This picture is repeated in the other emergency response agencies (PSAPs being 5-7.5% of the universe), which is a huge problem because NG9-1-1 rests on shared backbones and IT with them. How can we get them and the PSAPs together to get upgrades done?

Do it again is the Solution?? If the solution proposed is repeat the E9-1-1 experience, to upgrade PSAPs one at a time (or in groups of 3-10 at a time) with modern NG 9-1-1 capabilities (which will take care of concerns of this community, crash data and a whole lot more), don’t think you are going to see that any time soon. Right now there is no business or governmental alternative being proposed to the traditional way of doing business for end points (agencies).

There are very positive examples starting of shared networks (e.g. Indiana), although those are still limited only to 9-1-1. So while NENA recognizes the problem, and its NG Partner papers sometimes mention alternatives, NENA is stuck asking for more federal money to spread around to individual PSAPs or groups of them, and there won’t be anything like enough money.

No! Instead, Put your head in the Cloud: Similar problems are solved in the commercial world with software solutions offered from the network. Goes by various names: subscription-based, application service provider, managed services, network-centric solutions, cloud computing. Information technology experts can go on for hours on the differences between those four, but fundamentally they all mean the same thing to folks like us.

If you get them, in your PSAP you don’t have to worry about buying new equipment and new software, and then managing a complex information technology system. You do need to have modern windows computers, earphones and redundant, and secure connections to IP broadband networks (like Brian Rosen talked about here the other day) to plug into the software services – which are hosted remotely (at regional, state or national levels in highly secure, redundant data centers). The PSAP manager needs to worry about training staff and using the new information. S/he no longer worries about systems and upgrades to the software or equipment. R&D innovations are encouraged because now the market is clearly national, and innovations implemented rapidly and cheaply not every couple of years. Competition is enhanced.

The technology to do this is pretty straightforward and well established in the commercial fields and the US military. For it to work in safety, some work needs to be done in key areas (security, what we call “core services”). But the biggest problem in shifting gears to do it this way is the approach and decision making, the architecture/system design and procurement.

Focus on public’s experience, end to end: If we focus on the end points (upgrading the agencies themselves one by one), we will continue to upgrade very, very slowly, and very expensively, repeating the E9-1-1 Trail of Tears on a much larger scale. But we have a good chance of succeeding if either government or private sector leader(s) develop an architecture that treats safety as a “virtual enterprise” (i.e. looks at the overall picture, end to end, from the perspective of the best and least expensive service to the public), and then offers agencies the network-centric, shared services needed to get calls and data to the right places, and the option of subscribing to the best modern safety IT for handling the information delivered to them, managed in top of the line hosting centers.

I am not saying every agency should stop buying and managing its own information and communications technologies. New York City, Washington and LA can and will do whatever they want to do. I am saying that if this remains the sole or predominant approach for all of the tens of thousands of individual organizations in the safety world, we will fail both these agencies and the public.

Right now, I am pessimistic as there is no entity in government taking this broader view, much less working on such an architecture. No agency has been put in charge of the overall emergency information and communications technology issue, the “virtual safety enterprise”. Perhaps more importantly, the companies that serve these markets today are stuck in the traditional sales models, while the companies which can deliver efficient managed services/cloud computing haven’t stumbled on this market yet, probably because it is so fragmented.

But we have new FCC leadership. We have a new Administration, and the recession may push forward thinking IT companies (inside and outside the safety industries) to look for new markets. So hope springs eternal!

I will award a special 9-1-1 coffee mug to the person who does the best job at boiling this down into one or two questions for the summit!

Monday, January 26, 2009

Some Myths and Misunderstandings about Wireless Safety Broadband

January 25, 2009

Myths and misunderstandings surround the discussion of the “D Block”, the proposed creation of a national wireless broadband network for safety agencies and users. Three in particular appear in almost every story or speech on this topic. These misunderstandings are also present in one way or another in most debates over the broader topic of emergency information and communications technology, of which the D Block is only one limited part.

1. Broadband and Internet Protocol will solve the problem”. “Pipes” alone will not solve the emergency response information and communications technology problems. Translating every communication into Internet Protocol won’t cut it. To hear some proponents of broadband, by itself it will reduce medical costs and make us all safer. The national 9-1-1 association, NENA, has the right perspective. It clearly stated in its January 22 letter to Congress that the new broadband stimulus package should not just be transport, but instead ensure that:

“all 9-1-1 centers and emergency response entities have access to broadband networks and the services and applications enabled by such networks. Deploying broadband networks, establishing emergency service inter-networks that utilize such capacity and developing the software applications, information services, and system interfaces required to take advantage of such infrastructure will truly bring emergency communications into the 21st century.” [Emphasis added]

To be sure, the integrated, interoperable emergency communications system needed for our times requires broadband connectivity for the more than 100,000 independent organizations in the US that respond to emergencies (9-1-1 centers, fire services, law enforcement, emergency medical services, transportation departments, public health offices and numerous other support agencies, plus “N-1-1” groups, NGOs like the Red Cross, and a variety of private organizations). We cannot seriously talk about a modern emergency response system unless all these entities are connected to secure IP backbone broadband networks, and ideally have wireless broadband access to extend those capabilities into the field. The traditional focus of first responder communications leaders on voice grade connections will not suffice.

Unfortunately, in the emergency space there has tended to be almost a total focus on transport, generally ignoring the application layer. But merely getting a “fat pipe”, merely getting access to Google and CNN, will not solve the problems of emergency response. Merely connecting all our doctors and emergency organizations to broadband won’t get us interoperable sharing of emergency medical information, including needed parts of electronic personal health records. It won’t get public warnings distributed, or OnStar data delivered usably to the correct 9-1-1 and trauma centers. That doesn't mean transport -- pipes -- is unimportant, but we already have lots of it, in lots of different flavors. Pipes alone can’t move information properly, interoperably in the emergency eco-system. Try playing on the Internet without a browser or domain name server.

As another example, the P25 first responder radio networks being deployed today incorporate broadband IP-based backbone infrastructures and VoIP technology, yet are not commonly capable of interfacing with the Internet or even other P25 networks because they lack the software applications that would support such interoperability.

This imbalance is a very, very big deal because the only way to make rapid progress on inter-domain, inter-jurisdictional, and inter-everything else safety information sharing is to convert every communication into Internet Protocol and then focus on the application layer; focus on what network-centric software things need to happen "in the middle" and with "interfaces from end points to the middle", shifting from focus on the end points (what happens in and at different agencies, or with the devices being carried by their staff). The “transport” focus has meant little to no federal or state government attention and funding of network-centric, application layer solutions and policies – and thus very little progress on overall emergency data interoperability.

2. "A new safety wireless broadband network will solve the interoperability problem." Lack of voice and data interoperability is a huge problem in emergency response. A prominent myth is that the primary reason for creating a wireless broadband access network (or any transport network) is achieving interoperability with other agencies. It doesn't, anymore than building any new network is about interoperability -- unless everyone will be on that network -- which is never going to happen. Right now billions of Federal and State homeland security dollars are being spent to build statewide P-25 radio networks for police and fire (with a national projected cost of over $50 billion to equip just all first responders). However, P-25 is an entirely different air interface than the LTE or WiMax technology likely to be used for a D Block broadband network (for which an additional $15-30 billion is sought). The key to interoperability is getting new and legacy systems (including but not limited to first responder radios) to communicate with each other, not putting everyone on the same network and buying everyone the same radio.

Interoperability is not going to get solved at the transport layer, other than the conversion of communications into IP at gateways. It will be solved first and foremost at the application layer, which IP makes much easier to do. Use whatever radio access works best for you and your agency, but convert the communications to IP with an inexpensive ($1500-$3000) gateway interfacing to a broadband IP safety infrastructure (which could be a combination of dedicated and commercial facilities). Then use the new sophisticated Radio over IP software packages like Cisco’s IPICS and Twisted Pair Solutions’ WAVE to tie it together with my cell phone, and your office wired phone or laptop, Charlie's old VHF police radio with IP, and Susie’s powerful new radio on the statewide P-25 network. And if the device manufacturers (e.g. Nortel, Motorola) will open their APIs, we can make signaling (device control features) interoperable, not just the communications content. The increasing linkage of varied safety agencies: first responders, 9-1-1, local, state and federal agencies to a common broadband infrastructure will provide a foundation for the growth of critical applications and services that will support interoperability.

There are lots of good operability reasons for having safety broadband networks (and P-25 networks); interoperability is not the driver.

3. "A wireless broadband network for responders is critical". Emergency response organizations don't just need a wireless broadband network. They need to be connected to all the broadband networks that are already there: terrestrial fixed (fiber, microwave), wireless and satellite for backup. Why are we only talking about mobile wireless, and focusing only on some of the incident needs of some responders? The primary reason is the balkanization of our decision making in emergency ICT which I have written about at length elsewhere. But even so, this narrow focus is mistaken. The information to be shared over wireless mobile broadband needs to come from and go to lots of places, not just be shared on the wireless link between a dispatch headquarters and its staff in the field. And fixed broadband networks that reach to those other information locations and agencies are already ubiquitous and cheap. Except in a few cases, we don’t have to build new ones; we just need to connect all emergency agencies to the private and public IP networks that exist and provide the network-centric applications that will allow the sharing of information over them (what we call shared and core services). Why are we reversing the model that is so wildly successful in the commercial and consumer spheres (explosive wired internet demand over time created a rapidly growing market for wireless broadband)? Getting organization to organization interexchange of information going over broadband will help create the demand for wireless broadband services for emergency purposes that is so small today.

Moreover, you can't have a regional or national wireless network without a huge wired network underlying it for backhaul and control purposes. Why aren’t the FCC, DHS, and everyone else looking at the synergies from combining these two closely connected, mutually supportive needs? Why is the emphasis only on the access needs of first responders on the scene, and not the need to get information (e.g. building plans) from third party sources to the headquarters so it can be sent out to the field? And what about the information needs (and inputs) of the myriad other organizations (9-1-1, transportation, hospitals, public health, etc.) that are critical in dealing with emergencies, but the primary communications of which are not wireless?


We are trying to foster the evolution of modern safety information and communications technology -- from tens of thousands of local, regional, state and federal silos that exist today towards a “virtual safety commons” supporting the exchange of critical information between these parties. We need to learn from the wildly success models of the commercial growth of the internet and wireless.

Start with a lean wired and wireless broadband infrastructure and the first generations of the key network-centric applications with limited capabilities. We should adapt as much of existing commercial transport and software solutions as possible to both speed the process and keep the costs down. For the transport layer, we should incorporate quickly what works from broadband wireless commercial service providers, wired broadband commercial service networks, and existing dedicated state and metropolitan broadband safety, transportation and other networks. At the application layer we should focus on developing and deploying the necessary shared and core services applications – in the middle -- supporting the messaging and data standards we already have.

Once emergency response folks see the benefits of such open architecture, and their masters see the cost benefits, I believe there will be an increasingly rapid development and deployment spiral. It won’t be a perfect network to start, but we don’t know now what the “perfect network" will be. Even if we did, we don’t have the current demand to support it financially, as the FCC and PSST leaders discovered last year when the D Block auction failed. Let’s avoid the tendency to declare we will build the perfect solution and bring in the consultants to spec the system. Doing that will produce a unique, overpriced and out of date solution, as we learned from the DOJ IWN (national network for federal first responders) project disaster. To reach a vision, we need a series of well founded steps with a regular re-charting of the progress to the vision, and sometimes of the vision itself.

Responses, critiques and suggestions are welcomed.

David Aylward


COMCARE Emergency Response Alliance