Inside Tennessee's Regional Coordination Centers

Check out our photo gallery of Tennessee's Regional Coordination Centers here. 

A typical day at Tennessee’s Johnson City MedCom could have flight operators sending aircraft to motor vehicle accidents or hospital helipads at outlying hospitals to fly patients back to the trauma center in Johnson City. A few feet away additional operators answer radio calls to local hospitals from ambulances transporting patients to the 21 hospitals in the regional Ballad Health System. Call center personnel answer some hospital radios via remote, taking the information down and assigning beds to ambulance patients using the health system’s Epic software before calling the facility to advise them of the incoming patient. When online medical control is required, operators contact the appropriate physician and connect them via radio.

At other times MedCom personnel are receiving 12-lead EKGs and routing them to receiving hospitals ahead of ambulances. Cardiologists and ED physicians interpret the EKGs and determine if their patients will bypass EDs and go straight to cardiac cath labs.

One thing that makes Johnson City MedCom—the emergency coordination center serving the area around Johnson City, Tennessee—unique is that every hospital in the region but one, a VA hospital in Mountain Home, is operated by the same health system. This has its advantages. Information sharing between hospitals becomes easier. Being on the statewide radio systems allows them to coordinate more easily with other flight operations centers when aircraft come and go between regions.     

Johnson City not only tracks flights for its contracted aeromedical service, Highlands Emergency Air Rescue & Transport (HEART), it also provides the same service for the Virginia State Police’s Med-Flight II program out of Abingdon, Virginia.

History

In the 1970s many states were beginning to make headway with the development of emergency medical service systems and lay the foundation for future advances in EMS education and operations. The Tennessee legislature passed Public Act Chapter 21 in 1977, establishing telecommunications resource coordination centers (RCCs). RCCs would be designated in each of the urban areas within state. 

The intent was to establish a statewide system of EMS phone and radio communications to help provide rapid EMS to the population. The RCCs would be the coordinating body of information in their region. 

Initially, the RCCs would serve as gatekeepers on the airwaves as ambulances competed for airtime on the hospital emergency administrative radio frequency. As systems advanced they assigned channels for ambulances calling into facilities.

In addition to these day-to-day activities, the RCCs would maintain disaster protocols and conduct routine radio checks with all EMS providers and hospitals on the state-designated radio frequencies. During disaster exercises they would ascertain bed availability by type in each hospital and the amount of each type of blood available. Ambulance services would also be polled for available ambulances.

State and local EMS officials could contact their local RCC when overwhelmed with a local MCI and seek more ambulances without tying up their own dispatch centers. The triage and transport officers similarly had a reliable way to allocate patients during an exercise or an actual event. It wasn’t perfect, but it worked.

Terrorism and the Post-9/11 Response

In the years after the 2001 attacks on the Pentagon and World Trade Center, the Department of Health’s new Emergency Preparedness division began partnering with the Office of EMS to expand the capabilities of RCCs. As health departments across the country began to receive major influxes of grant funds, Tennessee opted to reinvest in the communications infrastructure for hospitals and the RCCs. With a renewed emphasis on communications, the RCCs became referred to as RMCCs, or regional medical communications centers. 

Many of the initial RCCs designated were 9-1-1 dispatch centers. State leaders quickly learned the additional duties being asked of the centers would overwhelm a 9-1-1 center if an event took place. They began to rethink the designations, and all but a few were moved into aeromedical dispatch centers within the state (keeping the designated facility within the same urban area). Things worked better with health care-centered personnel helping meet the additional needs.

Tennessee has divided the state into 8 health care regions. Some regions segregate metropolitan health departments, as those are operated locally and not directly through the Tennessee Department of Health. The designated RMCCs in Tennessee are in Chattanooga, Columbia, Cookeville, Jackson, Johnson City, Knoxville, Memphis, and Nashville. 

Advanced Technology

Local agencies and counties in Southeast Tennessee and Northwest Georgia received a federal Public Safety Interoperable Communications (PSIC) grant to expand a local 800 MHz trunked system, then covering multiple states around the Chattanooga area. The system worked well, with stakeholders moving onto the platform from fire, police, hospitals, EMA, the Tennessee Emergency Management Agency (TEMA), and the Tennessee Valley Authority. Using the success of the TVRCS (Tennessee Valley Regional Communications System) network, the state began building out a statewide network using a VHF/700/800 MHz trunked radio system, with TVRCS being the original core of the system. The Tennessee Department of Corrections, Tennessee Department of Safety, and TEMA were the first agencies to begin using it. After ironing out a few remaining problems, other state agencies were added to the newly designated Tennessee Advanced Communications Network (TACN).

TACN is now used by the RMCCs to network with state partners to coordinate hospital and EMS assets in conjunction with public health. TACN buildouts have allowed county and municipal stakeholders to piggyback on the system at less cost than installing their own system.

The state’s Healthcare Resource Tracking System (HRTS) has been continuously updated since its implementation and is being rolled out as a smartphone app soon. Currently EMS providers are using dashboards built into the system to read service advisories and diversion statuses from HRTS on their smartphones.

Mass-Casualty Incidents

Using the tools at hand today, RMCCs across the state work with facilities to keep their HRTS status updated and report facility issues to the EMS providers across each region. Field personnel can look at regional dashboards to see if a facility’s emergency department is swamped and let patients know ahead of time if their preferred hospital may keep them waiting before they can be seen, giving them the opportunity to consider other options.

Supervisors and field personnel arriving at an MCI alert their RMCC when they realize a mutual aid response will be needed. The RMCC can activate the event notification in HRTS to simultaneously alert hospitals within a county, region, or statewide, along with state EMS and public health partners. The RMCC will then contact individual ambulance services via radio or telephone to obtain the requested number of ambulances and provide the location and contact information to check in.

Triage and transport officers have direct access to the RMCC to obtain the number of beds and services available and request aeromedical responses. Transport officers work closely with the RMCC to triage patients to appropriate facilities without overloading any single hospital and will use aeromedical services to transport some patients to trauma or burn centers farther away when the situation warrants.

Many RMCCs in the state have been tested in recent years due to widespread flooding and long-track tornadoes. They’ve all been up to the task, even though we continue to learn from each event and strive to make things better. We continue to evaluate and embrace new technologies, such as TACN and FirstNet. At one point we were tying the centers together with VoIP connections, but the technology was changing faster than the vendor could install the hardware. We’ve learned to be flexible and adapt.

Communications

Though communications across the state are not always consistent, Tennessee does require 3 specific VHF frequencies to be in each ambulance in the state for EMS mutual aid, hospital-patient medical communications, and on-scene tactical/or staging use. This minimum set of channels allows high-end systems using TACN or other 700/800 MHz systems to coordinate and communicate with other ambulances operating on med channels and/or VHF systems. Moving forward Tennessee hopes to move all EMS agencies onto the trunked multiband TACN system for better interoperability.  

John M. Dabbs is a consultant and investigator for the Northeast Tennessee Regional Health Office.