Communications Down Under; Photo: iStock.com/Photo Queensland Ambulance Service

By Michael “Mick” Lazell &
Colin “Col” Allen 

To provide the reader with some history as to how the Queensland Ambulance Service (QAS) arrived at where it is today, we have to take you on a journey back in time. In Queensland, ambulance services began Sept. 12, 1892, when the first meeting of the City Ambulance Transport Brigade was held. 

Military medic Seymour Warrian formed the brigade following an event he witnessed at the Brisbane (the state capital) exhibition grounds during Show Week in 1892. A horse rider fell and broke his leg, and bystanders walked the rider from the field, exacerbating his injury. The first ambulance station in Queensland operated out of the Brisbane Newspaper Company, and officers on night duty slept on rolls of newspaper on the floor. They had a stretcher, but no vehicle and transported patients on foot. 

For many years following, ambulance services expanded as need was identified by a community. Over time, this approach led to the establishment of 96 ambulance services in the state, each with varying levels of funding depending on what was raised from the local community. Associated with this funding base were varying levels of available equipment and training throughout the state, as well as differing levels of communications infrastructure. These circumstances probably led to inequities in patient care as one service that was well funded was able to provide better trained and equipped officers than those that weren’t. 

Communications center in Cairns

However, the people of Queensland expected to receive the same level of ambulance care no matter where in the state they lived. So in 1991, legislation was introduced in the state parliament to dissolve the 96 different employers and create the Queensland Ambulance Service (QAS). This meant that for the first time funds went to those areas that had the most need and equipment and training was standardized across the state. This also meant that instead of having 96 different communications bases, that number was reduced to 10 within seven regions. This rationalization reduced response times and increased responsiveness to community demands for service. The result was an ambulance service that is now the fourth largest in the world, with a communications infrastructure that covers almost the entire state of Queensland. 

In 2002, the Emergency Services Legislation Act brought together under one umbrella of the Emergency Services Department, the Queensland Fire and Rescue Service (QFRS), QAS and the State Emergency Service (now Emergency Management Queensland [EMQ]). Queensland’s Department of Emergency Services is unique in Australia. The agency provides services covering all phases of emergency and disaster management—prevention, preparedness, response and recovery—delivered by QFRS, QAS and EMQ across a single portfolio. The singleagency structure provides significant advantages and benefits to the community at many levels: from having single-point ministerial accountability for emergency services to the invaluable cooperation and coordination of operational staff in communities during emergencies and disasters. The emergency services portfolio employs more than 7,700 full- and part-time employees and is supported by more than 85,000 volunteers across Queensland. 

Secom

Centralized Communications
Ten communications centers were located within the state and all except for three were stand-alone facilities (the remaining three were co-located with QFRS). Between 1991 and 2007, the number of communications centers in Queensland has been rationalized, and now there is one in each region, for a total of seven. This process is set to continue as technology allows for the safe centralization of more services. Over the next three years, the QAS will combine all Departments of Emergency Services in the Southeast of the state into a state-of-the-art communication center located in Brisbane. This center is expected to cost over $70M (Australian) to build and will house medical and aeromedical coordination, as well as ground dispatch. Fire communications as well as EMQ will also be housed in this one-stop shop and provide for a level of interoperability between the emergency services and health services not previously seen in Queensland. 

9-1-1 Equivalent Service
The communications centers in each region receive emergency 000 calls (similar to 9-1-1 in the U.S.) from across the state. The provision of the 000 network is the responsibility of the national telephone provider (Telstra), which until recently was wholly owned by the commonwealth government of Australia. Information obtained from a 000 caller by the Telstra operator determines which service is required and the location of the caller. The call is then routed through the Telstra network to the relevant emergency communications center within the state, after matching data held in Telstra’s emergency information database. 

This is a national service for the whole of Australia, operating countrywide; it is accessed by anyone who is reporting an emergency to police, fire or ambulance. Each communications center is a complete facility that operates 24 hours a day. In the event that the demand for service in one communications center is exceeded and the staff on duty is unable to answer the number of 000 calls being routed to it, predetermined overflows are in place for the 000 calls to flow to another communications center. The designated overflow center will then take the call and input the case into the CAD system for geo-coding to the correct communications center to enable dispatch of resources to the incident. Each communications center in the state has a designated overflow backup for 000 calls. (Note: During 2005/2006, QAS employed approximately 2,780 paramedics who responded to 746,275 demands for service, including 536,227 emergency cases and 210,048 nonemergency cases.) 

Townsville Communications Centre

Once the case is received by the communications center, it is entered into the CAD (utilizing Pro-QA). At present, the state uses two CAD systems, the southeast corner of Queensland uses Premier CAD, while the rest of the state uses Right CAD. 

Across the state of Queensland, calls are dispatched using pagers as well as, in some areas, radio Selcall. All communications centers use Pro-QA to provide a consistent approach to the coding of calls across the state. This provides a standard of dispatch across the state that enhances the QAS response to emergency responses and provides the community with the same response whether in the south of the state or in the far north of Queensland. 

Presently the Department of Emergency Services is working toward having one CAD system for the entire state that can be used for both ambulance and fire activities; this is expected to be fully implemented by early 2008. Once the single CAD system is functional across the state, the plan is to use a telephone routing system to send emergency 000 calls to any available calltaker, no matter what their location in the state is. This will allow for increased efficiency and responsiveness to emergency demands for service by creating a statewide virtual call center, with calls received anywhere in the state and then geo-coded to the local area for dispatch. 

In the southeast of the state, ambulances are equipped with mobile data terminals (MDTs) that display case details and allow officers to update their status from the vehicle independent of the communications center. The units in the southeast are also tracked via satellite using automatic vehicle location (AVL) to assist with coordination and dispatching of the closest unit to an incident. Ongoing projects look to integrate the electronic ambulance report forms (e-ARF, which is facilitated by Toughbooks, notebook laptops) with the CAD system to allow case details to be downloaded directly to the Toughbook, as well as linking the CAD system with the payroll system. These initiatives aim to improve clinical case record efficiency, as well as provide transaction-point verification of staff entitlements. 

Rockhampton Communications Centre

The southeastern region includes several local government authorities as well as parts of Brisbane City and Redland Shire Councils, with an overall area of coverage extending 12,370 square km and a population of over 970,000. It includes a rapidly growing population with a number of new urban developments placing significant challenges on services. The southeastern region is home to a vibrant tourist industry and a number of major events. The major industry is tourism; however, there is a diversified mix of heavy and light industry, farming, mining, grazing and commercial endeavors. The area also hosts a growing international film industry located on the Gold Coast. The community in the southeastern region is served by 24 permanent and two honorary stations. Paramedics and a doctor are also located with the Careflight helicopter response located at the Gold Coast Airport. The region operates an integrated service with Water Police, Volunteer Marine Rescue and the Coast Guard. 

The region is home to the Lexmark Gold Coast Indy 300 and the Schoolies event (end-of-school-life celebrations for about 50,000 graduates); both of these major events are coordinated by a remote communications center setup in the major incident room of the Surfers Paradise Police solely to deal with these events. The remote communications facility coordinates all ambulance responses within designated precinct areas using a remote CAD setup. This arrangement not only responds to people directly involved in the event but assists the regional communications center in providing emergency responses to the surrounding areas. Increasingly, communications is becoming closer to operations in the field with evolving technology allowing for greater mobility and responsiveness. Each presents its own challenges for the staff in the communications center as it strives to provide a high-quality service not only to the community but to the officers on the road as well. 

Communications center in Cairns

In regions outside of the southeast corner of the state, vast distances mean that travel times are immense and that radio communications are challenging. These distances also mean that response times for medical care to arrive on scene may be extended and that pre-arrival and postdispatch instruction to bystanders and first responders really do provide the first line of treatment for many patients. 

Statewide aeromedical (both fixed and rotary wing) responses are coordinated from the Queensland Coordination Centre (QCC), which is located in Brisbane; this includes the ability to consult with a doctor 24 hours a day. The aeromedical wing responds to emergencies and performs patient retrievals from smaller rural hospitals to large specialty hospitals in metropolitan areas. 

Communications across the QAS radio network is conducted via UHF in metropolitan areas and VHF in rural areas. Combined with VoIP, this allows for most areas to be in radio contact with a communications center. All remote area units are equipped with satellite phones as a backup to their QAS radio communications. Satellite phones also link each of the communications centers in the event of a disruption of normal lines of communications. The statewide radio network is interlinked with various radio repeaters that allow for redundancy in the event of a facility failure. This business continuity planning is part of plans that provide for continuation of EMS service to the community throughout the state of Queensland. 

Sidebar: Fast Facts about Queensland
Queensland is Australia’s second largest state, measuring more than 1.72 million square kilometers or 25% of Australia’s land mass, which is four times the size of Japan, nearly six times the size of the UK and more than twice the size of Texas in the U.S. The total coastline is 7,400 kilometers with the corals of the Great Barrier Reef fringing the eastern coastline for more than 2,000 km. Brisbane, the capital, is located in the southeastern corner of the state. 

About the Authors
Michael “Mick” Lazell has more than 27 years of experience in EMS. He has been an on-road paramedic and worked in four of the communication centers in the state of Queensland, receiving the Commissioners Star Care Award for Communications in the State of Queensland in 2005 as well as various other Assistant Commissioners Awards for Performance over his years in the communications environment. 

Colin “Col” Allen has been with EMS for more than 22 years in the Southeast region. He is an advanced care paramedic and the convener/manager for the simulation challenge that was held during the Asia Pacific International conference in September 2007 on the Gold Coast. 

Mick and Col are presently Communications Centre supervisors in the Q6 region in Southeastern Queensland. Contact Mick via e-mail at [email protected] or Col at [email protected]. 

Originally published in Public Safety Communications magazine, Vol. 74(08):60-68, August 2008.