TETRA: Saving time and lives in Finland

Finnish hospitals have embraced TETRA's capabilities. Laurence Doe explores the changes in working practices that the technology has enabled and their benefits

Hospital_TH1n_20120413_5000.jpgFinnish hospitals have embraced TETRA’s capabilities. Laurence Doe explores the changes in working practices that the technology has enabled and their benefits

During medical emergencies, every second counts, especially when transporting trauma patients to the right emergency care professional. This need for speed and efficiency is the key reason TETRA is used in hospitals. The rapid call set-up time it provides and use of talk groups to allow users to communicate with many people at once gives it many advantages over traditional cellular phones.

“Ambulance crews on the road have been using TETRA for many years, and the technology has undoubtedly helped to save lives,” says Phil Kidner, CEO of the TCCA. “Now, in hospitals, TETRA is being used to enable staff to work more effectively – for example, to create specific talk groups, so a complete support team can be alerted to emergency admissions in an instant. TETRA has a solid future in developing and supporting best practice in hospitals.”

Past records
At this year’s Critical Communications World in Amsterdam, Kenneth Nilsson from Vaasa Central Hospital in Finland explained that it took several years before the full benefits of the hospital’s TETRA system were realised.

Doctors and hospital management were the main users of the system but thought the devices “felt strange and the acceptance rate remained low”, says Nilsson.

This resulted in the devices staying in drawers, turned off, and only utilised during major incidents. This led to those who were supposed to know how to use the radios not being able to operate the technology due to lack of use.

However, this changed in 2010 following structural alterations to the hospital’s emergency room, which made the area larger and communications more challenging, increasing the need for TETRA. More terminals were distributed and greater responsibility fell upon their users to use them in the correct manner. Management introduced handset training and nurses started to use the devices, initially purchased for use by doctors. Triage nurses (involved in the treatment of a large number of patients or casualties), internal disease staff and surgery departments were also given one terminal each.

The benefits “quickly became evident”, says Nilsson, adding that receiving patients took less time – as it became easier to ensure that the right specialists were present to deal with each patient’s requirements, and nurses’ work required fewer steps.

Before TETRA, the hospital’s laboratory received 200 phone calls a day, but this has since decreased and the phone lines are now “never occupied”, according to Nilsson. He adds that the demand for devices increased as TETRA became more “familiar”, leading to ambulances giving advanced alerts and the old phone system becoming increasingly redundant.

Another Finnish hospital that has benefited from using TETRA is Northern Karelia Central Hospital in Joensuu, Finland. It is the largest hospital in the area, serving a local population of 176,000. In 2008, the hospital had 30 radios but kept only one in constant use for day-to-day communications.

Hospital response times sped up after the use of TETRA was fully implemented due to the processes becoming “more fluent”, says Susanna Wilen, the hospital’s chief emergency medical doctor. Airbus Defence and Space compared the use of the TETRA system against that of the old GSM and phone-only system and found that roughly 913 man-hours were saved over one year when ordering laboratory tests. This was due to TETRA’s rapid call set-up time compared with that seen with mobile phones. Wilen says that not being able to speak to many people at the same time was also an issue, which the radios solved.

Caption._Nurse_Jari_Hirvonen_says_that_staff_satisfaction_has_improved_and_internal_communication_as_a_result_of_TETRA_devices_2.jpgThe hospital is currently using TH1n and THR880i TETRA portables from Airbus Defence and Space over the national VIRVE network operated by the State Security Networks Group (Suomen Erillisverkot). “Here at the emergency care unit, everyone uses TETRA radio – including doctors,” says Jari Hirvonen (pictured), an emergency care unit nurse. “Substantial benefits have been achieved, such as with trauma alarms. Before, it took 16 to 19 calls to make one, while with TETRA everyone can be reached in one minute.”

However, moving over to the new radios “wasn’t easy”, says Wilen; staff had found them cumbersome until the recent update. “They were big… more designed for use outdoors by fire departments, police, border guards and military,” explains Wilen. They were “not nice to have in your pocket” for staff used to slimline smartphones.

Technological improvements
“Reliability and security of communications are essential for hospitals, and TETRA delivers both to a standard that cannot be achieved by commercial networks,” says Kidner. “In Norway, for instance, the TETRA Nødnett network is used by both core and wider medical teams, in a Trondheim hospital, those within the hospital as well as the air ambulance and Red Cross. This seamless communications approach can help to ensure the highest standards of healthcare service.”

Kidner refers to the use of Norway’s nationwide public safety TETRA network, Nødnett by St. Olav’s Hospital in Trondheim. St. Olav’s Hospital was the national pilot for testing the system inside Norwegian hospitals. Other selected trial groups included trauma teams and medical centres. After this, the deployment of Nødnett-compatible TH1n radios from Airbus Defence and Space were delivered as part of a contract with radio equipment supplier TC Connect.

Finland trialing LTE with TETRA
In Finland, the State Security Networks Group, the public safety operator of the VIRVE network, will perform a technical and operational pilot trial to assess the use of Airbus Defence and Space’s Tactilon Agnet application. It allows smartphone users to make instant group calls through a PTT feature and provides seamless and secure integration of nationwide public safety TETRA radio users with those using Tactilon Agnet on their smartphones. The trial will run under the network’s standard operating conditions and will make simultaneous use of the public broadband networks and the VIRVE TETRA services to collect information on how the application’s features can be used in an LTE environment. It will take place until the end of the year.

“Doctors might not be permanently involved in TETRA talk groups, but it is essential that they are sometimes in these groups,” says Kai Schlichtermann, external communications manager at Airbus. “Therefore it doesn’t make sense for them to carry a TETRA device 24/7. They only need a smartphone with the Tactilon Agnet app, and this allows them to easily and immediately participate in hospital talk groups.”

 Schlichtermann adds that if a doctor is off-duty and his expertise is needed in the hospital, the app can allow them to give instructions from home to the hospital staff. This ability can also be extended to volunteers. “For example, medical and healthcare professionals could manage the Tactilon Agnet communication with volunteers looking after elderly people in nursing homes.” He adds that technicians in hospitals dealing with water supply, electricity, heat and ventilation can communicate within their team using Tactilon Agnet in case of a technical fault impacting medical procedures.


Enhancing practices
Guards now use TETRA technology at Vaasa Central Hospital to monitor situations in the accident and emergency room and be better prepared to deal with any incidents. The rescue department has also been given its own call group and the X-ray department is also now more aware of patients being admitted.

“Ambulances can notify us by PTT and they give us critical information about the patient. We then prepare for the trauma inside the hospital with the surgery [department] through medical information provided, X-ray, every department at the same time,” says Nilsson.

He says that this information is relayed anywhere between five minutes to an hour before arrival depending on the emergency. He gives an example of how the technology helped when a patient fell from 50 metres. The only data that came through was how the injuries occurred. This was relayed to the hospital a couple of minutes before the patient was admitted. As a result, there was enough time to prepare and get the situation under control by the surgeon, a doctor and the X-ray department once the patient arrived on-site.

The hospital also increased the use of TETRA in 2013 to allow those performing heart surgery to direct a patient with an acute coronary syndrome, such as a heart attack, from outside the hospital to Vaasa’s angio surgery table – used in delicate operations. The psychiatric unit and five acute departments have also received terminals, with an additional two supplied to patient transporters and four to the control centre. All of this has led to 100 terminals being in active use.

The importance of TETRA was made very clear in August 2012 when a distribution failure at the national electricity grid caused the hospital’s phones to stop working. To solve this problem and maintain cohesion, TETRA terminals were distributed to all the critical units of intensive care, the operating room, recovery ward and child delivery room, along with the hospital’s technical unit.

A new chapter
Of Northern Karelia Central Hospital’s 1,500 staff, there are now 1,200 TETRA users using 110 radios. Across the region, this rises to 2,500 healthcare TETRA users and 220 radios, and the use of TETRA saves more than 600 working hours each year.

“When we save time, we save money, and that means better and faster care for patients,” says Hirvonen. “When calling a laboratory nurse to take blood samples, one cellular call is about one minute, totaling 180 minutes each day. The TETRA group talk saves around two hours every day and 730 hours each year. Using talk groups such as the X-ray unit and operating theatre has meant faster medical examinations. The talk group in X-ray saves about 200 minutes every day.”

Northern Karelia was a 2015 International TETRA Awards (now the International Critical Communications Awards – ICCAs) finalist. It was recognised for its use of TETRA to alert users and call medical staff to situations where immediate patient attention was required.

In its maternity unit the midwife can send an alert to a section group of 10 people. This allows for a gynaecologist to give the order for a caesarean section based on the baby’s heart rate. It is also used if the midwife needs assistance when a newborn requires resuscitation, as an alert is sent to a ‘Baby Revive’ alert group.

In the triage-nurse operations, the alert goes to a trauma team, staffed by 20 or more with up to 40 people being
able to respond to it. This is used for cases such as high -energy incidents where cars have crashed at speeds of more than 80 kmh.

“When this happened, or when we rehearsed it, we weren’t able to communicate… that has changed a lot and now we can use it,” explains Wilen.

“The new radios [TH1n] are better, but we really needed to order people to use them. The head of the hospital ordered ‘on-call’ doctors in the hospital for the emergency department to use the radio.

“I have a good overview of the situation when I have my radio on my desk all the time,” she adds. “It scans all the traffic in emergency and out-patient emergency and allows paramedics to talk to each other and also my staff in the emergency department. It allows me to hear when difficult patients are coming to the hospital.”

The hospital has a trauma process in which all the departments and major wards use TETRA radios to prepare for a patient’s arrival and to receive information on their status. Nurses also use the radios’ push-to-talk function to get instant answers from the blood-tech department regarding any samples that may have been analysed. Before this they had to make cellular calls.

“If we have five patients come in at the same time, the information for all of them can be passed onto the surgeons, X-ray department, laboratory, blood transfusion centre and for the nurses and doctors in the emergency department,” explains Wilen. “Everybody has the same picture of the situation and we don’t have to call each other all the time and repeatedly make sure that they understand [the situation].”

Even though the new TETRA system is serving Northern Karelia Central Hospital well, Hirvonen says it is a “hope” that LTE technology will be in use within a few years, but expects that TETRA could be in use for 10-15 more years.

 “LTE provides more applications through mapping, calendar and alerts so that we know address by calendar and position by GPS,” says Hirvonen. “Patient information can be provided by the smartphone, and also faster data through the Airbus Defence and Space Tactilon Dabat device.” This integrates a fully rugged smartphone and TETRA radio in one handset.

The advice that Wilen would give to those implementing a TETRA system in their hospital is that you need management to support the use of radios by enforcing their use and training people to use them.

“After a while they realise it’s good,” explains Wilen, adding that broadband capability and a larger screen would be a good addition, as other technology currently provides these capabilities to staff. But overall “there is no better way to communicate, even though I like my mobile phone”.

Both the Vaasa Central and Northern Karelia hospitals initially failed to realise TETRA’s full benefits. The technology was there, but kept as a last resort rather than used as the main communications system. However, with staff receiving the correct training, a system put in place clearly outlining how each department should be using TETRA, and management leading the way, this has all changed and the results speak for themselves.

Advantages of the alert call group at Northern Karelia Central Hospital

  • In a trauma alert a patient is sent to the operating theatre 20-30 minutes faster
  • Preliminary information can be quickly communicated such as when the incident happened, what took place, how many people were involved, the injuries sustained and patients’ vital signs
  • An alert is sent in 30 seconds or less, whereas before TETRA, five cellular calls were required
  • Saves three or four minutes of time, which can mean the difference between death or brain damage in certain cases as this can happen within four to eight minutes.

Northern Karelia Central Hospital

  • Features: group calls, status alarms, text messages, SDS, direct calls, DMO and data
  • Authorities co-operated with: Emergency response centre, ambulance services, health centres, hospitals, medical helicopter, rescue department, Finnish border guard, police, social services and the military
  • Talk groups: 13 internal talk groups and one for every unit, and one common group for the entire hospital
  • Training: provided by an internal programme as well as online (www.tetrasim.com/en/Online/TETRAsim_Online_Course).