Shachar Harari, chief business officer & head of Cardo Crew, discusses the limitations of traditional voice comms technology in critical care and how these could be improved by wireless mesh communication.
At the height of the COVID-19 pandemic, hospital staff had to rely on tried and tested communications technology like walkie talkies, WhatsApp and even pagers in order to communicate, while fully gowned up in PPE and working in isolation from the rest of the hospital in hectic ICU wards. In order to identify colleagues on ICU they wrote their names in marker pen on their gowns and visors. It may have been basic stuff, but lives were at stake and medics are notoriously practical folk. They use the technology that gets the job done, even if it’s far from an ideal solution. With mobile phones banned in clean areas, walkie talkie technology or Private Mobile Radio (PMR) was essential as medical staff on ICU had no other way to talk to colleagues in other departments like radiology or A&E without leaving the ward and suffering the laborious process of taking off and putting back on their PPE.
While I applaud their inventiveness, there has to be a better way to enable doctors, nurses and other healthcare professionals to communicate more effectively in a surgically clean environment, taking into account the constraints imposed by PPE. So, what are the key considerations here? We need to find a way to naturally communicate that’s close to normal every-day speech. It needs to be easy to set up and needs to be hands free; medics have their hands full saving lives. It needs to work in an environment where things change fast, people move around and the last thing they need is to worry about going out of range or logging on to the network every time they enter the department. We believe the answer lies in wireless mesh communication and in particular a technology known as Dynamic Mesh Communication (DMC) which meets these criteria and works in many critical team-working environments like first responders and construction sites but has yet to be adopted in a healthcare setting.
Let’s talk walkie talkie
Before making the case for DMC, let’s take a look at some of the alternatives that we touched on earlier and examine why they do not, in my opinion, hit the mark. Private mobile radio (PMR); the walkie talkie is a bulky hand-held device that allows one person at a time to talk. It’s a work-around but it’s not natural speech. It uses “push-to-talk” so it’s not hands free and you physically need to press a button and risk cross contamination as the device gets handed from person to person. While PMR does offer great transmission range and could cover an entire city, let alone a hospital, it does require infrastructure in the form of base stations and repeaters.
So why not just use your iPhone?
While it’s common to see medics using smart phones both for speech and text communication and increasingly to share image files like scans, and photos of trauma or surgical procedures, these devices rely on cellular coverage which may be patchy and they are typically not hands free. Also, phones are banned in most clean areas as they carry a major risk of cross-contamination.
What about Bluetooth?
Bluetooth is a familiar technology and is indeed used in certain hospital settings like cardiac catheterisation procedures. It allows handsfree, two-way communication. It doesn’t need additional infrastructure like a base station, so it would seem ideal, but it has three major drawbacks. First, range is limited (usually up to 100 metres), so a medic may drop out of range when going to an adjacent ward. Second, its daisy chain configuration means that when one headset drops out the whole systems ceases to function. Finally, it can be fiddly to set up in that you have to physically register each device to the network as you enter into service.
A special case for wireless mesh communication and DMC
Wireless mesh communication using DMC was specially designed for this kind of mission-critical application and, I believe, it has a vital role to play, not just in fighting the current pandemic but in any critical care environment. It doesn’t replace the PMR or cellular as each has their unique role but it is particularly well suited to small work groups who need to exchange complex time-critical information in real time, under real pressure with the added factors of PPE and social distancing. So, what are the key attributes that make a case for this relatively new technology?
First and foremost, it allows hands-free, two-way, natural voice communication between everyone in the work group. You know who you are talking to and they can hear what you are saying loud and clear and you can hear them. In short, you can talk to each other like human beings, even in full PPE or at a social distance.
Second, it’s an autonomous network. No need to install base stations and no need to rely on mobile cellular network coverage. In fact, each device works like a mini-communications hub in its own right. This brings the third advantage in that it can work over a far wider range than Bluetooth as each individual unit extends the range of the overall network. It can also connect up to 15 users with a range of 3000 metres for the whole group (when used between three or more users), as each unit acts as a communication hub.
Network, heal thyself
If one person does drop out of the network temporarily, the rest of the team continues to function. The remaining devices dynamically reconfigure the network and carry on as normal. This ‘self-healing’ function of DMC is essential for critical care environments and is a major advantage over Bluetooth. A final advantage of DMC over Bluetooth is that it automatically signs you into the network as you come within range. So, a surgeon or anaesthetist in full PPE can walk onto the unit and doesn’t need to mess around with registering a device to the network before getting on with the procedure in hand.
As the pandemic struck, people used the tools they had to hand in order to get through the day and save lives. The NHS has taken on board many new ways of working under the pressure of the pandemic. We have seen that there were certain gaps in the system and staff heroically found ways to improvise. They shouldn’t have to improvise. They deserve to have the best tools for the job and I believe that in the area of voice communication for work groups, wireless mesh communication and DMC technology can play a vital role in improving healthcare outcomes both in times of crisis and as part of the ‘new normal’ in hospitals.
