**Primer on**

**Redundant Communications**

**Recommendations of the**

**State Expert Panel**

**on Communications**

**Wisconsin Division of Public Health**

**Hospital Disaster Preparedness**

**February 2007**

**Primer on Redundant Communications**

The HRSA and CDC Preparedness Cooperative Agreements have required that
hospitals and health departments have communications redundancy so that
should one communications system fail to function, there are other
technologies that can be implemented so as to maintain communications
among emergency responders.

To provide recommendations for hospitals and health departments
regarding telecommunications technology, the Wisconsin Division of
Public Health, Hospital Disaster Preparedness Program, established the
State Expert Panel on Communications. The Panel was composed of
representatives from hospitals, health departments, EMS, Emergency
Management, State Patrol, law enforcement, National Guard,
telecommunications companies, amateur (HAM) radio, fire departments, and
911 Dispatch.

The result of the work of this Expert Panel was the recommendation that
each hospital and health department in the State of Wisconsin have four
tiers of communications redundancy:

-   Landline/Cellular Telephones

-   Two-Way Radio (UHF/VHF/800mhz)

-   Satellite Telephone

-   Amateur (HAM) Radio

To support these four tiers of redundancy and to assist hospitals and
health departments in the implementation of these four levels of
communications, the Expert Panel offered 45 recommendations for
consideration.

**Note**: These recommendations represent the consensus of the Expert
Panel. They were developed for the State of Wisconsin. All
recommendations may not apply to all States and even regions within
various states.

In late 2006 the state Hospital Disaster Preparedness Program identified
certain recommendations that were required of all hospitals, if they
were to use federal preparedness funds for the purchase and/or
implementation of telecommunications technology. These "required
recommendations" are in BOLD print:

**Baseline Recommendations**

The recommendations, offered by the Expert Panel, are "baseline"
recommendations. "Baseline" refers to the fact that these
recommendations will help hospitals and health departments establish a
foundation of telecommunications technologies. "Baseline" also refers to
the fact that these recommendations are intended to evolve over time as
these organizations learn more about these four levels of redundancy and
how they can be further enhanced.

The Expert Panel also recognized that the availability of communications
technology and staff with communications expertise varies at hospitals
and health departments. Some of these recommendations can easily be
implemented because of IT staff availability and expertise; other
organizations will find it difficult to implement even some of the most
basic recommendations.

Each hospital and health department is to adapt these recommendations to
their unique environment. Not all recommendations are meant to be
implemented equally across all organizations. There is also more than
one way to implement each recommendation. Each organization will also
need to consider the operational and financial impact of these various
recommendations as they develop their plans.

**[Tier 1: Landline and Cellular Telephones]{.underline}**

Landline-dependent telecommunications technologies include (not
inclusive):

-   Analog and Digital Telephones (corded and cordless)

-   FAX Machines

-   Landline Telephone Calls to Cellular Telephones

-   Cellular Telephone Calls to Landline Telephones

-   Dial-Up and DSL[^1] Internet

-   Dial-Up and DSL Email

-   Voice Over IP[^2] via Dial-Up or DSL

-   T1[^3] (or higher) Lines

**T1 (or higher) Lines** are dedicated landline circuits and are used,
especially by hospitals and health departments, for dedicated data
access. These lines are more likely to get overloaded at the "server" or
beyond, when many users are trying to access certain web-sites such as
the state Health Alert Network. Since these lines are dedicated
circuits, they are not shared outside the organization. They can become
inoperable due to damage, but overload can be prevented by an internal
usage policy. T1 lines allow for 24 talk paths (48 users); some of these
paths can be used for access to the Internet, while other paths can be
used for voice communication.

**Why do landline circuits get overloaded?** The landline system is
typically built for 18% capacity. The assumption is that, at any given
moment, 18 or less of 100 users are on the telephone. Circuits were well
over capacity in New York City on 9/11. Events such as Mother's Day
(busiest calling day of the year) and snow storms (everyone is calling
home before leaving work) can overload circuits.

**Cellular telephones use landlines** when a cellular telephone calls a
landline telephone or when a landline telephone calls a cellular
telephone. If landline circuits are busy or down, then cellular
telephone calls to landline telephones and/or landline telephone calls
to cellular telephones may not go through, since the cellular telephone
is using part of the 18% landline capacity.

**Cellular Telephone to Cellular Telephone**: If landlines are down,
cellular telephones may still call cellular telephones, assuming towers
are functional. Cellular telephones are also typically built for 18%
capacity. When this capacity is reached, the cellular circuits are
overloaded. Extended power outages can exhaust back-up power supply at
cellular towers and thus cause cellular telephones to fail. Note that,
technologically, "Blackberries" and other such devices are the same as
cellular telephones.

With this introduction to landline and cellular phone technology, the
Expert Panel made the following recommendations.

1.  **All hospitals and health departments are to identify personnel
    that fulfill critical functions and determine what communications
    technology these critical functions are to have available**.

> **Note**: A Worksheet that can be used to identify critical functions
> and what telecommunications technology should be available for each
> critical function can be found on pages 20 and 21.

2.  All hospitals and health departments are to have landline telephone
    capability for critical functions.

3.  All hospitals and health departments are to have FAX machine
    capability for critical functions.

4.  All hospitals and health departments are to have cellular telephone
    capability for critical functions.

5.  **All hospitals and health departments are to have T1 (or greater)
    lines for high speed access to the Internet**.

6.  All hospitals and health departments are to have partial use of T1
    Line for voice communication.

7.  **All hospitals and health departments are to have an internal
    policy to manage use of T1 lines, when there is the potential for
    staff to overload these circuits**.

8.  All hospitals and health departments are to have email capability
    for critical functions.

9.  All hospitals and health departments are to have Internet access for
    critical functions.

10. **All hospitals and health departments are to have dedicated
    telephone lines (POTS**[^4]**) for critical function areas**.

> **Note**: Dedicated telephone lines are defined here as a unique line
> that goes from a specific telephone within the organization to the
> outside by-passing the organization's telephone system.

11. **Each dedicated line is to include the telephone number clearly
    marked on the instrument along with instructions on how to dial**.

> **Note**: Sine the dedicated line bypasses the organization's
> telephone system, a person unfamiliar with the dedicated line may
> attempt to dial "8" or "9" in an attempt to make the call and thus be
> unable to complete the call.

12. **All hospitals and health departments are either [not]{.underline}
    to have cordless telephones for critical functions or to have
    emergency power/battery backup for cordless telephones**.

**Power Outage**: Most landline and cellular telephone companies have
emergency power backup. Remember any cordless telephone will need a
battery backup in order to be used in a power outage (the base station
needs electrical power to operate).

**Cable Internet**: Cable Internet is dependent upon electrical power.
Cable can be damaged physically. However, Cable Internet can continue to
be accessed even if landlines are down or overloaded, provided there is
electrical power.

13\. **All hospitals and health departments that use cable for Internet
are to have discussions with their cable provider about what back-up
systems are available**.

**Satellite Internet**: Satellite Internet is also dependent upon
electrical power. The satellite dish can be physically damaged,
interfered with by sun/weather or be susceptible to landline problems.
However, Satellite Internet can continue to be accessed even if
landlines are down or circuits are overloaded, provided there is
electrical power.

**Email and Internet**: Dial-Up and DSL Email and Internet depend upon
landlines and thus are subject to overload and physical damage.

14\. The Expert Panel does not recommend Satellite Internet Service as a
redundancy for Internet access.

**Physical Damage**: Besides being overloaded, cellular telephones,
landlines and T1 lines can be damaged physically, e.g. "digging in your
garden", "blowing up the switching station" intentionally, such as by a
terrorist attack, "blowing up the switching station" unintentionally,
such as by a tornado or a backhoe accident.

**G E T S**: "Government Emergency Telecommunications Service" provides
emergency access and priority processing. GETS can be accessed, if there
is a dial-tone. On 9/11 18,000 GETS calls worldwide were made with a 95%
completion rate. GETS is not just for long distance, but is also
extremely useful for local congestion and damage.

**How GETS Works**: 1) You call the GETS toll free number and enter your
PIN 2) GETS (transparent to you) connects you to MCI, Sprint or AT&T
(alternate numbers are also available if these are not your long
distance carriers)

**Cost for GETS**: There is no activation or monthly fee. The fee is
\$0.075 or \$0.10 per minute (dependent upon your carrier). A GETS
account must be established.

15\. **All hospitals and health departments are to have GETS access for
critical functions**.

**W P S**: "Wireless Priority Service" is the wireless complement to
GETS. Calls are queued for the next available radio channel by calling
\*272. Currently, WPS is available in Wisconsin through Cingular, Nextel
and T-Mobile. Sprint and Verizon are also scheduled for WPS. If landline
networks are congested, dialing \*272 + GETS toll free number will give
the caller priority on both the wireless and landline networks. Cost for
WPS is a \$10 activation fee, a \$4.50 monthly fee (This is a cap only;
the actual fee may be less dependent upon the carrier) and a
\$0.75/minute airtime charge. The use of WPS does not count against
cellular plan minutes.

16\. All hospitals and health departments are to have WPS access for
critical functions

**T S P**: "Telecommunications Service Priority" mandates that telephone
companies prioritize service requests for TSP subscribers. There is an
annual cost associated with this service. Telephone companies usually
work with local authorities to prioritize repairs.

16\. **All hospitals and health departments are to consult with their
local telephone company about repair priority. Depending upon the
established priority, the hospital or health department may consider
getting TSP**.

**What technologies does the telephone company use for redundancy?**
They use exactly what the Expert Panel is also recommending for
hospitals and health departments: cellular telephones, two-way VHF/UHF
radio, satellite telephones, Amateur (HAM) radio.

**[Tier 2: Two-Way VHF/UHF/800MHz Radio]{.underline}**

**Understanding Radio Communications**: "If you understand two tin cans
and a string, then you understand radio communications". There is one
receiving and one transmitting unit. The signal is sent over the
airwaves (the string). Only one person can talk at one time. The
limitations of communicating using two tin cans and a string are also
the same limitations of two-way radio.

**What Is Radio Communication?**: Radio provides the ability to talk
over the airwaves: [Simplex]{.underline}: one radio unit communicates
with another radio unit on a single frequency; [Duplex]{.underline}:
multiple radio units can communicate with multiple radio units through a
"repeater" system, using two frequencies (listen and transmit
frequencies are simultaneous). A "[repeater]{.underline}": a tower that
picks up a signal from a radio and transmits it to another radio.

**What Bands Are Used?**: VHF, UHF, 800 MHz, 900 MHz (cellular
telephones), Microwave

**Who Uses Two-Way Radio**: Radio is mostly used by Public Safety: Law
Enforcement, Fire Departments, Hospitals, Emergency Medical Services,
Emergency Management, Public Health, Government, Businesses (such as
utilities).

**Who Can Use Which Frequencies?**: In the State of Wisconsin, for
example, each Public Safety discipline is pre-assigned a specific
frequency. For example: 155.475 is assigned to Law Enforcement; 154.295
is assigned to Fire Services; 155.340 is assigned to EMS

**What Is a Trunking System?**: A trunking system is a digital system
(computer operated). Think of a line in a Bank: all people stand in one
line and then you go to the first Teller available. A trunking system
pools all frequencies and makes the line that first becomes open,
available to the first user (system is transparent to the user).

**Advantages of Radio**: Radio allows for a large number of users, the
ability to communicate with many other users at once (broadcast
capability). Radio has inexpensive upfront costs and minimal recurring
costs. It is easy to operate (push-to-talk), independent of other
communication systems and fairly easy to learn.

**Disadvantages of Radio**: You cannot "ring" someone (some systems now
have this capability). The range is limited by power, terrain and system
design. Battery life is also limited for hand-held radios. There are a
limited number of frequencies and talk groups (radio frequencies are
shared). There is the high potential for unauthorized use of and access
to frequencies. Communication is not secure (encryption requires
additional equipment).

**Interoperability**: The definition of Interoperability is the ability
of various groups to talk with one another by radio. It requires a plan
to know on which frequencies they will communicate and what equipment
will enable this communication on these frequencies. This plan needs to
deal with obstacles to communication (terrain, power, etc.).

There are very few, if any, interoperability problems with a telephone.
You simply pick up any telephone, anywhere, dial the number and you can
communicate. Interoperability is not that easy with radios. Users of
radio choose one or more of the multiple bands with different
frequencies available and with different equipment available. This
creates many problems for users in communicating with one another.

Users have different radio systems. One system works well in one
location but not in another. There are different protocols and frequency
bands. Oftentimes, there is the lack of knowledge of who has what
frequencies. There are also political and "turf" issues.

**Project 25**: Project 25 (P25) is the standard for interoperable
digital two-way wireless communication products and systems, developed
by state, local and federal governments and the Telecommunications
Industry Association (TIA). P25 is accepted as the standard for public
safety, security, public service and commercial applications. P25
standards are not required for EMS and hospital base stations (unless
equipment is being purchased with Homeland Security funds). Other public
safety agencies do not need to upgrade to P25 for the next 5 -- 10
years. There will be no negative effect upon State EMS and hospitals
communications as others become P25 compliant. The cost for P25
equipment is 2 - 3X greater.

**Internal Radios**: Radios can be used within a hospital or health
department so that staff can communicate with one another and also with
others outside the facility such as law enforcement. If the hospital or
health department emergency communications plan includes communications
with law enforcement, the radio must be capable of transmitting on law
enforcement frequencies \-- with permission!

**"Narrow Band" Project**: This is a project that is already underway.
It is the ability to create more frequencies by "narrowing" the band.
All radio equipment must be narrow band operational by CY 2013. For
example:

-   155.340 (existing band)

-   **"155.3475" (created by narrowing the band)**

-   155.355 (existing band)

**Statutory Requirements**: Hospitals and health departments should know
the statutory requirements for two-way radio in their state. For
example, in the State of Wisconsin, EMS and hospitals are required to
obtain an FCC[^5] license for operation of a two way radio base station.

17. **All hospitals are required to have the ability to communicate on
    the State EMS channel so ambulances from any area can make contact
    with the hospital**.

18. **All hospitals are to have UHF/VHF two-way radio communication with
    EMS**.

19. **All hospitals are to have radio communications with local EMS, if
    different from VHF**.

20. **All radio licenses must be current and up-to-date**.

21. Any new radio equipment purchased by hospitals and health
    departments are to support state-wide interoperability and have
    access to statewide frequencies.

22. **Any new radio equipment purchased by hospitals and health
    departments is to be narrow band capable**.

23. Each hospital and health department is to have an Interoperability
    Plan for its home county.

> **Note**: See Example of a County Interoperability Plan on page 22.
> The intent of the plan is to have each emergency responder list the
> frequencies that they use and then for other emergency responders to
> determine with whom they need to communicate and on which frequencies
> and then to determine if their equipment will permit them to
> communicate on those frequencies.

24. Each hospital and health department is to have an Interoperability
    Plan for its collar counties.

> **Note**: The emergency responders do the same process as in #23 for
> their collar counties, if applicable.

25. Any new equipment purchased by hospitals and health departments is
    to have the capability to communicate on all channels, identified by
    the Interoperability Plan.

26. Each hospital is encouraged to have an additional multi-channel
    radio to communicate on ALS and EMS Coordination channels. A) This
    additional radio is also to have scanning capability. B) This
    additional radio is to have access to 155.280 for inter-hospital
    communications.

27. **Each hospital and health department is to have internal radios so
    that critical functions can communicate with one another and with
    others outside the facility (if necessary)**.

28. **If internal radios are used to communicate with others outside the
    facility, there must be authorization to use their channel and also
    agreement on which channel to use**.

**[Tier 3: Satellite Telephone]{.underline}**

**Why Satellite Telephones**: Landline circuits can get overloaded or
damaged. Cellular telephones do not work everywhere. Radios do not work
everywhere. Amateur (HAM) radios: you are usually dependent, due to FCC
regulations, upon a non-staff person to operate the Amateur (HAM) radio.

**How Does the Satellite Telephone Work?**: A satellite telephone can
call another satellite telephone. 1) The call goes from one satellite
telephone to the satellite. 2) The signal then goes from the satellite
to a ground station. 3) The signal goes from the ground station back to
the satellite. 4) Then the signal is sent to the satellite telephone
that is being called.

A satellite telephone can also call a landline telephone. 1) The call
goes from the satellite telephone to the satellite. 2) The signal then
goes from the satellite to a ground station. 3) The ground station then
connects your call to the landline network.

29. **Hospitals and health departments are to have a fixed satellite
    telephone.** (In the State of Wisconsin, hospitals and health
    departments were encouraged to buy a specific brand of satellite
    telephone because this brand offered the following benefits:

> **Note**: The following features and benefits are listed only so as to
> provide a guide for a user when considering various vendors.

-   This satellite telephone is widely used by Wisconsin Emergency
    Management and by many emergency response agencies throughout the
    country

-   This satellite telephone allows calls to be made anywhere in the USA
    and throughout most of the world without any coverage gaps

-   This satellite telephone provider has LEO (Low Earth Orbit -- 853
    miles up) base stations (48) in outer space and thus the calls are
    not affected by hurricanes, earthquakes, landline or cellular
    overloads

-   This satellite telephone allows the user to call any other brand of
    satellite telephone or any other type of telephone, pager, cellular
    phone, etc.

-   This satellite telephone provider system is built for 14% capacity

-   The user can connect up to 6 extensions (using corded or cordless
    telephones) to the satellite telephone; a cordless telephone allows
    the user to be mobile. However, it must be remembered that there is
    only one line. For example, a hospital could have a satellite
    telephone extension in the Command Center, Emergency Department,
    Medical Director's Office, Security, Plant Operations, Nursing
    Director Office

-   With this satellite telephone there is no "rain fade" effect

-   With this satellite telephone there is no voice/signal delay ("as
    seen on CNN")

-   This satellite telephone allows for Voice Mail (The user can access
    Voice Mail simply by dialing the satellite telephone number from any
    telephone anywhere, inclusive of the satellite telephone. There is
    no cost for accessing voice mail.)

-   This satellite telephone allows the user to send and receive Email

-   This satellite telephone allows for the transmission of data and
    documents. (The user can connect the computer to the satellite
    telephone and can transmit data and documents through the computer
    as per usual.) The satellite telephone can transmit at "dial-up
    speed": a 10K document is transmitted in 10 seconds (1 minute of air
    time usage); a 100K file in 100 seconds (1.6 minutes of air time
    usage); a 1,000K file in 1,000 seconds (16.6 minutes of air time
    usage)

-   The satellite telephone has multiple call plans similar to a
    cellular telephone. (If hospital or health department has more than
    one satellite telephone line, all minutes can be pooled)

-   The satellite telephone provider is also an Internet Service
    Provider (ISP) and its Internet service is independent of the ISP of
    the hospital or the health department (users must establish a
    separate email address, e.g. "gmail", "hotmail", etc.)

**Is the Satellite Telephone Call Secure**? It is very difficult to
intercept a satellite telephone call. All calls from the satellite
telephone are encrypted. The weakest link is from the ground station to
the landline or cellular telephone being called or from the personal
computer to the satellite telephone (these are the same weak links in
normal day-to-day communications).

30. **All hospitals and health departments are to have a fixed satellite
    telephone, capable of transmitting voice, email and data**.

31. All hospitals and health departments are to have satellite telephone
    capability for critical functions

32. **All satellite telephone extensions are to be cordless telephones
    with battery-back-up for portability**.

33. All satellite telephones are also to have connectivity to the
    personal computer of critical functions so that they can email and
    access the Internet.

34. **All hospitals and health departments are to have a protocol to
    test the satellite telephone and its various functions (voice,
    email, data transmission) at least quarterly**.

**What About Hand-Held Satellite Telephones**? Hand-held units have
limited utility. Obviously, it must be used outside and must be used in
areas where there are no obstructions 10 degrees above the horizon. In
bad weather, the user may be faced with inclement conditions. An antenna
may be used and mounted to the outside of the vehicle to allow the user
to stay inside the vehicle in inclement weather.

**[Tier 4: Amateur (HAM) Radio]{.underline}**

Many people think of HAM radio as a large metal box with all kinds of
glowing tubes (that was yesteryear). Today a HAM radio can be as small
as a credit card.

**Who Uses HAM Radio**? HAM is a free radio service, authorized by the
FCC, utilized by licensed operators. HAM radio is used by these
operators to assist in emergency situations. Amateur Radio Emergency
Service (ARES) and Radio Amateur Communications Emergency Services
(RACES) consist of licensed amateurs, who have voluntarily registered
their qualifications and equipment for communications duty when a
disaster strikes.

**How Far Can HAM Radio Reach**? A small 5W radio can transmit up to 15
miles. Using a repeater, the same radio can transmit up to 100 miles.
Using shortwave radio frequencies, HAM radios can transmit anywhere in
the world.

**How Does HAM Radio Work in an Emergency**? Hospitals and health
departments have been encouraged to have a Memorandum of Understanding
with the ARES/RACES team. The ARES/RACES team provides the hospital and
the health department with the operator to assist the facility with
communications. The ARES/RACES operator operates the radio; the facility
controls the communication messages. Some hospitals and health
departments have an antenna fixed and available for the ARES/RACES
operator. If there is no available antenna, the ARES/RACES operator will
provide the temporary infrastructure.

HAM radio can serve multiple purposes within a hospital or health
department. The most obvious function is for HAM radio to be used to
communicate with emergency responders outside the hospital. Another very
valuable use is for HAM radio to serve as a proxy for the hospital
telephone system, should that system become dysfunctional. In this case
HAM operators at various locations can communicate with one another much
like a PBX system.

**Note**: See an example of an ARES Emergency Communications Hospital
Plan on pages 16 -- 17.

**Can an Employee Operate a HAM Radio**? No, the ARES/RACES operator
must operate the HAM radio. If an employee has a HAM radio license,
he/she may operate the radio, if radio operations are not part of
his/her daily job responsibilities.

35. **Each hospital and health department is to include HAM radio as
    part of their redundant communications plan**.

36. **Each hospital and health department is to have a Memorandum of
    Understanding with the ARES/RACES team to provide HAM radio
    services, when requested, in an emergency**.

37. **Each hospital and health department is to provide orientation to
    any new HAM operator regarding his/her responsibilities in an
    emergency**.

38. Each hospital and health department is to involve the Ham radio
    operator in at least one exercise annually.

39. Each hospital and health department is to have a pre-designated area
    in which the HAM operator will work.

40. Each hospital and health department is to have a fixed antenna and
    power supply for the HAM operator (if applicable).

41. Each hospital and health department is to consider having a staff
    person with a HAM radio license

**[Exercising Telecommunications Redundancy]{.underline}**

Funding from HRSA and CDC Preparedness Cooperative Agreements will help
hospitals and health departments to enhance their communications
CAPACITY (equipment). The CAPABILITY (ability and proficiency) of
hospitals and health departments to know who, where, how and when to use
these communications technologies comes only through EXERCISE. Thus, the
Expert Panel made the following recommendations

42. All hospitals and health departments are to include use of redundant
    communications in each exercise (as appropriate).

43. All hospitals and health departments are to ensure that critical
    functions exercise the use of communication technologies assigned to
    them.

44. All hospitals and health departments are to involve their emergency
    response partners, at least annually, in a test of the redundant
    communication systems.

45. All hospitals and health departments are to have an exercise of
    their 4 tiers of communications without commercial electrical power.

**["Recommendation 46"]{.underline}**

The Expert Panel recognized that it was not possible to address every
telecommunications recommendation to fit the unique situation of
individual hospitals and health departments. Thus, "Recommendation 46"
is for each hospital and health department to complete a
telecommunications needs assessment to determine what telecommunications
technologies and set-up is needed for its unique situation.

**[Funding Hospitals for Telecommunications]{.underline}**

The Wisconsin Division of Public Health, Hospital Disaster Preparedness
Program provided funding to all hospitals to enable them to have the 4
tiers of telecommunications redundancy, recommended by the Expert Panel.

Phase I in FY 2005 involved the purchase by the Program of satellite
telephones for all hospitals and community health centers.

Phase II in FY 2005 allowed hospitals and community health centers to
request funding for telecommunications enhancements according to any of
the 45 recommendations. \$1.4 million was made available for this
purpose.

Phase III in FY 2006 allowed hospital and community health centers to
request further funding for telecommunications enhancements. However, in
order to be eligible for this funding, hospitals and community health
centers need to certify that they were in compliance with all of the
recommendations above that are in BOLD. This ensures that all hospitals
have the 4 tiers of redundancy and have implemented at least the
essential recommendations to enable interoperable communications in a
disaster.

The following is a listing of some of the projects that were funded
under Phase II:

1.  Additional Satellite Telephones

2.  Satellite Telephone System Installation Costs

3.  Extra Equipment for Hospital Incident Command Center

    a.  Laptops

    b.  Fax Machines

    c.  Telephones

4.  Computer(s) for Use with **WITrac** (the system in Wisconsin for
    tracking of bed capacity, resource availability, alerting and
    communications)

5.  Inter-hospital Radios

6.  Base Station for ALS/EMS Coordination

7.  Fiber Connection for Internet Access

8.  Radio Repeater System

9.  Cordless Telephones to Connect to Satellite Phone System

10. HAM Radio and/or Antenna, Associated Cables, and Power Supply

11. HAM Radio Installation Costs

12. Laptops for EOC Hospital Liaisons, who will be reporting to
    Local/County EOC

13. Blackberry, Treo or Cellular Telephones for Incident
    Command/Essential Personal

14. HAM Radio License and Testing Fees for Staff

15. Dedicated Telephone Lines - POTS (Plain Old Telephone System) for
    Critical Function Areas

16. Mobile Cart for Command Center (i.e. 10 laptops and a wireless
    access point)

17. Additional Frequency for the Facility (including Licensing)

18. VHF Radios for Hospital Ambulance Crew

19. Pagers for EOC Hospital Liaisons, who will be reporting to
    Local/County EOC

20. Plenum-Rated Cable

21. Duplex, Red, Emergency Power Outlets for Communications Equipment

22. Telephone Jack Installation in Hospital Incident Command Center

23. VHF Portable Radios for Incident Command and/or Security

+-----------------------------------------------------------------------+
| **For questions regarding this document, please contact:**            |
|                                                                       |
| Dennis Tomczyk                                                        |
|                                                                       |
| Director, Hospital Disaster Preparedness                              |
|                                                                       |
| Wisconsin Division of Public Health                                   |
|                                                                       |
| 608-266-3128                                                          |
|                                                                       |
| [**tomczdj@dhfs.state.wi.us**](mailto:tomczdj@dhfs.state.wi.us)       |
+-----------------------------------------------------------------------+

St. Camillus Hospital

Ozone County

**Emergency Communications Plan**[^6]

** **

In the event that a communications casualty occurs at St Camillus
Hospital (SCH) requiring OZARES[^7], the following plan will be
activated. Upon notification by SCH, Ozone County Emergency Management
will activate OZARES. A resource net will be established using 147.330
and available personnel will be directed to report to the Ambulance Bay
at SCH.

> ** **
>
> **1\] The first OZARES member to arrive at SCH** will go to the
> **Emergency Desk** and **contact** the Emergency Room Supervisor or
> the **House Supervisor** to determine the nature of the communications
> assistance required.
>
> **2\]** **Get the tote with radio equipment from the storage room** at
> the east end of the Ambulance Bay. The Emergency Department Supervisor
> or Hospital Security (ext. 797) can open the room. The combinations
> for the case locks are 5555 and 6666.
>
> **3\]** **Set up the external antenna that is stored in the SW corner
> of the bay.** It is to be erected in the existing pipe located between
> the driveway and sidewalk, about 15 feet west of the west entry door.
> The coaxial cable from the antenna connects to a cable box adjacent to
> the vehicle entry door, above door level.
>
> **4\]** **Set up the radio equipment on the counter at the east end of
> the EMT room.** Check in on the resource net (147.330). At this time
> activate the 800 MHz trunk radio located in the cabinet above the
> counter. The trunk radio will provide coverage for the **SCH** and
> Ozone County Emergency Management talk groups.
>
> **5\]** **Initially establish a tactical net using OZARES TAC 1
> (146.400).** The net will provide communications between Net Control
> and the following locations:
>
> Incident Command
>
> Triage
>
> Surgery
>
> ICU (Intensive Care Unit)
>
> Supply
>
> These locations may be changed and personnel reassigned by the
> Incident Commander or the Emergency Room Supervisor if designated by
> the Incident Commander.
>
> **6\]** **When a mobile unit capable of operating as a crossband
> repeater is available, it should be set up** on the eastern edge of
> the east parking lot adjacent to Main Street. **OZARES CBR1** will be
> the designated primary circuit. After the mobile unit has been placed
> and satisfactory operation verified, Net Control will direct all
> stations to shift operations over to CBR1, Primary.
>
> **7\] Two persons should be assigned to the Net Control position.**
> They may provide breaks for each other on an hourly basis or sooner as
> operations permit. Net control operators should be relieved on a
> two-hour schedule.
>
> **8\] All operators should be relieved on a four hour schedule** if
> replacements are available or they should be rotated between stations.

+-------------------+----------------+---------------+----------------+
| #                 |                |               |                |
| ## Frequency Plan |                |               |                |
+-------------------+----------------+---------------+----------------+
| ## [OZARES CBR    | **[OZARES CBR  | ###           | ### [Sec       |
|  One]{.underline} | Two]           |               | ondary Simplex |
|                   | {.underline}** | ### [Pr       | ]{.underline}  |
| HT Transmit -- 2M |                | imary Simplex |                |
|                   | HT Receive --  | ]{.underline} |  OZARES TAC 2  |
| 146.490 pl 100.0  | 2M             |               |                |
|                   |                | ###           | 146.580        |
| HT Receive --     | 147.555 pl     |  OZARES TAC 1 |                |
| 70cm              | 100.0          |               |                |
|                   |                | ###  146.400  |                |
| 441.425 pl 100.0  | HT Transmit -- |               |                |
|                   | 70cm           |               |                |
| Mobile Receive -- |                |               |                |
| 2M                | 446.425 pl     |               |                |
|                   | 1000.          |               |                |
| 146.490 pl 100.0  |                |               |                |
|                   | Mobile         |               |                |
| Mobile Transmit   | Transmit -- 2M |               |                |
| -- 70cm 441.425   |                |               |                |
| pl 100.0          | 147.555 pl     |               |                |
|                   | 100.0          |               |                |
|                   |                |               |                |
|                   | Mobile Receive |               |                |
|                   | 70cm           |               |                |
|                   |                |               |                |
|                   | ###            |               |                |
+-------------------+----------------+---------------+----------------+

> ** **
>
>  

###  

###   

**[A True Story: February 2007]{.underline}**

I don\'t know how many of you were affected by the cutting of the fiber
cable on Sunday, but we were. I received the call a little before 6 am
to tell me the cell phones and long distance was out. The staff had
noticed the cell phones out of service about 0130 but didn\'t need them
or need to make a long distance call until just before calling me at
6:00 am.

I checked out incoming T1 circuits and all seemed OK, but thought I
would contact our long distance/circuit manager, Norlight
Communications. I was surprised to find even the 800 numbers wouldn\'t
work. No problem, I pulled out the satellite phone and went to dial, NO
DIALTONE. I couldn't believe it, but it was dead also. I couldn\'t
imagine there would be a relationship between a satellite device and a
landline outage, but sure enough it seemed to be.

My next option was to fire up the amateur radio and see if I could get
to someone outside of the affected area. I got right through to a HAM
friend not too far away, but one that had the ability to make an 800
call. I had them relay the information to Norlight Service to get a
ticket started for me. He came back while the tech was on the line and
told me there had been a major fiber line cut somewhere between Baraboo
and Madison or near Madison and everything this direction was out.

Apparently it is a major backbone as many areas were affected. I could
dial local to our own prefix, but not to other local areas. He couldn\'t
dial out long distance other than the 800 number so I made a contact
with someone further out that had all their services and they were going
to just stand by in case I needed a messaging service. I let the nurses'
stations know that if they needed to make a long distance call for an
emergency to contact me in the Emergency Communication Center and at
what extension and I would get it out of the building. Fortunately we
did not have any emergencies that needed to have phone calls made but we
could have gotten them through.

We got our satellite service back about 1030 AM and all services were
restored by 2:30 PM. They had to do some rerouting and splicing around
the site but managed to get everything up and going. I closed up the ECC
by 2:45 PM. On Monday I called our Regional HRSA Coordinator for a
satellite telephone contact to find out what was going on and was
somewhat relieved to hear that their outage had nothing to do with the
cut fiber. It was coincidental but they are in the process of relocating
some satellites to make room for a couple new ones and said we will
experience some periodic outages until they are done in May. It just
happened to be at the same time of the other outage. What are the
chances of that happening?

The bottom line is, if you have not got with your local amateur radio
people to get your communication system up and going, it is a really
good thing to do. It was our only means of communication out of our town
for several hours on Sunday. I now have applied for the second go around
of grant money to enhance the system to add packet data equipment to
also be able to send emails direct from the amateur setup also. We will
have the ability to set one up to cross band and then use a handheld at
the nurses' stations on low power to repeat the signal out at a higher
power on the big antenna to message from a remote location while still
having the other system for email or voice as needed.

We have requested some of the new Motorola 900 MHz digital radios for
our in-house communications. If you haven\'t tried them they are
unbelievable in their coverage. They covered easily our entire grounds
and as far as a couple blocks away and the fact that they are digital,
they are crystal clear in their voice quality. They have many options
like group call which is the ability to call every radio that is turned
on, only a specific group (Maintenance, for instance) or even a private
call to a specific radio without anyone else hearing anything. They are
limited in that they can\'t be used to contact with outside agencies,
but for us they are going to work great.

I know we all are struggling with the time and funds needed for someone
to manage this redundant communications requirement, but I certainly am
not going to look a gift horse in the mouth and will put in for all I
can get. I have seen the results of the efforts so far and say it works.

### 

**[Example A: Critical Functions and Telecommunications
Capability]{.underline}**

The following is only an example and is not meant to be a representation
of the Critical Functions nor of what telecommunications modalities each
Critical Function should have available. This planning Tool is very
important for helping you to determine what telecommunications equipment
is necessary for which critical functions. Please remember that these
are telecommunications modalities that should be available to these
Critical Functions in a disaster situation and not necessarily for
day-to day communications.

<table>
<colgroup>
<col style="width: 17%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Critical Functions</strong></td>
<td>Landline</td>
<td>Cellular Phone</td>
<td>FAX</td>
<td>Internet Access</td>
<td>Email</td>
<td>GETS</td>
<td>WPS</td>
<td>Internal Radio</td>
<td>Satellite Internet Jack</td>
<td>Dedicated Line</td>
<td>Satellite Phone Extension</td>
</tr>
<tr class="even">
<td><strong>CEO/Administrator</strong></td>
<td><h1 id="x">X</h1></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
</tr>
<tr class="odd">
<td><strong>Medical Director</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
</tr>
<tr class="even">
<td><strong>Emergency Department</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
</tr>
<tr class="odd">
<td><strong>Incident Command</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
</tr>
<tr class="even">
<td><strong>Plant Operations</strong></td>
<td><strong>X</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
</tr>
<tr class="odd">
<td><strong>Nursing Director</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
</tr>
<tr class="even">
<td><strong>Security</strong></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td></td>
<td></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
<td><strong>X</strong></td>
<td></td>
<td><strong>X</strong></td>
</tr>
</tbody>
</table>

**This blank Worksheet is available for you to use as a planning tool as
you consider what telecommunications equipment to purchase with your FY
2006 funds. Please remember that these are telecommunications modalities
that should be available to these Critical Functions in a disaster
situation and not necessarily for day-to day communications.**

<table>
<colgroup>
<col style="width: 17%" />
<col style="width: 8%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 5%" />
<col style="width: 6%" />
<col style="width: 5%" />
<col style="width: 7%" />
<col style="width: 8%" />
<col style="width: 9%" />
<col style="width: 9%" />
</colgroup>
<tbody>
<tr class="odd">
<td><strong>Critical Functions</strong></td>
<td>Landline</td>
<td>Cellular Phone</td>
<td>FAX</td>
<td>Internet Access</td>
<td>Email</td>
<td>GETS</td>
<td>WPS</td>
<td>Internal Radio</td>
<td>Satellite Internet Jack</td>
<td>Dedicated Line</td>
<td>Satellite Phone Extension</td>
</tr>
<tr class="even">
<td><strong>CEO/Administrator</strong></td>
<td><h1 id="section-6"></h1></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Medical Director</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Emergency Department</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Incident Command</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Plant Operations</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="odd">
<td><strong>Nursing Director</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><strong>Security</strong></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
</tr>
</tbody>
</table>

**[Example of a County Communications Interoperability
Plan]{.underline}**

[^1]: A digital subscriber line (DSL) connection is a very high-speed
    connection that uses the same wires as a regular telephone line.

[^2]: Voice over Internet Protocol, also called VoIP, IP Telephony,
    Internet telephony, Broadband telephony, Broadband Phone and Voice
    over Broadband is the routing of voice conversations over the
    Internet or through any other Internet Protocol (IP) based network.

[^3]: If you have a T1 line, it means that the telephone company has
    brought in a fiber optic line (a T1 line might also come in on
    copper). A T1 line can carry 24 digitized voice channels or 48 paths
    (your call going out and the other call coming in) or it can carry
    data at a rate of 1.544 megabits per second. If the T1 line is being
    used for telephone conversations, it plugs into the telephone
    system. If it is carrying data, it plugs into the network\'s router.

[^4]: POTS stands for "Plain Old Telephone System". Non-POTS lines are
    based on high-speed, digital communications lines, such as ISDN
    (*integrated services digital network)* and FDDI *(fiber distribute
    data interface)*. The main distinctions between POTS and non-POTS
    services are speed and bandwidth. POTS is generally restricted to
    about 52 kbps (52,000) bits per second or "dial-up speed").

[^5]: FCC is the Federal Communications Commission

[^6]: This is an actual plan. The names and telephone numbers are
    fictitious.

[^7]: OZARES is the ARES Emergency Management Coordinator in Ozone
    County