title: Text messaging as a strategy to address the limits of audio-based communication during mass-gathering events with high ambient noise.
abstract: BACKGROUND
  The provision of medical care in environments with high levels of ambient noise (HLAN), such as concerts or sporting events, presents unique communication challenges. Audio transmissions can be incomprehensible to the receivers. Text-based communications may be a valuable primary and/or secondary means of communication in this type of setting.
  
  
  OBJECTIVE
  To evaluate the usability of text-based communications in parallel with standard two-way radio communications during mass-gathering (MG) events in the context of HLAN.
  
  
  METHODS
  This Canadian study used outcome survey methods to evaluate the performance of communication devices during MG events. Ten standard commercially available handheld smart phones loaded with basic voice and data plans were assigned to health care providers (HCPs) for use as an adjunct to the medical team's typical radio-based communication. Common text messaging and chat platforms were trialed. Both efficacy and provider satisfaction were evaluated.
  
  
  RESULTS
  During a 23-month period, the smart phones were deployed at 17 events with HLAN for a total of 40 event days or approximately 460 hours of active use. Survey responses from health care providers (177) and dispatchers (26) were analyzed. The response rate was unknown due to the method of recruitment. Of the 155 HCP responses to the question measuring difficulty of communication in environments with HLAN, 68.4% agreed that they "occasionally" or "frequently" found it difficult to clearly understand voice communications via two-way radio. Similarly, of the 23 dispatcher responses to the same item, 65.2% of the responses indicated that "occasionally" or "frequently" HLAN negatively affected the ability to communicate clearly with team members. Of the 168 HCP responses to the item assessing whether text-based communication improved the ability to understand and respond to calls when compared to radio alone, 86.3% "agreed" or "strongly agreed" that this was the case. The dispatcher responses (n = 21) to the same item also "agreed" or "strongly agreed" that this was the case 95.5% of the time. CONCLUSION The use of smart phone technology for text-based communications is a practical and feasible tool for MG events and should be explored further. Multiple, reliable, discrete forms of communication technology are pivotal to executing effective on-site medical and disaster responses.
authors.affiliation: Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada. adam.lund@ubc.ca
authors.forename: Adam
authors.initials: A
authors.lastname: Lund
authors.forename: Daniel
authors.initials: D
authors.lastname: Wong
authors.forename: Kerrie
authors.initials: K
authors.lastname: Lewis
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Turris
authors.forename: Sean
authors.initials: S
authors.lastname: Vaisler
authors.forename: Samuel
authors.initials: S
authors.lastname: Gutman
mesh_terms: D000846:Anniversaries and Special Events; D001291:Attitude of Health Personnel; D002170:Canada; D003142:Communication; D004632:Emergency Medical Services / Q000379:methods* / Q000458:organization & administration / Q000639:trends; D005240:Feasibility Studies; D006801:Humans; D008399:Mass Behavior; D009622:Noise / Q000009:adverse effects*; D015397:Program Evaluation; D011845:Radio; D060145:Text Messaging