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Flaw In Emergency Response System May Have Killed Hundreds 437

Posted by timothy
from the problem-with-algorithms dept.
Hugh Pickens writes "The Telegraph reports that a flaw in the way emergency response software was set up to handle Category A responses in Great Britain may have cost hundreds of lives over the past ten years. Most ambulance services use an international computerized system designed in America and in the US version, a fall of more than 6 feet receives the maximum priority response. However, the government committee which governs its use in Great Britain decided that such cases should be deemed less urgent, and excluded from an eight minute category A target response time. If a call involved a fall of more than 6 feet it was designated a lower priority 'category B response' despite the presence of life-threatening conditions which were supposed to receive the most urgent category A response. The flaw came to light after Bonnie Mason, 58, fell 12 feet down the stairs and died from a head injury after emergency controllers in Suffolk failed to identify her situation as 'life-threatening.'"
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Flaw In Emergency Response System May Have Killed Hundreds

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  • by Anonymous Coward on Sunday March 21, 2010 @09:04PM (#31562134)

    It is worse than that actually. The operators were prohibited in upgrading the priority manually. The emergency services just trusted the computer program.

  • Ambulance Service (Score:3, Interesting)

    by lymond01 (314120) on Sunday March 21, 2010 @09:10PM (#31562200)

    We have friends in England and one of them had her hip replaced. A couple weeks after she was able to walk on it, she was doing the dishes and the replacement broke -- basically either the hip or femur end broke and was completely out of socket. Her husband called 999 and the ambulance at first refused to come because it wasn't a life-threatening emergency. "Can she just walk to the car?" "Can you carry her to the car?" You can probably imagine your wife screaming in pain, you not knowing if some vein or artery has been sliced, and any movement at all just makes her scream more. "Yah, it's cool. I just duct taped her mouth and threw her over my shoulder. I think she's passed out from the pain so tossing her in the back seat should work a treat. We'll be at the hospital in no time!"

    I realize a line needs to be drawn somewhere. Some people will call for an ambulance when they've cut themselves shaving. But you know, when you can hear the screams in the background...you should probably get off your asses and help out.

  • by MWoody (222806) on Sunday March 21, 2010 @09:12PM (#31562228)

    I know this is Slashdot and all, but for the rest of the world, "system" means any organized collection of rules and doctrines. "System" here refers to the Emergency Response System as a whole, including the computers, the people who run them, the officials responsible for determining policy, etc.

  • by Anonymous Coward on Sunday March 21, 2010 @09:40PM (#31562446)

    Nice FUD there... but actually, the British selected a lower category than the default for that situation, according to the summary.

    Note:

    Most ambulance services use an international computerized system designed in America and in the US version, a fall of more than 6 feet receives the maximum priority response. However, the government committee which governs its use in Great Britain decided that such cases should be deemed less urgent, and excluded from an eight minute category A target response time.

    Also, to the GGGP, TFA states that the fine tuned algorithm was supposed to invoke additional training for ambulance staff to elevate issues manually if life-threatening conditions were detected. In any case, I'm confused on how they would do that as, by my understanding, the categorisation determines response time which would delay the initial response... hardly giving them a chance to upgrade the category of the incident. But hey, I didn't read it that thoroughly, so correct me if I missed something.

  • Re:May have... (Score:5, Interesting)

    by jo_ham (604554) <joham999NO@SPAMgmail.com> on Sunday March 21, 2010 @09:53PM (#31562538)

    The actual event in question happened a year ago. Given the recent news in the USA - something to do with some sort of bill about healthcare, and the imminent UK general election, I find the timing from a right wing newspaper here in the UK to be highly sensational - especially since the issue has been corrected in the new version of the software, that was released and rolled out last year.

  • Re:Ambulance Service (Score:3, Interesting)

    by Cassini2 (956052) on Sunday March 21, 2010 @09:55PM (#31562554)

    Her husband called 999 and the ambulance at first refused to come because it wasn't a life-threatening emergency.

    I must be missing something here. Where I live, if you call for an ambulance, it comes. If something serious is going on, call the fire department and the ambulance, because the fire department has a quicker response time. There is no option for "not show up". Some injuries (like concussions) don't look like emergencies immediately. As such, the procedure is to get you to the hospital, and have the nurses and doctor's deal with the situation.

    Sure, if you call an ambulance over a stubbed toe, then the ambulance guys will send you a bill for the ride to the hospital, and the police might charge you for wasting everyone's time. However, the ambulance, police and fire will show up.

    Do the ambulances in England have an option to refuse to come in an acute, emergency situation? involving major fractures? dislocations?

  • by 0123456 (636235) on Sunday March 21, 2010 @10:05PM (#31562642)

    And yet, the 'rationed' socialist healthcare here in Britain is still a metric fuckton better than what you get in the US

    How strange. When I was living in the UK there always seemed to be some kid on TV looking for money to pay for them to fly to America to get treatment which they couldn't get under the rationed socialist NHS.

  • by Cassini2 (956052) on Sunday March 21, 2010 @10:43PM (#31562904)

    Anyway, there is the Swansea AMPDS codes (with the Govt Standard also listed) http://www.sufr.co.uk/Initial_Actions/ampdsv_11.3.htm [sufr.co.uk] -- you can see there that Fall >6ft is assigned amber (Cat B).

    This list could go seriously wrong when responding to emergencies. It's virtue is that it is a great list for a triage assessment at hospitals. A trained triage nurse could use it to call codes, after quickly examining a patient in front of her. Yellow is "> 5 min", Red is "possibly dead in 5 min", Purple is "almost / already dead", and Green is "No Hurry".

    A 911 operator (or a 999 operator) is communicating with paniced people without medical training. These people will not be able to give a "medically accurate" descriptions. For instance, the list differentiates between Cardiac Arrest, Chest Pain (Non-Traumatic), and Abdominal Pain. It even includes Abdominal Pain "not alert" as a yellow, and Chest Pain "not alert" as Red. I don't think the average caller can tell the difference, and some patients will die before anyone figures it out. I'm not sure what the emergency response times are in Swansea, but if you spend more than 60 seconds on the phone debating if a person is Red, then you will be losing a measurable percentage of the Red patients.

    The building fire section is also a bit strange. If you have a building on fire, with people reporting it (visual identification), if people are in the building, you have to role an ambulance. Don't wait until the occupants are out of the building, before escalating the call. Do you need 5 people unconscious on the lawn before deciding it is a Code Red (multiple victims)?

    Triage lists for 911 / 999 response must be based on what paniced people can communicate. For example: Is the person breathing? Are they conscious? Do you see smoke/flames? Are people in the building? People can answer these questions quickly.

  • by izomiac (815208) on Sunday March 21, 2010 @11:26PM (#31563208) Homepage

    While I was a student there were two cases of someone in my group of a dozen friends having a serious medical problem and being told that there weren't resources in American hospitals, despite their good health insurance, to treat them promptly enough to prevent permanent disability. Both went to India and received immediate care that successfully fixed their problems

    As a medical student I may be a bit idealistic, but AFAIK this sort of thing should not be possible for about half a dozen reasons. What sort of illness did your friends have, and why was no doctor in the whole country willing to treat it?

  • by Cimexus (1355033) on Monday March 22, 2010 @12:25AM (#31563582)

    Indeed. The quality of heath care in the US is top notch ... if you can get it/afford it. It's that "if you can get it" that's the issue.

    A little story. I'm Australian. We have free universal health care in Australia, like most other countries. And the quality of that healthcare is good. Better than in the UK, IMO (I've lived in both countries). Three months ago I was visiting relatives in the US. Unfortunately I suffered an acute illness that required hospitalisation. I should point out that I'm young (27) and healthy, and have never required admission to hospital before. Now as a visitor to the US for three weeks, naturally I have no insurance/employer/any other connection to the US.

    I was only in the ER for 89 minutes. The bill was over $2000 USD for that hour and a half! What struck me most about the US system though, more than the COST, was the incredible inefficiency. A bill from the hospital got mailed. Then a separate bill from some other company who apparently had some role. Then another bill from the doctor himself (wtf, doesn't the doctor work for the hospital?). All this paperwork, all these separate entities at play. In Australia and most other countries, there's a single payer system. You pay nothing and a single (government) insurer picks up the bill. It works well, not because it's socialised (the hospitals/doctors themselves are still private enterprises), but because it's just more efficient. Health care providers don't have to chase down 100s of different insurers with different paperwork and different requirements. They just batch their bills up and a single entity pays them.

    But I do admit that, although expensive, the doctor gave me excellent treatment. He did many tests (including ones that I thought were unnecessary, and probably wouldn't have been done in the same situation at home). This is probably why the cost was so huge.

    So yes, US healthcare is excellent quality. And particularly so for more advanced or cutting edge treatments - you can often only get them in the US (mostly because most health research is still done in the US). But if you are poor, God help you, because you can't afford it. Or if you are a visitor like me - I'm not poor and I have private health insurance at home in Australia, but that doesn't mean Jack in the US.

    Ironically, if I were an American visiting either Australia or the UK, and the same thing happened to me, I'd get the same treatment for free. THAT irritates me ... my tax dollars pay for treating US tourists, but they don't extend the same courtesy to me as a visitor to their country.

  • by twidarkling (1537077) on Monday March 22, 2010 @12:42AM (#31563716)

    Since reading is so fundamental, here's something you may enjoy:

    http://www.cracked.com/article_18458_6-subtle-ways-news-media-disguises-bullshit-as-fact.html [cracked.com]

    The summary is bullshit, and you know it. Take a gander at "burying inconvenient facts." The summary was organized in such a way as to be misleading, and phrased in such a way to lend itself to casual misinterpretation.

  • by sycodon (149926) on Monday March 22, 2010 @12:44AM (#31563728)

    Sound like that could be the case. You can't buy a kidney in the U.S. You can in India.

  • by Anonymous Coward on Monday March 22, 2010 @12:53AM (#31563774)

    Yeah, so here's the trick for a foreigner dealing with the US health care system:

    Don't bother paying.

    They've only got 3 years to try to sue you for the bill, and if you're in another country, they're not going to actually bother.

    A US emergency room is obligated to provide care when you walk in with an emergency. They can't deny emergency care, they can just send you a bill. And the only thing they can do to collect it is actually sue you, which is rarely done. They can't put it on a credit report. And they can't deny you care if you come back without having paid.

    It's how the homeless in the US get care, since it's the only care they're actually able to get. And it's how illegal immigrants get care.

    But I don't think Americans can actually get care for free in the UK. I'm not sure about Australia. And I know we can't in Canada.

  • by epine (68316) on Monday March 22, 2010 @02:04AM (#31564076)

    Forbidding the staff to exercise judgement in an emergency call center is the best illustration I've come across in a long time of what Barry Swartz refers to as the "war on wisdom".

    Barry Schwartz on our loss of wisdom [ted.com]

    From the online transcript:

    The truth is that neither rules nor incentives are enough to do the job. How could you even write a rule that go the janitors to do what they did? And would you pay them a bonus for being empathic? It's preposterous on its face. And what happens is that as we turn increasingly to rules, rules and incentives may make things better in the short run, but they create a downward spiral that makes them worse in the long run. Moral skill is chipped away by an over-reliance on rules that deprives us of the opportunity to improvise and learn from our improvisations. And moral will is undermined by an incessant appeal to incentives that destroy our desire to do the right thing. And without intending it, by appealing to rules and incentives, we are engaging in a war on wisdom.

    This is actually a bit of a talking head lecture. Not much sizzle, but a message worth repeating.

    There ought to be nowhere to hide for a bureaucrat forbids the use of human wisdom when the rigid system that ensues makes a total hash of things.

  • by Gnavpot (708731) on Monday March 22, 2010 @03:38AM (#31564434)

    No one is perfect, yet somehow society demands perfection from its doctors.

    Funny, as I member of society, I see the situation as this:

    No one is perfect, yet somehow doctors always arrogantly pretends that they could not be wrong.

    You have set the standards yourself. Live with it.

    As an engineer, working with processes much, much simpler than the human body, I am fully prepared to accept that doctors can't know everything because the human body is far from fully understood. When they pretend to do so anyway, it insults my intelligence.

    (Please disregard my first post. Should have used preview.)

  • by HungryHobo (1314109) on Monday March 22, 2010 @05:17AM (#31564746)

    No comment, because everyone eventually makes mistakes including myself.

    It's curious how members of the medical profession close ranks when the posibility of incompetence crops up.
    Everyone in every field meets other members of their profession who are shit at their job yet it's only doctors and nurses who seem to do with One-For-All crap.

    Programmers? They'll decide that one of their own is inept and loudly proclaim it to all around them.
    Physicists? They eat their own.
    Engineers? A whiff of fuckup and the one who screwed up will be derided by all around them.

    Doctors? "we all make mistakes"
    What the fuck is with that?
    The only other example of this kind of "see no evil, hear no evil, speak no evil" bullshit I can think of is some of the more blinkered and powerful teachers unions.

    You'd think doctors would be less inclined than other professions to put up with incompetence within their own ranks but the oposite seems to be true.

  • by AK Marc (707885) on Monday March 22, 2010 @05:41AM (#31564820)
    No one is perfect, yet somehow society demands perfection from its doctors. Fat chance.

    No, we demand humility and get hubris.

    Every physician would suspect some sort of life threatening condition first - to be RULED OUT - and then work towards diagnosing more benign problems.

    The problems with this are two (well, at least two). One, the person answering the call isn't a doctor and doesn't know triage. They don't have medical resources available. They look in a chart (or a computer does it for them in this case) and the priority is assigned. Two, if everything was "urgent" then there'd be a number of critical cases which were responded to too slowly because they have to treat every case as critical. It's called triage. And when you have no medical training (well, I'm sure they give them first aid classes, but from what I've seen of dispatchers, not any more than that) and the computer is doing triage based on inputs, then you have to assign values to things. Either the medical board didn't have a doctor on it, or a doctor (or doctors) made a mistake that cost hundreds of people their lives.

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