Flaw In Emergency Response System May Have Killed Hundreds 437
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.'"
More like a flaw in statistics (Score:5, Informative)
The summary sounds like "we underestimated how dangerous a medium distance fall can be, so we didn't have the correct priorities and more people died than could have". That isn't really a flaw in the algorithm, it's just a flaw in one specific parameter in the algorithm.
Re:More like a flaw in statistics (Score:5, Informative)
Alternatively, we could have a US system, where the ambulance won't set off unless your insurance covers it, or won't take you to the nearest hospital because that is not "in network".
Or, they'll take you to the hospital, unconscious, and then stick you with the bill because the trip wasn't "pre-approved".
This has nothing to do with socialised care and everything to do with bureaucrats making decisions that affect people - it's is not exclusive to socialised medicine. Regardless of how you slice it, ambulances and ambulance crews are a finite resource and priorities have to be set. They should not be set by non-medical people though, as in this case which was clearly wrong, and in the case of a lot of medical decisions under the US system (where your insurance company, and not a doctor, decides the care you receive).
I'll take the NHS any day.
Re:More like a flaw in statistics (Score:5, Informative)
Just replying so that people know not to take your post literally. Ambulances in the US will take you to the nearest hospital with appropriate facilities for your condition.
Re:More like a flaw in statistics (Score:3, Informative)
Your insurance company however, can still do ridiculous things to you if you were taken to a provider they don't cover, etc.
Re:Dangers of technical rationality (Score:3, Informative)
There is an inherent risk to allowing operators of software to override the systems rules.
I like to call it the "Red Exclamation Point Problem" or the "High Priority Problem." To a not insignificant portion of the population, opportunity to elevate, upgrade, bold, underline, highlight, or change the font red is taken at nearly every opportunity. This defeats the priority system that was set out with the intention of reducing costs, and in this case, saving more lives by better prioritizing the use of a finite resource in emergencies.
While I agree there are a number of industries and professions in which not allowing user intervention is mistaken, and while I agree that the administration who altered the system in place poorly are at least somewhat to blame for the needless deaths, I don't think dispatchers should have the ability to arbitrarily override the priority system either. It looks like the software handled everything it was told to do correctly, but the administrators made a mistake in designing and testing alterations to it and perhaps did not even consult medical professionals. As a result, people died.
And lastly, the problem isn't that most falls should probably be category B. That's already taken care of, but falls over six feet being category A must have made sense to someone, and apparently it cost lives changing it.
Re:More like a flaw in statistics (Score:2, Informative)
Seems this committee might be relevant, and if you check the 2nd link in Google, there are quite a few doctors on it:
http://www.google.com/#hl=en&source=hp&q=%22department+of+health%22+great+britain+ambulance+committee&btnG=Google+Search&aq=f&aqi=&aql=&oq=%22department+of+health%22+great+britain+ambulance+committee&gs_rfai=&fp=ae8f9588018abe0f [google.com]
Perhaps there are other factors or committees involved who ignored medical advice.
Re:More like a flaw in statistics (Score:3, Informative)
I hate to break it to you but the NHS is the worst of all the western public healthcare systems.
I'll take the Australian, German or French system any day over the abomination that is the NHS.
And I'm sure that you're aware that most states in the US (which of course are as populous and economically large as most European countries) have various forms of public insurance and public public care, so much so that even the "worst case" "victims" the administration keep bringing out to show how awful the current US healthcare system is have all been covered and receiving full treatment in their respective states public systems. Something the administration always conveniently neglect to mention.
The current rigmarole in the United States regarding healthcare is not about public / private, it's about the Federal Government moving into areas that it's does not have the authority to legislate. It's directly comparable to if (when) the European Union decides it's going to "take over" all of its member states discrete healthcare systems and run them from Brussels.
When that happens the EU *certainly* won't choose the UK model, and given how noisy and condescending you Brits have been about the Americans unwillingness to allow complete take over of healthcare by their Federal government don't expect any sympathy when the EU (yes they are talking about it http://ec.europa.eu/health/ph_overview/co_operation/mobility/patient_mobility_en.htm [europa.eu]) comes to take over yours.
Re:More like a flaw in statistics (Score:3, Informative)
While some services spotted the risk, ordering operatives to override the computer’s orders manually, five of England’s 12 ambulance trusts did not allow call handlers to upgrade such calls. They include the East of England ambulance service, which covers Suffolk and which only identified the risk after Mrs Mason’s death.
Re:More like a flaw in statistics (Score:5, Informative)
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.
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 and despite the fact that they had to pay 100% of the cost of surgery, the total cost including airfare was thousands less than their share of the cost for the same procedures under their health plans. Here near the northern border of the US I know someone who goes to Canada to get treatment unavailable under the rationed capitalist American system.
Very misleading title and description ! (Score:4, Informative)
The title of this thread is "Flaw In Emergency Response System May Have Killed Hundreds"
The first sentence contains the following: "... 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"
BOTH ARE VERY MISLEADING !!
The FLAW of the whole thing is the BRITISH GOVERNMENT COMMITTEE which decides that a fall of more than six (6) feet SHOULD BE DEEMED LESS URGENT, AND EXCLUDED FROM AN EIGHT (8) MINUTE CATEGORY A TARGET RESPONSE TIME " !!
Why blame the software or the emergency controllers when it's the idiotic British bureaucracy which has fcuked up in the first place?
Re:More like a flaw in statistics (Score:3, Informative)
You seem to be under the impression that the private U.S. system doesn't have any waiting or prioritizing of response. You've obviously never been to an ER or called for an ambulance. We have rationing now, it's just an incredibly inefficient version that's based on economic status rather than medical need.
The sad thing is that the attempts to kill a sane reform are working. They've managed to steer it to mandating that people buy insurance they can't afford in the first place.
Re:More like a flaw in statistics (Score:4, Informative)
Probably because socialized systems won't perform a futile procedure, but in the U.S. if you have the bux, you can get any treatment you want, even if it's useless.
Re:More like a flaw in statistics (Score:3, Informative)
The US medical system isn't really even in a position to care about matters of fine degree like this, since we already know tens of thousands of people are grossly under-treated for known, curable ailments.
Re:More like a flaw in statistics (Score:5, Informative)
No, you don't have your own continent, and we have a Queen you may have heard of. [wikipedia.org]
Signed,
Canada
Re:More like a flaw in statistics (Score:1, Informative)
Its best to ignore good ole jeff, he has sparks of intelligence, but he usually does devolve to political rants
Re:More like a flaw in statistics (Score:3, Informative)
And if you had read them you would have realized that it was an issue of the Canadian facilities being the ONLY facilities nearby, not one of cost or coverage.
I've worked as a Paramedic (Score:2, Informative)
I've worked as a Paramedic under the Advanced Medical Priority Dispatch System (AMPDS).
Whether you are given a Cat A or B generally makes no difference in the response time of the crew to the scene - i.e. they always drive as fast as they safely can no matter what the emergency.
Incorrect triage by the communications centre is routine. This is usually not the comcen's fault - it is almost always incorrectly reported information from the caller. Things like whether there is a pulse or not, whether they are breathing or not, whether they are bleeding or not, are often incorrectly reported from panicky callers.
Or you can get correctly triaged responses with totally different results. You might get a call saying a patient has severe gastric pain which ends up being a myocardial infarction.
You might get a call from a patient with severe difficulty breathing (which is a cat B emergency) only to find they are having a panic attack or have a sore knee (patient lie all the time to get either free drugs, attention, a free trip to hospital, etc.).
In regards to the height of a fall problem consider this. A 6 foot plus tall person falls 6 plus feet to the ground when they pass unconscious from standing - yet the person reporting won't usually think of saying they fell six feet (we're talking head impact here - not much else matter until you're falling from really big heights and can start shattering lots of bones). A very common example of misreporting from callers.
Re:More like a flaw in statistics (Score:3, Informative)
Even so, the problem I have with the single payer system isn't to do with efficiency or with the cost or with the quality of care, but with fairness and, really, liberty. You can simplify all kinds of things by making the government take care of them, but it doesn't mean that its a good idea. To take an extreme example, why go through all the hassle of comparing the prices of groceries, clothes, electronics etc etc, each store having to bill you separately, why not just take whatever you need and the stores can send the bill to a single payer - the government. Feel free to apply to everything else. What we have is a system where you pay for the services you use and you don't expect other people to pay for you (well we don't really but that would be the ideal in my view). What you have is a system where every specific individual is forced to pay for the services that other people use regardless of where that individual is using them him/herself. It's a pretty fundamental difference: in one system the individual is sovereign, in the other system the collective is treated as the most important entity and individuals are treated as interchangeable parts. In case you are wondering why there is so much anger over the health care bill in the US, it is because we seem to going further down the road toward losing that concept and a lot of people consider it to be a very valuable thing.
Re:Very misleading title and description ! (Score:5, Informative)
Because there were two things which went wrong:
1) falls from over six foot were deemed to not be that serious but also
2) a computer error (in program or configuration) caused that to override anything else.
That is, under the decisions made by the bureaucracy the rules should have said:
1) if someone has fallen from a great height it is a type A (highest class) emergency
2) if someone has fallen from a moderate height it is a class B emergency unless there is something else which elevates it to a class A
3) if someone has fallen from ground level (slipped or tripped), it is a class B emergency unless there is something else which elevates it to class A
4) if someone is having trouble breathing, it is a class A emergency
5) is someone is bleeding profusely, it is a class A emergency
(etc).
The rules as implemented by the system actually effectively said:
1) if someone has fallen from a great height it is a type A (highest class) emergency
2) if someone has fallen from a moderate height it is a class B emergency
3) if someone has fallen from ground level (slipped or tripped), it is a class B emergency unless there is something else which elevates it to class A
4) if someone is having trouble breathing, it is a class A emergency
5) is someone is bleeding profusely, it is a class A emergency
(etc).
Note the shortened version of rule 2 and why this is relevant: moderate falls were being categorized as class B even when there were other risk factors. In the example case, we had an ambulance which was on its way to treat a woman who had fallen a moderate height and was bleeding profusely. It was diverted to instead help a woman who had slipped and fallen and was having trouble breathing because the first was classified as urgency level B and the first as urgency level A. This is clearly an error in either the software code, configuration, or the use of the program (most likely the configuration, I would guess, but that's just speculation on my part).
The committee's decision was that moderate falls shouldn't automatically elevate to class A. In practice, the system was assuming that moderate falls always were class B. So something was going wrong with the program, its configuration, or its use.
Re:More like a flaw in statistics (Score:2, Informative)
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.
Actually, that *isnt* true.
We charge Americans (or their insurers more likely) for care required here while on holiday. We have reciprocal agreements in place with the rest of the EU and a few places besides for mutual free treatment of each others' citizens (eg. Aus), but we don't extend that privilege to countries which charge ours.
David
Re:More like a flaw in statistics (Score:3, Informative)
You could walk from Paris to Beijing or Johannesburg. If contiguity is the distinguishing factor, then Asia, Europe, and Africa are all one continent as well. However, they aren't. And so you are wrong. "America" refers to the USA and the USA alone. "The Americas" refers to North America and South America together. Someone from the United States of Mexico is referred to as "Mexican" just like someone from the United States of America is referred to as "American."
It's clear, unambiguous, and from my international travels, only people I've already identified as assholes every complain about it (interestingly one was an Argentinian travel companion I was with who would call himself "American" with the intent of deceiving others into believing he had US citizenship). People may complain about it, but they know exactly what you mean when you say it. But the worst are those who learned English as a second language and mistakenly attribute some rule in their native language as applying in that situation, so they essentially mis-translate into English and then proceed to declare "proper" English like they know better than a native speaker.
Re:Ambulance Service (Score:3, Informative)
Hmmm
I am sorry but that does not sound plausible. An ambulance will always be dispatched for that type of injury, it may be not always be classed as an emergency response and so may be delayed due to higher priority incidents but an ambulance will always arrive.
My mother fell and broke her hip in 2005. A neighbour heard the fall, went in to the house saw my mother on the floor and called the emergency services, the neighbour then rang me.
I left work, got on my motorcycle and did a high speed dash from my place of work to my mothers house (about 15 miles on the motorway), luckily there were no police on that portion of it. By the time I arrived at my mothers, the ambulance had arrived, had assessed her and were in the process of transferring her to the ambulance.
The NHS has a number of problems, but I have never known the ambulance service to out-right refuse to attend a scene. Mistakes can and have been made by dispatchers wrongly categorising injuries, but generally elderly people that fall are classed as high priority regardless of the symptoms.
Re:More like a flaw in statistics (Score:3, Informative)
Making shit up isn't helping anything.
Re:More like a flaw in statistics (Score:1, Informative)
I can tell you that that kind of talk will mark you unambiguously as a huge asshole anywhere outside of the USA.
I don't care if you call yourselves "Americans", it's just the most sensible abbreviation for a poorly named country. I avoid the term, but I don't think anybody uses it out of arrogance. It is what it is. However, I do understand why the rest of us in America (the continent) and others around the world find it almost offensive.