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.'"
Not a flaw in the system (Score:5, Insightful)
The system itself wasn't flawed, but rather whoever set it up decided that they should be category B. The system did exactly what it was told, it just was told to do something different than in the US, and something that was later deemed to be suboptimal.
I don't understand (Score:5, Insightful)
How is this a flaw in the Emergency Response System if the change initiated by a government committee is how the incidents were classified wrongly?
Re:Not a flaw in the system (Score:5, Insightful)
Re:I don't understand (Score:3, Insightful)
The article is a bit vauge but my reading of it is the flaw was that the system along with instructions given to staff combined to give a situation where the response was detemined by something other than the worst thing the staff member was told about.
That is someone with just the fall should have been class B but someone with the fall AND other issues could get misclasified as class B when they should have got a higher class from one of the other issues (in this case the person was unconscious and had breathing problems).
Re:More like a flaw in statistics (Score:5, Insightful)
It seems that the software downgraded to category B if the fall was larger than 6 feet regardless of other (category A) factors.
e.g., the patient has been shot and stabbed and drowned and fell 8 feet so it's a category B now.
That is a fault in the software.
Re:More like a flaw in statistics (Score:5, Insightful)
The summary sounds like "we underestimated how dangerous a medium distance fall can be
Obviously the committee didn't include anyone with medical training. I am a physician and we know that even falling your own height can produce life-threatening injuries. But of course why should a government committee do anything as mundane as seek professional medical advice?
The point (Score:5, Insightful)
I think that the comments I have read above me are missing the point, or maybe I am.
The software was changed so that falls of more than 6 feet no longer caused a case to be considered "category A", the problem is that (through a mistake when rewriting that bit of code I assume), mention of a fall was causing a case to be considered "category B" even if other things were present that would normally have made it "category A".
Re:More like a flaw in statistics (Score:4, Insightful)
The British aren't really Europeans. Socially, they're much more like Americans than they are like those from the Continent.
Government Committees, I need more please (Score:1, Insightful)
Dangers of technical rationality (Score:5, Insightful)
You're right: it isn't a flaw in the software per se, and I would not assign any blame to those who developed it (as opposed to those who implemented it).
However, it is a predictable of administration, and the use of information technology is often integrated into systems in just this way. The idea that risk can be rationalized and reduced to a number (class A, class B, and so on) is itself potentially dangerous. Though it is not necessarily dangerous in any particular situation, it is nevertheless predictable that administrative or technical rationality would make this kind of outcome more common.
You see, the problem was not simply that the response categories were incorrect. The problem was that the system (including its operators, operating procedures, and so on) was too rigid, too rationalized, and therefore unable to respond to unexpected events:
This kind of event was clearly unexpected by the systems implementors. But even if they had assessed the danger of falls differently, there is likely some other event that would fall outside the systems parameters. (Most falls probably should be category B events, not category A.) That's why you want to have human judgement and human overrides.
Treating a system in terms of independent technical components has a number of benefits, including efficiency. That's what happened here. The process was rationally divided into tasks for the humans and tasks for the computer. Nice, neat, clean: and likely to produce outcomes like this.
Re:The point (Score:3, Insightful)
Re:Lie (Score:3, Insightful)
Re:More like a flaw in statistics (Score:4, Insightful)
This is not a issue with socialised medicine, Its an issue with bureaucrats not listening to the experts. Same kind of thing would happen if medical care was completely privatised.
here's my beef (Score:4, Insightful)
Re:More like a flaw in statistics (Score:4, Insightful)
And yet, the 'rationed' socialist healthcare here in Britain is still a metric fuckton better than what you get in the US.
There is an important lesson to be learned- some people really are so stupid that they'll believe ridiculous scaremongering rather than risk having to re-examine their exiting ideology.
Re:More like a flaw in statistics (Score:5, Insightful)
The point is this: the software was written in the USA, and it murdered peaceful and enlightened Europeans.
The point is actually this: the software was written in the USA, but the Europeans had to go and dick with it thereby murdering the people that elected the retards who decided to perform the aforementioned dickery.
Re:More like a flaw in statistics (Score:3, Insightful)
Don't be surprised - accurate information about the US has never been a priority in Europe.
Order of Operations (Score:2, Insightful)
Re:Carol Beer was not a Satire (Score:5, Insightful)
Caller: Please hurry!! He's fallen down a 30ft well! Can't you get here any faster!?
A&E Drone: *clackety clackety* ...... Computer say Nooooo....
Caller: Well then I'm going to get my gun and put him out of his misery.
/If that doesn't bump you up to the highest priority, nothing will.
Re:More like a flaw in statistics (Score:1, Insightful)
The software worked fine until the government committee fucked with it. These people are bureaucrats, not doctors, not programmers, this change was undoubtedly necessary only to justify the continued employment of these otherwise useless people.
The software was fine, the fault was with the government. ... and perhaps a small amount for the emergency controllers who didn't recognize an urgent situation when they heard one, regardless of what the computer was telling them. It is also possible that the software wouldn't let them override the automatic priority, the summary didn't say, which I would point back at that committee until proven otherwise.
Re:here's my beef (Score:3, Insightful)
What kind of mad skills and knowledge are you expecting of a person being paid, on average, less than US$16.00 per hour?
Will you expect them to be able to diagnose illness and injury over the phone? A medical degree?
What happens if the dispatcher gets it wrong?
Re:Why does fall distance matter so much? (Score:3, Insightful)
The ambulance will only take you to the hospital. If the trip was deemed unnecessary and avoidable (or under false pretences), then you'll receive a sizeable invoice in the mail.
'Free' healthcare is not the bogeyman you think it is. Just because you don't become forever crushed by unrecoverable debt doesn't mean it's a free-for-all wanton orgy of people abusing the system.
Re:More like a flaw in statistics (Score:2, Insightful)
If you wait 13 hours to be diagnosed with life threatening conditions then the triage system has failed.
The US system "works" for the rich (and even then, not always - your insurance company decides when you are too expensive to treat) at the expense of the poor.
You get healthcare at the expense of those less fortunate than yourself, which doesn't sit well with me at all. It's also *absurdly* expensive, even before you factor in the private insurance cost - the US spends twice as much of its GDP per capita on the system it has compared to the UK.
Even Sarah Palin has to duck across the border to canada to afford medicine.
Re:More like a flaw in statistics (Score:4, Insightful)
Oh I'm fully aware that the French, Ausies and even Canucks have better social healthcare than the UK. I am all too aware - I live with the system. It is still infinitely preferable to the US system.
It is recovering from 20 years of neglect under a tory government in the 80s that could not outright kill it (that would be political suicide) but could starve it to death and turn it into a total mess. It is a mess that it has still not recovered from, many, many years later.
It is in serious need of fixing, but it is still in better shape than the US.
It has numerous flaws, and has the "media frenzy" cases that make sensational headlines (like the current one, even though it happened a year ago and has been fixed already - just politically convenient to run the story now), but at its heart it is a very effective system that keeps the UK populace healthy. Most importantly, it provides care for everyone equally for the cost of NI contributions. No one in the UK has to worry about medical bankrupcy, or have to deal with situations where an insurance company overrides your doctor's treatment decisions.
Incidentally, the UK also has a private healthcare system that its citizens are free to participate in if they like, if they feel the NHS cannot provide for them.
Re:More like a flaw in statistics (Score:5, Insightful)
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.
You see such cases on TV, because a person not getting the healthcare they need under a socialized healthcare system makes for a great story (= attracts viewers). When a person does get all the healthcare they need, it's system working as intended, which doesn't make a great story.
I mean, what exactly do you expect - daily headlines along the lines of "NHS provides heart surgery for patiena in need"?
Also, I wonder how many such cases are there in practice, in proportion to the total population count. Or, better yet, how many people die in UK vs US because of not receiving healthcare that they needed for any reason (waiting lists or unavailability in UK, inability to pay in US, etc). That would be a much more interesting statistic.
Re:More like a flaw in statistics (Score:3, Insightful)
Actually it actually sounds like they screwed up when they altered the parameters.
Instead of raising the threshold for a Cat A response from 6 feet to say, 8 feet, they set an exclusion which said "if the fall is greater than 6 feet, set to Category B".
There is a huge difference between the two. In the first instance, extenuating factors (a knife wound, abnormal breathing, etc) will always bump the Category up despite the height of the fall. It could be four feet or ten feet, it wouldn't matter. With an exclusion, however, ALL falls over 6 feet, regardless of extenuating factors, will always be bumped down to Cat B.
The fault lies squarely on the people who modified the system, and that was driven shortsightedly by this governmental committee.
More to the root problem, though, why the hell would they alter the well-established criteria for a dangerous fall to reduce the load on their ambulance network? Why in god's name didn't they get more frickin ambulances?!
All I can say is, welcome to government managed health care, where the least important person in the system is the patient.
Re:More like a flaw in statistics (Score:1, Insightful)
I originally modded you as informative, since you explained the problem very well. Now I'm posting to undo it since you managed to fit a 'government is evil' rant in there.
I call bullshit (Score:3, Insightful)
Re:More like a flaw in statistics (Score:3, Insightful)
Same kind of thing would happen if medical care was completely privatised.
Wrong, you get the same thing if medical care was completely monopolized.
Private or government, only a monopoly can have the kind of bureaucracy that consistently creates these kinds of decisions. You don't see this stuff happen in independent hospitals with lots of competition - the drive in such cases is always to provide better service at lower cost. If service drops off too far people go to another hospital. If the price drifts too high people go to another hospital. This dynamic creates the optimum price to service balance possible, and the result is premium hospital care.
Monopolies, whether governmental or private, destroy this dynamic and you end up with mind blowing decisions like "Even though we know falls over 6 feet are potentially life threatening and require immediate care, in order to save money we are lowering the priority of such cases." All it takes now is for someone to fuck up the logic and suddenly ALL cases of falls over 6 feet are given low priority, no matter how high and no matter how hurt the person is.
What's bad is not really the mistake, it's easy to see where they went wrong, and in a more competitive system someone would have fixed the problem as soon as it came to light (the first hospital will fix it in order to gain an advantage over their competitors, the rest will have to follow suit to stay competitive). What's bad is the government has known about it for the last 10 years and didn't do anything to fix it! Instead a little over half the Trusts manually over-ride such cases. It took an inquiry into the health department by someone who happened to know how the system was supposed to work to get the damn thing fixed!
So yes, the bureaucrats caused the problem, but the only reason they exist to cause the problem is because it is a monopoly, which tends to create such maddening bureaucracies to sustain itself.
Re:More like a flaw in statistics (Score:3, Insightful)
in fact if you're a physician I'm sure you've run into some.
No comment, because everyone eventually makes mistakes including myself. No one is perfect, yet somehow society demands perfection from its doctors. Fat chance.
However a real (substitute the word competent if you prefer) physician would ALWAYS give a trauma patient the benefit of the doubt when receiving a phone call saying that the patient has "fallen 3 feet and can't/won't get up". NO (competent) physician would say "oh, it doesn't matter it's not that high it can wait". Every physician would suspect some sort of life threatening condition first - to be RULED OUT - and then work towards diagnosing more benign problems. I fail to understand how a committee which includes (competent) physicians would expect a telephone operator following a script no more sophisticated than one used in an Indian call center to be able to take correct medical decisions when the same physicians would be hesitant to take the same decision on the phone - out of concern for a fellow human being or perhaps out of concern of being held professionally liable and literally having their "asses sued off".
I suspect that this has more to do with limited funding, limited resources and decisions based upon (incomplete) statistics. However one has to think about governments taxing a percentage of income (income tax), a percentage of every single transaction (sales tax/VAT), and any number of other creative direct and indirect taxes being unable to provide sufficient funds for life-saving services and yet somehow being able to fund any number of dead-end pet programs (commonly known as "pork") and unnecessary bureaucracy. I'm sure it exists in the UK too.
Re:More like a flaw in statistics (Score:5, Insightful)
UK - "The most critical emergency calls, referred to as "Category A" calls, have a response time requirement of eight minutes and zero seconds, with a 75% compliance requirement, and the additional stipulation that 95% of these calls must be reached within 14 minutes in urban areas and 19 minutes in rural areas. "
US - "For life-threatening emer-gencies, providing a transport-capable unit within 8:59 with 90% reliability is the most common urban benchmark. Common rural and wilderness benchmarks are within 15/90% and 30/90%, respectively."
So, comparatively the two countries are similar in numbers. UK is arguably a bit behind, but if you've ever been to both cities it is obvious why. The US was designed for cars, the UK for people or carriages in many parts. In any-case it is insulting to say that they are behind due to government negligence. And this is just talking about ambulance response times, in many other metrics the UK is far far ahead with their socialized healthcare. So please refrain from the rhetoric. I think we can all agree we have enough of that already.
Re:More like a flaw in statistics (Score:5, Insightful)
How strange. When I turn on the television, there always seems to be some American family who lost their house, had to declare bankruptcy and move in with friends or family after their greedy, captialist insurance provider dropped them because of a "pre-existing medical condition."
Re:More like a flaw in statistics (Score:4, Insightful)
It's not though, that's a myth. Survival rates for most major diseases are much higher in the US than in the UK. For example cancer: http://i.telegraph.co.uk/telegraph/multimedia/archive/00643/news-graphics-2007-_643378a.gif [telegraph.co.uk] For certain types of cancer the gap is much greater. For heart attack, 30 day survival is much higher in US as well, can't find a nice graph. It all depends on what you compare. Most generalized comparisons of health systems by country you see, such as WHO's, place a very high emphasis on access so a country with universal access can appear high on the list but in reality the health care may be very poor, just equally poor for everyone. So you get absurd things, such as Costa Rica or Morocco being above the USA. Btw, since you are such a big fan of NHS, would you go to for example Malta, Greece, Portugal or Oman for health care? They all rank above UK.
The system in the US is still crap, just not sure that moving towards NHS types system is going to improve it. Taking the government out and allowing real competition might.
Re:Very misleading title and description ! (Score:0, Insightful)
Neither one of those statements is misleading. Consider the headline: Flaw In Emergency Response System May Have Killed Hundreds
The "system" is the entire process, not just the software, and it was a flaw in the system.
The first sentence was even more clear: a flaw in the way [the software] was set up
Note that it doesn't say the error is in the software, it's in the way the software was configured.
Reading is fundamental.
It's not a bug... (Score:3, Insightful)
Re:More like a flaw in statistics (Score:1, Insightful)
Versus the US system where the least important person in the system is, uh, the patient!
The most important being the CEO of the insurance company of course.
Re:More like a flaw in statistics (Score:3, Insightful)
Re:More like a flaw in statistics (Score:3, Insightful)
Dear USA:
I support Canada's comment. I am in America too. No,the isthmus/Canal of Panama do not count to divide the continent. America still goes from Canada to Tierra del Fuego.
Sincerely,
Argentina.
Re:More like a flaw in statistics (Score:2, Insightful)
Sure, it is pointless to go back and forth like that. My only comment is that the internets are full of Americans begging for charity as the bank repossesses their house to pay their health bills. That is practically unheard of anywhere else. I don't think there is any justifiable claim that outcomes at the 'top end' of town are comparatively better in the USA either. Anyway, for those who can afford to pay, for most nation's health systems they can always go to a private doctor or hospital. This is certainly true in the UK.
Re:More like a flaw in statistics (Score:3, Insightful)
Jo-Ham, until this point I was going to write you off as a typical international victim of the echo chambers of Digg, Reddit, etc.
But after this: "Even Sarah Palin has to duck across the border to canada to afford medicine." you reveal yourself as an absolute partisan hack out to score worthless political points rather advance any sort of debate.
To those who don't know, in 1957 when Sarah Palin was a child living out in the middle of nowhere her father took her brother over the border once because they couldn't get out of their town by road or plane to the nearest Alaskan hospital after he burned himself. The train went over the border so they went with it.
It's *disgraceful* that you try and portray that in the way that you have here; as though recently she went over and that it was a matter of cost. You are disgustingly void of anything resembling intellectual honesty, this is the level of "discourse" in the political left at present and it SUCKS.
Re:More like a flaw in statistics (Score:3, Insightful)
Guess you read the NYTs version.
Re:More like a flaw in statistics (Score:4, Insightful)
Well! There is somebody who believes the basic assumptions of an outdated economic dogma can be applied to all areas of life. Here are a few ideas to ponder over....
1. Do people and companies react in a sane rational way, especially when it comes to healthcare?
2. Are you aware that large free markets have been proven to be disconnected from what is called "the fundamentals"?
3. Is a person or company acting in what is in their best interest always acting in the interests of the whole community?
4. Have you ever heard of game theory [http] or the prisoner's dilemma [wikipedia.org]?
5. Can we expect everybody patients have access to all information, allowing them to act rationally, or will they be making decisions on incomplete information?
And for some more direct questions:
1. Would it not be in a hospital's best interest to only admit "nice and easy" cases, and turn away 'hard cases', to help their statistics look good?
2. Why do the foreign quacks selling Cancer treatments and fake stem cell therapies not go out of business?
3. Homeopathy still attracts dollars, even when it doesn't actually work. Why?
You need to read more advanced economic theory...
Re:More like a flaw in statistics (Score:2, Insightful)
1. Do people and companies react in a sane rational way, especially when it comes to healthcare?
No. But government officials are people too and, in theory at least, respond (albeit imperfectly) to the demands of their constituants, who are even more irrational when it comes to politics than in market settings (see Bryan Caplan' s The Myth of the Rational Voter . The issue is not whether individuals always make good decisions. The issue is whether individuals typically make better decisions about their healthcare than a central planner.
Also, it is probable that the current system encourages people to be irrational. I.e. they are rationally irrational. If you don' t have to foot the bill (because the governement/your insurance company) pays for your healthcare, why shouldn' t you ask for this very expensive treatment that only has limited benefits?
2. Are you aware that large free markets have been proven to be disconnected from what is called "the fundamentals"?
It's very hard to prove such a thing and depends on what you include in " the fundamentals". If, for instance, a housing bubble is fueled (among other things) by misguided government policies, is it disconnected from the fundamentals? Or is it that market participants were reacting to then-present incentives and then-valid assumptions? Once again, if large free markets can be wrong (investors are not prescient, market value is only a best-guess), so can large government.
Ex post, it is easy to see how market value did not reflect the fundamentals. Ex ante, how do you suggest we identify bubbles? If it were that easy, then, by definition, there would not be a bubble as investors would exploit this profit opportunity.
Is a person or company acting in what is in their best interest always acting in the interests of the whole community?
No. The same remarks however applies to governement officials. The question is whether there is more accountability in the political or economic market. I believe that feedback is more direct and more accurate in the economic arena. If a product does not sell well, it can be easily killed. If you don't like a particular political decision, what do you do? The average congressman probably votes on thousands of policies every year. Maybe, on balance, you like the incumbent more than the challenger and you' ll still vote for him even though you disagree with many of the policies that he supported.
4. Have you ever heard of game theory [http] or the prisoner's dilemma [wikipedia.org]?
Have you ever heard of Public Choice?
5. Can we expect everybody patients have access to all information, allowing them to act rationally, or will they be making decisions on incomplete information?
There are always information asymmetries. Taken to its logical extreme, your argument should lead us to disenfranchise patients. Doctors should make decisions for them and pooh-pooh their concerns which, by definition, would be illegitimate.
Do note that most people don't know much about computers, cars, clothes, etc. Yet, there are functionning markets for all these things. When you don't know much about a field, you don't purchase things at random. You rely on other people's advice (e.g. Consumer Reports, what your more-knowledgeable friends advise you to do, etc.).
If people make spectacularly bad decisions about health care, I'd rather it be with their money (which should make them think twice about making unecessary expenses) than with mine.
2. Why do the foreign quacks selling Cancer treatments and fake stem cell therapies not go out of business?
Because there will always be a minority of people who can be defrauded of their money. Which is why fraud and false advertising are illegal. Once again, the question is whether the vast majority of people can make good decisions about their health, n
Re:More like a flaw in statistics (Score:3, Insightful)
Umm I hate to interrupt your long page of WRONG (and your little faux-outrage at the end) but tourists in Australia are most definitely NOT covered by Medicare - unless there is a reciprocal agreement with their home country.
From immi.gov.au:
Health Insurance
Medical treatment in Australia can be very expensive. As a tourist, you are not covered by Australia's national health scheme, unless there is a reciprocal health care agreement between Australia and your country. Health care for visitors to Australia is explained on the Medicare Australia website.
See: Medicare Australia Health Care for visitors to Australia
It is recommended that you take out health insurance for yourself and your family for the duration of your stay in Australia. You may be asked to provide evidence that you have health insurance or adequate funds to pay for emergency medical treatment while in Australia in order to satisfy the financial requirements for this visa.
Secondly regarding "the hospitals/doctors themselves are still private enterprises", the private hospitals here are PRIVATE and don't accept Medicare you require insurance or cash. The state run hospitals are run by...you guessed it, their respective states, employees of such are employees of the state government. Many work for both writing off their public system work as charity and recouping their uni fees / eight years of education in the private system. Is ignorance of your own healthcare system a must before posting long self righteous rants?
How embarrassing for you, in front of all these people as well.
But such is the level of discussion about National healthcare, page upon page written condemning the US and espousing the greatness of ones own countries system all of which is completely and utterly *wrong* and that's before you even reach the bit about the US's system.
Now I wonder if you'll be modded down now that you have been proven to be absolutely wrong, or if your spiel suits the political leanings of some around here enough to stay at +5 even though it's an absolute fantasy.
Re:Very misleading title and description ! (Score:2, Insightful)
DailyKOS trolls have mod points today I see.
Re:More like a flaw in statistics (Score:4, Insightful)
The software was almost certainly designed to be configurable, because having a fixed classification scheme would defeat the point of such system in the first place. Configuring a configurable system is not "messing with it".
The people who decided on the emergency response priorities were almost certainly medical professionals - maybe doctors, but quite likely also something more specialized. Emergency response statistics is a field of its own. People with an education in it would be in an uproar if random bureucrats decided issues like these. If you want to claim they let anyone mess with it, the burden of proof is on you.
(mandatory xkcd: Long light [xkcd.com])
I wish slashdot mods would see that you're not insightful just because you're blindly bashing government.
Re:More like a flaw in statistics (Score:3, Insightful)
Over here we have this thing called the Constitution that explicitly restricts what the government can do. But that doesn't seem to matter much to people anymore.
So long as the pet cause of the Administration is achieved, fuck the Constitution.
Re:More like a flaw in statistics (Score:4, Insightful)
Possibly more importantly, where is the feedback mechanism? (The continuous integration equiv?)
Does an A&E triage nurse confirm/alter the categorisation and is it used to improve the system? Or do we blindly assume what we have is right until The Telegraph prints something?
Sadly I believe the answer is (b).
Justin.