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Communications Government Medicine United Kingdom Science

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.'"
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Flaw In Emergency Response System May Have Killed Hundreds

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  • by selven ( 1556643 ) on Sunday March 21, 2010 @07:57PM (#31562066)

    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: (Score:2, Interesting)

      by Anonymous Coward

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

    • by Anonymous Coward on Sunday March 21, 2010 @08:09PM (#31562186)

      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: (Score:3, Informative)

        It's not clear from TFA whether it was a change in the software, or in parameters to the software that were changed. What is clear is that in the case used to highlight the problem, dispatchers were bound by policy not to override the software's recommendation, even if they knew it was wrong:

        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: (Score:3, Insightful)

        by Bigjeff5 ( 1143585 )

        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

        • by Idiomatick ( 976696 ) on Sunday March 21, 2010 @10:34PM (#31563258)
          Clearly the coders or whoever set it up that way fucked up. And you had me until the anti-government rant. Driving any vehicle at high speeds comes with danger so there are good reasons to lower the category. (Hong Kong has only 1 category and stats show that this is a shitty plan). Likely that they modified the system based on new information, incredibly well-established facts aren't always true.

          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.
    • by Dunbal ( 464142 ) * on Sunday March 21, 2010 @08:10PM (#31562212)

      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?

      • by nomadic ( 141991 )
        Obviously the committee didn't include anyone with medical training.

        I don't think that's obvious at all. I would guess the committee did include such doctors, but it's possible none of them had sufficient training in trauma response. Or maybe they're just incompetent. There ARE incompetent physicians you know, in fact if you're a physician I'm sure you've run into some.
        • Re: (Score:3, Funny)

          by nschubach ( 922175 )

          Either that or they put a bunch of bureaucrats and accountants in control of the money and they needed a measure to determine how to spend said money... you know, the stuff they keep telling us won't happen.

          • Re: (Score:3, Informative)

            by timeOday ( 582209 )
            I hate to tell you this, but only "bureaucrats," meaning a centralized comittee such as the one in this story, could ever access enough statistics and have a regimented enough procedures to even determine something like this. A physician practicing on the basis of his personal experience would never have a clue whether one class of accidents turns out to have a few more or less deaths than another when averaged over thousands and thousands of cases.

            The US medical system isn't really even in a position to

        • Re: (Score:3, Insightful)

          by Dunbal ( 464142 ) *

          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) physic

          • Re: (Score:3, Interesting)

            by Gnavpot ( 708731 )

            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

          • Re: (Score:3, Interesting)

            by HungryHobo ( 1314109 )

            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

          • Re: (Score:3, Interesting)

            by AK Marc ( 707885 )
            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
    • by jythie ( 914043 )
      I would not even call this a flaw in a 'parameter' but in government process of assigning priorities. Bureaucracy kills again.
  • by Raptoer ( 984438 ) on Sunday March 21, 2010 @07:59PM (#31562086)

    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)

    by zappepcs ( 820751 ) on Sunday March 21, 2010 @07:59PM (#31562090) Journal

    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: (Score:3, Insightful)

      by petermgreen ( 876956 )

      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 bre

    • by Geof ( 153857 ) on Sunday March 21, 2010 @08:16PM (#31562264) Homepage

      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?

      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:

      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.

      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: (Score:3, Informative)

        by Anpheus ( 908711 )

        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 fini

      • The idea that risk can be rationalized and reduced to a number (class A, class B, and so on) is itself potentially dangerous

        Of course. A two metre fall on to my feet would do little or no damage to me. A fall on to my head on the other hand would do a lot of damage.

        A plumber I had working at my place fell three metres on to his feet but the salient point I passed to the ambulance operator was that he wanted to sit up but experienced great pain when he tried.

  • 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....

    • by TubeSteak ( 669689 ) on Sunday March 21, 2010 @09:08PM (#31562668) Journal

      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.

      • by WillDraven ( 760005 ) on Sunday March 21, 2010 @09:31PM (#31562826) Homepage

        A friend of my dad's garage had been broken into several times. One night he heard the guy breaking in and called the cops. The dispatcher said nobody was available right then and he'd have to wait. He hung up the phone, waited a minute and then called back and said "You can take your time, I shot him." and hangs up.

        A minute later 3 cop cars come screaming up and catch the thief trying to run out the garage. The cops talked to the homeowner and said "We heard that you'd shot him."

        He responded "And I heard there was nobody available!"

  • Ambulance Service (Score:3, Interesting)

    by lymond01 ( 314120 ) on Sunday March 21, 2010 @08:10PM (#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 jo_ham ( 604554 )

      If that actually happened as described, then the dispatch centre was grossly negligent, or the information provided by the person calling initially led the dispatcher to determine that it was non-life threatening.

      Regardless, ambulances are routinely dispatched for non-deadly situations - which is the point of the categorisation that led to this article in the first place. Alternatively you can phone your GP and arrange an emergency home visit from whoever is on call for that, out of hours.

    • Re: (Score:3, Interesting)

      by Cassini2 ( 956052 )

      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 h

    • Actually, hip fractures are quite common for old people. They often break when the person is standing up from a sitting position, which used to be mis-diagnosed as "fell when getting up". Some of the relevant data is described at http://www.pnas.org/content/102/41/14819.abstract [pnas.org]. And from experience with some old relatives, as long as they're splinted and the leg supported in the most comfortable position for that person, it's quite surprising how calm they can be about it. So I suspect that "hearing the sc

    • Re: (Score:3, Informative)

      by Faluzeer ( 583626 )


      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 p

  • "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." I just have to wonder, what was the make-up of this committee? Was it bureaucrats, or actual medical and emergency response professionals, or a combination of the two? What was the justification and evidence used to determine the likelihood of cases such as these to be life-threatening? If I lived in England, I
  • The point (Score:5, Insightful)

    by kdcttg ( 980465 ) on Sunday March 21, 2010 @08:11PM (#31562220)

    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: (Score:3, Insightful)

      by socsoc ( 1116769 )
      I'm with you... I am thoroughly confused about the newsworthiness of this aside from that Hugh Pickens submits tons of stories.
  • by Kev Vance ( 833 ) <kvance@kvanceTIGER.com minus cat> on Sunday March 21, 2010 @08:18PM (#31562270) Homepage

    Is anyone else reminded of Star Control 2? The "peaceful" Slylandro probe... which was misconfigured with bad priorities.

    Captain: Your probe DOES destroy ships and I can prove it!
    Slylandro: No! It cannot! It is not programmed for hostile behavior! What is your reasoning?!
    Captain: Think about what a probe does when it meets a ship.
    Slylandro: Space ships are the probe's highest priority because we want more than anything to make friendly contact with alien races.
    Captain: Think about a probe's Replication behavior.
    Slylandro: The probe seeks raw materials, and processes them in preparation for Replication.
    Captain: Think about the effect of changing the replication behavior's priority.
    Slylandro: The answer is simple... it would spend more of its time seeking raw materials for its replication process. So what?
    Captain: Now, what will it do to a ship, given that its Replication priority is set to maximum?
    Slylandro: I don't see what you are getting at, but I'll play along with you.
    Slylandro: Like I said, alien ships are THE top priority target. Once a probe scanned a ship, it would instantly move toward it. Then, when it got to the ship, it would initiate communication automatically. When communications were terminated, a new behavior would be selected, and...
    Slylandro: Uh-oh.
    Slylandro: A new behavior would be selected, and since the Replication setting was set to maximum the probe wouldn't get time to pick a new target... it would use the current target--the ship--for raw Replication materials. It would process the ship, break it into component compounds with electrical discharges.
    Slylandro: Oh no! what have we done? Traveller! You must tell us what we can do! How can we stop the probes from destroying all life in the galaxy?!

  • here's my beef (Score:4, Insightful)

    by timmarhy ( 659436 ) on Sunday March 21, 2010 @08:21PM (#31562298)
    Shouldn't the 911 operator taking the call be well trained enough to know what's life threatening and whats not? this culture of "the computer will do the thinking for us now" needs to stop.
    • by jo_ham ( 604554 )

      Yes, they are - and they can override the automatic priority set by the computer based on the information they receive and their own judgement. They also will stay on the line and talk a caller through vital life saving steps while the ambulance is on its way. They are remarkable people, far from the "computer says noooooo" drones that your "culture" seems to suggest.

      Of course, they are human and sometimes make mistakes, or are sometimes sub-standard at their jobs, but the vast, vast majority are a credit t

      • so why is it a problem that the computer had a bug in it's logic? or is this just more wozerism from online meia?
    • Re: (Score:3, Insightful)

      by DaveV1.0 ( 203135 )

      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?

  • May have killed hundreds...

    May also have killed nobody.

    How sensational!

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

      by jo_ham ( 604554 ) <joham999@gmPERIODail.com minus punct> on Sunday March 21, 2010 @08:53PM (#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.

  • by Anonymous Coward on Sunday March 21, 2010 @08:31PM (#31562382)
    At least the Brits can be credited for the genius of their new number and catchy jingle. Oh one one eight, nine nine nine--eight eight one nine nine, nine one one nine seven two five! .... three.
  • by Vexo ( 825223 )
    Besides the questionable decision regarding the severity of a 6 foot fall, the flaw here seems to be the order in which the conditions were evaluated when determining which category should be assigned. It sounds like when they made the modification, they introduced a bug where a 6+ foot fall would force the call into category B, ignoring other serious condition entries that should have forced it into category A by themselves.
  • It seems that what is lacking is the ratio ( deaths in mode X / deaths in mode Y ). So if they change it to category A and something else becomes category B by falling off the end, what death toll does that have and do they even know?
  • by PPH ( 736903 ) on Sunday March 21, 2010 @09:34PM (#31562852)

    What's that in meters?

  • It's not a bug... (Score:3, Insightful)

    by Hawthorne01 ( 575586 ) on Sunday March 21, 2010 @11:10PM (#31563460)
    ... it's a feature! Now victims of falls from more than six feet can die at home, rather than in the horrible NHS-run hospitals!
  • by epine ( 68316 ) on Monday March 22, 2010 @01:04AM (#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.

Successful and fortunate crime is called virtue. - Seneca