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: (Score:2, Interesting)
It is worse than that actually. The operators were prohibited in upgrading the priority manually. The emergency services just trusted the computer program.
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: (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.
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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
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: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.
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Making shit up isn't helping anything.
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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)
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: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?
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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.
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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.
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The US medical system isn't really even in a position to
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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
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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)
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
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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
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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.
Re:More like a flaw in statistics (Score:4, Funny)
The British aren't really Europeans. Socially, they're much more like Americans than they are like those from the Continent.
It's the other way round actually. Americans (or the subset in the US, and a bit in Canada, rather) are much like the British and therefore aren't very European because the British refuse to be since they are after all 20km away from the continent. :)
The same continent they kept trying, sometimes successfully, to invade, during the last thousand years. Now they just send us their pop singers while acting rude in their trash newspapers.
We still enjoy going for a visit though because they have fine beers
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Nice FUD there... but actually, the British selected a lower category than the default for that situation, according to the summary.
Note:
Also,
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:5, Funny)
...and we have a Queen you may have heard of [wikipedia.org].
Please be Elton John...
Please be Elton John...
Please be Elton John...
AWESOME!
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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.
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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
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: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: (Score:3, Interesting)
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.
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: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.
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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
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...
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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.
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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.
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.
I call bullshit (Score:3, Insightful)
Re:More like a flaw in statistics (Score:5, Interesting)
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?
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Re:More like a flaw in statistics (Score:4, Interesting)
Sound like that could be the case. You can't buy a kidney in the U.S. You can in India.
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: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: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:More like a flaw in statistics (Score:5, Interesting)
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.
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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 o
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.
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Your insurance company however, can still do ridiculous things to you if you were taken to a provider they don't cover, etc.
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Don't be surprised - accurate information about the US has never been a priority in Europe.
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Oh I know, I should have added a (/generalisation) tag - I know a US ambulance will take you to the closest ER, but the GP's description of how this one flaw (that happened a year ago, and was fixed last year, months before the article) shows what would happen if "Obamacare" passes is just senseless hyperbole.
There are a great deal of things wrong with the US system, but my post was (mostly) hyperbole of my own.
Re:More like a flaw in statistics (Score:4, Funny)
ambulances don't run on good deeds and angels wings.
They would if those gosh darn republicans would just get out of the Obamassiah's way!
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Last time I had a ride in an ambulance nobody asked me if I had insurance... only what hospital was preferred.
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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 U
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.
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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 cou
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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.
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Guess you read the NYTs version.
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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.
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.
Re:Not a flaw in the system (Score:5, Insightful)
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Re:Not a flaw in the system (Score:5, Funny)
Mod parent up. What we should be reading is a headline that says Great Britain Death Panel Doing Bang Up Job.
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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.
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?
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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
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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 i
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.
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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
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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.
Carol Beer was not a Satire (Score:5, Funny)
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....
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:Carol Beer was not a Satire (Score:5, Funny)
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)
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.
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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.
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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
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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
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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 p
Government committee (Score:2)
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".
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Slylandro probe (Score:4, Funny)
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)
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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
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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... (Score:2)
May have killed hundreds...
May also have killed nobody.
How sensational!
Re:May have... (Score:5, Interesting)
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.
0118 9998 8199 9119 725 3 (Score:4, Funny)
Order of Operations (Score:2, Insightful)
More evil than alternative? (Score:2)
A 6 foot fall (Score:3, Funny)
What's that in meters?
It's not a bug... (Score:3, Insightful)
Barry Schwartz on our loss of wisdom (Score:4, Interesting)
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.
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If you tell the emergency dispatcher that some property was damaged by the person falling head first down the stairs they will send the police right out to arrest them, so maybe they will get some medical attention that way.
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If its not a life critical, time sensitive emergency, don't call 9-1-1, or 9-9-9 or whatever the emergency number might be!
Sadly, you're assuming at least a semblance of rationality in a country where people will call 9-9-9 for an ambulance because they're too lazy to walk across the road to the hospital, or because they're drunk and want a ride home (read some of the British paramedics' blogs for even better stories).
That's what happens when you promise everyone 'free' healthcare... if it's free, why would you bother to walk or pay for a taxi?
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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.