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Flaw In Emergency Response System May Have Killed Hundreds
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.'"
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.
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.
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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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....
May the Maths Be with you!
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.
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".
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.
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?!
F0 07 C7 C8
The whole point of the article is that the logical failure in the system would cause it to consider the crocodiles basically harmless because the fall was greater than six feet.
# cat
Damn, my RAM is full of llamas.
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.
If you mod me down, I will become more powerful than you can imagine....
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.
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.
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.
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.
How could such an audience miss this opportunity to quote Python (Monty)!
What's that in meters?
Have gnu, will travel.
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?
Muchas Gracias, Señor Edward Snowden !
There weren't resources in American hospitals to tread them promptly enough to prevent permanent disability? Which hospital? What insurance plan? What was the illness?
... 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!
"Only two things are infinite, the universe and human stupidity, and I'm not sure about the former."
I've worked as a Paramedic under the Advanced Medical Priority Dispatch System (AMPDS).
Whether you are given a Cat A or B generally makes no difference in the response time of the crew to the scene - i.e. they always drive as fast as they safely can no matter what the emergency.
Incorrect triage by the communications centre is routine. This is usually not the comcen's fault - it is almost always incorrectly reported information from the caller. Things like whether there is a pulse or not, whether they are breathing or not, whether they are bleeding or not, are often incorrectly reported from panicky callers.
Or you can get correctly triaged responses with totally different results. You might get a call saying a patient has severe gastric pain which ends up being a myocardial infarction.
You might get a call from a patient with severe difficulty breathing (which is a cat B emergency) only to find they are having a panic attack or have a sore knee (patient lie all the time to get either free drugs, attention, a free trip to hospital, etc.).
In regards to the height of a fall problem consider this. A 6 foot plus tall person falls 6 plus feet to the ground when they pass unconscious from standing - yet the person reporting won't usually think of saying they fell six feet (we're talking head impact here - not much else matter until you're falling from really big heights and can start shattering lots of bones). A very common example of misreporting from callers.
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
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.
In other news:
"A flaw in Slashdot's sensationalistic story submission system may have caused hundreds to accidentally RTFA.."