The Humans are Dead

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In case you've not noticed before, I've added some news feeds to the blog, about topics related to themes in this blog.  (There's a tab up top!)  As I was glancing through this afternoon, I came across this article from the York Daily Record about the county looking for a more accurate way to track EMS (ambulance) response times.

Photo by Coolcaesar

This, I think is one of those things that I think most people assume is far more technical and precise than it is.  If I were to ask ten people on the street how EMS responses were recorded and reported, both in real time and for statistical purposes, I'm not sure what they would say.  I doubt many would say, "It's based on what you say on the radio."

Here's how it works in our area, and it's somewhat similar in most places.  This process holds true for both volunteer and professional EMS units, though the professional units are usually stationed at their ambulances and so don't require a second alert tone.

1. Dispatch receives an alarm (e.g., a 911 call or a Life Alert).
2. Dispatch sends alert tones to an EMS unit.
3. After two minutes, Dispatch sends second alert tones to EMS unit.
4. EMS crew assembles, and reports on the radio that they are responding.
5. Ambulance drives to scene.
6. When ambulance arrives at scene, driver reports on the radio that the unit is on scene.
7. When the ambulance is ready to leave the scene, the driver reports that, as well as the current mileage on the odometer.
8. Ambulance drives to hospital.
9. When the ambulance arrives at hospital, driver reports on the radio that the unit is arriving at destination, and reports the ending mileage.

Seems simple and reasonable when you see it spelled out like that, and it typically works pretty well.  For better or worse, though, it depends on humans.    Someone must report and someone must hear.  Someone must speak clearly and someone must understand correctly.  No one can forget a step, or the entire record is essentially meaningless.

For instance, in our area, we are permitted to take a patient to an out-of-county hospital if they request, but we are required to report on the radio our time leaving the county and our time back in the county. (Among other reasons, so that dispatch doesn't try to divert us to another call, but also so that our response can be accurately timed and recorded.)  It's an easy thing to overlook while on a run.

Even if the calls are made as they should be and understood as they should be, the information has to be recorded and input.  

Things get even murkier when it comes to recording which district the response is in.  It's important for a number of reasons to know how often our EMS unit covers a call in another territory.  This information comes entirely from two sources: a note made by the dispatcher, based on their understanding of the geography; and a note made by the EMT who fills out the reports, based on their understanding of the territories.

Some areas have begun using GPS, RFID, and other technologies to track the real time movements of emergency personnel, but these tools are expensive -- not to mention invasive.  In our area, GPS systems are used to record the speed of ambulances, but not to actively monitor locations or to track response times or route efficiency.

NASA Android,
photo by Geoff Stearns

This is an interesting topic specifically, but I think it also plays into a broader conversation about relying on humans in this increased technical era.    We have come to expect mathematical precision in everything, and every year that passes increases the needle-point fineness of the precision we expect.    When we don't have the precision, we fear we are wasting money.  We fear we are jeopardizing public safety.  People will cry about government waste and the safety of the children.

And, then, when technological solutions reduce the number of employees required to conduct business, we lament lost jobs.  When humans are replaced by machines, we weep over the dehumanization of our civilization.  When we track people's movements and record their performance to the millisecond and millimeter, we object to the invasion of privacy and grumble about micromanagement.

And, yet, we want precision.  We want accuracy.  We want what we call scientific certainty.

But we want it with a human face.

'Tis a pickle, my friends.  'Tis a pickle.

.Nevets.