Submitted for your consideration - Tell me where I am going wrong with
this train (wreck) of thinking
Emergency Services in Massachusetts - The Need For Renewal
Problem statement - When I call 911 because I am having a heart
attack, I want the closest CPR trained person coming to my aid.
Garbageman, milkman, mailman - I dont care who it is - I want them by
my side in under 1 minute. If someone is chasing me with a knife or
gun, I want someone with a gun or baseball bat chasing after the
gunman ASAP. If I am drowning, burning, electrocuted, contemplating
murder or suicide - I want help ASAP in under 1 minute - not 5 or 7
minutes later.
The State of The Art - Technology - With the widespread use of GPS and
cellphones, a centralized 911 dispatch center can facilitate all of
the objectives mentioned above with the push of a single button.
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Barriers to Meeting The Goals of The Problem Statement
Police, fire, ambulance - the emergency services. The men and women
with loud sirens and flashing lights. They respond to 911 calls to
resolve dangerous situations, combat crime, treat the injured, save
lives, prevent property damage, etc. Emergency responders do NOT
respond with lights and sirens to reports of fraud, fire code
violations, building code violations, upset stomachs, sore toes, a
alcoholic who is about to take a drink, etc. There ARE limits to what
is perceived to be an "emergency".
The "emergencys" that do receive a "hot" (lights and siren) response
are very random - in both place and time. It is rare to have more than
one major incident in any one neighborhood. It is also rare to have
more than one major incident occur simultaneously. Statistics tell us
that little can be predicted about the timing and location of low
frequency random incidents such as this. Even "minor emergencys" can
be seemingly totally random. Perhaps the only common denominators are
- police are busy on Friday and Saturday nights - ambulances are busy
during weekdays - fire departments are busy during extreme weather
conditions - police are not busy when it is rainy.
Healthy amounts of money are spent to fund the emergency services.
Much of the time, police, fire, and ambulance personnel are just
waiting for the next call. Rarely do police prevent crimes in
progress. Rarely do firefighters rescue someone from a burning
building. Over 300,000 people die from sudden cardiac arrest in the
USA each year - fewer than 5% are resuscitated. Recent research tells
us that defibrillation can save 40% of victims if applied within 2
minutes - only 20% after 2 minutes. 911 dispatch times alone are
typically over 2 minutes.
In Massachusetts there are large numbers of private ambulances which
operate almost totally independent of the 911 system. Local police and
fire agencies mostly operate totally independent of each other. GPS
units in emergency vehicles are rare. Mobile computers are slowly
being introduced. Common radio channels have spotty coverage and are
rarely used. "Boundary drops" are rare - each Chief protects his / her
fiefdom. The chances of the closest unit actually responding to an
emergency are probably less than 50%.
Boston has 6 trauma centers within 2 miles of each other. Western
areas of Massachusetts, and Southeastern areas. essentially have no
trauma center coverage. There are no fire service helicopters in
Massachusetts. The State Police helicopters do not respond to medical
emergencys. The 2 medevac helicopter services operate entirely
separate communication systems. No federal agencies or local agencies
operate any medevac aircraft. Private for-profit medevac planes are
available for the very rich.
There are no fire, police, or ambulance units operated by any private
foundations or charitable organizations that provide emergency
response services to the general public.
There are profound artificial boundaries that separate communities,
providers, funding sources, etc. Public - private cooperation is only
seen where private ambulances are contracted to provide emergency
ambulance service in specific municipalitys.
Many public safety agencys seem to be desperately clinging to the
past. The level of education attained by most public safety agency
leaders does not lend itself to the accurate analysis and
implementation of technological advances.
In the USA - 40,000 people die in car crashes annually. 30,000 people
commit suicide annually. 20,000 people are murdered. 300,000 die of
heart attacks. The news media concentrates upon storys concerning
starlets, terrorists, and insane politicians. The level of denial
(regarding preventable deaths) is extremely high. Perhaps there is
something deeply rooted in the human psyche that needs wanton and
needless death. Why else would the 911 response system be so
ineffective?
September 29 2010 - posted to my various lists - massfire - sme2
- firealert - firerad2 - sonofrcma - etc
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October 2, 2010 - The Other Side of the Equation
The other side of the equation is -
How much can the 911 system accomplish? How many victims are actually
dead within one second? Strokes - major heart attacks - gunshots to
the chest or head - electrocution - major trauma - knife wounds to the
chest - one breath of super heated gas in a fire - all of these can be
fatal within one second - because we just do not have the capability
to effectively reverse these situations.
Some EMS systems claim 50% save rates for cardiac arrests. Others seem
to have 5% save rates. That is a huge difference. Apparently there is
much room for major improvements in most ambulances systems in the
USA.
Sometimes fire victims are known to be in buildings, but they are not
saved. How often does this happen? WTC - South Boston - Gloucester -
it happens. Would faster dispatch and response save the day? Would
better training and better equipment save the day?
What if every car was required to have a ice helmet? And a emergency
alert receiver? Your emergency alert receiver activates - your GPS
leads you to a victim in 30 seconds - you put the ice helmet on the
victim - the victim is viable for 1 hour before an OR is reached.
Just wondering - just talking out loud
Oct 2 2010 - posted to my various lists
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I forgot to mention school nurses. Many public schools in Massachusetts
have a nurse on duty during normal school hours. If these nurses were
integrated into 911 / EMS, there could be significant results.