Need for Renewal

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.