More Crystal Balls Up

I've written before about our 'psychic computer' and the new policy of Active Area Cover (AAC), we've been told that it is to improve the public perception of the service and to better let us hit those rather pointless government targets.

If you remember (or reread the article) it involves a computer that was no doubt bought at considerable expense which predicts where calls are going to come from next Something that I firmly believe in a urban setting like London to be utter hokum.

But it would appear that it's not always being relied on, and instead those high up in management are making things up as they go along.

Consider the following two bits of evidence that I have collected personally over the last two days.

In the first episode, we were told to go on Active Area Cover on a street 0.2 miles distant from our station. As the policy lets us roam around within a radius of 0.5 miles I informed Control that we would therefore return to station and wait for a call there, incidentally allowing me to have my first cup of tea of the day. Our dispatcher agreed.

Then I suspect that someone had a word with her because she called us up less than 20 seconds later to move our AAC point much further away.

Surely if this is a science then the first AAC point would have been the best and it would mean that we shouldn't be moved seemingly on a whim just to keep us from the station.

The second episode was just as foolish. We are not supposed to be put on AAC within half an hour of the end of our shift. So I was surprised to be told to go out with just 12 minutes left in the window of opportunity. Well, I'm not allowed to refuse, so I asked where the psychic computer was telling me to go – for hasn't it scientifically predicted where the next call will be?

“Oh, go anywhere”, I was told.

So with 42 minutes to go to the end of a twelve hour shift we were being told to go and drive around for twelve whole minutes.

I'm in the process of reading a book at the moment concerning American ambulance workers, and one part seems particularly apt – in it a supervisor is asked about how to manage ambulance staff and he replies that, as we are trained to gather evidence about a person's illness or injury in three minutes, we question everything. You can't just tell us that 'this is the way we are going to do things' and expect us to roll over and do it without some form of explanation or evidence.

A good example of this is the CPR guidelines that keep changing based on evidence – we have no problem in adapting our practice to use the latest evidence, and no-one questions it.

So here is the challenge – I know management read this blog. I want management to provide me with scientific, peer-reviewed evidence that Active Area Cover works in a high population density area. I don't want the marketing guff that the software company sends you – I want proper evidence. After all, isn't evidence what all modern medicine should be about.

I'd also like an assurance that the system is being used properly, and not to 'punish' crews. Is there an audit in place for example to see which manager sends which crews out?

Until I get that reassurance I will continue to suggest that the best thing for ambulance efficiency would be to buy the management in Control a load of cat toys, and let them play with catnip woollen mice rather than get bored and annoy road crews (and the poor dispatchers who have to phone us up and give us the bad news that we aren't allowed to remain on station).

On a more amusing note, two things which have lived up my shifts of late.

The first was when I asked a woman how many children she had given birth to and she answered, 'six or seven, I can't remember'.

The other was the GP who told a mother that the best way to get earwax out of her five year-old child's ear was to use eardrops and then root around with a cotton bud. Needless to say we were sent to the child after her ear started bleeding. As I've always been told that you shouldn't stick anything in your ear smaller than your finger, I suspect that this GP may have bought his GP certificate from a market stall.

Either that or the mother was mistaken – it happens sometimes.

23 thoughts on “More Crystal Balls Up”

  1. I have no problem with the notion that the computer can be a tool (because I happen to be a professional computer programmer), and I have no problem with the idea that some useful information might be gleaned by analysing historical data for your area. It seems natural to me that there could be established patterns in terms of the level of load in a particular area at a particular time of the day / week. Fair enough…However, anyone who reckons that they can predict, with the aid of a mother (as opposed to ouigi) board, where the next call is coming from is a bloody fool. Hear ye not of chaos theory?

    This sort of analysis is the sort of thing you might use when asking yourself somewhat broader questions like “roughly what level of operation cover do I need in this particular station here on Monday mornings…”. It is, I would suspect, of precious little use guessing a sequence of events – this happens here, and then that happens there…

    Aside from that though, the basic fact is that this AAC does not appear to be justified. Why piss off your crews to this extend for something so vague? Why risk health problems like posture, muscle problems etc by pointless hours in a cab when the people we're talking about are required to be physically fit?

    All strikes me as someone trying to keep their budget…

    Martin

  2. Maybe bosses need to face up to the fact that they built the hospital in the wrong place. To optimise A&E efficiency, perhaps the computer can advise them where it should have been located instead.

  3. I think that the entire problem with management (at least when being done by mid-level government lackeys) is summed up in your first paragraph.The whole point of AAC is to improve the public perception of the service?

    Won't the public percieve the service as good when everyone's still alive after their heart attacks and road accidents?

    This is not to say that perception isn't important, but it should at least be secondary to actually helping people. In my opinion, it should be secondary to not wasting money as well, but I don't pay taxes in the UK. I like being an Expat.

  4. I thinkl the problem with management is that they feel the need to manage. To them letting people sit around doing nothing while waiting for a call looks inefficient so they would mush rather to have people driving around doing something. It looks like this new predictive software gve the managers an excuse to generate lots of additional activity.Given the current Government's obsession with collecting statistics I am sure there must be figures available to show how effective this new system is. It would be very interested to see what the figures showed. Mind you the fact that a meaningless (In health terms) figure such as time to respond seems to have been taken as the gold standard to measure success suggests that the figures are all about public perception rather than actually caring for people's health.

    AJ.

  5. If they continue to deprive you of coffee perhaps you should take out the defib (which lets face it, only ever gets used on real calls, had any of those lately?) and put an expresso machine in the truck in it's place. It can kick start you back into life, and you will never need to return to station again. Also you could lure the drunks some place where they can sober up without anybody noticing them and bothering you.

  6. [longtime reader, longtime lurker]I'm in the health evidence business, and your question made me curious, so I went and did a (very) quick check of http://www.thecochranelibrary.com, googlescholar and PubMed and there are, as far as I can see, no trials or systematic reviews to provide evidence for or against AAC (which really does seem like a lame policy). It sounds like a great opportunity for some enterprising soul to get some research funding and do a study on it.

    Or the service could just do the sensible thing and chuck it out.

  7. I have visions of management lying on their backs with arms & legs in the air playing with giant toy mice suspended from the ceiling!

  8. Audits, fairness and evidence? Come on, Tom, That's far too reasonable for self justifying management to use. Good luck getting that evidence, it would be nice to know that someone in management is on the staff's side.

  9. AAC to 0.2 miles away? Has LAS management not seen the price of diesel these day??? Perhaps you should suggest a review of costs and look at the extra used for this pointless policy. When I was a student nurse (yes I know it was a while ago) the only time our crews weren't allowed to stay on base was if all the crews from the neighbouring town were out on calls (basically to provide cover).

  10. Actually the ear drops state that you need to use cotton wool (Maybe the mother misheard this bit). You drop a few drops in and then leave it for 2 minutes and then soak up the wax.

  11. I have been wondering about that 8 min target for some time now, trying to understand why 8, instead of 5 or 10. I couldn't find a reason at all, our limits are quite different. Until I did my A-CPR refresher course this summer (at a new hospital, mind you). It appears 8 min is the time you can leave a heart alone (no cpr, no oxygen), and still expect resuscitation to be successful. It has to do with it filling with blood, stretching of fibres and so on. You probably knew this already, but maybe that's where the 8 min come from?

  12. I may have said this before – “A camel is a horse designed by a committee” You couldn't make it up – maybe you could challenge it on the grounds that you are wasting tax payers money using unnecessary fuel or hang on, what about increasing Global warming – that's a popular one…

  13. Ah LIspers be wanting to test out the customer response program,LISP an artificial intelligence language for super computations .How come they have not given thee a sandwich board requesting product testers to dial the correct number and get a free ride for a shot that may fix that that ails them.Why the distance, it be so that thee cannot jog back for a quick fix of java. and it too far to send any flaming arrows.

  14. Far too many years ago, Notruralshire Police acquired several small cars which were allocated to outlying 'beats'. Driver instructions were to go and park them up where something might happen, 'so they could be seen' – and then to walk around the area (also 'to be seen') but not get too far away, in case they had to drive to where something happened where it WASN'T expected.Plus ca la change?

  15. Your future be great so say the stars, Upper management will move tothe Sandwich Islands, as they have HD tvs and can monitor at will, thy driving habits, as each ambulance, will have 6 cameras, one in each head light, one in the tail light, one watching thy hands on the wheel and two in the patient area, then each NHS person will have a black box in the belt monitoring all vital signs along with voice and video inputs.The control will be in a hill village close to Everest, each will have control over a wandering Satellite, and a drone that can lead the way, but therei are plans afoot to have each land vehicle to be controlled from a satellite station so saving one college educated driver.

    Oh for the peek into near future , Jules Verne

  16. During the Vietnam war, the Americans had computers to tell them where the Vietcong would strike next. After a while the Viets worked out the pattern by watching where the American troops were being sent and adjusted their tatctics accordingly. So the Yanks adjusted their computer system and the Viets adjusted… Well, you get the idea.The Yanks still lost and the Viets didn't use computers.

  17. Our management in Melbourne Australia is using a piece of software called “SIREN LIVE”. Same sort of thing. It's made by a New Zealand company formed by Students and lecturers from one of the Kiwi unis. It is supposed to be able to “predict” where jobs will come in next based on “historical data”. Isn't that like trying to predict where the next mortar round will land? One EMS forum from the US had a physician/ex ambo who looked into it and was told by some other uni Statitistics professors that you would need between 40 and 100 years of accuarate data to come even close. Coincidentally thats the same amount of data needed to predict – you guessed it – the weather. And we all know how accurate that is. The whole thing is a sham – clever commercial opportunism. Oh look at all the pretty flashing lights.Our system has been going for a while now and sucks. Just about every time we have been SIRENED away from our branch a case has come in just around the corner. But be afraid readers because the time is coming when you won't be having that cup of tea at your station – you will be sitting on the corner at three o'clcok in the morning outside the local burger king. Its already happeneing in the US and Canada.

    Why is it when things are going pear shaped our bosses turn to a mute, dumb, blind virtual friend like a program instead of asking the experst who do the real work every day – that's you campers.

    It's all frogshit. The politicians want numbers for the next election and the bosses want to keep their bonuses by “meeting KPI's” – key perfomance indicators ditto response times which are bullshit anyway. How many more experts have got to say curb time is innacurate – the vertical response time is what counts ie when you actually get to the patients' bedside?

    It's all coming unstuck people no matter whether you are in London, New York, Toronto, Copenhagen or Melbourne.

    Ambulance services are too scared to say no to patients – risk averse AMPDS systems – frogshit. law suit averse more like.

    How about this – Reduce the calls by educating the public about the system, when ansd how to use it wisely and tell them that you will say no to an ambulance request if your call is bullshit.

    In the meantime you workers will be wearing the workload and treated as expendable commodities. And if you don't like it stiff shit – leave and we will repalce you with a 20yo uni graduate with no life experience, no job experience, no communication skills and entirely maleable to do the bosses biddings – no sticking up for your rights/ OH&S/conditions/breaks – just work. When they get tired of it, which is usually about 5-7 years in the job for most, the 20 somethings will move on. Thats what they do and thank you very much – no sick leave, no long service leave, minimal superannuation payouts, no industrial strife etc.

    I can't see in my room because its full of the steam coming out my ears.

    AMbos everywhere are going through the same thing I can promise you and managements have now turned away form “human resources” and are looking for the fixes only a computer screen or a statistical avergae can produce. There's not much room left for real world any more.

    Clincial care is/will be described by a digit on a computer screen and quoted by a politician.

  18. Worked out a way to solve the problem. Arrange for the management to have some problems that require the minions that they abuse so happily. Have the crews as far away as possible from where they are really needed, preferably in the rush hour. That should ensure that the whole system is junked.

  19. AAC from the Control POV.As far as response times are concerned, AAC does work. It takes a crew approximately a minute to get in the vehicle and leave station, so if they are mobile, that's a minute saved. However, it really doesn't matter *where* the mobile crew are. The Blue 8 software (the thing that is supposed to predict where the demand will be) fails to take into account the Law of Sod which states that wherever you send your crew, a call will come in at the opposite end of their patch. It is kind of useful in the “rural areas” (eg. getting a Romford out to Rainham/Upminster or a New Addington to Biggin Hill) but fairly pointless everywhere else.The worst thing for me is that it's another thing us control staff have to inflict on crews that they don't like, and another thing that creates the whole “us and them” feeling and conflict and grumpiness. Being the kind of person who likes to get along with crews, I tried to make it as easy as possible on them by asking if there was somewhere there would particularly like to go, and do you know what happened? An AOM rang the control room to complain about me. Apparently the crew had left the station “laughing and joking about AAC” (note that they LEFT THE STATION promptly which is more than most crews do when asked to go out and were LAUGHING which means they were happy, surely?) and this was a bad thing because we don't want happy crews, do we?? I was very annoyed by this.Also, on the topic of public perception, is it really going to do any good for the public to see lots of grumpy, sleepy crews twiddling their thumbs in their vehicles between calls? Wouldn't they be better off on station where they get some rest?I think management's next move may well be to switch off those pesky phone lines so we don't get any calls and can devote ourselves solely to giving crews breaks and putting them on AAC.

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