A Day in the Life of a Paramedic
10:05 Unit 286 respond code 2 to an incoming call on Elm Street.
10:06 Unit 286 you are responding to 123 Elm Street for a 20 year old male with a hemorrhage complaint. Continue code 2.
10:07 Unit 286 upgrade to code 1 response. Hemorrhage reported as bad. Patient reports a laceration to his thumb.
Unit 286 was now driving lights and siren through heavy traffic to get to this emergency call. An elderly couple, who was in the vehicle in front of the ambulance, almost went off the road because the ambulance siren scared them. The driver was not sure how to respond. As ambulance 286 arrived on scene, the paramedics were met outside by the twenty year old male who had called 911 looking for a band aid for the paper cut he sustained to his thumb. A band aid was applied (sticky side down) and then the paramedics collected his personal information, conducted a complete body assessment including vital signs, and they got him to sign a non transport form. The ambulance went “available” after being with the patient for 20 minutes. These twenty minutes were required not because of his injuries, but because the system is designed to collect lots of information for quality assurance purposes, billing, and statistics. The paramedics complain to one another on the drive back how this call was an abuse of 911 and that they can not believe that the communication center sent them code 1 for a paper cut. The ambulance gets back to base and for the next 30 minutes the electronic patient care report is being typed up and submitted.
The above ambulance call is one that I had actually done (some details changed, not to identify anyone). For years I have complained that it seems we are like robots responding to a computer program on how we should respond to an ambulance call. You would think that the call taker taking the information would know that sending an ambulance to a paper cut on a thumb is not a life threatening emergency requiring a lights and siren response. To think that a car with an elderly couple, almost went off the road so we could get to a paper cut because the twenty year old male had no band aids in the house. This is hard to justify in my mind. I mentioned this to my supervisor and he tells me that the dispatch computer program makes those decisions and not the communication officer sitting in the chair. For the past fifteen years I have been accustomed to accept this answer and it is expected that we ourselves don’t question the computer, but rather comply, like a robot would respond to a command. In Shop Class As Soulcraft: An Inquiry Into The Value Of Work, Matthew Crawford talks about “Expert Systems” which he mentions is a term coined by artificial intelligence researchers which found their way into medical diagnosis. In The Electronic Sweatshop: How Computers Are Transforming the Office of the Future into the Factory of the Past, Barbara Garson details how “extraordinary human ingenuity has been used to eliminate the need for human ingenuity.” Garson also states “To build an expert system, a living expert is debriefed and then cloned by a knowledge engineer… The knowledge engineer watches the expert work on sample problems and asks exactly what factors the expert considered in making his apparently intuitive decisions. Eventually hundreds or thousands of rules of thumb are fed into the computer. The result is a program that can make decisions or draw conclusions heuristically instead of merely calculating with equations. Like a real expert, a sophisticated expert system should be able to draw inferences from iffy or incomplete data that seems to suggest or tends to rule out. In other words it uses or replaces judgment.”
So what do these statements mean and how do they apply to my situation. Well, when someone calls 911 a number of predetermined questions are asked and dependent on what they answer, more questions are asked. Think of it like the board game Chutes and Ladders. You land on a square and if the square has a chute you go down to another section of the board. If you then latter land on a ladder then you are moved up the game and this continues until you reach the finish line. Well the finish line in the 911 call could be considered when the 911 dispatcher hangs up the phone and terminates the phone call or when paramedics arrive on scene. If the situation is serious enough, pre arrival instructions are read word for word from a computer screen. Some examples would be how to do C.P.R., control serious bleeding, or perhaps how to prepare for childbirth. Now I will admit, in most cases the questions asked are very appropriate and the pre arrival instructions are helpful. The down side of following strict computer guidelines is that it lacks “common sense”. The human thought process is taken away. As in the ambulance call above, when the twenty year old male called 911 and stated that his thumb is bleeding badly, there was no follow up question like “describe bad, is it cut off”. Because the caller used the word “bad” an emergency response was generated. If there was a paper cut action guidance card, the ambulance would have been sent code 2 and the elderly couple driving the car wouldn’t have almost gone off the road.
I would like to discuss how my ambulance call can be tied into lifelong learning. We are all educators. Some of us have formal educational training and lots of us do not. When we share our thoughts and ideas to one another in our human culture, we are indeed educating others. It is important to remember what makes us human. We have the ability to think for ourselves, rationalize, and come up with our own thoughts and ideas. If we continue to allow computer programs to make more and more of our decisions, then we could become dependant on the very computers that we use every day. Don’t be like the 911 dispatcher, our life does not always fit into computer cards, being human is much more complex then any computer can “understand.” We are much more then a series of ones and zeros in a computer program. So the next time that you are faced with someone that is bleeding you can ask yourself, what will the 911 operator tell me to do or should I just hold pressure and apply the band aid sticky side down like my mom taught me.
Great Blog Calvin!
ReplyDeleteAs I was reading your blog I couldn't help but think of my own experience with a 911 dispatcher. I was so frustrated with the system by the end of that call. A family friend had been over visiting and while sitting at our kitchen table he took what turned out to be a diabetic seizure. At the time no one was sure what exactly was happening so I called 911. The dispatcher answered the phone and began asking me what at the time seemed like a thousand questions. If you know anything about me it is that I belong nowhere near the medical field! She was asking me questions that I did not know the answers to including his age (which I could guess at), his birthday (no idea), medications (again no idea), health conditions (I knew he was diabetic), and the list of "I don't knows" went on and on! All I wanted to know at that moment was what I should be doing for him and what to watch for while waiting for the ambulance. I finally had to stop her and say "can I answer these questions after you tell me what to do?" to which she replied "I need to know the answers before I tell you what to do!"
This made no sense to me and I will never forget the frustration. It goes directly to your point about the computer system ladder. I didn’t know the answers so she couldn’t tell me what to do! I don't know much about the medical field but thankfully, we did know that there were certain steps to take when someone is taking a seizure.
Again, it goes back to the fact that we get so caught up in following computerized protocol that we forget to use our human common sense! This is not only relevant to paramedics but to many, many occupations and procedures in our society. Although technology has made wonderful advances in our lives, one has to wonder how much we are losing with it!
Calvin, I am sure you don’t remember me but I remember you. I had to move home to look after my terminally ill parents who died a year apart. You can imagine I had to call a lot of ambulances. The reason I remember you and the people you worked with was because of your compassion. You not only were comforting to my parents but to me, who often rode in the back of the ambulance with them. It was always a rather panicky situation but the professionalism of the ambulance workers always put us at ease. One of your coworkers used to joke with my mother and tell her they were going to give her “frequent flyer’ points. We used to get a big laugh out of that. It is always in the darkest moments of life that you learn to take advantage of the smallest pleasures. I was so touched by the care your company gave our family I had a plaque made as a gift after my parents passed away. Someone from the company called me and said they had never received anything like that before, I believe they should have.
ReplyDeleteI agree with your point about computers. They can solve a lot of problems, make businesses more efficient and take some of the drudgery out of life but there are limitations. They can not replace people. There is a higher or of thinking that belongs to us. They definitely can’t show compassion.
Thank you for the glimpse into the life of a Paramedic. It takes a special person to commit themselves to such an occupation. The emotional and human aspect of this job must be difficult at times. Your job must be challenging and exciting, starting each day not knowing what adventures are around the corner. I am sure that your kind, easy going nature and good sense of humor go a long way with making people feel at ease while in the midst of a crisis. Such qualities and abilities cannot be replicated by the wonder of technology. As Mathew Crawford said; “ Our ability to make good judgements is holistic in character and allows for repeated confrontation with real things: comprehensive entities that are grasped all at once”.
ReplyDeleteYou make some very interesting points about technology. I can see why these “expert systems” are so frustrating to you and your colleagues. Technology cannot replace the human to human experience that you encounter every day. As a human being you have the ability to show empathy, compassion and respect to people in a state of vulnerability.
One can’t help but marvel at the technological advancements of society, however, we need to be aware that it limits our human experience. “ The computer comes to represent an ideal, in light of which real thinking perversely begins to look deficient” ( Crawford. Shop class as Soul Craft).
We are naive in our assumptions that society is becoming more intelligent because of technology. I think our intellect is being hobbled. In many cases we have become too reliant on machines to do the work on our behalf. Cash registers help us to figure out how much change to give back, and we never remember phone numbers or addresses, we just program them into our phones.
Human beings are supposed to be social creatures. Why bother meeting a friend for coffee when you can use the chat feature on facebook to catch up on all the news.We spend less time in face to face interaction and more time with our computer screens. Technology is making us socially inept.
Computers in the classroom are both a blessing and a curse. Kids have become too dependant on technology to get quick answers, they don’t want to have to think or engage their brains. This preoccupation with technology has also stifled the imaginative and creative capacities of children. For many years I ran the Library at my son’s elementary school. It was a Library/Computer Lab. There were very few students actually interested in reading and signing out books. Computer time was made a priority and encouraged by the teaching staff. When students were working on research projects I would often recommend reading material and I would get the following response “ you mean you can use books for research too?” The kids didn’t even know how to use the Library to find reading material. What a shame! I think Crawford sums it up nicely by saying; “ If thinking is bound up with action, then the task of getting an adequate grasp on the world, intellectually, depends on our doing stuff in it.”
Irene