Monday, February 22, 2010

Consider the wallet before dialing 911

Thomas Freedman used an article by the CBS Sacramento affiliate discussing a new requirement that residents pay for 911 calls in his in his latest column as a segue into a discussion of America's "lean years". Residence are given an option of paying $48 a year for unlimited 911 service or $300 per call. While the discussion of lean years is interesting, Freedman never returns to it. I find this issue a little too jarring to move on so quickly. Though most people would intuitively feel like paying for the use of 911 is a bad thing, it's worth unpacking the subtleties in order to understand who is really most affected by this change. But first, some obvious questions:
  • Do non-resident also have to pay if they dial 911? One would assume so, but the article doesn't actually say that. This question is particularly relevant in Tracy where a veritable web of intersecting major highways exist. (As an aside, these are extremely high speed merges with many confused drivers. For some reason I've also gotten a lot of heavy downpours in Tracy. It's never seemed safe.)
  • If multiple calls are placed to 911 regarding the same incident, is each caller charged? Again, when you think about the frequency of highway accidents in Tracy, this starts to seem like a racket.
  • What if the caller isn't the one in distress?
This last question deserves a little more fleshing out. In the case of a horrific car accident, someone would still call (one would hope). What about weird screams, people that just don't look right, those sorts of things? These are cases where 95% of the time it turns out to be a false alarm, but sometimes not. A good friend of mine once called 911 after witnessing an altercation on the side of the highway, would the risk/reward analysis be the same if there was an exorbitant cost associated with it? A man stumbling on the street who "just doesn't look right" may just be strange, or they may be having a diabetic emergency or acute Valium withdrawal, both life-threatening.

Surely this new policy is born out of severe budget woes. It's likely, though, that the answer to the "why 911 and not something else?" question is related to a mentality of frustration associated with the response to none emergency situations. Professional EMS providers get frustrated responding to relatively minor calls. City officials likewise bemoan the amount of money spent on these calls. This is a mental trap, however, that we shouldn't let ourselves fall into.

The National Outdoor Leadership School provides a conceptual definition of risk that lends insight into this issue. They define risk as the product of the probability that something bad will happen and the consequences of the accident. Risking a toe-stub while walking around barefoot (likely accident, minor consequences) and riding in an airliner (extremely unlikely accident, near certain death) are both low risk activities. Going for a serious bike ride is a considerably higher risk activity. If only 5% of EMS calls are life-threatening, this is still an extremely high likelihood (if you participated in an activities with a 5% risk of death each day, you'd make it an average of two weeks before kicking the bucket). Since consequences are, by definition, life-threatening, every 911 call is extremely high-risk.

One population that will be unevenly affected by this change is geriatrics. A doctor giving a lecture in our EMT class last week quoted his father saying "being old is not for the timid." Although their bodies maybe frail, old people tend to be tough as nails. They don't complain of pain until it's serious and, for a variety of reasons, resist going to the hospital. To make things worse, symptoms of life threatening conditions in geriatrics are more subtle than in younger people. While a 40 year old having a heart attack might complain of crushing chest pain with pain radiating down their arm, the most common symptom of heart attacks in older people is shortness of breaths. Other symptoms include back pain, general malaise, even toothaches. Abdominal pain in geriatrics could be caused by constipation or an upset stomach, or it could be a deadly GI bleed. The point is that these are symptoms that could be confused with "just growing old". In a population that's on an ever dwindling budget, older patients may think twice about spending $300 on a 911 call for nondescript symptoms similar to their daily aches and pains.

The beauty of our 911 system is that it's prepared to handle any type of emergency. While people may not realize that 911 is prepared to handle emotional and behavioral emergencies, it is surely prepared to deal with them. If you see a glowing yellow liquid flowing into a storm drain, you can call 911. If your neighbor hits their head, you can call 911 even if they want none of it. If in doubt, you can call 911. That is, unless you're in Tracy, where you should probably think about it first.


  1. Here, here! Isn't this what taxes are for?

  2. Yeah, this is totally messed up and not well thought through. In fact, it seems like they haven't thought of any of these important factors (the most obvious being the role of the concerned citizens in saving the lives of people who are incapable of dialing 911 for themselves).

    I thought with the expansion of 580 through Tracy I could stop hating the place, but now i have another reason...