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Written by Alistair Norman on Tuesday, 03 May 2005
/surgeon.jpgEmploying almost one million people (or around 780,000 WTE),the NHS is the biggest single employer in the country. Nationally, the Police service employs in excess of 250,000 staff. The Fire and Rescue Services provide a 24 hour a day, 365 days a year service to all areas of the country, attending thousands of incidents a year. Given the scale of these organisations, the pressures they work under, and the complex information needs they have in doing their jobs, it is no surprise that they have taken to information technology like ducks to water. And it is also no surprise that, as mobile technologies have become available and matured, that they have also adopted these tools in the pursuit of greater effectiveness, improved efficiency and increased flexibility. The tools they use are as diverse as the services they are in use in:

  • Ambulances are using remote telemetry on in-vehicle tablets to give heart patients hospital standard care within a couple of minutes of arriving at a remote rural location.  Previously, as a worst case it could take up to an hour to reach a coronary care unit.  

  • Police officers can attend a missing person report and, using a handheld PC, within ten minutes of arrival can have a report on the Force Intelligence system and an alert out to all officers in the area, together with a photograph of the missing person.  It used to take up to 4 hours to get the report on to the system and other officers would usually only get it at the next briefing, which could well be the next day. The means that information can be provided to officers within the “golden hour”, the time period in which the potential for success and a swift resolution is at it’s highest.

  • Fire Officers can get details of an incident, including maps, chemicals data and wind speed sent directly to terminals in their car or Fire appliance. They can even have the terminal read it to them if they are alone in the vehicle. They used to have to get all of this from separate paper files or by radioing back to a busy control centre for each piece of information they needed. This means that officer gets what they want, when they want it, the intermediate stage being eliminated.

So, there are lots of emergency services using mobile technologies to deliver real benefits for their staff, and for the public they serve. A few examples:

  • Remote telemetry has been used over a hundred times in just one Ambulance Service and has saved numerous lives.  It has also reduced recovery times for patients and freed space in hospitals as patients recover faster. Like the Police, this service has a golden hour, the ‘ pain to needle’ time period which needs to be minimised in order to maximise survival potential.

  • One Police force has estimated that it can increase the time each front line officer spends on the street by an hour per shift per officer by using mobile technologies (one force estimated that the cost of an officer hour is £50).  Across the whole force that equates (there are over 50 in the UK), to an increase in visibility equivalent to putting an extra four hundred plus officers out on patrol. With 50 forces in the UK, this could mean massive gains in both officer visibility and effectiveness.

  • Fire Crews can attend incidents faster, despite often poor address data from callers, using satellite navigation, and are better prepared when they get there. This is because important information such as local hazards and the possible presence of chemicals onsite. One Watch Commander commented ‘It stops little incidents becoming big ones ‘.

There are no reliable figures for the numbers of mobile devices in use in the emergency services as a whole but we know there are over 30,000 at the moment. And we know the number is growing daily.  One police force alone plan to have over 2,000 units in service by the end of the year and others are not far behind. Many of these devices are in car units with A5 screens, others are ‘traditional’ laptops and tablets, some are smartphones, and soon there will be a new device – the Airwave Data Companion, a highly portable A5 screen tablet tailored specifically to the emergency services in the UK by mmO2 Airwave, who provide the secure bearer channel for a lot of the communication in the blue light services. But by far the greatest number are handhelds in the conventional sense; XDAs, Ipaqs, Palms. They are starting to take root in the pockets and affections of emergency services staff right across the UK.

So far so good.  However, as is often the case when you introduce a technology, once you have it you find it can do more than you thought.  Emergency services are no exception to this rule.  They have invested heavily in providing staff with mobile technologies for good business reasons, such as the ones outlined above and, as a result, there are thousands of staff out there with little screens in their pocket or on their harness, or in their car, ambulance or fire engine. And these users, as well as the organisations they work for, are coming to the realisation that they could be using this technology to provide learning opportunities or support staff in making decisions in complex and pressured situations.

Currently, however, there is little being done to make specific provision for decision support and learning making use of the features of mobile technologies.  All of the emergency services are providing information to staff using mobile technologies and people do learn from that. A few organisations are providing some Word documents on handhelds for staff to consult and some are also giving access to intranet information on browsers on mobile devices.  Much of this, however, is based on mobilising the applications which already exist rather than providing specific learning applications which are tailored to the learning needs of the mobile worker and the capabilities of the mobile technologies they use.

Now, there is a philosophical debate to be had here about what learning is and I don’t intend to go there in this article, but for our purposes we can identify a few areas where emergency services staff can make use of mobile learning or mobile information:

ß Instant information – getting the answer to the question ‘are we looking for that car?’, ‘what is the law on special licensing hours?’, ‘how do we treat this chemical spill?’
ß Decision Support – guiding staff to make decisions in uncommon situations by providing information in a format which supports good decisions, ‘I’ve got a situation that needs handling here, but I’ve never had to handle one before, what do I do next?’,  ‘I’ve got a couple of choices here, which one best fits the response specified by the protocol?’. 
ß Updating – as new laws come into place, as evidence based practice updates medical procedures and as new threats bring new challenges to staff.  In all of the emergency services staff need to update, and this can be done in many cases by using mobile learning just as well as by taking people off active duty.  Briefings are another area of m learning in this updating category – the ability to ‘self brief’ means that an officer who has missed a briefing doesn’t have to be at a disadvantage all shift.
ß Forward learning – staff have to study to progress to new roles, tasks or responsibilities.  Mobile learning provides a way of allowing them to do some of that study in time which would otherwise not be used productively.  In the shorter term this could also be the situation where a police officer for example parks for ten minutes and checks the law and Force policy before they proceed to deal with a non urgent call. The result is a better informed officer and, hopefully, a more effectively handled incident.
ß Audit learning – making sure that lessons learnt in other settings are internalised and taken forward – maybe by the use of check questions emailed to a smartphone or access to a web page on a PDA based browser.

Taken together these areas provide quite a few opportunities. They also provide some unique challenges which may set this area of learning on mobile devices apart from many other contexts:

Much information is sensitive, some of it is classified – so putting it in a Word document on an SD card isn’t really a good idea.

  • Situations develop and unfold rapidly, so information may have to be provided in very small and easy assimilable chunks, maybe in a speeding ambulance en route to an emergency for example.

  • Situations often put users in the emergency services under extreme pressure – never the best situation in which to take on board new information and one where we may not make the best decisions we can unless supported effectively.

  • Conditions are often not ideal – so screens need to work at night, while walking and in many other contexts.  And devices themselves need to be rugged enough to support this – although fully ‘ruggedised’ kit is not needed as often as you might think.

  • Information can be highly dynamic and so may need to be updated frequently or in real time.  Where that happens (or where security dictates that information cannot be held on the device) then there are issues about which bearer to use.  GPRS is often faster but Airwave ( the Tetra based public safety network) will also carry data effectively and it is secure, resilient and paid for.

But, getting information out to officers, firefighters and paramedics is only a part of the equation. If the organisation is to be as effective as possible as a whole then information has to flow back from the field, sometimes in real time and sometimes as a result of a debrief. This organisational learning facilitated by handheld and other mobile devices is maybe not as apparent a focus as that of getting information out to users in the field, be they road warriors in sales or firefighters on a fire ground, but it is equally real and emergency services are starting to make inroads there as well.  GPS systems mean that information can be proactively pushed to users without their having to request it, integration with command and control systems allows organisations to profile types of crime as they are reported from the streets, ambulance crews can use telemetry to provide huge swathes of data to hospital staff while they are bringing a patient to the ward, and police officers can file intelligence reports seconds after having seen a ‘person of interest’ rather than hours.

I see information as the basis of effectiveness in most organisations.  But information alone is not enough.  People need knowledge to be effective, and knowledge is information in a context, available to a person with the mental tools and maps to make use of it. Mobile technologies affect every part of this process of creating knowledge in situations: mobile information systems receive, process and provide the information, mobile learning helps to provide the mental tools and maps to turn information into knowledge. Mobile decision support is important because it provides the necessary checks and balances to cope with issues around decision making models and the complexities of making life and death decisions in pressure situations. Taken together, in any organisation, all of this adds up to increased effectiveness, to saved time, greater efficiency and, in the emergency services context it means lives saved and crimes prevented.  So, what are we waiting for?

Alistair Norman

Alistair Norman works for AIMTech which is a research group of Leeds University Business School under the direction of Dr David Allen and Professor Tom Wilson. AIMTech carry out research and consultancy in the area of information management and mobile technologies in the public sector with specific reference to the emergency services and public safety.  They have recently completed projects for the Office of the Deputy Prime Minister, for the Police Information Technology Organisation and for the ODPM sponsored Project Nomad, as well as for numerous individual companies, police forces and other emergency services. Current projects include police command and control systems, mobile decision support models, mobile learning, cultural enablers for interoperability, and ambient intelligence.



Comments from the forum:
Handheld Public Services
Rod    July 28th, 2005 - 9:16 PM


Alistair provides some useful examples of the use of handheld technology in the emergency services, however the picture, certainly in the NHS, is patchy. A survey was released earlier this week by the Royal College of Nursing (see Informaticopia piece for references & discussion http://www.rodspace.co.uk/blog/2005/07/nurses-bypassed-by-nhs-it-projects.html) showing how little nurses use technology or are involved in it's development and implementation and that many (including district nurses and others for whom handheld applications would be extremely useful) are sharing access to a PC at their base site with up to 20 or 30 other staff. In this situation using mobile technology to provide learning opportunities is still a pipedream.

The position in relation to computerised decision support systems may be a little more positive with the announcement (also this week) that the National Institute for Health and Clinical Excellence (NICE) is working with Connecting for Health (CfH, formerly the National Programme for Information Technology) to undertake a pilot study to develop methods for evaluating computerised decision support systems (CDSS). (http://www.rodspace.co.uk/blog/2005/07/nice-to-assess-feasibility-of.html for more).

The sensitive nature of a lot of the information related to health and emergency services can also act as a break on the role out of new technologies, and current debates about ownership and rights of access to health data need to be resolved (social & moral aspects, not just technical) before real benefits will be obtained.
Re: Handheld Public Services
bastefany    August 18th, 2005 - 1:25 PM
Reading to catch up on discussions has its advantages.  One post states that handhelds suffer from socioeconomic barriers and another indicates that privacy issues on data still needs to be conquered. 
  To me the issue is control.  Handhelds offer the potential to create a system and cycle of information rather than to "offer" information.  It is at this point that we stall as a system is foreign to our concepts.  A system which is open changes our whole method of process and delivery.  It also requires that those using the system be capable to both utilize as well as input in a reliable manner.   
  The answer to that problem is the age old one, education.  The current education system, however, is threatened by a system that is readily available and user friendly.  The answer is small, user specific "communities" breaking the larger system apart until society can reform its own institutions. 

BA Stefany

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