Fiasco london ambulance

The London Ambulance fiasco
● The London Ambulance Service (LAS) Computer Aided
Despatch (CAD) system failed dramatically on October
26th 1992 shortly after it was introduced:
• The system could not cope with the load placed on it by normal
use;
• The response to emergency calls was several hours;
• Ambulance communications failed and ambulances were lost
from the system.
● A series oferrors were made in the procurement, design,
implementation, and introduction of the system.

Managed by South West Thames Regional
Health Authority.
● Largest ambulance service in the world (LAS
inquiry report)
• Covers geographical area of over 600 square miles
• Resident population of 6.8 million people (greater
during daytime, especially central London);
• Carries over 5,000 patientsevery day;
• 2,000-2,500 calls received daily, of which 1,300-
1,600 are emergency calls.

Provide one or more of the following:
• Call taking;
• Resource identification;
• Resource mobilisation;
• Ambulance resource management.
● Consist of:
• CAD software & hardware;
• Gazetteer and mapping software;
• Communications interface (RIFS).
• Radio system;
• Mobile data terminals (MDTs);• Automatic vehicle location system (AVLS).

Call taking
• Recorded on form; location identified in map book; forms sent
to central collection point on conveyor belt;
● Resource identification
• Form collected; passed onto resource allocator depending on
region; duplicates identified. Resource allocator decides on
which resource to be mobilised; recorded on form and passed
todispatcher;
● Resource mobilisation
• Dispatcher telephones relevant ambulance station, or passes
mobilisation instructions to radio operator if ambulance already
on road;
● Whole process meant to take < 3 minutes.

Concept/design of the CAD system
● Existing systems dismissed as inadequate and
impossible to modify to meet LAS’s needs
• Intended functionality “greater than available from anyexisting
system”.
● Desired system:
• To consist of Computer Aided Dispatch; Computer map display;
Automatic Vehicle Location System (AVLS);
• Must integrate with existing MDTs and RIFS (Radio Interface
System).
● Success dependent upon:
• Near 100% accuracy and reliability of technology;
• Absolute cooperation from all parties including CAC staff and
ambulance crews.

Concept/design of theCAD system
● Existing systems dismissed as inadequate and
impossible to modify to meet LAS’s needs
• Intended functionality “greater than available from any existing
system”.
● Desired system:
• To consist of Computer Aided Dispatch; Computer map display;
Automatic Vehicle Location System (AVLS);
• Must integrate with existing MDTs and RIFS (Radio Interface
System).
● Success dependentupon:
• Near 100% accuracy and reliability of technology;
• Absolute cooperation from all parties including CAC staff and
ambulance crews.

Problems: Procurement (i)
● Contract had to be put out to open tender
• Regulations emphasis is on best price;
• 35 companies expressed interest in providing all or part of the
system
• Most raised concerns over the proposed timetable of less than 1year until full implementation.
● Previous Arthur Andersen report largely ignored
• Recommended budget of £1.5M and 19 month timetable for
packaged solution. Both estimates to be significantly increased
if packaged solution not available;
• Report never shown to new Director of Support Services.
● Only 1 out of 17 proposals met all of the project team’s
requirements, including budget of£1.5M.

Problems: Procurement (ii)
● Successful consortium
• Apricot, Systems Options (SO), Datatrak; bid at £937k was
£700k cheaper than the nearest bid;
• SO’s quote for the CAD development was only £35k
• Their previous development experience for the emergency services
was only for administrative systems.
• Ambiguity over lead contractor.
● 2 key members of evaluation team:
• Systems...