Ambulances & Vehicle Ops, Communications & Dispatch, News, Patient Care

Pa. Ambulance Misdirected Again Due to Incorrect Computer Data

LITTLE BRITAIN TOWNSHIP, Pa. — Marsha Wagner held her foster daughter in her arms.

The 2-year-old did not breathe.

Her heart did not beat.

Wagner’s sister, Debbie Wagner, called 911 and they waited at their Little Britain Township home for help.

Two off-duty emergency medical responders in a personal car arrived within several minutes of the 911 call and performed CPR, but the child died.

Wakefield Ambulance’s truck did not arrive until 18 minutes after the Feb. 4 call, according to Lancaster County-Wide Communications (LCWC).

Because of incorrect information in their computer system, county dispatchers did not direct the ambulance crew to the nearest crossroads to the Wagner home, but to one that left them three miles away.

On March 24, it happened again.

This time, Debbie Wagner’s 8-month-old foster daughter, who suffers from chronic lung disease, had turned blue and was gasping for breath in the Wagners’ 2313 Ashville Road home.

The same two responders, again off-duty in a personal car, arrived well before Wakefield Ambulance after the Wagners called 911.

The ambulance again went to the wrong location because of the same county dispatch computer error, not corrected after the first incident.

It didn’t arrive on scene until 20 minutes after Wagner called 911, according to LCWC, even though Wakefield Ambulance is stationed just six miles away.

The infant spent four days in the hospital, but apparently suffered no long-term effects.

Marsha Wagner, 32, does not blame the slow response time for the death of her 2-year-old foster daughter, who had cerebral palsy. But she wants the mistakes corrected in case another emergency arises.

County officials say such incidents are rare.

But the Wagners, a local EMT, a township official and a state representative all question if more people in the county are being put in danger by incorrect data in LCWC’s computer system.

State Rep. Bryan Cutler (100th District) is meeting with the Wagner family on Friday.

“They have a legitimate concern,” Cutler said of the family. “I’m sure it’s not the only place it happened. The roads on this end of the county are complicated.”

In both instances, dispatchers sent Wakefield Ambulance the correct address: 2313 Ashville Road. But they also relayed that Lloyds and Spruce Grove roads were the closest intersections, or “cross streets,” with Ashville Road to the Wagners’ home.

Actually, the closest intersection is Ashville and Little Britain roads.

So, the ambulance traveled east on Route 272 and north on Lloyds Road to Ashville Road, a 10-mile, curve-laden route to the Wagners’ home. With correct cross streets, the ambulance could have traveled north on Little Britain Road to Ashville Road, cutting drive time almost in half.

That doesn’t count the time it took for the ambulance driver to figure out he was in the wrong spot and to get headed in the right direction.

“911 called us back and said the ambulance is sitting out in front of your house,” Wagner said of one of the incidents. “I said, ‘No, they aren’t.’ “

Richard Schmidt, a volunteer EMT and crew chief with the Wakefield Ambulance, was one of the first two emergency medical responders in both Wagner calls. He said he was able to locate the home using his personal GPS system.

On the second call, Schmidt and his partner, Laura Long, used suction equipment the Wagners had on hand to assist the infant until the ambulance arrived.

“These are life-and-death situations,” Schmidt said, adding that he is frustrated problems with the LCWC system have not been fixed.

He e-mailed a letter March 26 about the problem to Cutler, Sen. Gibson Armstrong, the Emergency Health Services Federation, Little Britain, Fulton and Drumore townships, Wakefield Ambulance Association, LCWC and various media.

Schmidt and Greg Culler, chairman of the Little Britain Township supervisors, say they wonder if other areas of the county – especially the southern end – could be at risk due to the same type of problems.

Ironically, a year ago, Little Britain Township and LCWC changed the addresses along Ashville Road so there would be no duplicate numbers in different blocks. That was done to make it easier on emergency responders, delivery men and anyone else to find a specific address.

At the same time, the cross street information in LCWC’s computer system was updated for the area as well.

But the section of Ashville Road where the Wagners live was missed.

LCWC operations manager Rick Harrison and deputy director Tim Baldwin blamed the oversight on human error by LCWC staff in a New Era interview Tuesday.

That error was not fixed, even after the second incident, despite Wagner telling Little Britain Township officials about it, and a Southern Lancaster County Chronicle newspaper’s story on the incident.

So, correcting the information for the stretch of road was missed two different times.

“We should have fixed it,” Harrison said. “It should have been corrected.”

Harrison and Baldwin said the errors are rare and the LCWC database file is “very good” and it is improved almost daily.

County Commissioner Scott Martin said updating the county’s emergency responders’ equipment was one of the first major things the new board of commissioners has undertaken.

A new system to relay cross street information is already being pursued, and the long-delayed new radio system is also moving forward, he said.

Harrison and Baldwin both said the errors in the Wagner cases were not due to old equipment or computer error, or even lack of manpower or any other issue.

It was just human error.

They said they are taking steps to minimize future errors.

First of all, they are sending a complete list of addresses and cross-street information to Wakefield Ambulance so they can be verified for accuracy.

LCWC will do the same for any other emergency service in the county that requests it, they said.

They said updating the system’s data is a continual process, thanks to construction projects, road changes and other variables.

The state Public Safety Emergency Telephone Act requires counties to achieve at least a 95 percent level of accuracy between their Master Street Address Guides and their 911 databases.

Lancaster County’s accuracy is over 98 percent, Baldwin said, but LCWC will strive for an even higher number.

Schmidt said that confusion occurs regularly enough on calls that Wakefield Ambulance has included a check box in its reporting system for 911 dispatch misinformation.

Wagner wants to see any problems are corrected.

“We have no lawsuit or anything,” she said. “We just want to know the next time we need them, it’s fixed.”

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