WEBVTT 00:00.000 --> 00:11.680 Cool, good afternoon. My name is Skylamak Donald and I am CAD and technical lead at the London 00:11.680 --> 00:17.260 Ambulance Service. For the next 25 minutes or so, the D in CAD is computerated dispatch 00:17.260 --> 00:23.440 rather than design because that's going to make the whole talk a lot less confusing. Essentially 00:23.440 --> 00:27.880 all of the technology and systems in our control room are looked after operationally by 00:27.880 --> 00:34.080 me and my team. And I'm about to tell you a little story about the worst day of your life. 00:34.080 --> 01:04.000 You are in cardiac arrest. Your heart has stopped beating. You have stopped 01:04.000 --> 01:09.480 breathing and medically speaking you have died, which is not a great start to your afternoon. 01:09.480 --> 01:13.960 But worry not, somebody has called 999 which for the avoidance of doubt is the Brexit version 01:13.960 --> 01:21.520 of 1-1-2. So that's already increased your chance of survival from 0 to somewhere slightly above 01:21.520 --> 01:26.960 0. But you don't care about all of that. You want to become less dead. This is the story 01:26.960 --> 01:33.000 about all of the technology, systems and geospatial data that is going to help the London Ambulance 01:33.000 --> 01:37.960 Service save your life. Now I'm going to go back to the beginning. So you'll have to bear 01:37.960 --> 01:42.240 with me a minute before I get to the actual geo stuff. I promise it's coming. You've 01:42.240 --> 01:46.440 gone into cardiac arrest and someone has called 999. Someone has identified that you've 01:46.440 --> 01:51.320 stopped breathing and medical help has been summoned. But the start of that 999 call was 01:51.320 --> 01:56.560 interesting. Put it out of your mind for a moment. Think about if you were designing the 01:56.560 --> 02:01.760 platonic ideal 999 call. The kind of call that's perfect for treating spherical patients 02:01.760 --> 02:08.080 in a vacuum. How would you start a 999 call? What's the first bit of information you would 02:08.080 --> 02:13.120 ask for? Would you get the address? Would you find out what's wrong with the patient? 02:13.120 --> 02:18.800 So let's talk about this because as you know now you're wrong. As you heard, this is the 02:18.800 --> 02:25.600 opening phrase for all 999 calls to English ambulance services. And to understand why, I'm 02:25.680 --> 02:29.840 going to play the clip again, but I'm going to dim it a bit and I'm going to overlay all of 02:29.840 --> 02:34.080 the stuff that's going on whilst the call is in progress. Don't worry about understanding 02:34.080 --> 02:37.680 it yet. I'm going to go into it as the talk goes on. But let's have a look. 02:56.560 --> 03:07.680 It took 11 seconds from the call being answered until an ambulance was dispatched 11 seconds. 03:09.440 --> 03:13.600 It's pretty impressive to be fair not to do our own horn. But as for how and why that happens, 03:13.600 --> 03:20.160 let's explain why. So obviously not every call is going to be someone who stopped breathing. 03:20.240 --> 03:25.520 So in 2017, NHS England replaced the previous sort of mesh match of call priorities 03:25.520 --> 03:30.080 with the ambulance response program, which is five key levels of emergency response. 03:30.080 --> 03:35.600 Category one is calls from people with life-threatening injuries and illnesses where every second 03:35.600 --> 03:40.960 counts. Category two is for other emergency calls such as heart attack, serious bleeding, 03:41.920 --> 03:46.880 other emergencies that really need to get to hospital quickly, but don't need that time critical 03:46.880 --> 03:53.520 by the second response, including emergency care or PR. Category three is for urgent calls, 03:53.520 --> 03:58.880 things like broken legs and falls without serious injuries, where you need to get to hospital, 03:58.880 --> 04:04.000 but they can wait if we have higher priority calls and not enough ambulances. Category four is 04:04.000 --> 04:09.520 less urgent calls for conditions such as sorry to save us at lunchtime, but diarrhea and vomiting. 04:10.720 --> 04:16.240 And that sort of infection, those kind of things where an ambulance will eventually be sent 04:16.240 --> 04:22.240 if there's no alternative, but you might get some advice or referrals instead. Category five 04:22.240 --> 04:28.800 kind of doesn't exist. These are calls that almost definitely won't get an ambulance without 04:28.800 --> 04:36.240 having some sort of assessment first by a clinician. Each call has a response time set by NHS England 04:36.240 --> 04:42.080 of how long it should take by rolling average for us to get there. Category one is any resource 04:42.160 --> 04:47.840 needs to get on scene within seven minutes and try to assist patient the rest of the categories 04:47.840 --> 04:53.200 except Category five, which as I said, we don't really go to. We need to send the full ambulance 04:53.200 --> 04:59.200 response within these timeframes. Some other facts for you at the moment in England, 05:00.320 --> 05:07.040 ambulances never wait on station for calls to come in. Almost every ambulance, almost everywhere 05:07.120 --> 05:13.520 in the UK, is currently on a job for the 10 million ish people that are in London right now, 05:13.520 --> 05:17.520 including the 8 million live there and the 2 million that can be used in for work or leisure. 05:19.280 --> 05:26.080 There are about 400, 300 to 500 ambulances on duty. So, there are never enough available. 05:26.080 --> 05:30.400 However, if an ambulance needs to be diverted to a higher priority call, we can do that. 05:30.400 --> 05:36.080 In London, that happens all the time. But how do you get your priority? You heard the nature of 05:36.080 --> 05:41.280 call questions or knock questions in our clip because what Frostam really needed is another acronym 05:41.280 --> 05:47.520 that ends in O.C. So, let's talk about the pre-tree our civ. These are the questions we are 05:47.520 --> 05:51.920 asking at the beginning of the 999 call to establish if there's something critical happening 05:51.920 --> 05:58.880 that we need to get a response sent ASAP. You heard is the patient breathing and we then ask if 05:58.880 --> 06:03.920 the patient is breathing whether they're awake. If they're not awake, we ask whether they're 06:03.920 --> 06:09.360 breathing is noisy because noisy breathing has been shown to when your unconscious has been shown 06:09.360 --> 06:15.360 to be an indicator of potential cardiac arrest. And then we ask, tell me exactly what's happened. 06:15.360 --> 06:22.800 That then lets us establish basically what's going on with the call. Finally, all of this, 06:22.800 --> 06:29.520 we will ask, well, not you, you're dead per unit. We will ask, what's the address of the emergency? 06:30.160 --> 06:35.360 This isn't a list though as you'll remember from the clip we kind of jump depending on where 06:35.360 --> 06:41.760 it's relevant if we identify a critical situation in the earlier questioning. So, why do we do it this 06:41.760 --> 06:48.240 way? Why not get the address first? There are two reasons we do this. One, we already know where you are. 06:49.520 --> 06:56.800 Ish? So, when your 999 call connects in the UK, it's answered by BT, the formerly nationalised 06:56.800 --> 07:02.480 telecoms company. BT, British telecom then pass it through to the service you ask for, 07:03.360 --> 07:09.120 and when it connects to us, they deliver us this information. This is how it looks on our map. 07:10.400 --> 07:15.840 This is called ISEC, the enhanced information system for emergency calls. We love a snappy acronym 07:16.800 --> 07:22.080 and the it represents your approximate location based on the cell tower through which you made 07:22.080 --> 07:28.560 your call and the signal strength is used to calculate this sort of radius. About 20 seconds into the call, 07:28.560 --> 07:35.680 your phone sends an SMS message, yes, really, in 2025, in Britain, an SMS message with more 07:35.680 --> 07:41.040 accurate location information once it's kicked in your GPS. This is called advanced mobile location, 07:41.040 --> 07:46.880 or a ML, and it reduces the size of the circle because we now have a more accurate idea of where your 07:46.880 --> 07:54.720 phone actually is. I am pleased to inform you that now over a decade of ML was introduced in 2025, 07:54.720 --> 08:01.760 we are finally doing this with HTTP and we get streaming updates if your device changes location, 08:01.760 --> 08:07.760 or the GPS fix gets better and the circle gets smaller. The second reason we ask the questions 08:07.760 --> 08:11.920 the other way up, which you've probably already worked out by now is we're looking for a category one. 08:12.880 --> 08:19.360 These are the most time critical life-and-death kinds of calls, as I said, so the quicker we can identify 08:19.360 --> 08:25.440 one, the quicker we can get help sent to you. If we identify one of those conditions in the pre-3RC, 08:25.440 --> 08:29.920 we can send off what we call a predicted category one. At the point we heard into the presentation, 08:29.920 --> 08:36.960 it's not breathing, it's not awake with noisy breathing or in certain other conditions. From the call, 08:37.040 --> 08:42.480 you'll see the category one not predict identified stage here, 10 seconds into the call. 08:43.920 --> 08:48.960 As I say, we have other reasons to send out calls, a category one calls based on the nature of what's 08:48.960 --> 08:54.800 happened. If response to tell me exactly what's happened, they trigger another one of our knock 08:54.800 --> 09:00.720 criteria. That might include someone actively having a seizure, drowning someone who's unconscious 09:00.720 --> 09:06.000 following trauma, that kind of stabbing one of those kind of really serious incidents where 09:06.000 --> 09:12.400 every second counts. So if we've already spotted a cat one and we already have kind of a good 09:12.400 --> 09:19.760 enough location, why are we even bothering with the rest? Why are we actually asking for the address 09:19.760 --> 09:25.840 of the emergency at the end of the pre-3RC? Let's have a look at the question. Have you spotted 09:25.840 --> 09:33.920 the reason that we still ask the question? How about now? There are myriad reasons why somebody 09:34.000 --> 09:37.040 who's making the call might not be on seeing with the patient. You might be calling on 09:37.040 --> 09:42.080 behalf of a friend, a relative who's not with you. You might be working in another service 09:42.080 --> 09:47.280 control room, like police or fire and you need our assistance with an incident or as we've seen 09:47.280 --> 09:52.640 the ISEC and AML information just might not be that good. Some people inexplicably do still have 09:52.640 --> 09:59.360 knockier brick phones. Although I've got to say fair play to them because I'm still proud of my 09:59.360 --> 10:06.080 snake high score 20 years later, but yeah, sometimes the data that we get from them is just 10:06.080 --> 10:11.520 just not very good. Time for the first and my interesting tangents. So I will cue my interesting 10:11.520 --> 10:18.160 tangent music. What happens if you have no signal or you haven't paid your phone bill? Can you 10:18.160 --> 10:23.920 still call 999? How does that work? You will have seen emergency calls only on your phone unless 10:23.920 --> 10:28.960 you have an iPhone because this is an argument I'm still having with Apple to this day, but that means 10:29.040 --> 10:35.680 your phone can't see your mobile network, but it can see other mobile networks. So it uses one of 10:35.680 --> 10:41.600 those to contact the emergency services. However, when you do that, it doesn't pass any information 10:41.600 --> 10:47.760 from your device to us. We see this as your mobile phone number, which obviously is not real, 10:47.760 --> 10:52.880 so that doesn't give us any indication of where you are or who's calling, which is why we also 10:52.880 --> 10:57.600 ask for your telephone number to confirm that we've received correct information from your device. 10:58.560 --> 11:03.360 So that's how that works and it's extremely important that we double check the information 11:03.360 --> 11:08.480 that we've given for that reason, but you don't care about any of that. For those of you just joining us, 11:08.480 --> 11:12.720 you are dead and we're trying to prevent that from happening. So far, we know you're not breathing 11:12.720 --> 11:17.600 and we've predicted a category one call. We know roughly where you are and we've asked for your 11:17.600 --> 11:23.920 exact location. Next, we need to find your precise location and then while you wait, we're going 11:23.920 --> 11:29.360 to try and get you some help, send you an ambulance and then give you some advice while you wait. 11:30.720 --> 11:37.040 So we need to talk about the 11 seconds thing and we need to talk about why we're still asking 11:37.040 --> 11:41.600 for the precise location and finding it. Because right now, the ambulance crew this will be 11:41.600 --> 11:46.960 their mobile data terminal is navigating to this. These are the ordinance survey easings and 11:46.960 --> 11:52.400 nothings of the call that we've received via ISEC. Later, we can have an argument about the 11:52.400 --> 11:57.600 merits of X and Y coordinates versus Latin law. For now, just pretend the UK is a flat rectangle. 11:59.520 --> 12:05.280 But it will be grand if we could turn that into something that means anything for our ambulance 12:05.280 --> 12:11.680 crew. Unfortunately, all so for our call, handlers, CAD isn't Google. Our control room is 12:11.680 --> 12:17.920 completely air gap from the public internet. So we have to rely on information that we have already 12:18.000 --> 12:22.880 to find canonical addresses. We can't send them wherever the caller says. The address has to 12:22.880 --> 12:28.560 exist. The address point has to be something we recognize. So we get our location data from the 12:28.560 --> 12:34.720 ordinance survey, which is a great Britain's national mapping agency. They give us their product 12:34.720 --> 12:38.880 called address based premium, which is their location, Gazette here for free. Thanks to the public 12:38.880 --> 12:44.640 secretary of spatial agreement. Thanks ordnance survey. Which gives us the database every address 12:44.640 --> 12:49.040 point in the UK. Later, we can have an argument about what constitutes an address point. 12:50.480 --> 12:55.120 So we have every address point in the UK. Well, in Great Britain, I should say that's a 12:55.120 --> 13:00.560 political thing I'm not waiting into. In our database that can be queried by call handlers. 13:00.560 --> 13:08.240 So what's the address of the emergency? Bugger. See, the thing about Baker Street tube station 13:09.120 --> 13:16.240 is no one knows where it is. I mean, people know where it is. It's there. But no one knows it's 13:16.240 --> 13:21.360 full address. According to transport for London, it's not even on Baker Street. The official address 13:21.360 --> 13:26.800 is on Marleybone Road. How is a member of the public going to know the address of Baker Street 13:26.800 --> 13:33.840 station when TFL themselves don't have the full postcode on the website? We need to find Baker 13:33.840 --> 13:38.480 Street station without having to enter a full address. Now, the CAD system can obviously match 13:38.480 --> 13:45.120 on a partial address string. But if you type in Baker Street, you'll find the station and also 13:45.120 --> 13:52.240 every address along this road here. Also, because the tube has been around for more than 160 13:52.240 --> 13:58.560 years, there are many different canonical ways of referring to stations for of which appear in the 13:58.560 --> 14:05.760 ordinance of a product. So it's a bit more difficult than you might expect. I'll tell you how I 14:05.760 --> 14:13.600 fix the problem. Open data. Usually gets a woo. You open data geo people come on. Thank you. 14:14.960 --> 14:19.040 It turns out that TFL will just tell you where all their stations are with coordinates. If you 14:19.040 --> 14:26.720 ask their API nicely, I then scrape all of that information and turn it into one canonical way to 14:26.720 --> 14:33.360 refer to stations I use U-slash G because it's fewer keystrokes than underground and we use the 14:33.360 --> 14:40.480 coordinates returned by the TFL API to fill the database with the canonical location of every 14:40.480 --> 14:45.360 tube station. The call handler can then just type in Baker Street U-slash G and it populates 14:45.360 --> 14:51.200 with the full address on Marleybone Road and with the other half of the postcode. TFL, you're welcome. 14:52.400 --> 14:56.320 We also do this sort of thing for the whole country's national rail stations which we get directly 14:56.320 --> 15:00.720 from the Department of Transport, other transport for London services like the Overground, 15:00.720 --> 15:05.680 the Elizabeth Line, etc. Our own ambulance stations because it would be exceptionally embarrassing 15:05.680 --> 15:11.760 if we couldn't find those and these driver location signs that are on all of England's motorways 15:12.320 --> 15:18.000 every 500 meters. We get them from the national highways agency. We use this tool that I built 15:19.200 --> 15:25.520 to compile all of that information from the various sources and produce address entries 15:25.520 --> 15:30.480 that we can then load into our system. We give them our own UPRN that starts with LAS because 15:30.480 --> 15:38.080 they're not real UPRNs but we take in data from various sources, CSV files, APIs etc. 15:39.440 --> 15:42.720 And we transform them into canonical address style records. 15:44.640 --> 15:50.560 Another interesting tangent quickly, what happens if you get sick underground with no mobile signal? 15:50.560 --> 15:53.840 There is now mobile signal on most of the London underground, however, 15:54.800 --> 15:59.360 if you are without phone signal, you need to find somebody who works there. 15:59.360 --> 16:04.160 They will use a London underground radio to contract their control room and then their control 16:04.160 --> 16:11.760 room will phone us. However, if you're in a control room, you can't tell me where to go. 16:11.760 --> 16:16.160 If you're a caller on a scene, I can ask you what you can see around you, but if you're in the control room, 16:16.160 --> 16:20.800 you need to be able to tell me which of the three entrances to Baker Street station we need to go to. 16:21.680 --> 16:26.720 Fortunately, TFL being the clever so-and-soes they are, have assigned a numerical code 16:26.720 --> 16:32.560 to each of the entrances to Baker Street station. We take all of these into our address database. 16:32.560 --> 16:37.600 We create records for each one. So the call handler can just type it in. This isn't a real one. 16:37.600 --> 16:42.400 I'm not allowed to show you a real one, but they type into the district box because London doesn't 16:42.400 --> 16:47.680 really have districts. We can argue about that later because it definitely does, but we don't use it 16:47.840 --> 16:53.680 at the LAF. So we can type in the code and find exactly where TFL need us to get to. Anyway, 16:53.680 --> 17:00.160 back to you and being dead, that's ticked off your precise location. So now we need to send you an ambulance. 17:00.160 --> 17:06.640 So it's finally time to address the 11th seconds thing. We need to talk a bit about triage, 17:06.640 --> 17:11.600 and we need to talk a bit about how you get your priority. We've talked about what the priorities mean, 17:11.600 --> 17:16.080 but a call handler doesn't just get to pick one. They don't get to just choose what to assign you. 17:16.080 --> 17:20.800 So we use one of the two triage systems that are approved for use in the UK in England. 17:20.800 --> 17:26.320 I should really say there's MPDS, the medical priority dispatch system, which is a system of choice 17:26.320 --> 17:31.600 here in Belgium. Also in about half of the English ambulance services, including the London 17:31.600 --> 17:38.800 ambulance service, and NHS pathways, which is an NHS product. So it's only used in England. 17:38.800 --> 17:44.560 It's used at the other half of services as well as on non-emergency medical advice service one or more. 17:46.320 --> 17:51.840 After the talk, we can have an argument about which one's better, but MPDS is the one we're using. 17:51.840 --> 17:57.280 London, and fun fact, we also contribute the most changes back to the MPDS in the world, 17:58.240 --> 18:06.000 based on our clinical audit and research. In the MPDS, there are 35-ish protocols that 18:06.640 --> 18:13.120 can go into essentially exactly what's happened. It has every possibility of why you might need an ambulance, 18:14.000 --> 18:20.240 and that allows us to assign the priority based on the system. It spits out a triage 18:20.240 --> 18:24.800 determinant code that looks like that. I would love to explain what it means, but I don't have time. 18:26.640 --> 18:33.200 So whilst we may see you as this, the system sees you as this, but because the system sees you as 18:33.200 --> 18:38.640 this, it knows the priority. There's a group in NHS England called the emergency called 18:38.640 --> 18:46.000 Prioritization Advisory Group. They go by ECB, you'll be unsubvised to learn. The signs all 18:46.000 --> 18:53.040 1,800 MPDS codes and the equivalent pathways, the priorities in advance. We loaded into a look 18:53.040 --> 18:58.560 up table, and then the CAD can find you. And the CAD can prioritise you, sorry. 18:59.840 --> 19:08.240 See where it says type code. This is a type code essentially. And that allows us to do automatic dispatch. 19:09.120 --> 19:13.680 So now we know where you are, and we know you're a category one, CAD is going to start searching 19:13.680 --> 19:19.440 for available ambulances using the mobile data terminals in the trucks. There's one, which transmit 19:19.440 --> 19:25.360 their GPS information directly into CAD continuously. And then as long as that call exists in the 19:25.360 --> 19:30.000 system, the CAD is going to assist the dispatcher in trying to find you an ambulance. Even if the 19:30.000 --> 19:37.440 dispatcher hasn't opened the call yet. So that ticks off this bit, right? We've sent you an ambulance. 19:38.400 --> 19:43.840 Yes, we have, but we can do a little bit better than some people in a big yellow van. 19:44.640 --> 19:49.840 Each of the type codes also allows us to create a response matrix. I would love to go into this, 19:49.840 --> 19:56.640 but I don't have time. You get sent a double crude ambulance, the standard big yellow thing, 19:56.640 --> 20:01.680 but we also send various other types of units to do CPR on scene, provide other treatments, 20:01.680 --> 20:06.400 et cetera. Don't have time to explain that, but they're so low paramedic respondent vehicles. 20:06.480 --> 20:10.720 We need to make sure at least one person we've sent is a paramedic so that they can give you 20:10.720 --> 20:17.760 what my boss has asked me to stop calling the good drugs. And we also send a volunteer responder 20:17.760 --> 20:25.120 if we can to provide you that basic first aid on scene while you wait. One final thing, we 20:25.120 --> 20:29.680 figured out where you are and how to get you help, but what are we going to do while you wait? 20:30.560 --> 20:36.000 It's not like on TV dramas where you just make the call and then hang up and then the ambulance 20:36.000 --> 20:51.280 arrives. I'm also not sure how film Mitchell plans to get an ambulance talking to his 20:51.280 --> 20:56.560 lock screen there, but we digress. This is the MPDS instruction required to be given to all 20:56.560 --> 21:02.160 callers after triage is complete. There are instructions that the MPDS contains that you give to 21:02.160 --> 21:07.920 the caller to talk them through first aid. That can be all manner of things, including not having 21:07.920 --> 21:13.280 anything to eat or drink, in case you need surgery later, bleeding the drill or for you who's currently 21:13.280 --> 21:19.920 dead, it's going to be CPR. How do you take someone CPR over the phone if they've never done it before? 21:20.000 --> 21:33.280 That's obviously a joke, but having said that, the British Art Foundation did produce a 21:33.280 --> 21:39.520 Spotify playlist of songs that are the right BPM to do CPR to, Google Life Saving Beats and 21:39.520 --> 21:45.120 save that to your phone later. Unfortunately I can't really show you the specifics because it's 21:45.120 --> 21:50.720 all copyrighted and licensed and basically I'm not allowed to show it to foster. However, what I 21:50.720 --> 21:54.640 can tell you is we essentially give you a crash course in CPR telling your where to put your hands 21:55.600 --> 22:00.720 and all that sort of thing and then count out metronome style 1, 2, 3, 4 to make sure they're 22:00.720 --> 22:04.480 getting the rhythm right. We can give all kinds of first aid over the phone as I said, 22:04.480 --> 22:11.520 including bleeding the drill, use of an epipen or in a lock zone, even delivering a baby, 22:11.600 --> 22:15.760 things we're going to buy is over the phone. I personally have delivered five babies over the phone. 22:16.800 --> 22:22.560 When you do that, our clinical audit research unit give you this little badge. It's a little 22:22.560 --> 22:29.920 stalk and that leaves on my work lying out, right? That's almost it. We've completed our list, 22:30.880 --> 22:35.520 but in the words of so many apple keynotes, one more thing. Do you remember when we were talking 22:35.520 --> 22:42.080 about the BHF a moment ago? That was kind of a check-offs gun. There is another geospatial data 22:42.080 --> 22:47.440 set I want to tell you about and it is the circuit, the BHF's national defibrillator database. 22:48.640 --> 22:53.520 This is the map of all the defibs around electromagnetic field, which is the hacker camp I 22:53.520 --> 22:59.600 lasted this talkout because I've very lazily not updated the PowerPoint, but this information 22:59.680 --> 23:04.720 is also available in an API and you know enough about me by now to know I love an API. 23:05.680 --> 23:10.320 Because we've assigned you these type codes, CAD knows that you're in cardiac arrest and we can 23:10.320 --> 23:17.440 program it to do other stuff, including dispatch a defibrillator. We get a data dump from the BHF via 23:17.440 --> 23:23.040 the circuit API into the CAD system. So the call handler can tell you where the nearest defibrillators are 23:23.040 --> 23:27.920 and if it's a defibrillator we've put there because we have given defibrillators to every tube station 23:27.920 --> 23:32.480 a lot of public buildings in London will send an automated text to their security or because 23:32.480 --> 23:38.080 studio and the defibrillator to us and to take it to the patient. So now that really is it. 23:39.200 --> 23:47.120 So we do one more of these for all time sake and then I have to finish. What happens when it all 23:47.120 --> 23:52.640 goes sorry I forgot the tangent music? There you go. What happens when it all goes wrong? What 23:52.640 --> 23:58.000 about when there's a problem with the database with our connections? Many of you in this audience 23:58.000 --> 24:03.840 will have experiences of systems that have been less resilient than you'd like them to be. 24:04.160 --> 24:11.680 Working here is the first time I have ever seen a 100% uptime SLA, but it's an unfortunate reality 24:11.680 --> 24:18.080 that outages happen. How do we cope? Well unfortunately a lot of these fancy geo stuff goes out 24:18.160 --> 24:25.360 the window and we use this delightful publication. The geographers A to Z master map of London 24:25.360 --> 24:31.760 we find the map reference on the page and we use the index to validate that the road exists 24:31.760 --> 24:38.400 and is where we expected to be and then we give that map reference over the radio to the ambulance crew 24:38.400 --> 24:43.440 so that they can be on the same page as us literally. Each ambulance has one of these in the glovebox 24:43.440 --> 24:51.600 so they can refer to it if we're having issues. That's kind of a lie. We do do that, but also 24:51.600 --> 24:57.600 usually when the CAD system goes down we've still got access to the internet or our local network 24:57.600 --> 25:01.040 so we have a little web tool that sits on our network that can actually just query the 25:01.040 --> 25:05.920 ordinance survey API because that's a lot easier. It's still generates the map reference and we 25:05.920 --> 25:11.440 still do train people on how to use these and rely on them if the network doesn't work but 25:12.160 --> 25:17.760 yeah those are kind of not true. As for the rest of it that's kind of a tangent on the tangent 25:18.800 --> 25:25.200 we have to be able to operate the whole ambulance service on pen and paper. I find this personally 25:25.200 --> 25:31.360 very fun everyone else finds this hell on earth. Don't know what that says about me but we write 25:31.360 --> 25:36.240 down the call details in triplicate on these lovely carbon copy pads and we have a paper 25:36.320 --> 25:41.520 flipped file version of the triage system so we can go through it with our computers. If a call 25:41.520 --> 25:46.240 taken in our south London control room needs to go to a north London crew it's sent to them with 25:46.240 --> 25:50.880 one of these things. For the young people in the audience this is a fax machine and please find a 25:50.880 --> 25:57.040 grown-up to explain how it works and finally to make sure that the calls that we're already in the 25:57.040 --> 26:02.320 CAD system at the time of the crash are dispatched and responded to a piece of software written by 26:02.400 --> 26:07.040 yours truly. Copy is them to redundant work stations in each control rooms of in the event. 26:07.040 --> 26:11.680 It can no longer see the CAD database they can get printed out onto those pink slips you saw 26:11.680 --> 26:19.200 a moment ago. So now that everything all our tangents complete we've ended the story. If we 26:19.200 --> 26:24.000 found you using open data, aided by the live geospatial information from your phone we use the 26:24.000 --> 26:28.480 world's most popular structured emergency medical triage system which is a hell of a thing to say 26:29.360 --> 26:34.080 so you can see why there isn't another. To identify what was wrong with you we got you the best 26:34.080 --> 26:39.120 possible response based on exactly what had happened to you and everybody lived happily ever after. 26:39.120 --> 26:43.760 Well not you you spent a month in the hospital having heart surgery but because you received 26:43.760 --> 26:50.080 that early CPR and early defibrillation we were able to give you an up to 70% chance of surviving 26:50.080 --> 27:04.640 your cardiac arrest and that is how to save a life. Do I have time for questions? 27:06.640 --> 27:10.480 Does anyone have any questions? 27:10.480 --> 27:29.040 Yes the AML. Yes so that works based on the GSM standard so when your phone knows that it's 27:29.040 --> 27:35.040 dialing an emergency number it texts that to in UK it texts it to BT here it will text it to 27:35.040 --> 27:39.760 whatever telecoms agency is responsible for transmitting that to the emergency call handling 27:39.760 --> 27:44.400 centers but it's kind of pre-programmed configuration in the phone based on the GSM spec. 27:46.240 --> 27:52.720 Over here. So you've written a bunch of these tools for the actual technologies behind 27:53.360 --> 27:58.800 how this works but you mentioned but you also had done this back call for itself. 27:58.800 --> 28:04.880 Is that common thing when we love the AML service? Well there are exactly two of us that have 28:04.960 --> 28:12.640 done that. Unfortunately she's on holiday. The question was is it a common career path 28:12.640 --> 28:18.400 in the London AML service to start as a dispatcher as I was and then go on to write the tools 28:18.400 --> 28:25.200 and technology myself? I've been very very lucky. Is the answer to that question? There are 28:25.200 --> 28:32.160 two CAD and technical leads at the LF but yeah I'm one of them but a lot of people do go on to 28:32.160 --> 28:38.160 work in other areas of the service like IT like systems or they go and work in operations management 28:38.160 --> 28:41.360 or they go out on the road. A lot of call handlers will go out on the road because they want to 28:41.360 --> 28:45.120 actually get stuck in and help. Over here. 28:54.400 --> 29:00.000 Yes so when you call from underground where there's signal on the London underground etc 29:00.960 --> 29:05.840 is the first approximate location useful. Yes we've done a big bit of work with the mobile networks. 29:05.840 --> 29:10.880 There was a news story a while ago that said emergency services are blocking the road out 29:10.880 --> 29:18.880 of 4G on the underground sorry that was me that was my fault genuinely was me but that's because 29:18.880 --> 29:24.000 we had them develop a version of the ISEC system that transmits directly to us that you're in a 29:24.000 --> 29:29.040 tube station so if you call it doesn't actually use your GPS location because you're going 29:29.040 --> 29:33.840 through a repeater station that's on the underground it comes up and says you are at Baker Street 29:33.840 --> 29:45.360 station on our end so we can confirm that so it's very usable. Behind you how do I find location 29:45.360 --> 29:51.440 if someone calls from a landline BT send through the registered emergency address which is usually 29:51.440 --> 29:58.160 where the bills go to unless but if you have like a VoIP a SIP landline in the UK you have to 29:58.160 --> 30:02.160 register an address for that landline in case of emergency calls and that just comes through 30:02.160 --> 30:08.320 as text and matches one to one with the address based product unless you're in a Markson Spencer 30:08.320 --> 30:12.880 because they've all registered their locations to their head office so you can call from any 30:12.880 --> 30:18.960 Markson Spencer shop in the UK and it all comes through to their head office not not great over here. 30:19.200 --> 30:22.480 Thank you. 30:25.280 --> 30:30.880 Non-English speakers and people with disabilities so we have access to a 24-7 translation service 30:30.880 --> 30:37.920 into a protection service for about 200 odd languages I think and they will help us if the 30:37.920 --> 30:45.520 person can speak but not speak English if someone is unable to speak you can also send SMS text messages 30:45.600 --> 30:51.520 to 999 in the UK or we accept teletype calls where a relay a system will come on the line from 30:51.520 --> 30:56.000 BT and do the typing and talking depending on what the caller is able to do. 30:57.600 --> 31:02.720 In the front of the WIFI calling in the round of a university for example. 31:02.720 --> 31:09.680 WIFI calling is kind of similar to the landline side of it the location comes from 31:10.560 --> 31:17.360 through so I think it tries to send your AML over the WIFI connection because we're doing it with HCCB now 31:18.240 --> 31:25.040 but usually the cell companies that enable the WIFI calling have kind of location that comes through 31:25.040 --> 31:31.200 that's a bit like the ISEC location but not quite as good. It's complicated as the short answer 31:32.000 --> 31:35.680 but it works most of the time because it can use the AML in the back. 31:39.680 --> 31:44.400 What's the nature of the argument I'm having with Apple about emergency calls? In the UK, 31:44.400 --> 31:49.520 in other countries when it's emergency calls only it comes up with SOS on the phone in the UK it just 31:49.520 --> 31:54.960 comes up with no service. We would love it to be the other way around so people know they can make emergency calls. 31:56.560 --> 31:57.680 Was there another hand? 31:59.120 --> 31:59.520 Dad. 31:59.680 --> 32:07.280 Ratio of proprietary and open source tools that you use ratio of proprietary and open source tools that 32:07.280 --> 32:15.520 I use got a good question mostly proprietary. I would say unfortunately however we're trying to 32:15.520 --> 32:20.800 change that with a much open data as I can put in the database but most of what we use for location 32:20.800 --> 32:24.000 certainly is the ordinance survey so that's proprietary. In the back. 32:29.920 --> 32:34.880 If I'm writing scripts for API, do I get to publish those or do I have to live on my machine? 32:34.880 --> 32:40.000 A good question we are still working through that. Most of them I think are underground copy 32:40.000 --> 32:44.640 rights or I can publish them but there are some things that we do that are internal because 32:44.640 --> 32:48.720 they map to processes that we don't really own like the London Underground numerical codes so I'm 32:48.720 --> 32:52.560 not allowed to share that information over here. 32:53.120 --> 33:01.280 Did we consider open street map? We are using open street map for a new project which we should 33:01.280 --> 33:07.840 be rolling out very soon for finding parks and squares and open spaces and it's definitely something 33:07.840 --> 33:12.880 we're considering. We have to legally we have to rely on the ordinance survey in the first instance 33:13.680 --> 33:17.520 but anything we can use from OSM to supplement that we will definitely. 33:18.400 --> 33:26.480 In the back. The question was I've heard the police use what three words does that apply to 33:26.480 --> 33:31.120 the ambulance service if you'll just excuse me. I just have to pop this on the screen. 33:34.000 --> 33:39.600 So we do accept what three words locations at the ambulance service most emergency 33:39.600 --> 33:45.600 services in the UK do. We don't love it because obviously it's not tremendously accurate and it 33:45.600 --> 33:51.040 requires the caller to do something so if we can't find you we don't like encourage the caller 33:51.040 --> 33:56.640 to the call handler to send you the what three words link but if we're given a what three words 33:56.640 --> 34:01.920 address we can or location we can geocode it we have their API and they do let us use it for free. 34:10.800 --> 34:12.560 Thank you very much.