Saving Lives with Distributed Intelligence

One of the general features of information technology is that through coordination it makes better use of distributed resources, such as workers, automobiles or energy. An excellent case in point is being tested in Stockholm, Sweden. SMSlivräddare (in Swedish) has a large list of people who are trained in cardiopulmonary resuscitation (CPR). When an emergency call is received indicating a possible heart attack, SMSlivräddare finds the mobile phone user(s) closest to the potential victim and alerts them with a text message. The message also contains a map to the victim’s location.

Survival rates for heart attack outside a hospital in Sweden are low, only about 5-10% but every minute shaved off the time it takes to begin CPR increases the survival rate by 10%. When notified, SMS responders arrive faster than ambulances about 50% of the time so the potential for saving lives is quite large (final data on the research project are not yet in).

Could such a system work in the United States? Maybe, a similar but more passive app is available in a few locations. Legal issues are a threat. Good Samaritan laws offer some protection although they often apply only to medical professionals. The threat, however, is not really to the responder but to the service. It’s interesting to watch Shark Tank, anytime a medical entrepreneur makes an appearance the sharks run away for fear of liability. Still, if the service were attached to a hospital and integrated with ambulances services, it ought to be possible to be insulated but this will require significant political entrepreneurship.

Hat tip: Connor Tabarrok.


Already available in the US, offered in conjunction with local "fire" departments

Thanks Rick, noted.

Anecdotally, many medical professionals have standing orders not to have CPR performed on them. It might work if you are young and healthy, but then you probably aren't getting the heart attack anyway.

Very interesting reading; thanks for the Link.

From a legal perspective, what's the US-law rationale for restricting Good Samaritan laws only to medical professionals?

It seems a US quirk. Most other jurisdictions have wide Good Samaritan protection sometimes stretching so far as to be even a "duty to rescue". e.g. France, Germany

Anyone know the legal basis? Was American law always so restrictive on good Samaritan protection?

'Good Samaritan laws offer some protection although they often apply only to medical professionals. '

This is not true in Virginia, where Profs. Tabarrok and Cowen are employed by Commonwealth, as the law states in its opening -

'A. Any person who:

1. In good faith, renders emergency care or assistance, without compensation, to any ill or injured person at the scene of an accident, fire, or any life-threatening emergency, or en route therefrom to any hospital, medical clinic or doctor's office, shall not be liable for any civil damages for acts or omissions resulting from the rendering of such care or assistance.' -

The one exception I remember, and this was decades ago, was CPR (right around the time the technique was actually being introduced). We were taught that only someone certified in CPR was allowed to administer it - and considering just how many people saw CPR on TV only, the stories we were told by a paramedic were shocking - 'good samaritans' practicing their version of CPR broke ribs, punctured lungs, and one could safely assume, according to him, killed people - though the dead ones were people who did have heart attacks. Unlike the far too many cases of broken ribs and punctured lungs.

And here is that passage - '6. Has attended and successfully completed a course in cardiopulmonary resuscitation which has been approved by the State Board of Health who, in good faith and without compensation, renders or administers emergency cardiopulmonary resuscitation, cardiac defibrillation, including, but not limited to, the use of an automated external defibrillator, or other emergency life-sustaining or resuscitative treatments or procedures which have been approved by the State Board of Health to any sick or injured person, whether at the scene of a fire, an accident or any other place, or while transporting such person to or from any hospital, clinic, doctor's office or other medical facility, shall be deemed qualified to administer such emergency treatments and procedures and shall not be liable for acts or omissions resulting from the rendering of such emergency resuscitative treatments or procedures'

The key point in the 'good Samaritan' law is 'without compensation' - at least in Virginia, the inverse of what Prof. Tabarrok wrote is true. A medical professional who expects compensation is not protected by the law.

And yes, Germany has a duty to help law, a first aid couse is mandatory to acquire a driver's license, and a first aid kit is mandatory in every automobile and truck. Though the course and kit are pretty superficial, to be honest.

"considering just how many people saw CPR on TV only, the stories we were told by a paramedic were shocking – ‘good samaritans’ practicing their version of CPR broke ribs,"

I was under the impression that very often even in correctly delivered CPR broken ribs were an acceptable and legitimate collateral damage. I don't view broken ribs as evidence of wrong or overzealous technique.

I could be wrong.

Rahul, I don't think you are wrong:

"A 2004 review of scientific literature showed that conventional CPR can cause fractures of ribs and/or the breastbone (sternum) in at least one third of cases.† In a related study of people who had received such injuries from CPR, the fractures did not cause any serious internal bleeding or death.‡ On the other hand, the chance of surviving an out-of-hospital cardiac arrest is near zero for a victim who does not immediately receive high-quality chest compressions with minimal interruptions followed by additional therapy within minutes (a defibrillating shock and/or more advanced care from EMS personnel)."

There's also this:

"Dr. Michael Sayre, a spokesperson for the American Heart Association and a professor at the University of Washington in Seattle, said broken ribs are to be expected when doing CPR and the worry of causing a break shouldn't deter people from helping someone in cardiac arrest."

And here's another relevant link:

only about 5-10% but every minute shaved off the time it takes to begin CPR increases the survival rate by 10%

Citation, please?

Also, clarification, please? Are we saying "the survival rate was 5-10% but with help two minutes earlier it would have been 6-12%" or "the survival rate was 5-10% but with help 2 minutes earlier it would have been 25-30%"?

Yes, I would also like to see a citation. There's absolutely no way the survival rate goes up by 10 percentage points for each minute saved (your latter interpretation). Even the alternative interpretation seems dubious.

I think this is a wonderful innovative system. I agree totally that the system would have to undergo a great amount of enhancements. However the core of the system is a very efficient way to effectively respond to these heart patience. With the connection of this system and a hospital, would be supreme. The suing country that America is these days makes even strangers hesitant to respond to an emergency.Hopefully compromises in medicine can be made to make these advancements possible but with the government in shambles as it is; I highly doubt any such compromise will happen any time soon.

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