Memphis Mulls Over IBM’s Initial 911 Overuse Data Findings

In the city of Memphis, Tenn., 911 has been used as primary basic healthcare and transportation, but thanks to an IBM Smarter Cities Challenge grant, several data-backed solutions could help the city reduce millions in EMS shortfalls while improving healthcare for residents.

MEMPHIS, TENN. — Overreliance on 911 has led to an annual $20 million shortfall in the Memphis Fire Department’s EMS budget, according to Fire Dept. Division Chief Andrew Hart.

It’s an issue that’s being faced nationwide,” says Doug McGowan, chief operating officer for the city of Memphis.

Hart says the number of ambulance rides increased 24 percent to more than 124,000 trips each year from where it was five years ago. Also, while the city’s population has stayed at 650,000 people since the 1970s, the distance EMS travels has vastly increased. The city has doubled in size from 170 to 350 square miles. There are times when ambulances are not available for service calls.

The high 911 call volume in Memphis is very complex, says Masharn Austin, a workforce strategist on the city’s IBM team. A lack of readily accessible transportation is one reason why, he says.

“Calling 911 is purely a function of not being able to get to basic care,” says Austin.

For others, it’s upfront cost. By 2014, the poverty rate in Memphis was 30%1.

“We recognize our answer for the past 50 years is if you call 911, we will give you a ride to the hospital,” says Hart, adding that in Memphis, there are two options—call 911 and pay nothing up front, or find a ride and pay to see a doctor.

“It almost leads people to call 911,” says Hart.

Data-Driven Change

Memphis was one of 600 cities worldwide to apply, and one of 16 selected, for the 2015 IBM grant because of the opportunity to align on a major problem with data-driven solutions.

“Our goal is being brilliant at the basics,” says McGowan, part of Mayor Jim Strickland’s Innovation Delivery Team, which is charged with helping to make Memphis as effective and efficient as it can be.

The city had already put some thinking in how to reduce calls by establishing programs that put healthcare navigators in the community and nurse dispatchers on the telephone to find other solutions for frequent 911 callers.

IBM’s data crunching, which included using its Watson Analytics predictive analytics and data visualization tool, validated the programs. City officials say the results are giving them the confidence to keep moving forward with paramedicine and telemedicine programs they started last year.

An overview of the analysis, which the city and the company shared with EfficientGov, revealed some 2,000 frequent 911 callers for the navigators to work with.

It’s something that we struggled with. Having outside experts was huge,” says Hart. “Working with IBM is very beneficial in showing insurance companies that the cost savings [of the paramedicine program] is beneficial,” he adds.

Other IBM findings can help focus the city on solutions for the Memphians that use the 911 system. For example, a heat map reveals the zipcodes with the highest volumes of calls. New healthcare opportunities based in those areas or transportation vouchers to travel to points of healthcare could start reducing the number of 911 calls from those areas.

“We have to think differently. We have to think about the customer journey…We’re thinking from the point of service backwards,” says McGowan.

Surfacing Smarter Solutions

The IBM team arrived in Memphis in late February and spent about 10 days conducting more than 80 stakeholder interviews and gathering all relevant data from various city departments.

Key findings focused on the 911 process, collaboration among city departments, gaps in service, transportation issues, incentives and dis-incentives, educating the community and funding.

“This is not something one group could do on their own,” says Hart.

A lot of the things Memphis was doing, they were doing a good job at, they were just doing it in silos,” says Austin.

While IBM is still working on the final report, expected in May, the team’s recommendations are focused on collaboration among healthcare stakeholders, innovating Memphis’s 911 process, providing healthcare service alternatives, creating incentives and impactful corrective actions and launching a citywide education campaign.

On a micro level, some recommendations like consolidating systems data or establishing mobile health units are going to take time, money or collaboration from the city’s partners.

However, Austin points out that while the costs for some recommendations might be high, such as $500,000 per year just to operate a mobile health unit, the return on the investment is justified—one long-operating mobile healthcare unit in Boston shows a 36:1 return.

“It’s unbelievable the impact you can have in the community by providing immediate care,” says Austin.

IBM summarized recommendations based on the magnitude of the impact and how hard or easy each solution would be to implement.

Other recommendations, like empowering EMS to treat on-scene and EMS initiated refusal, will be hard to implement but would have high impact in addressing the problem. Memphis is debating the possibilities now. McGowan thinks that there are opportunities for paramedics to treat on scene and get ambulances back out for service faster. “We have faith and confidence in our front lines to make decisions,” McGowan says.

However, Hart cautions on legal concerns. The city has engaged its risk management team to look into what would be required to give EMS the authority, qualifications, compliance, etc…

A major piece is educating citizens on when to call 911, and when they really shouldn’t. IBM recommends campaign messaging based on what are the consequences of calling 911 just to get a ride. “It’s educating people through shaming,” says Austin.

While 911 shaming might not be the specific focus of a public outreach campaign, Memphis began talking this week with film production crews about the success of negative ad campaigns, such as the National Council Against Smoking’s campaign. Memphians could possibly save some lives by not tying up an ambulance to go and fill a prescription.

Comprehensive U.S. Map of Drug Deaths by County

The opioid crisis is a modern American epidemic punctuated by skyrocketing deaths. Our interactive map shows which counties are hardest hit.

Drug overdose deaths and opioid-involved deaths continue to increase in the United States. States like Maryland have passed bills to address the statewide crisis and increase access to naloxone, while Connecticut has coordinated efforts across municipalities and jurisdictions to address a dramatic rise in opioid abuse through training, referral and medication-assisted treatment.

According to the Centers for Disease Control and Prevention, the majority of drug overdose deaths (more than six out of ten) involve an opioid. Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) has quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses.

The counties with the highest mortality rate and the highest number of overdose deaths from 2016. We have also created an interactive map that allows you to see how your state has been affected by the opioid epidemic.


    • Data for this article was found at County Health Rankings as an aggregate of Centers for Disease Control and Prevention data.
    • Age-adjusted death rates were calculated as deaths per 100,000 population, using the direct method and the 2000 standard population.
    • To find 2017 data, the CDC calculated a summary of changes in the 2017 measures from those used in 2016 and a summary of all changes since the first release in 2010.

5 Domestic Terror Groups to Keep on the Radar

From killing in the name of the unborn to racking up $48 million+ in damage to save the planet, five domestic terror groups have plagued the last 20 years.

According to a 2015 study by the Triangle Center on Terrorism and Homeland Security, most police agencies view anti-government violent extremists – not radicalized Muslims – as the greatest threat of political violence they face. In that same study, eco-terrorism ranked third, right below violent extremism inspired by Al-Qaeda.

Here are five terror threats to keep track of:

#1 Army of God

The Army of God is a Christian extremist organization linked to multiple incidents of anti-abortion violence spanning over decades. Formed in 1982, members of the terrorist group are notorious for the bombing of abortion clinics, acts of kidnapping, murder, and attempted murder.

One of the most well-known incidents of violence tied to the group was the 2009 assassination of physician George Tiller, who was shot to death while serving as an usher during a service in his church. He was targeted for performing late-term abortions.

The Army of God recently made headlines in 2015, when Robert Lewis Dear, Jr. opened fire in a Colorado Planned Parenthood clinic. A police officer and two civilians were killed. Five officers and four civilians were wounded. Dear told police “no more baby parts” after he was taken into custody.

While not directly affiliated with Army of God, Dear described its members as “heroes” years prior to the attack.

Donald Spitz, Army of God’s spokesperson, continues to run the organization’s website, where Dear is listed as a “hero who stood up for the unborn.” The FBI has been watching Spitz for over 20 years.

#2 Phineas Priesthood

The Phineas Priesthood is not a group, but a name for individuals who commit acts of violence based on ideology detailed in a 1990 book written by white supremacist Richard Kelly Hoskins. This brand of Christian terrorism lists interracial relationships, homosexuality, and abortion among its targets.

As the Southern Poverty Law Center outlines, the Priesthood does not have leaders, meetings, or a traditional membership process. Those who wish to become a Phineas Priest are ordained by committing a “Phineas action.”  Like many terror threats on this list, the lack of any formal organization makes predicting or thwarting an attack difficult.

Followers of the Phineas ideology are responsible for a number of violent attacks. Among them was a series of incidents in 1996, which included the bombings of the Spokane Spokesman-Review and a Planned Parenthood office, as well as multiple bank robberies. The FBI has been investigating the Priesthood for decades.

The Priesthood recently made headlines after a 2014 shooting rampage in downtown Austin. Larry McQuilliams opened fire on a number of buildings, including the Austin police headquarters and a federal courthouse. Over 100 rounds were fired during the incident, in which McQuilliams also attempted to burn down the Mexican Consulate. Police later discovered a copy of Hoskins’ book in McQuilliams’ rented van.

“What keeps me up at night is these guys,” then-Austin Police Chief Art Acevedo said at the time of the attack. “The lone wolf.”

Morris Gulett, the former leader of the Aryan Nations, launched a new extremist group in 2016 that incorporates the Phineas Priesthood emblem.

#3 Earth Liberation Front

Defined as “eco-terrorists” by the FBI, the Earth Liberation Front is a decentralized domestic terror group responsible for a series of attacks that date back to the early 90s. The group is driven by a shared ideology of “economic sabotage and guerrilla warfare to stop the exploitation and destruction of the environment” and carries out attacks, most commonly in the form of arson and vandalism, in cells or individually. From 2001-2011, no group was responsible for more terrorist attacks on U.S. soilthan the ELF.

Although the group’s activity has waned in recent years, these attacks have resulted in millions of dollars in damage. No deaths have been attributed to the ELF, but one FBI official told CNN in 2005, “Plainly, I think we’re lucky. Once you set one of these fires they can go way out of control.”

Joseph Mahmoud Dibee and Josephine Sunshine Overaker, both affiliated with the group, remain at large and on the FBI’s most wanted list for domestic terrorism. They are wanted for a string of attacks across multiple states totaling over $48 million in damages.

#4 Sovereign Citizens

The threat on this list that law enforcement officers are likely most familiar with is the anti-government sovereign citizen movement. Sovereign citizens follow their own interpretations of the law and disregard all others. Members believe most or all of the U.S. government operates without legitimacy.

Sovereign citizens are responsible for a number of attacks on cops. In 2010, two officers were gunned down at a traffic stop by sovereign citizens. In 2014, a married couple that identified themselves as part of the movement entered a pizzeria and murdered two cops who were dining there, leaving a note on one of the bodies that read, “This is the start of the revolution.”

The fatal 2016 ambush that left three officers dead in Baton Rouge was perpetrated by a man who declared himself a sovereign citizen.

Although the movement has no leadership or formal organization, the SPLC estimated as many as 300,000 Americans identified in some way as sovereign citizens in 2011. Terry Nichols, who had a role in the 1995 Oklahoma City bombing, was a member.

#5 Animal Liberation Front

Closely tied to the ELF, the Animal Liberation Front is a terror group that engages in crimes, including arson, harassment, and vandalism, in the name of animal rights. Like the ELF, it is decentralized and carries out its actions via autonomous cells and individuals.

The American branch of the ALF began in the late ’70s, and over the decades broke into sub groups. While no deaths have been attributed to the ALF, its members have committed crimes of increasing severity. From 2001-2011, the ALF was second only to the ELF for the most terrorist attacks committed on U.S. soil. Their targets have included food producers, biomedical researchers and law enforcement, according to the FBI.

The group is responsible for millions of dollars in damage. A few of their tactics include the mailing of letter bombsfood scares, and the use of incendiary devices. In one particularly disturbing incident in 2006, a UCLA researcher was targeted in an attempted firebombing, but the device was placed at the wrong home. The FBI told reporters at the time of the incident that the crude explosive, which did not go off, had enough power to kill the home’s occupants.

Read the original story on the PoliceOne website.