DESIGN experts have revealed a redesigned interior for the emergency ambulance – the first element of an integrated mobile emergency healthcare system developed over six years.
In 2005 the National Patient Safety Agency asked a team brought together by the Helen Hamlyn Centre for Design (HHCD) to explore ways in which traditional ambulances could be improved, following an unacceptable number of adverse incidents. One resulted in the death of a patient who had managed to open the door of the vehicle while it was driving at speed along a motorway.
The project, entitled Future Ambulances, identified 10 design challenges; areas where better design could improve safety and efficiency for both patients and clinicians. The results contributed to the current national ambulance standardisation programme and created the Smart Pods project opportunity.
Smart Pods, funded by the Engineering and Physical Sciences Research Council (EPSRC) ran from 2007 to 2009 and looked at ways of delivering healthcare in the community, reducing hospital admissions and patient journeys. These would be achieved through the enhanced capabilities of emergency care practitioners; highly-trained paramedics able to diagnose, treat, refer and discharge patients with complaints that can safely be treated without admission to an A&E unit. The Smart Pods vision of integrated mobile healthcare brings together conventional emergency ambulances, small single-responder urgent care vehicles, deployable treatment spaces, standardised equipment and an operations management system to handle the necessary logistics.
Improving the emergency ambulance itself was the logical next step, since it would establish many of the key principles of the broader system, be readily understood, and easy to introduce within existing services, and would incur relatively manageable development costs. The project cost roughly £350,000, of which £150,000 was contributed through NHS London’s Regional Innovation Funding programme and the balance met by the HHCD.
A co-design process was used involving members of the public, patients, frontline clinical staff, healthcare managers, operational managers, commissioners and purchasers as users. Researching the requirements with this team, distilling an evidence base and designing and building several iterations of working mock-ups for evaluation have led to the creation of a mobile demonstrator unit, which was recently unveiled at the London Design Festival.
Among the changes are rationalised equipment storage spaces and an easy-cleaned interior, making cleaning and infection control much simpler and more effective. The vehicles are also equipped with some of the advanced technologies that everybody takes for granted in mobile phones, computers and passenger cars. Properly linked together in an ambulance, these revolutionise patient vital signs monitoring and data transfer to the receiving hospital, provide video links to specialist clinicians and facilitate navigation to specialist stroke, cardiac or trauma units.
Possibly the design change with the biggest impact was the decision to move the stretcher from its traditional position against the side of the ambulance and place it in the centre, so staff have 360° access to the patient. All equipment and consumables, waste disposal, hand cleaning and seating are carefully placed to provide a logical, ergonomic layout. The updated design also includes bigger windows to allow more natural light into the interior, and sophisticated lighting controls.
The changes emerged from the user research that included working with ambulance crews on 12-hour shifts, and shadowing paramedics to see where the pressure points lay.
Gianpaolo Fusari, a research associate at the HHCD, which is located at the Royal College of Art, told BBH: “There are many problems with the design of existing ambulances, impacting negatively on patients and paramedics alike. They’ve evolved from horse-drawn carts used in the Crimean War and nobody seems to have stood back and designed the treatment space in the back of the vehicle from first principles. “This environment is difficult to keep clean, given the frequency of use and infrequent opportunities to scrub the vehicle down. This frequently leads to hygiene and infection control problems. Ambulance crews also suffer from poorly thought-out ergonomics, badly laid-out equipment and difficult-to-access storage spaces, all of which can affect performance in critical, life-threatening situations.”
He added: “There has been virtually no standardisation of ambulance specifications across the UK, which has created logistical and managerial problems for ambulance trusts. A patient in need of emergency treatment can have a quite different ambulance experience depending on where they are geographically in the UK. All these problems can combine and compromise safety and make the ambulance service more intimidating.”
Also on the design team was Professor Lord Ara Darzi of Imperial College London, who added: “Ambulances were originally built to simply transport patients to hospital, but today’s paramedics initiate the treatment and take patients to the best place for their needs, often bypassing the nearest A&E.
“Services, especially in the London area, have taken the lead in addressing current challenges in emergency healthcare and the ‘smart ambulance of the future’ will help them to deliver that highest level of care.”
The new design is already proving a hit with staff. Senior paramedic, Dixie Dean, who provided feedback for the researchers, said: “The design team’s approach of involving clinical staff from the beginning has ensured the current design will improve the experience for patients and create a better treatment space.
“My colleagues and I have tested the prototype by treating mock patients and are fully supportive of the new design.”
The design has been named a finalist in the Design for the Real World Redux International Design Competition and will be exhibited across Europe and the USA next year. If successful, it could then be adopted across the UK and further afield.