New Ambulance Design for the 21st late 20th Century

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I found this article New ambulance design: Making responses fit for the 21st century at the EMS1.com website and was excited to read it. Well, until I read it, that is.

What I found was a bunch of “advances” that are all pretty much common on North American ambulances and have been for years. I won’t quote the entire article, you should read it yourself, but I will quote some parts and add my own pithy comments.

‘Nobody, until now, has stood back and looked at the design of an ambulance with what it has to do now, where you’ve got paramedics that are trained to diagnose. They don’t just have to take people straight to A&E; they carry quite sophisticated drugs with them, they prescribe and administer and they can actually discharge people on scene.’

Except that 60% of the time, they do have to take people to the hospital. Which is why ambulances are designed to do just that.

The first rather radical step in terms of research was for members of the Hamlyn design team to ride with an ambulance crew on full 12-hour shifts around London.

Oooo, radical. 12 whole hours to see what paramedics do, so now they are experts in ambulance design.

Part of the solution was a ‘working wall’ that had all the equipment readily available, including five universal treatment packs containing consumables for commonly occurring call-outs – namely wound dressings, airways and oxygen, maternity, burns and cannulation. ‘So that it almost jumps to you rather than going to a cupboard and finding your way,’ Fusari said.

Does he mean to say that ambulances in England don’t have jump kits, primary bags, airway bags, or whatever they might be called? On each call do the medics have to go to the “cupboard” and scoop up an armload of equipment and supplies? One of the very first things I had to do when I first started working on an ambulance full time over 30 years ago was to buy my own jump kit. I could fill it with supplies issued by my agency, and the agency even had issued kits I could use if I wanted to. Only no one wanted to because they were so lame. They weren’t made to be useful, they were made to comply with state regulations.

By creating a leaner internal environment, the team was able to free up space and move the patient trolley bed into the middle for 360° access. In current ambulances, the trolley is clamped to the right-hand side of the wall, making it difficult for paramedics to work on the left-hand side of the patient.

Center mounted cot? New? Really? We don’t use them currently, we tried them and found out that they didn’t work for us. Other systems have used them for at least 10 years, maybe more. Along with the CPR seat, which we also hated.

Another modification was to include a moulded composite interior with just two components, creating a single seam in the middle, complete with curved, flushed surfaces for shelves and cupboards. This was intended to help with infection control.

This isn’t a bad idea, but two pieces is. Inevitably, something will crack and need to be replaced. With the current design with all those panels and screws, if a panel breaks, it can be replaced. A modular design will require half of the interior to be replaced. Seems like a waste to me.

The overhead monitor above the patient trolley folds down and carries all the functionality of a Lifepak 15 device, including a defibrillator and a monitor for oxygen saturation and blood pressure. The monitor also has a video link to the receiving hospital doctor or expert consultants for complex cases.

So, the patient has to be dragged out to the ambulance to be attached to the cardiac monitor? In the late 1970s when the LifePak 5 was introduced paramedics finally had a lightweight cardiac monitor/defibrillator that could be easily brought to the patient’s side. Ever since then the trend has been to make equipment more capable and keep the portability factor constant. The industry hasn’t always succeeded, but the trend has held in general. With this innovation we are faced with bringing the patient to the ambulance to see what their heart is doing or duplicating equipment by having a fixed monitor AND a portable monitor. That not only sounds inefficient, it sounds expensive. And impractical.

The link to the hospital doctor or expert consultant has been tried and isn’t really practical. Emergency Departments, at least around here, are way too busy for doctors to stop what they are doing for a video conference. Nor do I see them making decisions without having the patient in front of them and being able to examine them.

Of course the UK system might be totally different.

Meanwhile, the driver’s console includes satellite navigation as well as the option to see what’s going on in the back.

Satellite navigation = GPS box. Which most of the ambulance services around here have had for 5 or more years. Cameras in the back? The driver should be keeping his eyes on the road, not the patient compartment. No mention of a back up camera, which seems to becoming more or less standard on ambulances in the US.

Finally, there is a handheld digital tablet for administration and entering patient reports. Data from the central monitor is automatically uploaded to it.

Been there, done that, got the stylus. Really, this technology has been around since the early 1990s, although it’s improved dramatically in the past 10 years. I can upload ECG data into my patient care report and then upload that to a central server for billing, case review, court testimony, and complaint investigation. It is not, as a friend of mine says, rocket surgery.

It seems that what the designers have done here is not create a new ambulance, but have tried to transform it into a primary care vehicle. Here are things I don’t see in the not very well done video or the artist renditions in the referenced article. Back boards, splints, scoop stretcher, stair chair. Do ambulances in England now have those devices? Every one of those devices is designed to facilitate treating and moving an injured person to the ambulance and thence to the hospital. An absence of any reference to them reinforces my thought that this isn’t an ambulance, but a primary care delivery vehicle that will secondarily transport patients to the hospital.

That this is hailed as a 21st Century design has me baffled. There is little new here, little that is not already in common use in many ambulance services. There is also little that is going to make the daily work life of EMTs and paramedics any easier than it is now.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.

6 COMMENTS

  1. The advantage of the CPR seat (does anyone actually do CPR sitting down, I wonder?) is that I can wear a seatbelt when performing a task (IV, etc) on the patient’s right side. Leaning over them is just asking to get tossed.

    We have a LUCAS device now, so we could probably eliminate the “CPR seat” in future vehicles, but I’d still feel better having a seatBELT on that side.

  2. I can see where your thinking comes from, however you’re coming from a culturally different viewpoint to us in the UK.

    There is a move that as autonomous practitioners we’re more able to carry out more primary healthcare tasks. This might be a move to be able to walk the 80% of non life threatening patients UK ambulances go to and assess, treat and refer to more appropriate care pathways than the ED where they don’t necessarily need to ne. Video link to a doctor, more than likely to the new non emergency control (111) where a primary care General Practitioner can give a second opinion. Better than a phone/radio patch as a picture paints a thousand words.

    Where the US model is transport for payment, we are attempting to reduce inappropriate ambulance callout and when we attend low acuity calls that don’t need ED attendance this *might* be a case of having a mobile assessment/referral unit, that might occasionally need to transport the 20% of time critical patients we go to. There is the argument for EMS 2.0, these vehicles could be the step towards EMS 3.0 which is the UKs next step.

    • All well and good, but then say so. And, as I asked in the article, what do you do for those acute cases, how does this vehicle help you treat really ill or seriously injured patients? What about the studies that have shown that paramedics are particularly bad at determining who does and who doesn’t need to go to the hospital?

  3. Regarding “new” interior design, there is hardly anything new, if you would ask me. Check out German ambulance manufactures and you will see, center-mounted gurneys loaded on actual stretcher tables have been around since the early 70’s! Also, drawers, counter space, fold up chairs, etc as well as transport vents mounted to the ceiling (EKG cables coming off the ceiling as well) are old invention. It would have been very easy to just look over to mainland Europe to see what other EMS programs have been operating out of for 30 years and the UK could have benefited form it. Sorry, I am not impressed…

    links:
    http://www.wietmarscher.de/index.php?id=24&L=1 (go to rescue vehicles and open the individual pdfs)

    http://www.wietmarscher.de/index.php?id=24&L=0 (go to WAS Produkte and click on Rettungsfahrzeuge. Open the pds)

    http://system-strobel.de/rtw_daimlerkasten.php

    http://www.binz-mobile-systeme.de/index.php?option=com_content&view=article&id=10&Itemid=124&lang=de

    http://www.miesen.de/go.to/modix/2,544696/rescue_vans.html

    http://www.ambulanzmobile.eu/cms/en/products/emergency-ambulances/tigis.html

    http://www.ambulanzmobile.eu/cms/

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