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Home > EMS Products > Ambulances

New ambulance design: Making responses fit for the 21st century

The 18-month-long project was led by the Helen Hamlyn Centre for Design at the Royal College of Art in London

Editor's note: Some of the points made in this article are already being done in the states. However, it is helpful that our comrades across the pond are thinking of similar issues as they pertain to vehicle evolution. The concept of rethinking a unit to fit 21st century missions is a good one. But what's your take? How do you want to see ambulance design improve? Have your say in the member comments sectionArt Hsieh, EMS1 Editorial Advisor

The Engineer

LONDON — The figures are telling. In 2009-10, ambulance crews dealt with 7.87 million emergency calls – yet around 40 per cent did not require treatment in an A&E hospital.

The skills of ambulance staff and paramedics have evolved markedly, as has the technology potentially available to them, but their ambulances have failed to keep up. The problems are numerous but include hygiene and infection control, patient experience and digital communications.

The NHS has recognised the need for change since the 2000s, yet progress has been slow, with some conceptual projects funded but nothing concrete achieved.

However, the latest project to address the issue is altogether more ambitious – aiming to build a full-scale mock-up of the back of an ambulance fit for the 21st century.

Royal College of Art
The 18-month-long project was led by the Helen Hamlyn Centre for Design at the Royal College of Art in London, alongside the London Ambulance Service, Imperial College Healthcare NHS Trust and the University of the West of England.

'There's a number of problems with existing ambulances, because they've sort of evolved from horses and carts – it's an old cliché, but they were used in the Crimean War just to cart soldiers back from the front line and get them to some kind of hospital treatment,' project collaborator Dr Ed Matthews, senior research fellow at the Hamlyn Centre, told The Engineer.

'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.'

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.

The most immediate issue seemed to be a lack of space. The internal structure of an ambulance is very modular and vehicles are often overstocked due to the 'just-in-case scenario', and sometimes end up running over legal weight. Alternatively, equipment might be missing or batteries discharged. Moreover, there has been virtually no standardisation of ambulance specifications across the UK, which has created logistical and managerial problems for ambulance trusts.

'We started inspecting everything; we dismantled an ambulance and just took everything out in terms of equipment and consumables to understand volumes and where everything needs to be laid out,' said Gianpaolo Fusari, research associate at the Hamlyn Centre. 'At the same time, we were sketching ideas and doing 1:1 mock-ups and asking paramedics to come back and test these things with us.'

'Working wall'
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.

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.

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.

The design features a 'working wall', a patient trolley in the centre of the vehicle and a moulded composite interior
'If you look at a standard ambulance, it is full of panels and screws with lots of nooks and crannies – all put together with bits of melamine and Perspex – which gather dirt and bacteria,' Matthews said.

Off-the-shelf solutions
From a technological point of view, the aim was to choose the right off-the-shelf solutions and 'bolt them together' as robustly as possible.
There are also three so-called digital communication portals.

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.

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

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

'At the moment, [paramedics] write notes on their glove and then transpose those onto a patient's sheet, and then that gets transposed finally onto the NHS system and becomes digitised – with ours it's all wireless,' said Matthews.

The team has now built a full-scale ambulance in the back of a trailer box. It has been tested in clinical trails, where it showed significant improvements over conventional ambulances in dealing with scenarios such as cardiac arrests. Notably, a contamination scenario was performed with a simulated bleeding leg ulcer infected with MRSA. UV staining revealed a nearly 70 per cent drop in simulated infection spread.

The ambulance box is now touring the UK at medical conferences in the hope of raising awareness and drumming up further funding. Although there are promising leads, there is no main commercial partner as yet. Part of the problem lies with the conservative nature of the ambulance manufacturers, according to the team.

'They're very comfortable and happy to sit on their hands. They're paid £170,000 for an ambulance and we look at it and say: "Well there's a £15,000 chassis – how much does it cost to build a caravan on the back of that and then fit all the electronics?" They're spoon-fed by the NHS in a way and they're not used to thinking "how do we raise our game to get a bit more of the market share".'

Fusari added: 'We're in a position where the paramedics want it, and the NHS thinks it's fantastic, but they say "if you build it we'll buy it" – and the builders say "yes it's great" and "if the NHS buys it then we'll build it".

Key features

The ambulance is designed to meet the needs of modern paramedics

  • Single 'working wall' with modular treatment packs for common call-outs
  • Central patient trolley for easy access and improved patient experience
  • Central console with Lifepak 15 functionality, plus video link for consultation
  • Moulded composite interior with curved surface to enable improved infection control

Republished with permission of The Engineer

Comments
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Nieaal Williams Nieaal Williams Tuesday, January 24, 2012 1:17:52 PM really nice , when they thinking of bringing it in?
Anthony McCullough Anthony McCullough Tuesday, January 24, 2012 1:29:39 PM Why has it taken this long to get around to asking the people who work on these vevicles, and then apply a little logic?
Michael Frick Michael Frick Tuesday, January 24, 2012 1:33:20 PM Nice easy to find compartmentalization and smooth solid surface to keep clean.
Steven Couzzo Steven Couzzo Tuesday, January 24, 2012 1:40:34 PM Annoying video.
Andrew Tucker Andrew Tucker Tuesday, January 24, 2012 1:59:25 PM Video was...well...it gave the impression that the biggest design change was the mounting of an ambulance compartment to a trailer...beyond that it looked like every other ambulance Ive ever seen just a little bit more smooth and the rear door handle is on the opposite side from here in the states. Maybe if there was an actual zoomed out view of each interior wall of the unit we'd actually be able to understand the lay out. The camera technique used for this works well in Star Wars when the X-Wings are attacking the death star, but it doesn't do so well when utilized for showing people how things are laid out. Try selling your house like that: Slowly move the camera just about an inch or two over every surface in the house. It's a sure way for people to be able to know what the house is like!
Kevin Isaac Names Kevin Isaac Names Tuesday, January 24, 2012 2:02:02 PM I don't get it.. They are talking about features we have had in our rigs since the late 90's here in the U.S. Cots were able to be center mounted, the addition of the CPR seat, we have expanded compartmentation, and our favore in a bag one-stop solution the Thomas Pack.. Why doesn't everyone have these? Cost... But we've built them.. Check out Horton, Excellance, MArque, etc etc...
Lorenzo Bocchicchio Lorenzo Bocchicchio Tuesday, January 24, 2012 2:05:28 PM I'm with you on that matt but looks good.
Michael White Michael White Tuesday, January 24, 2012 2:18:07 PM Probably not going to be too fun getting blood, vomit, and any other body fluid you can think of off a computer keyboard...thin, flat touch screen on the wall would seeem to work better than what's shown. Any more bulky stuff they mount that sticks out, is just more things for crews to hit and get injured upon if the ambulance is involved in a crash, or dealing with a violent patient. Seems no different to me innovation wise as to what's been around for years in many other similiar vehicles around the world. So they added a few more shelves with some new, pretty colored labels.......neat. I know it's only a mock-up prototype for ideas, but our ambulance training simulator at the college where I teach EMS has more innovative equipment in it than this.
Cortney Eric Johnson Cortney Eric Johnson Tuesday, January 24, 2012 5:45:20 PM SPIFFY!
Mohammad Sali Mohammad Sali Tuesday, January 24, 2012 6:18:07 PM wish we could go back to horses.
Daniel Walsh Daniel Walsh Wednesday, January 25, 2012 10:29:46 PM Need to see more information.
Pam Walkowski Pam Walkowski Thursday, January 26, 2012 3:16:48 AM Did I really just waste my time watching the a time lapse of the sky and pedestrians in front of the Royal Art College? I'm with Matt, all "artsy" and less "smartsy". This was an art project only!
Morgan Scaggs Morgan Scaggs Thursday, January 26, 2012 6:13:53 AM While these are issues worth investigating, our number one priority should be crash worthiness and safety. As it is, we're riding around in a kitchen cabinet on wheels. To borrow another phrase from Dr. Nadine Levick, there are more safety standards governing the transport of livestock than the transport of patients. And while I appreciate that some groups have tried to make improvements and recommendations, until we involve automotive safety engineers in this process, nothing will truly change.
Glenn Luedtke Glenn Luedtke Thursday, January 26, 2012 8:07:28 AM While all of this is going on, automotive engineers and ergonomists in both the USA and Europe have been addressing the same issues in their respective countries. This past week the EMS Safety Subcommittee of the Transportation Research Board, part of the National Academies of Science, met in Washington to talk about, among other things, how we can share the information that we're developing independently. On February 29th, the TRB will sponsor its annual "EMS Safety Systems, Strategies and Solutions Summit" bringing together transportation and EMS safety experts to share their expertise and chart a course for the future. More details are available through the EMS Safety Foundation's web site (www.emssafetyfoundation.org).
Kernst Elie Dufresne Kernst Elie Dufresne Thursday, January 26, 2012 10:42:48 AM Hmm looks good
Tim Suggs Tim Suggs Thursday, January 26, 2012 10:57:26 AM looked like there was no where to sit on the left side of the pt. I like the center configuration of the ekg.
Lisabeth Bandl Lisabeth Bandl Thursday, January 26, 2012 11:23:14 AM nice ideas make it look roomier and I like that everything is had its own place and the clean look of the layout looks more like a patient room than an ambulance.
Michael Endres Michael Endres Thursday, January 26, 2012 5:58:27 PM Hold on a minute...Central patient trolley? Working wall? Central console? Moulded composite interior? I mean, no offence, but honestly, are you guys serious? We had all this (well, beside of the today's computer technology of course) since the 1980s in Germany. Obviously the UK is 20 years behind... Have a look at: AmbulanzMobile, System Strobel, Wietmarscher Ambulance, Binz Ambulance etc.
Robert Gift Robert Gift Thursday, January 26, 2012 7:00:30 PM Poor video. Why so much BLACK? Not informative. Stopped wasting time watching.
Richard C Nix Richard C Nix Friday, January 27, 2012 9:15:36 AM Damn Limey's. What a waste of time. I wish I had my 3:32 sec back. Art students creating an ambulance? WTF? As long as we're wasting our time, let's let a herd of 1st graders design one. Makes as much sense.
Amy Stamper Amy Stamper Saturday, January 28, 2012 6:53:49 AM This design might be great if your department didn't want you to do anything but unfortunately this design is impracticable, suggest you actually build in a ambulance not a Trailer and field test this design first before trying to sell it.
Dwight Jones Dwight Jones Saturday, January 28, 2012 7:27:38 AM I would suggest a strong UV light on the ceiling for sterilization when the ambulance is not active, and plugged in to 110V.
Kevin Brennan Kevin Brennan Sunday, January 29, 2012 5:42:14 AM I think the link must have been incorrect. I saw a video made by some art students who never consulted with marketing or EMS. The video showed 50% outside scenes of a box, and a super-white interior with supply boxes mounted on the wall - with plenty of room for germs and dirt to hide between the mounted boxes. If I had white surface in my kitchen, it would be dirty all day. I would always choose a gray surface - easier to clean. Most of what I need during a call is in one or two bags I take with me to the patient. Just some observations.