SCOTTISH AMBULANCE SERVICE
Andrew Flynn PDE3
THE BRIEF COMMUNITY FIRST RESPONDER “A person, trained as a minimum in basic life support and the use of a defibrillator, who attends a potentially life-threatening emergency.” Resuscitation Council UK. COMMUNITY FIRST RESPONDER
THEIR JOB A first responder’s primary job is to prolong the chain of survival. They provide a first point of aid in situations where it takes the ambulance service longer to get to. CHAIN OF SURVIVAL
ENVIRONMENT
THE PROBLEM Currently, the first responders must complete a patient care record form at the scene of the incident while administrating life saving first aid. This form is used to record crucial patient data which is then passed on to the ambulance service and finally the hospital.
WHERE THEY WORK
Patient’s home
It has been suggested that the PCR form is hard to use, especially in a fast paced and stressful environments. It has been noted that not all the information on the form is necessarily useful which makes it confusing and difficult to use.
Rural environment Industrial environment
THE TASK To improve the current form, making it user friendly and intuitive to use.
High rise flats
Improve the data capture on the form and explore design opportunities that would enhance data capture. Improve patient care.
Inner city
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
INITIAL RESEARCH TRAINGING DAY
CULTURAL PROBES
THE CURRENT FORM
Our first point of contact with the Scottish ambulance service was the training day with Murry. This day provided us with key insights into the jobs of the first responders. We were shown some of the key life saving techniques used during a typical call out. This gave us a good understanding of the type of environment they have to work in.
Due to the short length of the project the quickest way to gain an initial understanding of user profiles was to send out cultural probes to some of the first responders around Scotland. This gave us an early idea of what their job entails: how often do they get a call out, where they usually are during a call out and what happens during a typical call out.
Below is the current PCR form. From initial inspection the form appears cluttered, hard to follow and has no logical design. The graphic layout does not follow a particular pattern making it hard for the user to follow. There is also a lot of unnecessary drop shadows and heavily outlined text boxes. The form has no sense of hierarchy and therefore confusing to fill out.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
CFR FOCUS GROUP PREPARING FOR THE FOCUS GROUP
MEETING BOBBY
BREAKING DOWN THE FORM
Before the CFR focus group we closely studied the form. We decided we would breakdown the form into three gradings depending on their relevance to the first responder.
Bobby was an urban first responder who also worked at the EMDC. His scheme dealt with patients in town and city environments. Bobby gave us a breakdown of a typical callout and helped us breakdown the current form into the desired gradings we had set.
We graded the form into three colours. Each colour represented its relevance when being used by the responder.
RED This information is never used in an emergency situation. If required, this information is available on the ambulance tablet system or from the control centre.
AMBER Despite being medically relevant this information is rarely needed in an emergency. It is used by hospital nurses and doctors but it is rarely captured first hand. GREEN This information is best captured on the scene. It contains time dependent patient information that shows how their condition has changed over time. From talking to Bobby it was clear this information was the most important in an emergency situation.
OVERALL IMPRESSION Having broken down the current form and looked at its layout it was clear that it had not been designed with the intended scenario and user in mind. Hard to navigate with information in no logical order it was clear this form should not be used in a fast paced and high intensity environment.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
FRICTION POINTS CURRENT USER JOURNEY
FRICTION POINTS
After speaking with Bobby we had gained a range of key insights into what happened in a typical call out.
Speaking with Bobby allowed us to create a current user journey for a typical call out. This helped us identify sticking points within the journey
Creating a user journey allowed us to identify the current friction points within the service.
STRESSFUL ENVIROMENT
KEY INSIGHTS
A typical call out can often involve a fast paced, high stress environment making it hard to complete the PCR.
FIRST RESPONDER RECIEVES CALL
HARD TO LOCATE ADDRESS
NO HANDOVER
NOTES WRITTEN ON GOLVE
HARD TO TAKE NOTES Instead of using the PCR form, Bobby tended to use his gloves to take notes on. He created a timeline of how the patient responded over time. This can be confusing to read and is not a professional way to carry out the task.
Due to the stressful enviroment and poor design of the current form, the PCR is rarely handed to the ambulance service. Instead a verbal hand over is usually given. This wastes precious minutes which could otherwise be used treating the patient.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
NO HAND OVER OF FORRM
VERBAL HANDOVER
HARD TO COMPLETE FORM
INACCURATE DATA
SEPARATING THE FORM
DYNAMIC AND STATIC RESPONSE
DATA FLOW CHART
The purpose of this workshop was to help us understand and organise the data on the form. The first step was to take the current form and breakdown the data.
By studying the form it was clear there was two separate data types. Dynamic time dependent data and static data.
By splitting the data like this we were able to create an information flow chart. From this chart it was clear that static information belonged on the A4 form and the dynamic data belonged elsewhere.
CURRENT FORM
DYNAMIC DATA
INFORMATION ARCHITECTURE
DYNAMIC CONCEPT
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
STATIC DATA
ARRANGING THE DATA
By breaking down the data in this way opened up a design opportunity for the group. Design a product that will effectively capture dynamic data.
LIVE DATA CLIP
QUICK SNAP WRISTBAND
NOTEBOOK
CONCEPT DESIGN
This provided a low tech, cheap to produce solution to dynamic data capture. The time chart of the patient’s vital signs would be kept in a small note pad that also has an area for note taking. When the ambulance service arrived the small time chart could be removed and handed to them.
The Quick Snap wristband is a midtech solution designed to give the user more freedom while using it. The band is ‘snapped’ to the user’s wrist where it can be written on. When completed the form simply slides off the snapp band and can be passed on to the ambulance service.
The live data clip was our future concept, providing a completely hands free experience for the user. The product would consist of a transmitter and receiver. The transmitter would be attached to the patients wrist on arrival. This would take the patients vital signs and send them to the receiver located on the first responder’s wrist. When the ambulance arrived this data could be instantly synced to their tablet device.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
STAGE 1
First responder arrives on seen and attaches Quick Snap Wristband.
STAGE 2
The patients vital signs are recorded on the form by ticking a series of boxes which are colour coded to make the process more intuitive.
STAGE 3
USER JOURNEY
EXPERIENCE PROTOTYPING
The band is unrolled, the top cover of the form removed and handed to the ambulance service.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
THE WORKSHOP
THE ANALYSIS
THE RESULT
Having previous success with experience prototyping the group saw this as a good opportunity to test and analyse one of the three dynamic response concepts. The Quick Snap Wristband was chosen to be tested as we felt it could be problematic to use in a fast paste environment. A real life user scenario was acted out and the product put to test.
With the ability to play back captured footage a close analysis of the product could be conducted. It was found that during Stage 1 and Stage 2 the product encountered some sticking points. Getting the product on under limited time conditions proved problematic as the quick snap function did not work effectively. Secondly, due to the rounded nature of the form it proved to be tricky to write on with the user having to constantly reposition their wrist.
Due to the problems identified using the experience prototype this concept was not developed further.
FUTURE SOLUTION THE RECEIVER
THE TRANSMITTER
THE PROBLEM
The theory behind this product was to take existing technologies used to capture a patients vital signs ad combine them into one device.
The CFR would be wearing a receiver around their wrist when arriving to a call. The receiver is used to collect data from the transmitter. When the ambulance service arrives, data is instantly synced from the transmitter to their tablet device
On arrival to the scene, the CFR would attach the transmitter to the wrist of the patient. This would constantly monitor the patient and simultaneously transmit the vital signs to the reveiver.
After more research it was found that feasbility of this concept was low. For the purpose of this design project we felt the complexities of this concept outweighed the advantages the system would offer.
PULSE
COMBINING TECHNOLOGIES
PULSE: TEMP:
OXYGEN LEVEL
TEMPERATURE
OX LVL:
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
80 BPM 38째C 43
THE DESIGN
THE NOTEBOOK
HOW ITS MADE Inspired by the timeline Bobby created on his glove the group designed a time variable chart to catch and record a patient’s vital signs.
THE CHOSEN CONCEPT After an evaluation of each concept the group decided the most appropriate for a CFR was the A7 jotter. It is simple, cost effective and easy to use.
2 part black ink particle Top NCR copy Bottom NCR copy Isolated black ink component - Translucent Isolated black ink component - Translucent
This chart would be repeated as a series of carbon copy sets. The CFR would fill out a copy, pass the top sheet to the ambulance crew and keep the copy to later fill out the A4 form.
POST IT NOTE PROBLEM When pressure is applied to the top sheet with a pen, it transfers down through more than one layer of carbon copy paper.
By adding a Post It not between each layer of NCR paper a physical barrier is created preventing the ink from activating.
CURRENT SOLUTION Usually a thick material such as card is placed under the desired set of carbon copy paper. The thickness of the card stops pressure transferring through more than one layer.
When pressure is applied to the top sheet with a pen, it transfers down through more than one layer of carbon copy paper. ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
By peeling away the Post It note from the top layer, the first set of NCR paper becomes activated while the rest remain protected. The Post It note can then be stuck to the hard inside cover of the notebook providing the CFR with an area for notes. This concept provides a simple yet innovative way of capturing dynamic data which is easy to make and cheap to produce.
THE FORM INDUSTRY STANDARD
CURRENT FORM
When it came to redesigning the A4 form it made sense to study other public sector documents currently in circulation. After looking at a number of other forms it was clear that the current PCR did not fit in with the industry standard.
SAMPLING Taking samples from other forms helped us redesign the current PCR form. The form illustrated in the bottom left of the page is an example of one of the forms that was popular in design with the group.
PUBLIC SECTOR SAMPLE
THE PCR
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE
The final design of the form was based on the logic that as a member of the public, a CFR will expect a certain aesthetic from public sector paperwork. Therefore the new PCR has taken a lot of visual language found in current public sector documents.
MORE CONTENT. MORE SIMPLE The new PCR form includes a CFR care timeline, the number one CFR and paramedic requested feature. The form also captures all the necessry data from the original PCR while being more clear and easier to complete for the user. The new PCR is a result of current user insights used by the group to create a more approachable and intuitive form of data capture.
FINAL DESIGN THE FORM The redesigned form captures all the necessary data from the orginal form plus includes the number one desired feature - the patient care timeline. Not only does the form contain the vital data required but has been redesigned in a way that makes simple and easy to use.
THE NOTEBOOK The A7 notebook was the group’s response to the initial insights gained from the community first responders. It provides a simple and effective means of dynamic data capture while keeping the cost low.
TOGETHER When partnered together, the A7 notebook is used on the scene of the call out to record the patient care time line. A copy of the timeline is passed to the ambulance service. The CFR can then fill out the PCR in reflection using the notes and the vital signs taken down on the notebook.
THE FINISHED PRODUCT To complete the project the group produced a physical copy of both the A4 PCR form and the A7 notebook. The cost of production was very cheap working out at simply four and a half pence per CFR call out.
ANDREW FLYNN SCOTTISH AMBULANCE SERVICE