AM30 a safer & more flexible ambulance interior
Jakob Dawod - Term Project Masters Programme in Advanced Product Design Ume책 Institute of Design 2016
Jakob Dawod - Term Project Masters Programme in Advanced Product Design Ume책 Institute of Design 2016
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table of contents
intro
method
ideation
Time Plan
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Paramedics Historical Review
realization
Mood Board
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Initial Exploration
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Seat Development
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Storage Development
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Key Sketches
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CAID Development Seat
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CAID Development Interior
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Interior Architecture
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Inside Glimpse
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Seat Functions
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Ambulance Visit
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Interviews
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Observation
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Gathering Data
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Visual Social Persona
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Ideation Sessions
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Role-Plays
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Problem Areas
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Interior Modes
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Interior Problems
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Interior Functions
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Problem Description
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Scenario
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Design Opportunity
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Vehicle Context
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Goals & Wishes
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Market Analysis
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Workshop
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Final Presentation
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final design
final presentation
Current Package
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Conclusions
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Scenario - Chest Pain
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Reference List
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First Ideation
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Thanks To
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Concept One Wall
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Concept Two Walls
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Concept Three Walls
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Concept Evaluation
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Full-Scale Volume Study
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How To Slide?
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Future Scenario
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AM30 Jakob Dawod - Term Project Masters Programme in Advanced Product Design Ume책 Institute of Design 2016
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abstract Today the paramedics are in a lot of cases totally unsecured while treating a patient in the ambulance. They work without their belts buckled because of the flexibility that their work requires. Their work also requires them to focus on several things simultaneously when their primary task should be to fully focus on the treatment of the patient. This 10 week project has been developed in collaboration with the paramedics from Ume책 and with support from Laerdal. With the help of paramedics,
research, testing, sketching and prototyping led to a result that addresses the previously mentioned problems. AM30 is a future concept on how paramedics can treat their patients with less workload, more flexibility & in a safer way than they do today. Instead of an ambulance interior with one static seat on the side of the patient this concept offers a safe way of moving within the ambulance and the possibility to change the interior depending on the treatment.
a collaboration between
MFA Advanced Product Design
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intro
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i n t r o
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research compile info workshops briefing ideation evaluation refine concept modeling model making presentation report
submit design brief
- 23/11
ideation presentation
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- 4/12
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week by week
time plan These pages show my planning during this 10 week term project. This time plan was made in order to keep track of how much time I had to spend on the different phases of the design process. Each green square represents a different phase in
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the project, and these squares are divided into work days to make clear how many days would be spent on what. The deadlines are highlighted in the bottom to make sure that the deliverables were ready on these dates.
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16/ 12 - concept presentation internal presentation
- 20/01
external presentation
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- 22/01
i n t r o
background
paramedics A paramedic is a health care professional, working in the pre-hospital and out-of-hospital environment. Paramedics work mainly as part of emergency medical services (EMS), such as on an ambulance. The scope of the role varies widely across the world, having originally developed as a paraprofession in the United States during the 1970s. Since this time, in countries such as the United Kingdom, the paramedic role has developed into an autonomous health profession, with individual license to practice, whilst in other countries (including the United States) the paramedic remains an agent working on behalf of a doctor.
The quality and competence in ambulance medical care due to reductions in emergency treatment in Swedish hospitals has increased significantly over the past few years. The technical development of ambulance care have made it possible for ambulance personnel to perform assignments previously related to hospitals. From being only a transporting service of sick and wounded patients to the hospital, becoming more of an advanced profession requiring education of a nurse including advanced treatments, under stress, on the move, in a very tight confined working space obviously requires a certain set of skills and personality.
The profession has developed from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, including Sweden, the paramedic has a role as part of a system to prevent hospital admission entirely, and through practitioners are able to prescribe certain medications or do so called “see and refer� to refer a patient to specialist services instead of taking them to the hospital.
Recent statistics from SOS alarm show that the emergency calls in Sweden increased as much as 30% in the last five years, this increases work for the paramedics and might have a negative effect in their way of working. 1 out of 6 alarms result in patients staying home because no urgent healthcare is needed, this on the other hand might result in decreased motivation of performing their job.
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human centered design
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i n t r o
background
historical review Emergency care in the field has been put in different forms since the beginning of recorded history. The new testament describes “The good samaritan” as the man that bandaged the “patients” wounds pouring on oil and wine, he/she was then transported on his donkey and was later taken care of. The first use of the ambulance as a specialized vehicle (in battle) came in 1796. Back then it was used to transport fallen soldiers from the battlefield after they had received early treatment in the field. They were normally horse-drawn two- or four-wheeled wagons and were adapted to different conditions. The first known hospital-based ambulance service was based out of the Commercial Hospital in Ohio, 1865. It was followed by other services in New York.
Edward Dalton, which was a former surgeon in the Union Army created an ambulance service where he would bring the patient to the hospital faster and more comfortably. The ambulances had splints, morphine, stomach pumps etc. Dalton believed speed was of the essence, the ambulances (dragged by horses) were ready to go in 30 seconds from the call. This service grew rapidly and after 20 years the emergency calls had tripled from 1401 calls to 4392 calls. In the late 19th century Brazil, St Louis, Missouri and the United States started using trolley cars on their tram networks which were designed to act as ambulances transporting the sick and injured.
Horse-drawn ambulance, Bellevue hospital, New York City, 1895
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The first mass-produced automobile-based ambulance was produced in the United States in 1909. During World War One the Red Cross brought in the first widespread battlefield motor ambulances to replace horse-drawn vehicles. It was such a success that the horse-drawn variants were phased out. The first ambulances considered as “mobile hospitals� were first used in 1952, rather than just used for transportation of patients. Few or almost none of these ambulances could meet the standards that were set up concerning the height of the patient care area and the equipment that the ambulance had to carry. The design of ambulances therefore went through
major changes in the 1970s. High-top car-based ambulances were developed but still the internal fittings for carrying medical equipment were limited, most notably stretchers. As time went on, ambulances developed, gaining the capacity to carry both portable and permanently installed equipment. Today, modern ambulances are often custom built as well as the specialist medical equipment which is now built into the ambulances. Improvements to safeguard the health of the paramedics are constantly improving, tools for cutting down the amount of manual handling for example, to keep their welfare and healthiness in balance.
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method
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m e t h o d
research
ambulance visit first day During this hands-on project start we had the opportunity to visit the ambulance station in UmeĂĽ to gain deeper insight in how the life of a paramedic is. As a class we got an overview of the overall structure of an emergency situation. We got knowledge about who is involved in the process and how all these parties are involved, beginning from an emergency phone call, all the way into the hospital where the paramedics end their mission.
the station. We had coffee together with them to get to know them as individuals and know more about their interests in general. We saw their relaxing areas, sleeping rooms and work out facilities which gave us insight in that working as a paramedic is a way of life and that it can be difficult to live the same way as others. We also got a guided tour around their garage where we got to know all the tools the paramedics usually use when taking care of their patients, both inside the ambulance and outside.
During the visit we got the general process of a paramedics work covered while having a tour around
second day
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D AY S
12 STUDENTS
The second day of our visit we were divided into groups of four people. This time we got the opportunity to dig even deeper into our users and their everyday life as paramedics. We got a more in depth understanding of their tools and their way of working with those. We also got a good understanding of how they act in different emergency situations. Showing everything from a priority three emergen-
cy to how they improvise creating their own “tools� in major accidents. Throughout the day we also had the opportunity to ride-along with the paramedics in their ambulances to the emergency sites. Interviews were made during the day as well, this was when we really got to know the paramedics not only on a professional level, but on a personal one.
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CALL OUTS
Eric explaining different tools
“My hands are the most important tools” - pä r l i n d g r e n
Pär placing ECG-pads on my chest
Lars-Åke talking about the bone drill
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m e t h o d
research
interviews We had the opportunity to join the paramedics observing and interviewing them. This was a great way to see what roles they played at work, what emotions and desires they had and what they thought about their own situation. What we learnt from these interviews was that paramedics really are hard working people. Their work hours are long and unpredictable, they have to improvise all the time since every
emergency is different. Therefore they have to be creative, solve problems easily, be sensible and have team player qualities since they always work together. Not only are they hard working people at their job. The paramedics that we got the chance to interview actually had a lot of hobbies or other jobs beside their paramedic career, therefore I perceived them as very active individuals.
Traffic
the paramedic p r o b l e m s o lv e r team player sensible creative
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the ambulance visit
c accident, Ume책, Photo: VK
research
observation By observing the users in their daily work routines we could spot out smaller problems and interruptions that the users experienced. Things such as trying to do ten things simultaneously with only two hands. We also learnt that to work as a paramedic in Ume책 is not always what you might expect it to be. The majority of emergencies received were actually not priority one calls, and in many cases the para-
medics only did transporting jobs of patients from one spot to another. What we saw was that there are some issues both related to the equipment that the paramedics use, the space that they work in, the communication between the chain of care involved and the documentation of the treatments made to the patient.
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m e t h o d
workshops
gathering data The first step after we as class and after an additional day as group of four had done our visits, we gathered all the information that we had collected during our stay at the ambulance station. This was made by each group of four in different rooms. We discussed our visits and gathered, structured and visualized all the data to get a clear overview of the research.
Current tools used, trends in mobile healthcare, problem areas, flow charts, interviews and personas were all visualized to be understandable for us. We found a lot of problem areas and improvement opportunities and marked these out with post-it notes. After these sessions we structured all our findings so that they would be understandable for our other classmates. We then presented these to each group to get additional information.
discussing findings
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workshops
visual social persona A Visual Social Persona diagram was created after presenting our findings from the research to each other. This was visualized on a big roll of paper to boost our creativity. The intention with this was to give an as detailed overview as possible of an event-
ful workday as a paramedic. This was very valuable since we got a clearer picture of their actual work as well as relations with colleagues, their working environment as well as family relations and how their non-regular working hours affect the rest of their life.
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m e t h o d
workshops
ideation sessions Ideation sessions were made in teams of four. We first started out in groups to define seven main problem areas based on all our previous findings. We then gathered all the problems from the different teams and voted on which ones that were most relevant. These sessions resulted in twelve defined problem areas that we would in groups brainstorm around. Five minute brainstorms were made for each topic. A lot of ideas were generated varying from solutions for tight spaces in the ambulance, heavy lifting of equipment, stretchers that were more compact,
easier journal documentation, quicker ABCDE/Triage, better communication between SOS/hospital/ paramedics, transitions between stretchers, weather conditions and multitasking solutions. Out of these general ideas and problem areas everyone picked one area that they would develop a concept around, visualize it and then present it the next day. A lot of interesting initial concepts were presented that could work as inspiration further on in the project process. My concept “Triara� became a communication device between paramedics and doctors.
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presenting concepts
workshops
role-plays Based on the concepts that we individually created, we would in our teams choose one of those concepts and create a role-play based on it, this was then acted out to our other classmates. This way of working opened up our minds and allowed us to see details
and small issues connected to our solutions that we might not have adressed during our concept creations. A very simple but powerful way of showing if a concept works or not.
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m e t h o d
p r o b l e m a n a ly s i s
problem areas Based on the group workshops and team sessions we had during the week, several interesting problem areas were formed. This problem area visualization shows my process of thinking when deciding on
interesting areas to further explore during the project. During this problem area mapping I started to lean more towards the field of improving the safety, flexibility and multitasking inside of an ambulance.
areas of interest
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communication Storing of information Exchange of information Systems - paramedics - hospital Between paramedics in ambulance No connection between equipment
mobility Heavy equipment Rats nest of cables Lifting equipment from ambulance Running back and forth for tools
safety Reaching around patient Standing without support Unbuckling to access tools Unpredictable situations
experience Patient seeing info screens - stress Motion sickness, moving backwards Scary to transfer into ambulance
moving patient Into ambulance Between stretchers On graveled ground Upstairs/downstairs Maneuverability
accessibility Browsing through medication Reaching equipment in ambulance Patient information Structure of bags Finding tools
ergonomics Lifting in/out stretcher Reaching over patient Lifting equipment Back problems Heavy lifting Low ceiling
documentation m u lt i t a s k i n g Speaking in radio while treating Keeping track of many patients Treating patient while documenting Supporting both patient & next of kin
arrangement Keeping track of equipment Check availability every day
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Documentation of journal Notes on glove might get lost Typing while treating patient Information following patient Not connected outside ambulance Patient seeing info screens - inaccurate results due to stress Time consuming
m e t h o d
no access Taking things out from compartment requires ambulance to stop.
exposed
low ceiling
The paramedic is in the danger zone in The low ceiling in the ambulance makes it case of a crash, all heavy equipment is hard for the paramedic to stand up straight right behind him/her. while lifting, resulting in back problems.
writing journal Writing the journal distracts the nurse from treating the patient.
h a v i n g o n ly 2 h a n d s There are situations when the paramedic has to perform more than two different tasks simultaneously having only two hands to operate with. An example: Hooking up the IV while talking to the driver, suddenly the patient throws up, requiring the paramedic to reach for the throw up bags.
inte prob
patient belongings There is no designated space for the belongings of the patient which adds up to loose objects that might be a danger in a crash.
motion sickness Patients get motion sickness because of driving backwards. This adds to the tasks that the paramedic has to take care of.
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positioning Patient seeing monitoring feedback, gets stressed, gives inaccurate monitoring results.
far away
reaching lifepak
Impossible to reach from seat position, have to unbuckle seatbelt.
Hard to reach from seat, lean over patient, bad lifting, back problems.
reaching other side It is impossible reach around the patient which makes it harder when for example injecting and connecting IV to the right arm.
standing up The paramedic has to stand up behind patient when giving assisted breathing to keep mask stable. The paramedic is unbuckled and has to keep his balance because of all the motion from driving.
rior lems
reaching feet Reaching down to the feet/legs of the patient is another challenge since the paramedic has to twist around and reach behind the seat, eventually unbuckle as well.
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m e t h o d
conclusions
problem description Based on observations and interviews from the visits, some interesting findings were discovered, related to the ambulance interior and how the tools in the ambulance are used today. Since the main focus of an ambulance today is to transport patients to the hospital while treating them, it is important that these two activities are performed in a way both comfortable for the paramedic, the patient as well as
his/her next of kin. This user centered project will be focusing on improving the work environment of the paramedic inside the ambulance. We have seen the development of the paramedic starting from a transport of patients profession turning more into a mobile hospital service. So what could the next step be in this development?
overview Today the paramedics work in teams of two inside their standard ambulances. The driver is normally a paramedic or ambulance nurse while the person treating the patient in the back of the ambulance is an ambulance nurse. The main difference is that the nurse educates him/herself longer than the
paramedic and is allowed to give medication to the patient. The ambulance nurse is normally handling a lot of tasks simultaneously in a very tight work environment. This requires serious multi-tasking skills as well as great patience.
main problem The environment of an ambulance is in many situations a great risk for the paramedics. High speed transportation combined with unbuckling, standing without support and lifting heavy equipment are all potential risks for them. Taking these threats into
consideration in case of a traffic accident, the paramedics are exposed to extreme dangers. And not only is the paramedic hurting him/herself but becomes a risk for the patient and his/her next of kin.
“Waking up in the middle of the night for a call-out is dangerous, it is hard to think clearly and to fully focus on the driving� - e r i c pa l m c r a n t z
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w h o i s i n v o lv e d ?
nurse
ambulance interior
next of kin
pat i e n t
secondary problems There are certain overall secondary problems within the interior that would be valuable to improve to make the lives of the paramedics safer and easier.
They are divided into three main categories to give a more clear overview of what things actually need to be improved.
safety
lifting
comfort
To reach around the patient is a common problem, for example when giving IV. Reaching for different equipment is another challenge since many of the tools are out of “one arms reach� and means that the paramedic has to unbuckle the seatbelt.
Lifting the stretcher in/out of the ambulance is not ergonomic. There is some heavy equipment in the ambulance that the paramedics have to lift in/out, the ceiling is low and they have to lean over the stretcher which results in back problems.
The communication between the nurse and the driving paramedic is bad. Stretcher and seat distribution is uncomfortable, patients get motion sickness because they are facing backwards. Patient seeing info screens is stressful and affects measuring results.
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m e t h o d
conclusions
design opportunity The early ambulance has as mentioned earlier only been a service based on transporting a sick patient from one point to another. The evolution of the ambulance and the paramedic as profession has developed more into a mobile healthcare service. From a space to only transport the sick and wounded, the inside of an ambulance is slowly turning into a compact healthcare central, focusing on treating the patient as far as it is possible before he/she arrives
at the hospital. We see that the ambulance develops and allows us to do more. At the same time we see the development of self-driving cars that let us focus on other things than just driving the car. Taking the findings from our user research and keeping the paramedics dreams and desires in mind I ask myself what mobile healthcare could be like in 2030 meeting the demands of the paramedics today?
? 1890
1920
2015
I am intending to have a future time frame of 15 years in the project to be able to implement emerging technologies if needed. Implementing some of
2030
these technologies would be one of the steps in how the future of mobile healthcare could look like.
“It is heading towards letting paramedics do more work in the ambulance (pre-hospitally) than ever before” - e r i k pa l m c r a n t z
“Reaching around the patient is impossible, the ideal solution is if we can reach around the patient safely without changing the size of our ambulance” - ronny friberg
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w h a t w i l l m o b i l e h e a lt h c a r e b e in the year of 2030 meeting the demands of paramedics today?
flexibility
safety
m u lt i t a s k i n g
Reaching and treating the patient is challenging in terms of flexibility. Reaching feet for example requires the paramedic to twist his body and stretch the arms. Depending how injured the patient is, a team of paramedics might be required to keep the patient alive. The interior is not flexible in these situations which means that the paramedics rather treat the patient outdoors in really bad environmental conditions.
We need to meet the concerns of the paramedics being exposed to several dangers while treating the patient in a driving ambulance. Ideally would be to prevent them from being loose without any support while treating the patient. So can we prevent the paramedics from unbuckling while treating the patient?
A very common thing while treating a patient is to multitask. Performing more tasks than the paramedic can handle by himself is part of everyday life. What if we could somehow reduce the amount of work? Or stimulate multitasking if it is performed in a more safe and easy way? After all, in a hospital you are always more than one person treating a patient.
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m e t h o d
goals & wishes
goals The outcome of the design should ideally prevent the paramedic from putting himself in such a risk that his life is threatened inside the ambulance. The paramedic should be safe in any situation while treating the patient. Working as a paramedic requires you to be able to do several tasks simultaneously while treating the patient. The ideal situation would be if the paramedic could primary focus on the patient and do secondary tasks, such as writing the journal very easily, without drawing his/her attention from the patient. The solution should offer the paramedic to reach all parts of the ambulance without having to unbuckle
and take risks. To open up the working environment more to be able to communicate between eachother easier as well as pushing the fact of creating a “mobile hospital� rather than a hospital inside a car. The outcome should not be bigger than the current ambulances used. Feedback from the paramedics was that they need a more flexible working space, but not by changing the size of the car. This is because a bigger car would result in difficulties when it comes to accessing locations that are hard to reach such as narrow city streets etc.
prevent risks
keep size
s u p p o r t m u lt i t a s k i n g
o p e n u p s pa c e
improve accessibility
make flexible
wishes It should be comfortable to travel with the ambulance at any time, both for paramedics and patients. It should be easier to transfer the patient on the
stretcher into the ambulance. Preventing the paramedics from any unergonomic movements or lifting.
improve comfort
all ergonomic
easy transfer
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“Working alone with a patient is very uncommon in any other healthcare service. We have to do a lot of things simultaneously� - E R I K PA L M C R A N T Z
main goals flexibility
safety
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m u lt i t a s k i n g
a p p e n d i x
additional research
m a r k e t a n a ly s i s To get a good overview of the different ambulances that are out there today, a market research was done. As we can see there is a variety of different ambulances for different purposes. Some are used only as first assessment cars, these are used in situations that most probably will not need transportation or treatment on the way to the hospital like most of the priority three emergencies. In these cases the nurse
is able to stabilize the patient in his/her own home and can leave the patient there. The most frequently used ambulances are the “bigger” ones having the capacity of treating the patient inside the ambulance, with space for one nurse beside the stretcher to help the patient. In these ambulances the paramedics have almost all the tools that they need for their everyday routines.
“Sometimes when treating a patient on site, the environmental conditions could be very bad to treat in without proper protection. We can use the ambulance, but we can’t fit several people in there & it’s impossible to reach around the patient” - samy sadek
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volkswagen caddy The ambulances used in Sweden are provided by a company named Eurolans. They collaborate with car manufacturers like Volkswagen and Mercedes and rebuild their car interiors to fit the needs of paramedics. This model on the right is a Volkswagen Caddy which is more suitable for first assessments and when it is possible to treat the patient at his/her home, or in the ambulance but not during transport. It requires that the patient is able to inform the nurse that he needs treatment, and then the car has to stop.
mercedes-benz sprinter The most commonly used ambulance is the bigger model, based on a Mercedes-benz Sprinter. This ambulance is used for any emergency and is the most versatile one provided by Eurolans. This ambulance features a seat for the nurse in the back where he/ she can treat the patient while the paramedic is driving. Almost all of the tools that the paramedics need fit into this model. Some of the equipment is only reachable from the back of the ambulance, and some of the equipment requires the nurse to unbuckle to reach it.
chevrolet 709 The Chevrolet 709 is another ambulance in which its interior is built inside a “box�. This box can be moved onto a new chassi when the car model is being replaced. This ambulance model is a bit wider than the Sprinter, 2.2 metres, while the sprinter is 2 metres wide. The interior offers a bit more flexibility since it has two seats on each side of the stretcher which makes it easier to reach both sides of the patient. Ambulance models like these are more common in the states. The advantage is the space, but it makes the driving and the accessibility harder.
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ideation
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i d e a t i o n
interior studies
current package I made a study of the current ambulance based on a Mercedes-benz Sprinter to get a sense of scale and of what actually needs to fit into an ambulance. The reason to why I chose to maintain the measurements of the Sprinter was because the paramedics liked it when it came to the driving and accessibility qualities. They believed that their smaller ambulances were even better when it came to driving and ac-
cessibility, but a horrible alternative for treatment of a patient. In this phase of the project I therefor set up as a clear goal and challenge to keep the interior size of the Sprinter as a reference for my continuous project development. As the pictures show I already here started to experiment on how I could rearrange the ambulance to meet the needs of the paramedics.
Full-scale studies
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In order to explore proportions and relations between parts and paramedics in the ambulance I quickly modelled a package drawing in CAID based
on the Mercedes-Benz Sprinter ambulance. This together with a 1:1 mannikin gave me a good overview of what spaces I could utilize.
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i d e a t i o n
problem in context
scenario - chest pain A scenario of a typical emergency situation was made to get a clear overview of the different problem areas that a paramedic can get exposed to during a treatment session in the ambulance. The scenario illustrated on these two pages shows a quite
stressful situation to be able to cover the problems even if a worst case scenario would occur. The scenario gives examples of all three main problem areas that have been mentioned earlier, multitasking, safety and flexibility.
1 2 3 4 prioritizes ABCDE & Triage is performed Stabilized patient for now
emergency - prio 1 Chest pain - heavy breathing Middle of the night
1 ambulance arrives
enters ambulance
Stretcher, medicine bag & journal is brought with paramedics
Both paramedics enter front of ambulance
1 drives ambulance Tired & stressed, hard to focus on driving
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1st paramedic drives 2nd paramedic keeps contact with SOS & helps with wayfinding
F
Fills in journal
paramedics unbuckle Both paramedics unbuckle to easier access the patient during the CPR, for force during the compressions, and to keep mask in position
2 back to hospital Second ambulance arrives and the two paramedics keep treating patient while driver takes them to hospital
arrives at hospital Paramedics arrive & leave patient in very bad condition at hospital.
moves to ambulance
keeps patient alive
Moves patient on stretcher into amulance 1st paramedic enters front to drive 2nd paramedic enters back to treat patient
Both paramedics do their best to keep patient alive with CPR while waiting for second ambulance to drive them to hospital
2 back to station Paramedics refill their ambulance & drive back to the ambulance station
starts treatment
patient can’t breathe Driver stops to help paramedic with CPR Calls another ambulance to assist driving
Calms patient Unbuckles to grab medicine bag
Connects ECG pads & cables with patient
Checks vitals again Grabs bag patient throws up Shouts to driver to stop for ECG
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i d e a t i o n
interior ideas
first ideation A lot of thumbnail sketching was made to quickly generate ideas on how the identified problem areas could possibly be solved. Both based on the visits and facts from the paramedics as well as the scenario I created I could start generate these ideas. The main problem areas were safety when moving around in the ambulance, the possibility to safely and still under full control over the patient perform several tasks at once and the flexibility of the interior depending on different treatment situations. The most challenging part during this process was to solve these problems while at the same time take into consideration that the overall size of the ambulance should maintain the same as it is today. A lot of compromises had to be made and some of the
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ambulance parts almost had to squeeze in to the interior to make these ideas convincing and real. Already in this phase of the process I came to the conclusion that a concept solving these problems maybe would not be realizable today in its final form. But it would raise a question and show a possible way of solving a very big issue. It would hopefully inspire the ambulance manufacturers as well. Inspire them to take a leap into the future and rethink their way of approaching design for emergency services. These sketches show how space could free up by storing equipment differently, how the paramedics could move within the ambulance safely without unbuckling and how the interior can vary depending on treatment situations.
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i d e a t i o n
interior concepts
concept one wall Based on the early ideation shown on the previous pages three concepts were developed with slightly different directions. This concept is more based on the ambulance interior of today and how the current layout could change a little to make it more flexible and safe for the paramedic to move within the ambulance to reach different parts of the patients body and equipment. In this concept the paramedic would work in the same position that he does today, but he would be able to slide along the right wall to the front and to the back, as the right top picture shows. The sliding mechanism that the seat would be mounted to
would also offer the paramedic to rotate the seat to access the patient better and get closer to him/ her. The monitoring device would collect all the patient data from the different equipment and be positioned right in front of the paramedic to avoid the patient from seeing it which could in fact affect the results if the patient gets stressed. This concept was left behind fast (bits and pieces were used later) since after talking with the paramedics I realized the importance of reaching the head of the patient from behind, for example when performing CPR to hold the mask and the head of the patient in position.
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i d e a t i o n
interior concepts
concept two walls This concept is based on the idea of letting the paramedic move along the side walls of the ambulance interior. He would be seated facing the patient. A second paramedic would be seated on the opposite side of the stretcher if two paramedics would be needed for the treatment. If the paramedic would work alone he could then slide the stretcher either to the left side or to the right side, depending on which side of the patient he would need to work on. To reach different parts of the patients body or to reach the equipment on the right/left side, he would slide his seat to either side to reach the parts/tools he would need. This would be a great improvement from todays sit-
uation since the paramedics would be able to treat a patient without unbuckling themselves from their seat at all, working safely at all times. Because of the size restrictions the paramedics would when working together on each side of the patient have to work in a sit-standing position (shown on the image below), although this way of working would be more close to how doctors work in a hospital, creating the future “mobile hospital�. This way of working would also allow them to easier reach equipment above their head. This also means that the stretcher would be higher, which would leave space for storing equipment under it. It would free up space normally used for storage.
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i d e a t i o n
interior concepts
concept three walls Concept three was a kind of dream scenario for the paramedics to work in. This concept was also what they pointed out as most valuable to them during my concept evaluation at the ambulance station. This became the concept that I decided to work further on, but I knew that I had to further explore it to assure that it would be realistic within the tight space of the ambulance. This was the biggest restriction in a concept where the paramedics could slide their seats along three different walls on one continuous rail only. The reason to why this concept was chosen
was because standing right behind the head of the patient was a very important position to work in, in many of the most serious cases. This concept would also enable the paramedics to slide the stretcher to the right/left side as presented in the first concept. Another feature was the ability to store the outdoor equipment where the passenger seat normally is positioned. This was a good way of enabling space in the back of the ambulance and move all the equipment that normally is not used in the back anyways.
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chosen concept
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i d e a t i o n
interior experiments
concept evaluation To get professional opinions on my concept ideas I brought them with me to the ambulance station for feedback. A quick mock-up in scale 1:10 was built with very quick cardboard volumes to bring something feasible to discuss around and interact with to get some new ideas on how things could change.
After evaluating the concepts with the paramedics the final concept direction became a combination between concept one and concept three. The paramedics thought concept number three would solve a lot of their issues since they would have full accessibility around the patient without having to move away from their seat.
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Discussing concepts with paramedic Peter Johansson
i d e a t i o n
interior experiments
full-scale volume study After discussions with the paramedics I set out to explore if the chosen concept direction was possible in terms of size and movement. During testing I realized that I had to go back to the concepts stage and evaluate other solutions than the chosen one. The idea was that the paramedics would easily slide along three walls, the long walls and the wall that would separate them from the drivers cabin. This was an impossible thing to do because of the restrictions in size, a railing system like it would just not fit inside the ambulance without the paramedic bumping into the stretcher. Since I made that conclusion I started experimenting with how two paramedics could work on each side of the patient in a very critical scenario. And instead of having a railing system along all three walls these were instead separated into three rails.
One on each side of the patient, and one behind the patients head for critical CPR cases where the paramedic would be seated safely instead of standing up without any security. Since the flexible seats and stretcher required some space I also started rethinking how equipment would be stored in the ambulance. As the pictures indicate I decided to use the space under the stretcher for storage. The main module in the ceiling for storing i.e. IV-bags which would also include a screen on each side that would work as monitoring and journal system so that the paramedics would have them close in eye level while treating the patient. This would also avoid the patient from seeing the monitoring, which could cause stress and affect the measuring results.
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i d e a t i o n
technology
how to slide? To be able to create a solution where it would be easy for the paramedics to move along the three walls in the ambulance safely and without using too much space for the construction I had to evaluate and explore different ways of performing this action. The
same thing had to be explored for the sliding of the stretcher/storage unit. This was made to be able to proof that my concept could work in reality. At these two pages I show different methods and ideas of how this could be made.
sliding door mechanism
sliding rail chair
My decision became to go further with a solution that would have its mounting points in the ceiling and the floor structure of the ambulance. This was both for stability reasons but also for space efficiency inside the ambulance. Compared to a solution where
the paramedics slide along a rail that is integrated in the walls of the ambulance. It would be much more difficult to store equipment along the walls since a big part of them would get blocked by the rail.
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i d e a t i o n
on the way
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transfers patient
interior in use
future scenario When the decision on how the paramedics would move within the ambulance walls was decided, a quick future scenario was made based on the findings from the “current situation� scenario that was earlier made in the ideation process. This scenario aims to solve some of these problems that were identified. The picture sequence show how the paramedics first are on their way to the emergency site, we see one paramedic driving and the
other one in the back of the ambulance in a seated position. The reason to this is that the passenger seat section is now used as storage space for outdoor equipment. Further on in the second picture we see how the patient is transferred into the ambulance from the back. Since this patient is severely injured and has a hard time breathing two paramedics are needed for the treatment.
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3
activates autonomous drive
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p a r a m e d i c s w o r k s a f e ly & f l e x i b ly
One paramedic has to sit-stand on the side of the patient to really get close to the patients body to be able to perform the compressions on the chest. The second paramedic sit-stands on the seat behind the head to get a firm and steady grip to hold the patients neck and bag valve mask in place. As we can see in the third picture in this scenario, the paramedics do not have to wait for another ambulance to be on their way to the hospital. The main unit in
the middle of the ambulance not only works a monitoring & journal system but also as an activation to allow the ambulance to drive itself. This saves a lot of time and allows the patient to get hospital treatment faster. The fourth picture shows us how flexibly the paramedics are now able to work, they safely reach from the patients feet to head as well as all the equipment in the ambulance that they need for the treatment.
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realization
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r e a l i z a t i o n
form development
mood board In this stage I now knew the overall interior architecture of the final concept and I had all the concept details and scenarios finished to start develop my final design on. This mood board shows the overall design language and direction that I wanted the interior concept to communicate. The intention was to create the future of what an ambulance interior could look like and to create an interior where all parts were individually designed but clearly connected when together. One important feature was to really highlight the parts that would be movable or interactive to clearly communicate the functions of those. The goal was also to create a feeling of safety, em-
bracement and protection in the forms to communicate that the paramedics would be secure while working. I also explored how the patient area (stretcher) could contrast from the paramedic working area where the patient area would feel much more soft, embracing and calming and the paramedic area would express more functionality, safety, durability and flexibility. The choice of colours became a combination between white, light gray and “paramedic green�. Where the light colours would be easy for the paramedics to clean away dirt from and the bright paramedic green for highlighting functions.
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c o n n e c t e d
s u r f a c e s
soft
p r o t e c t i v e durable highlight functions
embracing
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r e a l i z a t i o n
form development
initial exploration With the mood board as reference some quick initial sketches were made to get better understanding for proportions and the overall layout and style of the
interior. Some of these sketches were later on taken into the next stages of the process and worked as reference material for the continuous form exploration.
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form development
seat development Since the seat was one of the most important components in this concept I had to explore how the paramedics would flexibly and comfortably move along the interior walls of the ambulance. In this phase I worked on how the shape of the seat would communicate to the user that it was movable. As the sketches show the sitting cushion is shaped in a saddle-like shape which communicates that the legs of the paramedic are more free to use for movement
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when sliding the seat than on a regular car seat. I also worked on how the seat would slide to be adjustable in heigh and how the neck-support could be adjusted. A lot of work was also put in how to separate the seating part from the back-rest part since the seat was a foldable one for different seating modes as well as space efficiency. The overall shape also had to express safety and feel embracing without interfering with their work.
form development
storage & main unit development This page shows a collection of sketches where the purpose was to explore both function and aesthetics of the storage compartments in the new ambulance interior. Important was to maintain a coherent design language throughout all these parts and make them feel like part of a family. The “main unit� basically is the part of the treatment area where the paramedics get all the feedback that
they need during the treatment. This unit works both as a monitoring/journal device and is also the part of the ambulance that interacts with the paramedics when it comes to the autonomous driving of the vehicle. Since this was a unit that they would interact with quite a lot it was logical to integrate it in the ceiling so that it would be in the eye-level of the paramedics during treatment.
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form development
key sketches These two key sketches summarize my thoughts of how the interior would look like based on the mood boards and the previous sketches shown. They create
a mood and an overall design language that would be further explored in the CAID modeling phase of the project.
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r e a l i z a t i o n
form development
caid development seat To roughly solve the technical parts and to create a final form as a base for explanation images and context images a CAID-model was made. The image on these two pages show the specific
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design evolution of the sliding seat. Most form development happened in the sketch phase, but CAID helped me in going into more detail on some parts of the seat design.
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r e a l i z a t i o n
form development
caid development interior After the seat design was finished I could put the seat into context and start modeling the other parts of the interior surrounding the seat. Since the seat some-
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how was the base for the project these pages show the rest of the interior elements.
Seat design
Compartment design
Main unit design
Stretcher design
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Compartment design
r e a l i z a t i o n
form development
interior architecture The new interior architecture that I propose as my final concept makes it easier for the paramedics to treat the patient from any different angle without exposing them to the dangers that they encounter today. The new interior space is much more open and flexible to work in than the interior used by the para-
medics today. The railing system that moves the paramedic along the walls makes it possible to easily reach the patient from head to feet. As shown I have maintained the exact same measurements from the current Mercedes-Benz Sprinter but I have implemented all parts in a much more flexible and safe concept.
sliding seat
entrance doors
storage under stretcher
sliding stretcher
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3250
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1800
2450
1700
5950
2000
emergency door
outdoor equipment cpr seat
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final design
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final design
inside glimpse An interior glimpse into the future ambulance of 2030. The seat and the stretcher discretely show their function by the railing systems growing out from both the ceiling and floor.
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f i n a l d e s i g n
final design
seat functions The seats are designed to meet the demands of the paramedics in terms of flexibility and safety. As the picture shows the seats move to left/right on the railing system mounted into the ceiling and floor structure. The seats can also be adjusted in height
depending on if the paramedic works sit-standing or sits down normally. The arm on the back of the seat can fold out if the paramedic is on the way to the emergency site and travels in the direction of the ambulance or if he treats the patient alone.
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As the left side of the picture indicates the seats are possible to fold so that they become completely flat against the wall of the ambulance. This makes the whole interior more flexible since the paramedics
can choose how to work. They can arrange the interior depending on the treatment situation and the amount of space that is required for that specific treatment.
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f i n a l d e s i g n
final design
interior modes The interior itself is designed in a way that encourages the paramedics to work in different ways depending on their needs during their stay inside the ambulance. On the set-up to the far left, the left seat is flat folded. The stretcher is also moved to the far left
to save as much space for the paramedic on the right as possible. This configuration is suitable during a call-out on the way to the emergency site when the ambulance drives very fast. Then it is important to sit in the direction of the car in case of a traffic accident.
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The middle configuration would be suitable in a case where e.g. the two paramedics have to help each other out during a CPR. They could then tell the car to drive autonomously so that they both can focus completely on the patient. One paramedic on the right side, and one on the seat behind the patients
head. The picture on the far right shows a configuration where all three seats are flat folded and there is full access around the stretcher in the middle. This is suitable in cases when the outdoor environment is so harsh to work in that the paramedics can work protected on the inside of the ambulance instead.
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f i n a l d e s i g n
final design
interior functions These two pages sum up the functions on the inside of the ambulance. Explained are the details of every component. How the specific parts of the seat were
storage
For equipment quite commonly used
storage
For small things such as needles, tissues, bandage, pads etc
designed, how to interact with the main unit and how it communicates with the car. How the stretcher adds to the flexibility of the interior etc.
rail
in/outdoor storage
To easily move within the ambulance to reach equipment & patient
For tools used both in & outside the ambulance, medicine bags, bone drill, measuring equipment etc
storage
door
Equipment frequently used closely connected to patient, ECG, bag valve masks etc
Side doors for entrance
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front cabin
Reduced in size to fit in equipment
outdoor storage
For equipment not usually used in the ambulance: leg splint, stair stretcher, neck support etc
lights
storage
Working light & light to confirm that ambulance is in autonomous drive mode, light travels from back to drivers cabin as a confirmation
Storage for commonly used equipment, IV-bags etc
screen
Voice controlled screen for journal, monitoring & for activation of autonomous mode
holes
For management of cables connected to patient
iv hooks
Hooks to hang IV-bags on
rail
rail
To slide stretcher into specific position
For movement along wall & to adjust seat height
neckrest Adjustable neck rest
foldable arm Foldable arm for seat rotation
b e lt
4 point seatbelt with highlighted buckle for quick interaction
folding seat
Foldable seat for different work positions, flexibility & space efficiency
saddle shape
To easily move feet when sliding, bump shaped end for support
tray
Tray for placing currently used equipment on
storage
For medicine bags etc
rail
To transfer patient on stretcher into ambulance
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in use scenario
on the way A priority one call. A person has a very hard time breathing and has a lot of chest pain. The picture illustrates the paramedic in the back of the ambulance while on the way to the emergency site.
transfer patient The paramedics reach the emergency site where they find an old person with a lot of chest pain, resulting in a cardiac arrest. They quickly transfer the patient into the ambulance to begin the treatment.
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go to hospital The paramedics tell the ambulance to drive autonomously since they both need to treat the patient. Instead of waiting for a second ambulance to drive them to the hospital, they now save time, and life.
treat patient One paramedic performs the compressions on the right side of the patient while the second paramedic behind the patients head pulls the stretcher closer to keep the neck in a stable position for the airflow. Both paramedics works safely buckled and secure.
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f i n a l d e s i g n
final design
vehicle context The interior in a possible future context when ambulances drive semi-autonomously to reduce the workload and dangers paramedics are exposed to today.
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final presentation
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m o d e l m a k i n g
model making
workshop Most of the parts for the final model were CNC milled because of the accuracy and detail that the CNC machine delivers, although two of the seat parts were 3D-printed. The model was made in scale 1:6 so some of the parts were really small. The right page
shows the overall process of the work performed in the workshop. From milling the parts, sanding, putty, priming, sanding, priming, sanding and priming again until the final layer of paint. The painted pieces were then assembled into the final model.
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the big day
final presentation On the presentation day I presented my concept together with the ten other concepts from my classmates. I pitched my project with a ten minute presentation followed by five minute feed-back from Robert and Fredrik from Laerdal Medical and paramedics from the Ume책 ambulance station. After all the presentations we had individual feedback sessions by our podiums and posters where
both the paramedics and Laerdal were very happy with my final result. I also got the chance to get interviewed by V채sterbottenskuriren which resulted in two articles in the paper the day after, both V채sterbottenskuriren and Folkbladet. The picture on the right left corner is the one that was published in V채sterbottenskuriren.
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t h o u g h t s
project thoughts
conclusions Why this concept? When looking back at the initial problems that from the beginning convinced me to raise these problems I was sure that there was room for improvement by examining the problems of todays ambulance interiors. And indeed I was aware of the size of this project and I had a constant feeling of uncertainty if this was the right decision to continue developing or not. I was still convinced that I wanted to improve these issues and show that I was able to cover a problem this big both in size and complexity.
I have improved the accessibility, since the paramedics now can move within the ambulance without unbuckling to reach equipment. The concept has also been developed to open up the space of the ambulance more, without changing the size of the current ambulance used, which was one of my restrictions. And in the end, the ambulance is now much more flexible and versatile to work in depending on the different treatment situations. The wishes that I set up were quite abstract and I did not really completely fulfill any of those. The ambulance is not necessarily more comfortable to the paramedics in all situations, if two paramedics work together with a patient, the space around them is quite tight. Although working alone, or as a whole team in there with flat folded seats is more comfortable than working outside in a harsh environment. The easy transfer of patients and detailed ergonomic studies was something that I did not manage to cover in an overall concept like this.
Looking back at the goals & wishes that I defined in the beginning of the project I managed to solve the goals that were set up. But since the size of this specific project was so big, I always had a feeling that I could not focus on the details in the same way as if I would have made a smaller more specific product. I do think that I in the end created a concept that would prevent the paramedics from exposing themselves to such risks as they do today, and I did create a solution for decreasing the amount of workload since the paramedics no longer have to drive the ambulance during serious cases which means that they can help each other out. The monitoring and journal system has also been moved to a more natural position right in front of the paramedics and is now more voice controlled so that they no longer have to to focus on writing the journal instead of treating the patient. Therefor I think that I achieved the goal of supporting multi-tasking too.
To sum up, the final result covered most of the identified problems. This product is probably not something that would be possible to produce tomorrow but I hope that it communicates a vision of the future and that it raises the question of a very important problem. I hope that my concept can inspire ambulance manufacturers the same way as it inspired the paramedics, to rethink their way of developing future ambulance solutions.
goals
wishes
Prevent Risks Support Multitasking Improbe Accessibility Keep Size Open up Space Make Flexible
Improve Comfort Easy Transfer All Ergonomic
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r e f e r e n c e s
sources
reference list internet http://www.svd.se/kraftig-okning-av-ambulanslarm http://www.gp.se/nyheter/sverige/1.2717192-ambulansutryckningar-okar-kraftigt https://en.wikipedia.org/wiki/Emergency_medical_services http://www.trafikverket.se/contentassets/625e4dfbfd7a41a5bee015d77dee0759/ambulansrelaterade_ skadehandelser.pdf https://www.vardfokus.se/webbnyheter/2015/april/over-50-ambulansolyckor-de-senaste-fem-aren/
interviews Peter Englund, 2015 - 03/11, Umeå Lars-Åke Lövqvist, 2015 - 03/11, Umeå Erik Palmcrantz, 2015 - 22/11, Umeå
photos Jon Sommarström Thomas Helmer Marc Saboya Feliu Daan Hekking Ahsen Gülsen Jenny Holmsten Anders Sandström Aileen Kassing Rik Oudenhoven Franziska Heuck James Skeggs Thomas Degn Västerbottenskuriren
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thanks to: Thomas Degn Johan Gustafsson Robert Provó Kluit Fredrik Hansen Daniel Sellberg The Paramedics Jon Sommarström Thomas Helmer Marc Saboya Feliu Daan Hekking Ahsen Gülsen Jenny Holmsten Anders Sandström Aileen Kassing Rik Oudenhoven Franziska Heuck James Skeggs Mattias Borg Ruben Eriksson Amar Dawod Maria Dawod Dawid Dawod Nathalie Linnér
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jakob dawod contact jakobdawod.com jakob@dawod.se +46 73 43 07 831