smart ambulance minds think inside the box

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SAEPP - Newsletter 1

Leading ambulance personnel representing 12 European countries gathered for a two day Kick-off meeting at the Royal College of Art’s Dyson Gallery in Battersea, London in February to kick-start a consultation process focusing on the design and build of an innovative hi-tech 21st century ‘Smart’ ambulance which, when completed, could significantly alleviate pressure on Emergency Departments and hospitals.

Smart Ambulance Minds Think inside the Box

Leading ambulance personnel representing 12 European countries gathered for a two day Kick-off meeting at the Royal College of Art’s Dyson Gallery in Battersea, London in February to kick-start a consultation process focusing on the design and build of an innovative hi-tech 21st century ‘Smart’ ambulance which, when completed, could significantly alleviate pressure on Emergency Departments and hospitals.

Participants viewed a full-size Demonstrator Box that embodies design features informed by a 9 year research project. The box, modelled on a typical A& E ambulance patient treatment unit, was designed by the Royal College of Art’s Healthcare Research Lab, part of the Helen Hamlyn Centre for Design. Ambulance and healthcare delegates from as far afield as Spain, the Netherlands, Denmark and Finland were shown the box’s hi-tech interior and invited to share their thoughts on what clinical design elements on display would best improve the shape of their own nation’s ambulance delivery.

Backed with nearly €500K of EC research funding, the RCA -led “Smart Ambulance:

European Procurers Platform (SAEPP)” consultation project will engage ambulance clinicians and design experts from across Europe over the next five months with the goal of developing a blueprint for a shared emergency ambulance vehicle prototype intended to demonstrate the enhanced role that ambulance services could play in delivering improved healthcare within the community, reducing unnecessary hospital admissions across the EC.

The SAEPP project is funded by the EC under the ICT 35-f European Procurers Platform (EPP) strand, which aims to bring together partners from across the EC zone to solve shared challenges in healthcare by forming consortiums to share healthcare and technology resources.

Also backed by leading surgeon and clinical advisor to the NHS, Lord Ara Darzi , the SAEPP project aims to help ambulance services across Europe to massively reduce unnecessary transports to hospital. In the UK alone, these amount to an average of 40% of all journeys conducted by NHS ambulance services.

RCA Senior research fellow and SAEPP Design-Lead, Ed Matthews, is looking forward to the challenge ahead and commented: “With the support of Lord Darzi and many other clinical thought-leaders, we’ve been developing our concept of an ambulance redesign that can alleviate pressures on hospitals and bring revitalised models of ambulance healthcare delivery closer to the patient for over five years now, so we’re delighted that our policy of active consultation and involvement among European ambulance partners is the ingredient that has carried us forward to this next stage.”

Ed added: “As a healthcare designer, I’m personally very excited about the technologies and systems this project is bringing together for the first time, but in the final analysis, it’s all about helping ambulance services across Europe to craft a new role for themselves in the wider healthcare landscape - not only as an urgent care transport mechanism, but also as a first-point deliverer of healthcare to the patient - one that can either treat them comprehensively on-scene, without the need to take them to a hospital, or one which can at least provide the right type of immediate care referral and help direct the patient to the right part of each member state’s healthcare system, faster and without any wrong turns.”

If successful the SAEPP project could be taken forward by as soon as 2016, resulting in the build of a number of fully-operational prototype ambulances that would then be tested in the field and evaluated across Europe within a further two years.

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 644329

Newsletter 1 - Smart Ambulance Europe Procurers Platform

SAEPP project kick-offmeeting workshopoutcomesBackground:A kick-off meeting inviting all the consortium partners of the SAEPP project was held during the 12-13th of February in London. The purpose of the meeting was to share and discuss the overall aims for the project as well as to provide an overview of the project activities and deliverables. The meeting provided an opportunity for consortium members to meet face-to-face, present their organization’s profile and share the role they will play during the project. During the second day of the meeting a design validation workshop was held to gain the feedback of all the consortium parties present.

Workshop aims:The purpose of the workshop was to validate some of the emergency healthcare research work the Helen Hamlyn Centre for Design and its partners have produced to date, and look for points of commonality between the different service providers across Europe. The workshop used the ambulance demonstrator unit produced by the HHCD and the different challenge areas it addresses as a starting point, with the objective of identifying opportunities to help address some of the common problems faced by services, clinicians and patients in different regions of the EU. The workshop asked participants to think about requirements that

should be included in a shared functional specification for the development of future vehicles.

The outputs of the workshop will help establish a baseline from which to start the development of an agreed outline specification for an EC H2020 PCP call.

Agenda:• Tours of ambulance demonstrator unit and project evolution presentationParticipants were able to see the ambulance demonstrator unit produced by the HHCD featuring a new layout for a box ambulance treatment space, followed by a presentation describing the rationale behind the project and how it evolved.

• Breakout session 1 - “Stop, Continue, Start”Facilitated discussion focusing on validating the design features presented in the ambulance demonstrator unit. Participants were divided into four groups to discuss the following key areas:• Group 1: Hygiene & Cleaning and Patient Experience • Group 2: Layout & Arrangement and Patient Accessibility• Group 3: Equipment Integration and Communication• Group 4: Stock Control and Sustainability and asked to organise their thoughts in three clusters:• Stop – Things that should be changed, barriers to innovation, practices that need to stop • Continue – Things that work well, positive aspects that should continue• Start – Areas of opportunity, things that should be put into practice

• Breakout session 2 – Prioritisation, what elements should go into an agreed outline specificationTaking the outcomes from the first breakout session, the teams focused on prioritising the top three most important factors to consider for an outline specification.

Outcomes from Break out session 1 (items have been taken as recorded on the flipcharts and post-its during the session, some of these points may need to be brought into context or need further explanation)Group 1Hygiene and Cleaning:

Stop• Bolt-on constructions, e.g. grab handles• Handling contamination cases (need to do differently)• No time to clean – only 20 minutes

“ The kick off meeting was a great opportunity to meet with EU colleagues. What stood out for me was the discussions

revealed the diversity and variation in both the environments that ambulance services have to work in and the different operating models for pre-hospital care. The useful interaction highlighted the need for the project to think about flexibility in smart ambulance solutions as, although aspirations may be aligned, the way we can make it work in the real world will need adaptability and there is no one size fits all.”-Janette Turner, University of Sheffield

“ First of all, on the behalf of Eksote, I want to thank you for the opportunity to meet you all and get acquainted with the development studies concerning smart ambulances. The kick-off was well organized and in particular the workshops helped understanding the project from all the aspects in a really interesting and multi-professional manner.

The kick-off also proved our goals were right and appropriate. In addition to e-recording of patient care/information and video consultation, automation of stock balance proved an interesting idea which would benefit us too. To develop point-of-care with the help of these previous points is very important, due to the characteristics of Finland, being sparsely populated and experiencing all four seasons. This also relates to the fact that the van type ambulance design (type II) is the preferred choice in comparison with module ambulance (type I/III).”

- Katri Länsivuori, Mika Mitikka, Jan-Erik Palviainen, Eksote

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Continue• Focus on hygiene and cleaning as a priority• Accreditation• Hygiene test every quarterStart

• Make sure there is enough time for cleaning • Should cleaning be done by staff or specialised people?• MRSA tests in vehicles• Learn from food industry or other industries with good regulations• Hand gel dispensers on vehicles• Muck off trolley before it enters the vehicle

Patient ExperienceStop

• Patient does not want to see the information (?) (wireless technology)• Travel sickness (stiff suspension vs. comfortable ride)• How is stretcher secured to the floor?

Continue• Natural light on new model• Adjustable suspension• Ask feedback from patient• Treatment space not storage• See the person who is treating you (human touch)• 360º good

Start• Adjustable suspension• Noise control• A place to put equipment while working• Grab handles• Weight of person displayed

• Try to reduce equipment needed / not too many wires / multi-tasking machines

ICT Opportunities identified during SAEPP Kick-off meeting

“The project has afforded SECAmb a fantastic opportunity to collaborate with European representatives from the design, procurement, manufacturing, research and clinical sectors to produce an innovative ambulance design fit to deliver cutting edge patient care for the foreseeable future”.- Paul Moorhouse, Paramedic Practinioner Co-ordinator, SECAmb




• Integrate sensor technology / smart clothes (does that work on the road?)• Emergency family contacts (apps)

Group 2

Layout & Arrangement and Patient Accessibility:

Stop

• Not practical to have paramedic chair behind patient – need to look at patient• Physical and ergonomic actions (especially when vehicle moving)• No need for too much stock inside at all times – challenge of convincing crews they won’t need as much stock

Continue

• Easy to clean structureStart

• Environmental change problem (home ambulance-hospital) • Shift stretcher position from middle to the side (most of the time you don’t need access to every side)• 3 attendants, there is space for three people• The system support should influence the re-stock program• Different countries will need different equipment – need different cupboards or equipment packs

Group 3Equipment Integration and Communication:Stop

• Having multiple devices for same purpose• Patient confidentiality has been barrier to allow access to information• Stop thinking of healthcare as a building – it’s a service• Infrastructure in some regions (no 3G/4G signal) can be a problem• Technology moves at a very fast pace, risk of becoming obsolete before a solution is rolled out

• EMS services are not always well connected to other healthcare services• Data ownership, where does it live?• Illegal to access personal data (Spain)

Continue• Interoperable TETRA Net (UK, NL)• Good integration with cardiology services (NL)• Constant upgrade of technologies – in NL it’s every 3 years• “Rack” system facilitates easy update of technology (NL)• Centralised system for easy data access (NL)• Integrated emergency services – information sharing (FI, NL)

Start

• Future-proofing for new technologies• Regional comparison across EU rather than comparing countries• NL may be a good test bed for urban focused proposals• Explore different digital communication solutions• NL is small enough to standardize• Proximity-enabled access to patient records• Exploring digital and real-time technologies• Explore nano-technologies for personal data storage• Explore proven technologies like voice recognition and wearable sensors to facilitate data input • Context based access to data

Group 4Stock Control and Sustainability:

Stop• n/aContinue• n/a

Start• Explore use of smart boxes that have check lists and know when things have been taken out, expiry dates• Need more workspace – shelf above treatment packs, possibility to put pack on the stretcher• Specification for compulsory equipment in Europe• Taking treatment packs outside of ambulance• Flexible stock levels for intended use that day• Pilot’s check list system if no Make Ready (flexibility)• System principles across different vehicles• Weight and size reduction• Hybrid electric/diesel vehicles?

Outcomes from breakout session 2:Group 1

Hygiene & Cleaning:

1. Provision of MRSA tests on board vehicles

“ As project coordinators, the kick off meeting was a key event to mark the start of the project. It was fantastic to meet colleagues from

across Europe and put faces to names.”-Alyson Brett, NHSCS

“From our point of view, it was great to be in London as we finally got to meet all the partners from the consortium. We had the chance to speak face to face with all the partners, and it

was especially useful to get in touch with the partners who are involved in the same work packages. After presentations from the members of the consortium we got to know in more detail the potential, weaknesses and strengths that every partner will provide to the consortium.The workshops organized about the different aspects to be considered to determine the common needs of the ambulance of the future were very interesting. Both by the information received during presentations and by participating in the workshops we got to know the current situation of ambulance services and Emergency Units in the different countries participating in the project, all with their idiosyncrasies.Finally, but not least important it was nice to see our project website where all our progress will be disseminated.”- Jose Carlos Prieto Baena, FIBICO-IMIBIC


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Our Consortium Members:Ambulance Today Ltd. BITECIC Ltd. Falck Danmark A/S FIBICO Fundacion Tecnalia Research and Innovation (Tecnalia) Health Innovation Zealand (ZEALCO) Helen Hamlyn Centre for Design (HHCD) and the Royal College of Art (RCA) Inem Lappeenranta University (LUT) NHS Commercial Solutions South East Coast Ambulance Service NHS Foundation Trust (SECAmb) Yorkshire Ambulance Service NHS Foundation Trust (YAS) Saimaa University of Applied Sciences (Saimaan Ammattikorkeakoulu Oy) Sheffield University (USFD) South Karelia Central Hospital (ESKOTE) University of the West of England Clinical Leadership UMCG Ambulancezorg

To visit our website: www.smartambulanceproject.eu

2. Focus on hygiene and cleaning as priority3. Better design of grab handles

Patient Experience

1. Use of sensor technology for patient monitoring2. Adjustable suspension3. Request feedback from patients

Group 2Layout & Arrangement:1. Flexible storage system2. Monitor as useful instrument3. Continuous smooth surfaces (for easy cleaning)4. Optional window for patients

Patient Accessibility1. Position and number of chairs – 3 ideally2. Accessibility to patient whilst seated3. Patients not getting worried by medical data

Group 3 Equipment Integration and Communication:1. Define IT architecture (standards, interchangability, modularity, etc)2. Define functions needed a. Access to patient records b. Communication with experts, receiving hospital, etc c. Navigation d. Stock control3. Explore new technologies

Group 4Stock Control:1. Smart Bag2. Modularity / size3. Standard equipmentSustainability1. Zero emissions vehicle2. Size reduction

Questions for the group:• How might we develop a mathematical model that is able to assess the current performance of the services across the consortium, and forecast the improvements that could be gained once the ICT solutions are in place?• How might we use this information to distill a functional specification that highlights the different system elements and features needed in order to achieve a given level of performance?

Next steps:This workshop was the first approach to understand some of the priorities of the different members of the consortium. Whilst the workshop was centered on discussing different aspects of the ambulance

service, equipment and vehicles, it is important to remember that the SAEPP project is responding to an information and communication technologies (ICT) call.

Moving forward, we should consider which of the opportunities identified and prioritised during the kick-off workshop could be addressed through ICT driven initiatives/solutions.

These opportunities should also be assessed taking into account the overall objectives of:

• Improving patient outcomes (e.g. more effective treatment / closer to home)

• Improving system efficiencies (e.g. cost savings from reduce hospital admissions)

“From my perspective it was great to match names to faces and to experience the genuine enthusiasm of the

consortium partners. I believe everyone went away from the kick off understanding the challenges facing the SAEPP Project over the coming months and the need for 100% commitment. I believe we have this.”- Richard Stack, BITECIC

“We have a very interesting and powerful consortium in hand. Yet, it became very clear that the modes and operating logic of

ambulance service differ in the parts of Europe represented by the consortium. It is an interesting challenge to us all to find such a functional specification for the new ambulance service that fits the different regional circumstances. We need to cover both the requirements at the levels of patient care and patient-professional interface, but also ensure that the new service mode is linked appropriately to the service system and the extended actor network derived from the need to avoid unnecessary hospital admissions.”- Jouni Koivuniemi, LUT Lappeenranta University of Technology

“ It was a great opportunity to visit the project’s Ambulance Demonstrator Unit in London which has many new and

interesting features. Patient and ambulance staff safety is a very important matter which should be noticed in the front line. At the same time it is a very important to reflect new ideas to treat more effective the patient on the pre-hospital scene and so to decrease A&E admissions and costs.The new applications of information technology will allow on the pre-hospital scene almost same examinations and treatments like in hospital. What we need is that paramedics should be able to use the latest information of the patient medical history and they should also have readiness to examine the patient with the same medical devices and labs as in hospital.”Simo Saikko, Saimma University

If after reading this article you would like to offer your own views on the development of the SAEPP smart ambulance, please feel welcome to visit our website and leave your feedback for us at:

www.smartambulanceproject.eu/contact-us/


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smart ambulance minds think inside the box

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