The Redesign of the UK Emergency Ambulance aims to improve the patient experience and enhance clinical efficiency by providing a better treatment space with improved equipment and technology.

The benefits of the new ambulance design include:

•Central stretcher position – 360˚ access to the patient

•Digital Diagnostics and Communications (DDC) system – better navigation, contact with hospital colleagues and ability to send vital signs and handover information on route to hospital

•Easy-clean, non-intimidating interior with improved lighting and general ambience

•Standardised treatment packs for efficiency, infection control and stock control

•The right equipment in the right places

Current ambulance interiors have evolved incrementally from a 20th century ambulance that was required to do little more than convey patients to the nearest hospital. However a 21st century healthcare service demands urgent care treatment at scene as well as emergency treatment and transport for seriously ill and injured patients to the centre best suited to their needs. In addition, emergency healthcare services face the hard reality of shrinking budgets while an increasingly ageing demographic is raising service demands.

As healthcare requirements change, technology evolves and ambulance crews receive better training, a need for an integrated system comprising better vehicles and equipment emerges. By providing the right treatment on scene it is estimated that up to 60% of unnecessary Emergency Department admissions could be avoided. By reducing unnecessary hospital admissions by a mere 5% more than £30 million (USD $50M) in annual savings can be achieved.

The project specifically addresses questions of how to:

• Reconfigure and design a standardised treatment space to improve clinical effectiveness and safety for patients and clinicians

• Reduce staff injuries through better ergonomics

• Improve stock control and standardise equipment

• Improve patient experience, treatment capabilities, working environment and infection control

• Improve diagnostics, communications and data transfer through digital technologies

Front line UK National Health Service (NHS) paramedics, clinicians, patients, researchers, engineers and designers worked together in a co-design process to develop and evaluate proposals using a systems-led approach to meet 21st century needs. By taking a fresh look at the whole mobile healthcare system in general and the ambulance interior in particular, we aimed to address the modern emergency healthcare requirements, improving patient care and safety alongside enhanced healthcare efficiency and reduced operating costs.

•Research began by accompanying ambulance crews on 12‐hour shifts to document, observe and understand the complexity of their work through a first­‐hand, immersive experience

•A paramedic seconded to the team helped gather key insights. Typical ambulance modes of use were mapped to understand needs and limitations that crews and patients face every day

•Ideas and concepts were explored, critiqued and translated into sketch designs. These were refined and developed as 3D data and into a full­‐size test rig

•Full­‐sized test rigs in wood and cardboard were constructed. Paramedics and patients were invited to evaluate and help expand some of the ideas

•Proof­‐of­‐concept models were built and evaluated by real ambulance crews through controlled, clinical scenarios. Results were analysed and translated into design improvements

•A virtual immersion space was used to review variations of interior layouts without the need to physically build them

Throughout the project development it was fundamental to test and obtain feedback from ambulance end users, consisting of clinicians and patients. The evaluation program was divided in three stages and ran as follows:

• 39 different ambulance crews were recruited, 24 answered questionnaires and performed clinical simulations, 15 made thematic analyses of the proposals using a Likert questionnaire with ratings ranging from 1 (worst) to 5 (best)

• During the first iteration the groups evaluated the standard ambulance and our proposed design to establish a benchmark. Subsequent groups assessed only new proposals

• 3 alternative proposals were assessed using a stereoscopic immersion system

• 5 patients volunteered for thematic analyses on all 3 evaluation stages

This ambulance interior is the result of an evidence-based design brief derived from ‘first principles’ research in consultation with paramedics, ED consultants, ambulance commissioners, procurement teams, ambulance manufacturers and patients. The new treatment space features:

1. Centrally positioned stretcher, allows clinicians 360° access to patient provides safer, more efficient treatment.

2. All equipment and supplies located on one side of the vehicle on ergonomically designed “working wall”, based on evidence from user research.

3. Modular treatment packs are loaded into the vehicle before each shift by the “Make Ready” team, containing everything needed for particular jobs.

4. The DDC system provides video link to hospital colleagues and specialists, remote access to patient records and enhanced road navigation. It sends vital signs and handover information directly to the hospital while en route.

5. An easy-clean interior designed to avoid corners and crevices where dirt collects, demonstrating significant improvements in infection control. The interior is better lit, has a better ambience and is less intimidating.

6. Simple hand-cleaning facilities have been added, and facilities are provided for storing personal belongings and a coolbox to reduce food poisoning among staff in hot weather.

Evaluations demonstrated the following benefits:

•Time taken to complete treatment reduced by 37% 50%

•Infection cross-contaminations reduced in the treatment space by 69%

•10% improvement in staff Technical Skills scores through better ergonomics, with positive impact on patient outcomes

•Estimated UK-wide cost savings of £30M (USD 50M) through reduced hospital admissions

•Patient treatment closer to home – a clear patient preference

When the results of Smart Pods were disseminated a detailed proposal outlining a project to produce the definition and implementation of the system was presented. We saw that a major research and design programme was needed to outline this, and that it would need to be supported by UK Government, the NHS, the collective and individual ambulance services and the manufacturing industry if it were to succeed and be adopted.

Acknowledging that it would be practically impossible to bring together the manufacturers, let alone the ambulance trusts, the NHS and UK government, we adapted our strategy to achieve our end objectives through smaller and more manageable steps, via a 3-stage programme:

1)Redesign the Emergency Ambulance

2)Design a Small Vehicle for ‘Urgent’ community treatment

3)Complete the design of the Integrated Mobile Healthcare System.

This first stage studied the work done by ambulance crews today, and through iterative development has created a Demonstrator Unit, well received by frontline staff and government officials alike.

Our demonstrator unit is realistic and has a solidly validated design. Influential individuals and organizations attended its launch, echoing the views of clinicians. Plans are now being made between Chief Executives of ambulance services to bring together all UK commissioners and procurement staff to agree common specifications. Manufacturers have agreed to estimate development costs, from which health service innovation specialists will work with funding bodies to raise finance to develop a working vehicle prototype. Initially for UK use, it will ultimately target EU and Rest of World markets.