Redesigning the Air Ambulance
North Carolina State University
Redesigning the Air Ambulance
This is a thorough, rigorous, solution-oriented approach to rethinking the interior design of helicopters used as air ambulances. The emphasis is clearly on physical and cognitive human factors, and we liked the way the problem was tough enough that everyone involved knows you can’t afford to be wrong.
The design team from North Carolina State University did a great job of challenging old orthodoxies, as exemplified in the way they chose to yank out the co-pilot’s seat to make more room for patient care, equipment and medical staff.
We also liked the way that the recommendations were communicated well— including clear diagrams that revealed how the design was completely optimized for effective medical care in tight spaces.
Redesigning the Air Ambulance
Redesigning the Air Ambulance Interior is a design research project, which utilizes the process of co-designing with medical flight crew from a level 1 trauma center in the United States, to envision an Air Ambulance interior. It utilizes the five design dualities surfaced from the study to enable the medical flight crew enhanced access to their patient, medication, and equipment during inter-hospital transfers.2. The Brief: Summarize the problem you set out to solve. What was the context for the project, and what was the challenge posed to you?
Air Ambulances, which have doubled to 400,000 trips over the past decade and feature numerous benefits such as reduced time out of hospital and lower incidences of adverse events have not changed much since the start of their use. The interior has become outdated and currently impedes the medical crew from doing their work effectively and efficiently.
The researcher chanced upon a flight paramedic's frustrations with the interior while doing research for another medical device and decided to take up this project as his thesis project.
Through design methods used with the medical crew, it was discovered there were numerous issues with accessibility and precision of getting their equipment and accessing the patient. The outdated seats in the helicopter are difficult to maneuver due to their bulkiness, have confusing controls, and limited range. This results in the crew being tempted to unbelt themselves to access their patient or face having to contort their bodies to access awkwardly placed equipment or even injecting the patient.
The storage system uses unclear organization principles as colors are used inconsistently and it has an overabundance of redundant medication and equipment which makes it difficult for the medical crew to precisely get the equipment they need to save their patient's life. The storage units are placed in ways that impede the work of the crew and prevents collaboration when complications arise. All this results in a stressful transfer experience for the medical crew.
Looking at the interior from a naive perspective from the researcher paired with the deep experience and expertise of the medical crew who use the interior allowed for a great combination of opportunities to rethink and redesign the interior.
The concept of small spaces was a major theme where it was about using the space to your advantage, making use of wasted space and to make it feel more spacious than its actual size. This was important in the beginning phase of the project as the general feedback was just to get a larger helicopter which would involve greater costs for the hospital when a smaller helicopter is adequate for most hospitals' needs.
With the researcher coming from a design background, the need for the space to be user-centered and to serve the medical crew so that they could focus on their patient was always a focal point. This resulted in the researcher spending a large portion of the project just understanding how the medical crew do their work.
Another theme included by the researcher was the type of emotional response that the space evoked in the crew when they were transferring a patient. While shadowing the crew, the researcher felt the anxiety that was created just by being in the helicopter due to the noise, wind, and vibration. The researcher included the criteria of having a calming effect on the crew when there were no complications but could spring into action when there was an emergency.
As the medical field is complex and hard to navigate, it was decided that a co-design process would be the most beneficial to tap on the medical crew's experiences since they were the target audience. Although the pilot, aircraft technician, and a larger medical crew was consulted at important stages through the process, a dedicated team of two flight paramedics and a flight nurse from a level 1 trauma center worked with the researcher throughout the entire process from opportunity identification till the final solution.
There was literature on inter-hospital transfers from a medical perspective but the area regarding Air Ambulance interiors was largely unexplored. Hence, 4 months of the project was just spent using different design methods to prompt meaningful conversations with the medical crew to allow the researcher to understand the context, the people, the procedures, the practices, and the policies regarding inter-hospital transfers.
An in-depth contextual inquiry was done with the team that included numerous interviews and observations of their work. The early phases used design methods such as business origami to understand the stages of inter-hospital transfer and the roles and responsibilities of personnel from receiving the call that an inter-hospital transfer needs to be done till the patient is placed on their hospital bed at the specialized hospital.
The next stage involved simulations of procedures in context. It started with the crew just demonstrating how their work was done until a mannequin was brought into the helicopter so as to get a more accurate picture and video of the complex descriptions from literature and to discover possible workarounds that the crew had unknowingly used. It culminated with the researcher shadowing the crew for 3 12-hr shifts to get the sense of their intense work. A list of opportunities was shared with medical crew with numerous discussions on the validity and accuracy of them.
The crew had numerous frustrations with the space, especially in the area of access to their medication, equipment, and patient. Prioritizing the long list of identified opportunities was difficult as the researcher tried to gauge which opportunity would have the greatest impact on the medical crew's work, how they could be possibly inter-related, and digging through the details to understand the root cause of their issues.
As the medical crew that worked with the researcher worked at the same hospital, the researcher also interviewed a flight nurse and explored an EC145 Air Ambulance from another level 1 trauma center to make sure the identified opportunities were scalable to other hospitals and helicopters.
The learning was consolidated into 5 design dualities as it was realized that different hospitals have different medical specializations so there was not one single type of patient that flies in the Air Ambulance and it needed to take into account those sometimes conflicting requirements.
User testing was done on different scales from confirmation of needs, feedback of sketch ideas, and testing of spatial and physical prototypes.
Despite the use of Air Ambulances almost doubling over the past decade and with numerous countries facing a greying population who would need these services, there has been very little research done on the interiors of Air Ambulances to enable medical crew to do their life-saving work. Most of the literature focuses on the individual and distinct procedures that are done instead of looking at it from a holistic perspective of the different ways the medical crew need to work in the interior, which was a focus of this project.
Distinct responsibility, shared accessibility. Fixed layout, flexible workspace. Displayed inventory, concealed storage. Provider-centered, Patient-focused. Diminished senses, enhanced senses. These 5 design dualities take into account the sometimes conflicting requirements for the interior of the Air Ambulance and serve as guiding principles for the design of Air Ambulances.
The interior space has been reconfigured to enable the medical flight crew to maneuver their seats to enable multiple configurations based on the condition and injury/illness of the patient through space freed up from the removal of the co-pilot seat and relocation of storage to unobtrusive locations. This is balanced with storage being placed within arm’s reach that correspond to their emergency procedures as well as storage in their seat that allows their high usage equipment to move together with them. The equipment is neatly packed into treatment packs that allow for higher precision of getting what they need to save lives.
The researcher took the project based on a 'gut feel' that there could be many opportunities in the redesign of the space. Hence, the context of the project was unclear in the beginning phases, especially because the crew had numerous frustrations with the space. It was through the use of design methods where the context became clearer that it was about the crew's accessibility to medication, equipment, and patient.
With the use of co-design, the researcher was always faced with the immediate issues that the crew were facing and the constraints and regulations that govern the current interior. It took a period of time before the researcher and the crew were open to the possibilities of a redesign of the space. This collaboration aided in developing concepts that were extremely simple and seemed almost obvious in hindsight. They could be implemented without the need for advanced technology and addressed the crew's frustrations with the space.
The focus of the project was on redesigning the Air Ambulance for the EC135 helicopter with the concepts presented placed in the context of the scaled interior of that model. However, the researcher broadened the scope of the project to include dualities to think about how Air Ambulances could be designed and came up with concepts based on these dualities that could possibly be scaled to other helicopter models.