Give 30 compressions at 100 compressions per minute, 8-10 breaths per minute, intubate, get intravenous or intra osseous access, assess the pulse of the patient, electroshock if necessary, prepare a saline bag and find a place to hang it from, find an adrenaline ampule, get a needle, draw up 10ml, inject adrenaline every 4 minutes, find a place to hang a saline bag… These are some of the steps that a team of two people have to face during a Cardiopulmonary Resuscitation (CPR) drug treatment.
The products that are currently used to perform the IV treatment do not take into consideration the amount of steps that are needed to inject one single dose of adrenaline from the moment the paramedic gets into the scene and the amount of people needed to perform the task.
Adrinject and Adripod are designed as a kit to assist paramedics in adrenaline administration during CPR procedures in pre-hospital contexts. Together two products will free up time, hands and attention and help the paramedics do what they are best at in critical situations when seconds matters the most.
Adjustable dose and double-confirmation system
Mechanical control of the fluid
1.2 m saline bag hanger
Extra power for long CPRs
This project was about coming up with new solutions for pre-hospital care. It started out in a 2-day-visit at the Umeå Ambulance Station where 12 Advanced Product Design students could understand the real problems of the paramedics. Throughout the project, we could dig into specific problems and get innovative solutions that could, in the end, save a life. The project involved tasks such as research analysis, testing the ideas with paramedics with mock-ups, sketching, and model building.
Night and day shifts, carrying excess of weight or dealing with death are some of the elements that a paramedic has to face almost every day. It is commonly known that the pre-hospital care is one of the sectors most affected by early retirement due to back pain or not being able to cope with the hard schedules.
The cardiac arrest is one of the big topics that came up during the stay in the ambulance station. Paramedics have to stick to very stressful and complicated procedures that involve, among others, injecting drugs into the patient, which is known as a tricky part of the CPR, mainly because it requires precision, speed and coordination. It is necessary to inject into the patient's body several doses of adrenaline every 4 minutes, which, in a situation where every second counts, it takes long to prepare and administer into the patient and it increases the chances of making mistakes.
During the different visits at the Umeå Ambulance Station we could analyse the the scenario of a CPR in depth:
- Get to the scene. A first team of two paramedics have to bring a large amount of equipment such as the defibrillator, a bag with drug ampules, and another with different tools for breathing. A previous quick analysis is needed to confirm that this person requires a CPR. A second team of paramedics is necessary to come afterwards to help with different tasks.
- Start the procedure. One of the paramedics of the first team start compressions and breathing while the second one starts the drug treatment. The paramedic has to assess if it is better to get intravenous or intraosseous access depending on the state of the patient and proceed to inject the needle to the patient
- Get doses ready. Unpack a syringe, break a glass ampule of adrenaline, and draw up 10 ml of adrenaline. It can take up to 2-3 minutes to get to this point since the paramedic starts preparing the dose.
- Inject diverse drugs. One of the most usual drugs used during a CPR is Adrenaline.10ml of this fluid has to be injected every 4 minutes to keep a more stable pulse on the patient. This is usually causes trouble to the paramedics because in such a stressful situation it is difficult to keep track of the time.
- Prepare the saline bag. To keep a better fluid flow it is mandatory to use saline bags, however, most of the paramedics skip that step because it takes time to find a place to hang it. This situation ends up in a third or fourth paramedic holding an IV bag, which wastes human resources for other tasks.
Therefore, the challenges are clear:
How can be the intravenous treatment done more efficiently?
How can we help the paramedics focus on what is important, the patient?
How can be the intravenous treatment done more safely?
THE BIG PROBLEMS
The main problems that need to be tackled are the following:
- Preparation. The paramedic team has to have the equipment ready as fast as possible.
- Decision making: In front of the unexpected, the paramedic has to follow a complicated CPR algorithm. In addition, the paramedic has to decide the right amount of fluid is and when to inject it. During a cardiac arrest, it is needed to inject the right amount of adrenaline depending on the patient's weight.
- Dose recharging. The paramedic has to break the bottle, transfer the right dose to the syringe, remove air bubbles and inject the dose every 4 minutes.
- Paramedic team inefficiency. There is a need call a second ambulance as a back up to help, although some of the procedures could be done with just 2 paramedics.
- Communication of the procedure done. Once the patient is stable, the paramedic has to transfer the procedure done to the next team for further procedures and reporting.
My solution for these problems is based on two products: First a semi-automatic adrenaline injector, Adrinject. And secondly, a foldable IV bag hanger, Adripod. Two products that can speed up the whole procedure with safety so the paramedics can focus on what is important, the patient.
IMPROVEMENTS - ADRINJECT
The combination of one single use 4-in-1 dose adrenaline and the semi-automatic injector allow instant preparation of the IV treatment after getting IV access. Since the administration of the following doses has been pre-prepared, the paramedics can focus fully on the patient and the CPR treatment.
One 4-in-1 dose last up to 20-minutes of CPR treatment. Just unpack it and plug it into the injector and it will switch on automatically.
Keep track of the time
After 4 minutes, the button unlocks and pops-up and an alarm informs the paramedic to inject the next dose. After pressing the button the timer is reset to 0. After additional 4 minutes the procedure is repeated.
Adrinject increases or decreases the travel of the button to adjust the dose. So, for example, if the patient is a child, the travel of the button will be very short.
The 4-in-1 doses can be used as a reminder for reporting the event, by keeping the empty bottles and/or reading the scale in the dose.
Forget about mistakes in dosage
Adrinject allows the paramedic to adjust the dose with precision when they need to do so. There have been cases where children as young as 2 year have had cardiac arrests, it is therefore necessary to assess the patient's weight and adjust the doses accordingly.
An overdose of adrenaline could kill a child, that is why this device is equipped with a lock-system until the dose is confirmed, firstly by locking the slider, and secondly by pressing the button on the top to push the fluid in. Furthermore, the dose for adults is highlighted in orange, so the paramedic gets an additional visual confirmation that the correct dose is being used.
Always be in control of the fluid
Based on feedback from the paramedics interviewed, Adrinject provides mechanical control on how the fluid (adrenaline and saline) is injected into the patient's body, just as if it was a normal syringe.
IMPROVEMENTS - ADRIPOD
Adripod is a foldable stand from which the IV bag can be hung. This enables the paramedics to focus entirely on the patient's needs on-site when it matters the most, instead of one having to hold the saline bag or constantly checking if there is enough flow in the IV tube.
Close at hand
Adripod can fit in most of the paramedics' bags, so it can be ready to use whenever the paramedic needs it.
Ready in a blink of an eye
The device can be unfolded in less than 5 seconds from different postures, just by pushing one button on the handle.
Adripod provides sturdy support of the standard 1-liter saline bags at the required height of 1,2 meters. Thereby freeing up one paramedic that otherwise might end up holding the bag.
Extend and hang
The handle is at the same time the hook for IV bags.
Never without power
Adripod, has a built-in back-up battery pack that insures that the Adrinject will have all to power it needs for as long as the paramedics will need it. The built-in battery is placed low to provide additional stability to the Adripod.
Adrinject can easily be attached to Adripod by a magnetic connection. The magnetic connection makes it possible for the paramedic to connect the two devices while at the same time focusing on the patient. It also helps to keep the Adrinject hygienic and clearly visible while charging and keeping it 'out of the way' when it is not needed.