As such, a number of requirements have been evolving in the design and construction of these emergency service vehicles over the past few decades. However, despite these changing needs, the interior layout of UK emergency ambulances has not changed to make them fit for purpose.

“The way that ambulances are built and laid out is problematic for both paramedics and patients,” explains Gianpaolo Fusari, a senior associate at the Helen Hamlyn Centre for Design (HHC) at the Royal College of Art (RCA) in London. “These vehicles are difficult to work in, difficult to clean and difficult to stock. They are also often intimidating for patients.”

Since February 2010, Fusari has been part of a joint project between HHC and the Vehicle Design Department at the RCA working on creating a new ambulance interior fit for 21st century healthcare. Titled ‘Redesigning the Emergency Ambulance’, it builds on the work carried out by two previous projects – Future Ambulances and Smart Pods.

“The main thing for us has been to provide frontline staff with a treatment space that will support their already great skills. Often patients and staff are let down not by the service they receive but by the equipment they use. That and hygiene were the biggest issues we wanted our design to try and solve,” says Fusari.

Following on from the work carried out in the previous projects, Fusari and his team wanted to specifically target 10 design challenge areas: hygiene and cleanliness; patient experience; stock control; technology integration; standardisation of equipment; diagnostics; future proofing; longevity and carbon footprint; treatment processes; and functionality.

Although an ambitious undertaking, Fusari explains that by tackling one area they would actually be addressing more. “Take hygiene, for example,” he says. “To solve this issue we wanted the interior to be free of nooks and crannies as much as possible to make it easier for staff to clean. So, we thought that a moulded interior would not only have the added benefit of making a lighter construction, impacting on the ambulance’s carbon footprint, but would also provide an environment that would hopefully impact positively on the patient experience.”

However, before actually sketching their ideas, the designers joined ambulance crews on callouts during 12-hour shifts to experience ambulance interiors for themselves. “I was expecting the ambulance service to be adrenaline packed with lots of road traffic accidents and blood all over the place, but the reality is a lot less like what you see on TV,” smiles Fusari.

“I did, however, learn a lot about the London Ambulance Service (LAS) and the great service they provide. Also, I’m not from the UK so being able to ride around with ambulance crews gave me a totally different perspective of London’s social fabric.”

After the field research, the designers started sketching their ideas in the design studio. This was followed by CAD models and a full-scale test rig made of cardboard and foam. Twenty ambulance staff and four patient representatives were then invited to evaluate and provide feedback on this first design iteration. In fact, this co-design approach carried on throughout the project with researchers and designers from HHC working closely with doctors, emergency medicine clinicians, paramedics and patients through an iterative process of design, evaluation and modification.

“The project does not come from the imagination of a single person, it is an effort that has involved many people across many disciplines and together we have been pioneering a co-design process to design the ambulance from the ground up, something that has never been done before,” says Fusari.

Co-design is an approach that is really championed by the HHC. In this project it ensured that the broad spectrum of ambulance users, from clinicians to patients, are all involved in creating and evaluating design propositions. “In addition to ensuring that the stated and unstated needs of the users are met as far as practicable, the growing buy-in through involvement in the process helps stakeholders to engage, own and accept any necessary design compromises,” explains Fusari.

An example of how this co-design approach enabled the team to design the best ambulance interior for everyone using it, is highlighted in the rejection of the side-loading proposal. Through initial research, observations and conversations with LAS staff, Fusari and his team identified an opportunity for a side-loading ambulance. The concept was tested with a broad group of paramedics and patients through simulated clinical scenarios. Results showed that although patients deemed it to be a safer way to be loaded into an ambulance, ambulance staff were against it.

“The design was very popular among the patients, and the crews liked some of the benefits, but ultimately they knew that a side-loading ambulance would not be practical for the streets of London or any other city. There could not have been any other way for the team to make an informed decision about this change except than by going through the evaluation process,” says Fusari.

Following three cycles of evaluation, modification and development, the last round of evaluation actually took place in a decommissioned ambulance. “For the final demonstrator build, my colleague – senior research fellow Ed Matthews – had the brilliant idea of buying an old ambulance off eBay. We completely stripped the interior and, with the help of a company that produces Lotus cars, we built our design proposals into it,” Fusari explains.

One of the most notable changes in the interior, and the one that Fusari says ambulance crews like the most, is the central position of the trolley bed. It completely transforms the way staff operate in the space as they are now granted 360 degree access to the patient. They feel that this will not only improve clinical efficiency but enhance patient safety too.

The interior also includes a lot of smaller improvements that make a big impact, such as the organisation of consumables. “We have organised consumables into easily identifiable treatment packs. This helps the paramedics grab the items they need quickly, thus helping to minimise infection spread. It also saves time and cost in the process of restocking,” says Fusari.

But the biggest impact, he explains, will come from the new digital diagnostics and communication system. “We’ve introduced a system that includes an overhead monitor for patient monitoring and integration of a digital interface. This system could integrate into a wider system, allowing paramedics to access relevant information and communicate faster with hospitals and GPs,” says Fusari, who is quick to point out that these innovations are all completely achievable and based on existing technology.

This full-size mobile demonstrator was launched in September 2011 and since then Fusari and his team have been working tirelessly to bring it to the attention of manufacturers and the wider National Health Service (NHS).

“We have carried out a considerable amount of planning and network building to enable the final small step to be taken to achieve the objective of the project – namely, to deliver the design of a better ambulance to clinicians, managers, specialists in ambulance fleet and procurement staff, backed up by the evidence-base, evaluation results and grass-roots support of the frontline ambulance crews who have helped us to design it,” he says.

So far feedback has not only been positive from those within the healthcare field, but the international design industry has taken an interest in the project too. In April 2012, it received the transport award for the Designs of the Year 2012 at London’s Design Museum, while in July 2012, it received a silver award for Research in the Industrial Society of America’s 2012 International Design Excellence Awards. The project has also been on show at a number of international galleries and museums.

“All this attention is really amazing. We are very happy that a project of this nature has received this much attention. An ambulance is not the most glamorous of products so this shows that people are paying attention to projects that look to bring benefits to the whole of the community,” says Fusari.

Although it has been very intense at times, mostly due to what they needed to achieve in such a short amount of time, Fusari admits that he couldn’t have asked for a better project to be a part of. “As a designer I think it’s very difficult to be involved in all stages of a project, especially if working in a consultancy,” he says. “With this project I have been very lucky to be involved in the research, development, testing and hopefully I will be able to see it through to the next stage.”

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