Usability testing of new Auckland HEMS packs

By Dr Chris Denny, Auckland HEMS Medical Director

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New packs for Auckland HEMS

In the early days of Auckland HEMS, we loosely ‘bolted on’ our equipment to the existing paramedic gear. As time passed and we forged a strong collaborative relationship with our paramedic colleagues, the performance gap in our gear required a solution. One year ago we held an ‘Ergonomic Equipment Exercise’, led by Dr. Samantha Bendall (on sabbatical from Sydney, NSW). From this evening of pack testing we learned to focus on integration. Several design concepts guided our work:

a) Functional coherence
b) Facilitation of communication
c) Facilitation of task accomplishment
d) Adaptable space
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We are now testing our prototype packs.
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This testing will move through three phases:
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Phase I: ‘Kicking the tyres”
Phase II: Simulation-based usability testing (carrying the packs, winching the packs, airway tasks, vascular access tasks, splinting tasks,…)
Phase III: Live operational testing
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Here is a valuable website: www.usability.gov
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ARHT paramedic Rob Gemmell winches with one of the packs

ARHT paramedic Rob Gemmell winches with one of the packs

We are very keen to learn from the HEMS community. What are other services using? What works? What is the future of PHARM medical equipment going to look like?

Please share your thoughts using the ‘comments’ section below, or the¬† ‘contact’ button on the home page of this site.

“Is there a doctor on board?”

airplane 2NEJM recently published a paper looking at the outcomes of medical emergencies on commercial flights:

  • 1 in 604 flights had a medical emergency occur
  • physician passengers provided assistance in 48% of cases
  • the most common problem was syncope/pre syncope, followed by respiratory or gastrointestinal symptoms
  • few in-flight emergencies resulted in death or diversion of the aircraft

The full article, including recommendations for physicians who provide medical assistance on a commercial airliner, can be found HERE.

 

Quik-what?

An inadvertent leader in trauma research..!

An inadvertent leader in trauma research..!

There have been significant changes in the delivery of acute trauma care as a result of the military conflicts in Iraq and Afghanistan. One of the recent advances has been the advent of haemostatic dressings for haemorrhage control, which are now being used in the civilian as well as the military setting.

Auckland HEMS carries a product called Quikclot Gauze. This is an inert mixture of oxides of silica, sodium, magnesium, aluminium, and quartz. The compounds absorb water in a physical (not chemical) reaction, which concentrates platelets and clotting factors at the site of administration.

In 2008 the Journal of Trauma published a case series of the first 103 documented uses of Quikclot, including uses in military and civilian prehospital and hospital settings. The majority of uses involved extremity haemorrhage, often when direct pressure and tourniquets and direct pressure had failed. First responders found Quikclot to be 100% effective. Quikclot was ineffective in a handful of hospital cases, which involved moribund coagulopathic massively-injured patients. Heat generation from the physical reaction was an issue, with 3 patients sustaining burns, and a quarter of concious patients reporting ‘moderate to severe’ pain.

Wound from helicopter rotor blade, with Quikclot applied

Wound from helicopter rotor blade, with Quikclot applied

There is also evidence from an animal model that Quikclot may allow sufficient haemostasis to reduce tourniquet time. This study involved a pig model of extremity haemorrhage and found that after haemostasis of a bleeding extremity had been acheived with a tourniquet and Quikclot, bleeding occurred only 20% of the time after tourniquet release, compared to a 100% failure rate with standard gauze dressings.

A systematic review of literature regarding haemostatic dressings was published in Injury in 2011, and can be found here. Overall data is scant and mostly observational/retrospective, but what is available suggests that haemostatic dressings like Quikclot should be a useful tool for controlling significant haemorrhage in our prehospital setting.

Full text pdfs for this post are here (secure area limited to ADHB staff only – ADHB has online subscription access to these journals through the Philson Library at the University of Auckland School of Medicine)