paramedics project - final report

innovation that matters

FINAL REPORT

by Daan HekkingFebruary 10, 2016

The paramedics project - Final report2

Daan Hekking - Advanced Product Design 1 3

1. Background 91.1 Project background 91.2 Historical review 91.3 Human centered design 10

2. Approach 122.1 Research 122.2 Design opportunity 122.3 Ideation 122.4 Conceptualization 122.5 Embodiment 12

3. Research 173.1 Investigative user research 173.2 Problem identifying 213.3 Visual Social Persona 223.4 Problem analysis 243.5 Ideation & role-playing 27

4. Design opportunity 284.1 Design opportunity 284.2 Electrocardiography 334.3 Paramedic 344.4 Patient 344.5 Ambulance 354.6 Hospital 354.7 ECG Electrodes 364.8 ECG Cables 374.9 ECG Paper result 374.10 LifePak 15 384.11 Display 38

TABLE OF CONTENTS


5. Additional research 405.1 Market research 405.2 Technology research 42

6. Ideation 466.1 Ideation sketches 466.2 Physical ideation 486.3 Ideation presentation 496.4 Chosen direction 50

7. Conceptualization 547.1 Wireles ECG-electrodes 577.2 Defibrillatorbase 59

8. Embodiment 628.1 CAID-Modelling 638.2 milling parts 65

9. CardiacStart 719.1 Overview 719.2 User interface 759.3 Defibrillatorbody 789.4 Defibrillatorinside 799.5 Wireless ECG-electrodes 80

10.Reflection 8211. References 83


CardiacStart is a new way of accurately acquire an electrocadiograph (ECG) of patients. The use of wireless ECG electrodes is making it able to acquire an ECG twice as fast. The self sensing electrodes are making existing wires useless, which results in a less busy workspace around the patient.

Themainbody,whichincludesadefibrillator,has a detachable monitor. When there is a less severe case (priority 2), the paramedic can carry the light ECG monitor to acquire an ECG. By replacing the printer, which is used in the current situation to print ECG’s, with a screen, the weight can be reduced with 2 kg.



1.1 PROJECTBACKGROUND

The project has been executed in collaboration with the local ambulance station and the Norwegian medical appliance manufacturer Laerdal. In the ten week project Laerdal has given design feedback on the produced ideas and concepts. The knowledge and experience of the paramedics was used to gain insights and validate ideas & concepts. The project includes an intense two week user research & ideation phase, concept phase and prototyping phase.

1.2 HISTORICALREVIEW

The role of a paramedic has changed during the years. “A paramedic is a health care professional, predominantly in the pre-hospital and out-of-hospital environment, and working mainly as part of emergency medical services (EMS), such as on an ambulance. The development of the profession has been

a gradual move from simply transporting patients to hospital, to more advanced treatments in the field. In some countries, the paramedic may take on the role as part of a system to prevent hospital admission entirely and, through practitioners, are able to prescribe certain medica- tions, or undertaking ‘see and refer’ visits, where the paramedic directly refers a patient to specialist services without taking them to hospital.” (1)

1 . B A C K G R O U N D


1.3 HUMANCENTEREDDESIGN

As described in the previous paragraph Project Background, intense user research has been done. The user research formed the basic of the design process because a Human Centered Design (HCD) approach was used during the project. IDEO describes the HCD process as following: ‘The reason this process is called “human-centered” is because it starts with the people we are designing for. The HCD process begins by examining the needs, dreams, and behaviors of the people we want to affect with our solutions.’ (2) During the two weeks of user research, several HCD based methods were used to investigate the needs, dreams and behaviours of paramedics.


2 . A P P R O A C H

Inthisparagraphyou’llfindthestructureofthe project. During the process, a human-centered approach was used. This resulted in a research phase with a following ideation phase. After validating ideas in the ideation phase, a concept was chosen and further developed during the conceptualization stage. The conceptualization was ended with a presenation to Laerdal Medical. During the embodimentphase,afinalvisualprototypewas realised.

2.1 RESEARCH

The project started with extensive user research. This means four days of interviewing and shadowing at the Umea Ambulance station with a group of twelve students. After four days of user research and problem finding,aworkshopwasorganisedtoindentify problems. Also a Visual Social Persona diagram (VSP) was created to gain a better understanding of the daily tasks andbehaviourofaparamedic.Afterfindingproblems and creating a VSP, a role play has been executed. We, a group of four students including myself, were able to execute a roleplay because of the generated ideas after theproblemfindingphase.

2.2 DESIGNOPPORTUNITY

In the design opportunity phase, an interesting design direction was chosen. The chosen directionwasbasedonthefindingsoftheresearch. During this phase, more academic reports were looked into and additional market- & technology research was done. This resulted in a more in-depth design opportunity document. This report became the red wire through the project.

2.3 IDEATION

During the ideation, the design direction was to the full extend researched with sketches and sketch-models. The paramedics gave feedback on ideas during this phase and the ideas were presented to Laerdal.

2.4 CONCEPTUALIZATION

The conceptualization, which started after choosing a promising idea, focussed on form- and function improvement. A keysketch was the endresult of this phase.

2.5 EMBODIMENT

In the embodiment phase, this keysketch was modelledinCADandafinalvisualprototypewascreatedbyusingdifferentprototypingtechniques.


RESEARCH

IDEAT ION

CONCEPTUAL I ZAT ION

EMBOD IMENT

Fig. 1. Overview research

DES IGN

O P PORTUN I T Y


RESEARCHt w o w e e k s o f u s e r - , m a r k e t - , a n d

t e c h n o l o g y r e s e a r c h h a s b e e n d o n e . I n t h I s c h a p t e r , t h e r e s u l t s w I l l b e s h o w n

a n d t h e c h a p t e r e n d s w I t h a w r I t t e n d e s I g n o p p o r t u n I t y .


Investigative user research

Problemidentifying

VSP

Problemdefining

Role playing

Design opportunity

Fig. 2. Overview research period


3 . R E S E A R C H

3.1 INVESTIGATIVEUSER

RESEARCH

During the user research, interviews were held with the paramedics. According to the paramedics, it is a job where they get a lot of satisfaction. The fact that they can makeadifferencetopeopleinneed,keepsthem motivated. Eventhough a lot of their equipment is not state-of-the-art, they are helping each other to make the best of it.

Besides interviewing the paramedics, a second user research method has been used. Shadowing is a research method

whereby the paramedics will be followed foraspecifiedtime.Inthiscasedifferentparamedics were followed for ten hours in total. During these ten hours, the paramedics were observed and analyzed during the patient treatment. As described in the previous paragraph, one reason a paramedic became a paramedic is because of the caretaking part of the job. The caretaking partinfluencestheparamedicsinthewayofapproaching patients. They want to give as much comfort to the patient as possible and keep them calm during their treatment and care.


Fig. 3. ECG Electrode placement


Fig. 4. Registering the patient in LifePak 15

Fig. 5. Shadowing the paramedic


3.2 PROBLEMIDENTIFYING

After interviewing and shadowing the paramedics at the local ambulance station in Umea, the data was analyzed in collaboration with three other students. The research was analyzedbydividingthefindingsindifferentcategories; daily equipment, communication andinformationflow.Thesecategorieswerecoveringallofthefindings.Theparamedicsconcluded that chest pain was the injury that occurred the most in the Vasterbotten region. Additional research shows that chest pain is the most frequent reason why people are calling the paramedics. In this case every second counts and the need of a fast analyze of the situation is therefore necessary to perform the next step of the treatment. The quicker a paramedic can analyze the situation of a patient, the quicker the paramedic can do second handlings such as Cardiopulmonary resuscitation (CPR) and/or defibrillation.


3.3 VISUALSOCIALPERSONA

After gathering, analyzing and presenting the data from the user research, a visual social persona (VSP) was created. The VSP was used to visualize the social character of the paramedic. The gathered data was used to create insights in ‘one day of a paramedic’s

life’. Paramedics liked it that not a single day was the same at the station. They never know whattoexpect,whichalsocanaffectthemnegatively. Overtime occurs weekly, which makesitdifficultforparamedicstostreamlinetheir leisure activities directly after work.


Fig. 6. Me in front of the sketched VSP


3.4 PROBLEMANALYSIS

Exploring sessionAfterpresentingtheVSP’s,differentgroupsof students were formed to dig deeper in the problems of the paramedics. Every group, which consisted of four students, discussed theidentifiedproblems.Alloftheproblemswere written down, analyzed and rated by frequency and level of disturbingness.


ClusteringAs described in the previous paragraph, the problems were rated by frequency and level of disturbingness. The problems were ranked in a frequency-severity matrix. (3) This matrix was used to create a clear overview of problems that occur often with a high impact. Besidesthisclassificationmodel,

the problems were clustered with colours as well. The problems were categorized in daily equipment, communication and information flow.Everycategoryhadit’sowncolour,which made it easy to identify what category had the most problems.

severity

frequ

ency

High frequencyHigh severity

High frequencyLow severity

Low frequencyHigh severity

Low frequencyLow severity

Fig. 7. Frequency-severity matrix


ClusteringAlready two criterias were chosen to select ideas with, namely frequency and severity. These two criteria made it easier to pick problems to solve. Besides this ranking system, personal opinions and favours were intergrated in the selection process as well Oneofthecriteriawasspecifiedbytheprogramme director. Every group had to present seven problems after the problem

selection phase. In this case every student in the group could select seven problems and mark these problem with a dot, which makes it atotalof28dotswithinourgroupondifferentpost-its. Some post-its had several dots, which made it obvious to select that problem. Afterdiscussingthedifferentproblemswithdots,thefinalsevenproblemswereselectedand presented to the rest of the class.


3.5 IDEATION&ROLE-PLAYING

Within the same groups, a braindump was organized to generate as much ideas as possible regarding the seven selected problems. Besides the seven problems that wereselectedinthegroup,fiveproblemsfrom other groups were added to create a wider view within the problems paramedics are facing. At the end, everey group of students chose a concept and prepared this concept to be acted in a role-play.

The role play was organized to challenge ourselves and express the concept in a more visual way. During this process, a lot of extra problems were faced and solved. This resulted in a well through thought role play.

Fig. 8. Role-playing during the research phase


4 . D E S I G N O P P O R T U N I T Y

4.1 DESIGNOPPORTUNITY

Chest discomfort is one of the most frequent and nuanced symptoms encountered in the Emergency Medical Service (EMS). (4) User research showed that paramedics were monitoring the heartrhythm(ECG)withtheheavyLifePakdefibrillator.Duetoit’sheaviness,paramedicsarenotalwaystakingthedefibrillatorwiththemtopatients.AfterusingtheABCDEandTriagemethodatthepatient,theparamedicsdecidetobringthepatienttotheambulanceorbringthedefibrillatortothe patient. In case of chest problems or a cardiac arrest, every second is crucial. This makes time management important for the paramedic and patient. In what way can the paramedic obtain an accurate ECG as fast as possible?

Fig. 9. Attaching cables to electrodes


cardiacmonitor ing

paramedic

ECG-electrodes

ECG-cables

ECG-paper

LifePak

display

patient

ambulance

hospital

P R O D U C T F L O W

P R O D U C T F E A T R E S


‘Sometimes we have to take the patient

to the ambulance to make an ECG’

Paramedic, Umea Ambulance station, week 01


Fig. 10. Pad placement on body with 12-Lead ECG


4.2 ELECTROCARDIOGRAPHY

Besides the stethoscope, the electrocardiogram (ECG) is the oldest and most enduring tool of the cardiologist. All the following information is based on the book ‘ECG Interpretation: Made incredibly easy’. (5) In this chapter the technology of making an ECG will be explained.The heart’s electrical activity produces currents that radiate through the surrounding tissue to the skin. When electrodes are attached to the skin, they sense those electrical currents and transmit them to an ECG monitor. The currents are then transformed in a graph which is displayed on the ECG monitor. These graphs, also called electrocardiographs, allows the nurse to monitor phases of myocardial contraction and to identify rhythm and conduction disturbances. A series of ECGs can be used as a baseline comparison to assess cardiac function.

An ECG involves attaching 10 electrical cables to the body: one to each limb and six across the chest. Every electrode is sensing the electrical activity from one view of the heart. Byplacingmultipleelectrodesatdifferentpositions on the body, an accurate view of the electrical activity of the heart can be conducted.Thesedifferentviewscanhelpparamedics, nurses and cardiologists to accurately determine which part of the heart is malfunctioning.


4.3 PARAMEDIC

User research showed that paramedics are more busy with preparing the ECG, then actual monitoring the patient. Attaching the pads and cables to the patient’s chest, arms and legs takes them around three minutes while monitoring of the patient is costing the monitoring device ten seconds. The display of the ECG is positioned on the right side of the patient, which is within an unergonomic reach length for the paramedic. The paramedic profession is a caretaking job as well. Attaching all the pads and cables does not feel like caretaking.

4.4 PATIENT

Within cardiac monitoring there are two types of patients. These are patients with a cardiac arrest and patients without. In the case with patientswhoarenotsufferingfromacardiacarrest, it is important to lay still to have the most accurate ECG results. Patients who are sufferingfromtremorssometimesneedtobestrappedsincethetremorscaninfluencetheECG result. Sometimes patients are becoming more nervous as the time passes since they don’t know what exactly is going on in the ECG-monitoring process.


4.5 AMBULANCE

The ambulance car, or the private working space as the paramedics are calling it, is the place where the paramedics are preferably monitoring the patient. There are two reasons why the paramedics have this preference.Thecurrentdefibrillatoranddefibrillatoristooheavytocarryaround,soparamedics prefer to bring the patient to the ambulance. In the ambulance all of the equipment is available and ‘within reach’. This is in contrast of the current trend in the paramedic profession. This trend says that paramedics are performing more medical care at the patient’s homes than in the ambulance.

4.6 HOSPITAL

When a patient is not stable enough to stay at home, the ambulance brings him/her to the hospital. The transition of the patient between the ambulance and hospital is worth noticing. The cables which are attached to the ECG-electrodes will be de-attached from the ambulance monitoring device. The hospital will then attach their own cables to the ECG-electrodes, which will stay on the patient’s chest, and continue monitoring the patient.


4.7 ECGELECTRODES

At the moment, the paramedics in Umea are using ten ECG-electrodes (12-Lead ECG) to make up an ECG. The ten pads are divided by six on the chest, two on the wrists and two on the ankels. Besides the 12-lead ECG, a 3-lead ECG exists as well. These 3-lead ECG devices are mostly used in home environment and used for constant monitoring. The main differencebetween12-leadand3-leadECG’sis the outcome. 12-lead ECG’s are designed for diagnostic use. The 12-lead ECG’s are showing the heart rhythm from more angles, which gives a bettter understanding of the heart rhythm. The 3-ECG’s are cheaper, more comfortable for the patient, less likely to be positioned wrong and the paramedic has more time to take care of the patient.

The ECG-electrodes are staying on the patient’s body from the moment of monitoring untill a doctor at the hopsital decides to take themoffthebodyduetorehabilitation.Incasethe patient has chesthair, this chesthair has to be removed with a razor. The paramedics are carrying this razor with them in their daily equipment bag. Additional research shows that inaccurate ECG-electrode placement can cause incorrent measurement. This can result in a series of wrong decision.


4.8 ECGCABLES

The ECG cables are connecting the electrodes to the monitoring device. The cables are the connection between the monitor device & the patient and are transmitting the electrical activity. The cables are color-coded and a code is printed at the end of the cable. This code represent the position of the electrode & cable on the patient’s body. According the paramedics, the cables are not user friendly, as it can get nestled and break. The cable can pull the pad down as well, which results in a discomfortable experience. The cables are a distracting factor when measuring blood pressure and saturation as well.

4.9 ECGPAPERRESULT

When using the 12-lead ECG, the printer of the LifePak 15 will print 12 electrocardiographs. The electrical activity of every lead will be printed at this paper, which can be reviewed by the paramedic afterwards. The paramedic has to do this check manually and additional research shows that wrong interpretations can be made in this crucial phase. (4) To compare an old ECG with a new ECG, the two papers have to be held next to eachother to see a trend between two ECG’s.


4.10 LIFEPAK15

The paramedics in Umea are using the LifePak 15 which weighs 11.2 kg and includesadefibrillator,ECG-,SpO2-,spCO-, NIBP-, CO2-monitor and printer. The LifePak 15 is using the GSM-network to connect to the hospital. The scanned data, in this case from an ECG, can herewith be directly transferred to the hospital. Before sending the information to the hospital, the paramedic has to register the patient in the LifePak 15 with a turning wheel. Registering a patient takes around four minutes according the paramedics.

4.11 DISPLAY

The display of the LifePak 15 can be usedtodisplayuptothreedifferentwaveforms.ThiscouldbethreedifferentECG’s, saturation or blood pressure. The LifePak 15 is located next to the patient in the ambulances of the Umea region. Patients can see the display as well, which canaffectthemnegativelyaccordingtheuser research. Patients are interpretating the results on their own, which could make them worried. In case the patient is worried,theheartwillreactandinfluencethe electrical activity from the heart at that point.


LifePak 15

Mindray Beneheart D3

Philips Heartstart MRX

ZOLL X-series

DefiguardTouch7

DefimonitorEVOPhilips Heartstart XL

DefimaxBiphasic

5 . A D D I T I O N A L R E S E A R C H

5.1 MARKETRESEARCH


More detailed information about market researchcanbefoundinthedigitalfile‘Appendices-Theparamedicsproject’

Lifebot

NihonKohdenTEC-8300

Cardiomax

USDefibE-heart

Corpulus 3

CardioAid 360B

‘ ‘


Intelesens Zensor

Kid ECG

E-Motion ECG Mobile

CardioSecur Active

iPhonECG case

Isansys Lifecare

Plessey Epic

Nymi Bracelet

RF-ECG

Wireless ECG

5.2 TECHNOLOGYRESEARCH


Corventus Piix

Ready electrodes

Holst centreE-motion ECG mobile

LifeLink (Behance)

More detailed information about technology researchcanbefoundinthedigitalfile‘Appendices-Theparamedicsproject’

‘ ‘

Gumpack wearable

VitalConnect Health MD

Quardiocore

Baby thermometer

Plessey semiconductors


IDEATIONt h e I d e a t I o n p h a s e w a s e x e c u t e d

I n d I v I d u a l l y a n d l a s t e d f o r t w o w e e k s . w I t h I n t h e I d e a t I o n p h a s e , a w e e k l y

t u t o r I n g s e s s I o n w a s p l a n n e d t o s t r e a m l I n e t h e p r o c e s s .


6 . I D E A T I O N

6.1 IDEATIONSKETCHES

During the ideation phase, sketches have been made to fully explore the potential within the writtin design opportunity. The sketches were used to communicate with classmates, tutors and even paramedics.


6.2 PHYSICALIDEATION

Besides sketching on paper, which is generally associated with the ideation phase, mock-ups have been made as well. In this case, the mock-ups from the role-playing are being described as a physical ideation. A physical object within the ideation phase can enhance the communication process. Not only the physical models, shown on the right, were used during the role playing, they were also shown to the paramedics to validate these ideas.

Fig. 11. Paper mock-ups of wireless ECG-electrodesThe paramedics project - Final report48

6.3 IDEATIONPRESENTATION

3. semi-wireless ECG monitor

2. sorted pads in external monitor

1. interchangeable wireless ECG electrodes

Wireless pads saves time by not having to attach

cables

Battery life of wireless pads could form problems

Portable ECG monitor ideal for priority two, but not

forpriorityone(theymightneedtodefibrillate)

**Portable ECG monitor could be used for

saturation, blood pressure and so on.

The use of standardized materials saves money

The cables will still be long because they have to

reach the ankles as well


6.4 CHOSENDIRECTION

After presenting the generated ideas to Laerdal, the most promising idea was chosen and developed further. As the design opportunity chapter describes, the product has to obtain an ECG as fast and accurate as possible. This means that time reducement, reliability and ergonomics are crucial in the development of the concept. These three factors were the red wire throughout the

concept and embodiment phase. On the next page, a short summary is given about the chosenconceptandhowitfitswithinthethreedecided factors.

Fig. 12. Key-sketch of the chosen concept


The concept that is shown on the left side isadefibrillatorwithadetachableECGmonitor. The detachable ECG monitor is using wireless ECG electrodes to create a less intrusive surrounding for the patient. The detachable ECG monitor can be brought to patients when there is a less severe chest pain call (priority two).

Portability As described before, ergonomics are a crucial factor. In pre-hospital care and in case of chest pain, every second counts. Research shows that paramedics don’t always bring the LifePak 15 with them when they’re having a priority two call. Eventhough it’s a priority two call, paramedics do admit that there is a need to obtain an ECG. By having a detachable ECG monitor, paramedics are able to easily carry monitoring equipment towards the patient.

Mobility & stabilityOne of the key elements of the product is

the intergrated handle. The handle makes itpossibletocarrythedefibrillatorverticallyinstead of horizontally. Paramedics were facingproblemscarryingthedefibrillatorhorizontally. The manoeuvrability of the product has improved by carrying the product vertically.

Reliability in wireless diagnosingThe wireless ECG-electrodes will transmit the electrical activity from the heart to the portable ECG-monitor. This will save time by taking away ten steps (attaching cables to the ten ECG-electrodes). The new wireless ECG-electrodes will have an intergrated LED. When the wireless ECG-electrodes are activated, every LED will then light up in a differentcolor.LED’sareintergratedbecausethe wireless ECG-electrodes are universal. Theparamedicwillknowwiththedifferentcolored LED’s what every wireless ECG-electrode is transmitting.

Fig. 13. Product architecture of the wireless ECG-electrode


CONCEPTUALIZATIONI n t h e c o n c e p t u a l I z a t I o n s e v e r a l

m e t h o d s h a v e b e e n u s e d t o t a k e t h e p r e s e n t e d I d e a t o t h e n e x t l e v e l .


7 . C O N C E P T U A L I Z A T I O N

After presenting the chosen idea direction to Laerdal Medical via an audioconference, prototypes were made to specify dimensions, materials and details. The diagram below isshowingthedifferentstepsintheconceptualization phase. The feedback of Laerdal was intergrated in this phase and the keysketch, shown in paragraph 6.4, was developed further. Within the conceptualization phase, more detailed physical models were built to improve the chosen direction.

KEYSKETCH

D IG I TAL FORM / FUNCT ION EX PLORAT ION

PROTOTYP I NG

C O N C E P T U A L I Z A T I O N

ECG - E LECTRODES D I S P LAYDEF I B R I L LATOR

includefeedback


Fig. 14. Form exploration


Fig. 15. Glueing the wireless ECG-electrode model together

Fig. 16. Visibility of the disposable sillicon pad and electrical activity transmitter

Fig. 17. Comparing the model with the current ECG-electrodeThe paramedics project - Final report56

7.1 WIRELESECG-

ELECTRODES

To gain more insights in dimension and function, several prototypes of the wireless ECG-electrodes have been made. As shown in the descriptive texts at the bottom of every picture, the wireless ECG-electrode is using the same product architecture as the current ECG-electrodes.

The wireless ECG-electrode exists of two parts. Part one is a disposable sillicon pad with a conductive gel and sticker at the bottom. The second part, in the pictures painted in red, includes the electronics that will transmit the electrical activity of the heart.

Fig. 18. Close up of disposable pad and electrical activity transmitter

Fig. 19. Electrical activity transmitter clicks in disposable pad

Fig. 20. Protective cover at bottom to protect glue and conductive gel Daan Hekking - Advanced Product Design 1 57

Fig. 21. Role playing shown in four imagesThe paramedics project - Final report58

7.2 DEFIBRILLATOR

BASE

During the conceptualization another role play was done to gain more insights into the usage of the defibrillatorbase.Twosizevariantshave been made and tested with users.

The use of a role-play resulted in an additional strap to easily carry the defibrillatoraround.Thehandlewasmainlyusedtomovethedefibrillatorbase around in a short range.

Fig. 22. Twodifferentsizemock-upsofthedefibrillatorbase

Fig. 23. Mock-ups of the wireless ECG-electrodes Daan Hekking - Advanced Product Design 1 59

EMBODIMENTt h e e m b o d I m e n t p h a s e f o c u s s e s o n

d e t a I l I n g t h e p r o d u c t I n c a d a n d I n t o a p h y s I c a l 1 : 1 m o d e l .


8 . E M B O D I M E N T

After the conceptualization phase, a decision was made to build the prototype 1:1. Autostudio Alias was used to model theproductin3D.The3Dfilewasusedasastartingpointfor modelbuilding.


8.1 CAID-MODELLING

As you can see at the pictures on the left side, the product has been modelled in Alias. To create a 1:1 model of this product, several modelbuilding techniques were used. DuringthisprocesstwodifferentCNCmillingmachines, a handmill, drills and sanding machines were used.


3. AVOIDINGUNDERCUTS

8.2 MILLINGPARTS

Intotal,themainbodyofthedefibrillatorexistsof 14 parts. This includes the main body, the screen, handle, buttons, covers and a battery pack. 14 parts was the minimum amount of parts that could have been used to avoid undercuts and correct splitplines.


Fig. 24. Sanding the parts Fig. 25. Parts prepared for primering

Fig. 26. Overview of milled and sanded parts


Fig. 27. Overview of milled and sanded parts

Fig. 29. Mould making for sillicon pads

Fig. 28. Close up of the handle

Fig. 30. Sillicon casting



presenting...


9 . C A R D I A C S T A R T

9.1 OVERVIEW

CardiacStart is a new way of accurately acquire an electrocadiograph (ECG) of patients. The use of wireless ECG electrodes is making it able to acquire an ECG twice as fast. The self sensing electrodes are making existing wires useless, which results in a less busy workspace around the patient.

Themainbody,whichincludesadefibrillator,hasa detachable monitor. When there is a less severe case (priority 2), the paramedic can carry the light ECG monitor to acquire an ECG. By replacing the printer, which is used in the current situation to print ECG’s, with a screen, the weight can be reduced with 2 kg.


Shock-resistant edge

Strap attachment

Release button ECG-monitor

Detachable ECG-monitor

Cover for pads

ECG-monitor

Wireless ECG-electrodes


Handle with rubber feeling

Accu pack

Release button accu pack

OverviewdefibrillatorbodyDaan Hekking - Advanced Product Design 1 73

9.2 USERINTERFACE

The user interface of the detachable ECG-monitor replaces the printer that is used nowadays because it’s using the same measurements as the printed ECG-paper. An integrated keyboard makes it able for the paramedictofillinthepatientdetailsfasterthen the current situation. The keyboard can

also be used to write comments whose can besendtothecardiologist.Besidesfillingin patient details and reviewing the ECG results, the user interface includes software that supports the paramedic during CPR and breathing assistence. A CPR assistence bar that goes up and down, beeps and voice assistence are examples of the supporting software.


9.3 DEFIBRILLATORBODY

Themainbodyofthedefibrillatorcanbeheldvertically with an integrated handle during carrying. It includes two orange buttons which can be pushed to detach the ECG-monitor or the battery. There is an option to attach a strap to the main body as well. The strap can be attached above the orange button, shown below, and at the bottom of the product. For long distance walks or when the paramedic is busy with both hands, the strap is a usefull feature.


9.4 DEFIBRILLATORINSIDE

The detachable ECG-monitor can obtain an ECG and can provide CPR-assistence for paramedics, but it can’t operate the defibrillator.Thebuttonstooperatethedefibrillatorwitharehiddenunderneathacover. Underneath this cover is a storage for thewirelessECG-electrodesanddefibrillator-electrodes as well. These electrodes can be placed in the cut-out you can see in the picture below.

Defibrillator buttonsAs described above, the buttons for the defibrillationmodearehiddenunderacover.These buttons will only be visible when the paramedic opens te cover. The paramedic

will only see the buttons when he needs them. Hiding buttons will result in a more calm and less screaming product. Also the cover protects the buttons when the main body falls on the ground.

The two buttons that are implemented are the ‘charge’ and ‘shock’ button. According to user research, these two actions, which can have a lot of impact, should stay manual with a press button.


9.5 WIRELESSECG-ELECTRODES

The wireless ECG-electrode exists of two parts which are visualized at the top picture on the next page. The part with the transmitter and electronics (1) is plastic and is a long-term use product. The pad (2) is a disposable sillicon part that is using a conductive gel at the bottom to receive the electrical activity better. Underneath the sillicon part, a plastic sheet protects the conductive gel and sensor (3). A click button is chosen because it’s used in the current situation, where it shows good conductivity.

Activating padsThe pads are activated when the plastic sheet is removed. When a second pad has been activated, the pads will start communicating with eachother to determine eachother’s position.

Fig. 31. Pads will glow when activated.


Clicking padThe part with transmitter (1) can easily be clicked into the pad. Also the button makes it easy to detach this part from the pad.

Size referenceThe pad is 40 x 40 x 10 mm

1

2

3


1 0 . R E F L E C T I O N

Working with a company is always a big drive to really push your limits and show what your capabillites are. During this project I enjoyed working with Laerdal Medical, who always looked with a critical eye towards everyone’s presentation. I believe that, with the help of Laerdal Medical and tutors, my concept was taken to a higher level.

Besides the guiding part of the project, I learned a lot about modelbuilding. I haven’t believed in modelbuilding that much, until I started making this model myself. The process to understand how you should build up your model inspired me a lot. This is the part where I learned the most as well. This way of thinking makes you realize how producable your own product actually is.

Above all I think the project was a lot of fun. The collaboration with the paramedics was rewarding and their feedback was incredible valuable. We, as a class, have created a strong and open collaboration with the paramedics and I’m proud of that. The fact that the paramedics were invited and came over to our presentations says enough in my eyes. I’m happy that I’m part of the class and that I’ve worked on this project!


(1). Degn. T (2015) Internal document. Used 21 November 2015(2). IDEO (2011) Human centered design: Toolkit (2nd edition) (3). Allen, C. (2004) Reducing uncertainty. Used 21 November 2015 https://www.fhwa.dot.gov/publications/publicroads/04jul/06.cfm(4). Rawshani, A., Larsson. A., Gelang, C., Lindqvist, J., Gellerstedt, M., Bang, A., Herlitz, J., (August 2014). Characteristics and outcome among patients who dial for the EMS due to chest pain http://www.sciencedirect.com/science/article/pii/S0167527314015101(5). Robinson, Joan M., Moreau, D. (2011) ECG Interpretation: Made incredibly easy (5th edition) Wolters Kluwer(6). Digiulio, V., (September 2015) Spot the STEMI #1 Used 22 November 2015. http://www.ems12lead.com/2015/09/19/spot-the-stemi-1/

1 1 . R E F E R E N C E S


THANK YOU!I f y o u w a n t t o c o n t a c t m e a b o u t t h I s

p r o j e c t , d o n ’ t h e s t I t a t e t o c o n t a c t m e !

d a a n _ h e k k I n g @ l I v e . n l


paramedics project - final report

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