A few years ago, while I was still serving, I wrote to all
the manufacturers of hospital acute care vehicles offering my services as a
consultant, free of charge. No false modesty here; I am one of the most highly
qualified people in the world, having used these vehicles every day for over
twenty-three years as a hospital porter. Throughout my long career I watched
technology advance to improve these vehicles... mostly... and it is important
for you, if you are a HP, that you learn about these tools of our trade and
their history. When I started at the John Radcliffe, almost the entire fleet
consisted of vehicles deployed to the hospital when it first opened in 1973 for
the JRI Maternity unit and 1977 for JRII general side. The maternity beds were
all equipped with "lift-and-pull" heads. There was a flat piece
attached to the headboards which could be pulled out at an angle to allow the
patient to sit up, with a few pillows behind her of course. This was considered
sufficient for maternity patients long after these beds became obsolete. They
were of fixed height, which was extremely awkward especially as Caesarean
patients were put on them immediately post-op to recover, even if they'd had
general anaesthetics. They had single wheel footbrakes on the front right and
back left leg; again, not very user-friendly because to secure the bed the
porter had to walk all the way round it. The footboard was a wooden one, but
these were upgraded to metal handled ones in the 1990's. One golden rule for
HP's, a footboard is absolutely essential. Without one your bed is like a car
without a steering wheel. I've seen porters struggling to manoeuvre beds by
clinging onto the corners of the mattress, sometimes grasping the woollen blankets
with their fingernails. Also, without a footboard the mattress tends to slip
off the stead as well. I've seen them half hanging off, threatening to dump the
patient onto the floor. (A possible exception to this rule is the Blue Egerton,
but I'll cover that in a future article.)
On general side these lift-and-pull beds were agreed on as
being inadequate for general patients and so we had beds with a sit-up
mechanism that raised the head section of the stead up at an angle. This was
operated by a handle under the footpiece which could be folded away. There was
also a hand-cranked system for raising and lowering the bed's level on the left-hand
side of the stead, but the handle was detachable; big mistake! It was stowed on
a pair of hooks beside the turning connector, and the designer naively assumed
everybody who used it would always kindly return it to the hooks afterwards. No
way! Anything in a hospital not tied down or nailed down grows legs and walks.
(This incidentally is why the AWARE study was doomed to failure, see: https://hpanwo-voice.blogspot.com/2014/10/proof-of-life-after-death.html.) Pitch was altered by a lever surrounding the level crank. It had three positions, foot-up, head-up or both together, which was the actual leveling. An awful piece of engineering. Another problem the original general fleet had was static shock. The motion of
its wheels would build up static in the metal frame that would sting badly when
it discharged to earth. This was an even bigger problem with other designs such
as the original Hill-Roms, but I'll cover that in a future article. Happily the
old rust buckets of the original general fleet have now been scrapped.
Hospital wheelchairs vary considerably in design, but they
fall into two basic categories; front wheel steering and rear wheel steering.
They all have four wheels, one at each corner with one pair fixed along the north-south
axis. The other pair are casters. Different HP's have different preferences and,
in my experience, there are advantages and disadvantages with both formats. The
original fleet were all rear wheel steered. In the case of wheelchairs single
wheel brakes are by far the best. In fact a later, supposedly more advanced,
design had a single footbrake, but it was operated by a long pedal that stuck
obtrusively out from the back right into the space where the porters' legs have
to move while pushing. It meant that the only way to push the chair was to
stand much further back and lean forward; which is actually a back care hazard.
What anti-genius came up with that quantum leap? You see why it's a good idea
to consult with HP's when designing these vehicles? I'll describe more modern
wheelchair designs in future articles. You may wonder what the difference is
between a hospital wheelchair and one made for use outside in the normal world.
Wheelchairs for disabled people in everyday life and designed to traverse
streets, pavements and other public places. They usually have pneumatic tyres
and suspension, and sometimes a large rear wheel with handle-rims if the person
is able to use their arms and hands to propel themselves. They often have to be
used for many hours at a time so they are cushioned to be comfortable.
Hospitals wheelchairs are designed only to be sat in for a few minutes to an
hour or so at a time so they have a straight seat and back without any angling
and minimal padding. Their wheels are solid and the hub is fixed to the axle
without shock absorbers or suspension. The tyres are usually solid rubber.
I like the word "gurney" because it is uniquely
descriptive, but it is only used in American English. We Brits still call the
narrow waist-high vehicles for supine patients "trolleys", which of
course means you have to add the word "hospital" in front of it if
there is any ambiguity of context, otherwise you might end up putting your
groceries on one in Sainsbury's. The original trolley fleet were used in A and
E, X-ray and a few other places. They were only designed to be lain on for a
few hours at the most; but, as is more and more often the case as waiting times
increase, some patients end up lying on them for too long. Beds should always
be used for stays of more than a few hours. The original fleet, amazingly were
also all fixed height. Their side-rails only had two positions, up and down; and they were lowered or raised by rotating away from the frame. This meant you had to do this while the trolley was at least the height of the side-rail's distance from the receiving vehicle. We did lose a few patients down that gap. The only difference with the resuscitation trolleys was
that they had an F-size oxygen tank holder underneath, and I once got into
trouble for putting one in the general trolley pool by the major side entrance
instead of in the resus room where it belongs. The mattress was foam coated by
heavy-duty plastic and we had to take it off the vehicle to wash it. The stead
and legs were bare steel and they used to rust after a while. This is the first
part of a series of articles about acute care hospital vehicles and in the next
one we will discuss the next generation of designs. This series is also
intended to be just one part of a larger project, the formation of a hospital
portering guild, see here for background: https://hpanwo.blogspot.com/2009/09/guilds.html.
Oh... and one last thing; to clear up the eternal confusion once and for all,
the rule for entering a lift with a vehicle is: bed and trolley feet first,
wheelchair head first.
