Tuesday 19 September 2023

Acute Care Vehicles 1- Original Fleet

 
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.

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