Monday, 27 November 2023

Acute Care Vehicles 2- Second Generation

 


I consider the second generation of acute care vehicles a golden age of engineering; this was from the late 1990's to the mid 2000's. The hero of this boom was undoubtedly Egerton, a company based in Poland. There were three general bed designs that made up the backbone of the JRH fleet. I can't remember their official names, but we nicknamed them the "blue" and "grey" because of their colours. The blue Egerton was a pleasure to handle. It was by far the most manoeuvrable bed I have ever used. It had a folding handle at the foot for the sit-up mechanism and a separate squeeze handle for the pitch. Level was raised and lowered by a pair of smooth pedals at the side which needed very little pressure to operate. The top level was about five feet which added to the vehicle's portability. The grey Egerton came in three models. There was one with a lift-and-pull headboard that was mostly used to replace the original fleet maternity beds. The second design was more like the blue, but had slightly different controls. The pitch was altered by two black squeeze handles at the foot. It was also slightly heavier. The third variant was basically the grey with electric posture controls. I have always considered electric power an extravagance and a typical example of over-engineering for its own sake. Early electric vehicles had to be plugged in whenever they were in use and had backup manual handles and pedals. They can also actuate by accident when, for example, somebody leans against the control paddle. They grey had no manual backup. It had a battery which very quickly ran flat because staff usually didn't bother to plug it in, sometimes because the ward bed-spaces didn't have enough electric sockets. Another problem was that very few staff used the proper storage hook for the flex and plug. Some developed a bad habit of wrapping it around the rear corner fenders. This not only made it easy for it to fall off, but when the bed was raised it sometimes ripped the flex out of its fitting. (One theatre porter in particular was very irritating because he would do this on purpose when I told him about the wrong method just to wind me up; because that's the kind of person he was.) The second generation was not all a bed of roses though, if you'll excuse the pun. I'm thinking of the Hill Rom. Only a handful of these awful contraptions ever made it into the John Radcliffe fleet, but I used to groan whenever I had to use one. They had a feeble plastic footboard that usually broke and without it, as I said in the background link below, it was like a car without a steering wheel. We often kept a secret store of spare footboards in the lodge and a Hill Rom one was like gold dust. It also had a nasty static sting problem, sometimes producing an audible crack and visible spark... Good job anaesthetics no longer use ether! There was one bed that was a real bummer; it lost one of its footboard mountings meaning it could only be used without a footboard. Whenever I saw it unoccupied I used to wheel it to the "cage", a store in the industrial block for vehicles needing repair. I stuck a note on it explaining that it was not safe to use, but the maintenance team always returned it to service without replacing the mounting. I was tempted to sabotage that bed quietly in secret so they had to take it off the wards. All the second generation beds have a centralized footbrake; the blue Egertons' were the best; they were easy to apply, like the level pedals, and the lever was unobtrusive. The Egerton's were also the first full-size beds to have a function previously reserved for trolleys; optional steering lock. By raising the brake pedal to a third position, usually at the top, the foot wheels would lock into a north-south position rather than the usual free caster. This made the bed very easy to manoeuvre and it could even be pushed with a single porter, but only when empty. We hardly ever used to wheel lock with a patient, but then we were never alone with a bed patient anyway.
The second generation also provided one of the best wheelchairs ever, the Bristol Maid. This was a nifty rear wheel steered chair with an excellent sliding footplate and retractable telescopic arms. Its small size made it ideal for cramped passages in corridors, wards and departments. It had a unique storage compartment at the back for patient notes folders, but I learned quickly not to use it because it was too easy to lose the notes, something that would get you into terrible trouble. If you get one of these chairs I recommend asking the patients if they can hold them, if they are able, or put them behind their back.
The second generation was the first to deliver what I regard as specially designed bariatric beds. Bariatric is a politically correct way of saying "very big and fat". These were sometimes based on standard designs but were bigger and stronger. There were some other models specialized for bariatric cases from the wheels up. Along with bariatric beds we were given equivalent wheelchairs, operating tables and even mortuary slabs. Together with these innovations were far better intensive care beds with inflatable soft mattresses to reduce pressure sores for patients who were stuck in them a long time. The largest and heaviest of these we called "the Beast" and it needed at least three porters to move it. I wondered where technology would take us in the future, to better or worse machines. The answer was both.

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