Accelerating the drug administration during cardiac arrest
10-week project in collaboration with Laerdal Medical and Västerbottens Läns Landsting
Every second counts.
During cardiac arrest, paramedics face a tough challenge: Providing high quality CPR , while providing Adrenaline (a.k.a Epinephrine) to the patient through intravenous or intraosseous access as quickly as possible. Every minute delay in Adrenaline administration is associated with decreased survival and unfavorable neurological outcomes (source).
What are the main factors that delay time-to-Adrenaline administration?
Keeping track of time
Adrenaline should be administered every 4 minutes to the patient to keep a more stable heart rythm. This is usually causes trouble to the paramedics because in such a stressful situation it is difficult to know when 4 minutes have gone by.
Subobtimal teams
When there is a cardiac arrest event, there is a need to call a second ambulance team to help out, as it is extremely hard to coordinate the compressions, ventilations and drug administration during CPR with just two paramedics.
Time-consuming preparations
To administer Adrenaline, the paramedic has to break the bottle neck, transfer the right dose to the syringe, remove the air bubbles and inject the dose.
Precise dose adjustment
Measuring the dose depending on whether it is an adult or a child can be hard in such stressful environments.
How might we speed up the preparation of adrenaline doses and optimize the intravenous process?
Adrinject and Adripod
Two products to optmimize the Adrenaline administration process during cardiac arrest.
Adrinject combines 4-in-1 adrenaline doses and 4 minute reminders to allow the paramedic to reduce the time-to-Adrenaline to a minimum and minimize delays in drug administration.
Adripod is a foldable stand from which the IV bag can be hung from. This enables the paramedics to focus entirely on the patient's needs on-site when it matters the most.
Quick set-up
After getting IV access, just unpack the 4-in-1 dose, plug it into the injector to switch it on and you are ready to go!
Preventing mistakes in dose administration
Adrinject allows the paramedic to adjust the dose precisely when facing with a pediatric patient. Once the dose has been administered, Adrinject will remind the paramedic to administer adrenaline again in 4 minutes.
Ready in a blink of an eye
Adripod can be unfolded in less than 5 seconds just by the push of button. The product ergonomics allow it to be deployed both standing up and sitting on one’s knees. It also fits inside most of the paramedics bags, so it can be ready whenever the paramedic needs it.
Sturdy mate
Adripod extends up to 1,2m to hang saline bags at the right height while being compact and lightweight.
Deep dive into the process.
Starting out in a 2-day-visit at the Umeå Ambulance Station to understand the real problems of the paramedics, I could dig into specific problems and get innovative solutions that could, in the end, save a life. The project involved tasks such as research analysis, testing the ideas with paramedics with mock-ups, sketching, and model building.
Ethnographic research
The Umeå ambulance station let us visit their facilities for 4 days. How does a day for a paramedic look like? What do they hate doing? What are they afraid of? What makes them feel proud of their job? After experiencing 30 calls, shadowing and in-context interviewing, there was enough data to build several maps to identify the main painpoints of this user group.
Many times, finding a direction for a project requires several activities to understand what the framework is, although in this case, during a casual conversation with a nurse about cardiac arrest, he mentioned:
“I wish there would be some way to tell me when I need to inject adrenaline to a patient during CPR.”
Such a simple and straightforward statement sparked my interest to look deeper into the topic, which resulted into several ambiguities and a range of user problems to be solved.
Designing together with paramedics
Building basic mock-ups is a great tool to start grasping what you are actually making and eliminating the big mistakes out of the way early enough. Visiting the Ambulance station several times with rough models to emulate what the device does helped geting quick cycles of feedback and evolving the concept quickly.
One of my main assumptions was that drugs such as adrenaline need to be used carefully as it may be limited. During the feedback sessions I learned it was the oposite, so I could speed up the preparations for adrenaline administration by combining several doses in one.
“Adrenaline is really cheap, I wouldn’t mind throwing away several doses if it was for a strong reason”
Concept generation
Based on the learnings from the sacrificial concepts, I conducted several rounds of sketch/build and to create several concepts that could fullfil the user needs and feedback received in the previous phase. One of the key aspects was to define the location of this device during CPR, as the paramedic will need to interact with it frequently.
During this exploration I learned that the adrenaline injector cannot work without a saline bag hanging from a certain height, which creates a flow towards the patient. Such key factor created the need for a device to hold the saline bags at a certain height.
Down to the last detail
From quick mock-ups in foam or paper, 3D modelling, roleplaying to validate usability and to the final model, these processes helped me quickly define critical and relevant details that improved the product semantics and functionality. For example, one of the most important details was the form factor of the stand’s telescopic handle. It was important that paramedics could deploy the device from a standing or kneeling position, therefore the ergonomics had to support this need.
