Critical list

Tom Reynolds wants engineers to listen to staff at the sharp end of the NHS and design the basics better


Those of us who work on the shop floor of the NHS are a simple lot. We want to get through the day doing the best for our patients. We don’t want things to be awkward or complicated. We just want to get on with our jobs.

Take my job, for example. I drive around in an ambulance and am called to assist people in various states of illness. All I want to do is make sure that my patients (and I) get to the hospital alive.

The equipment I use the most? A carry chair, a blanket and the machine for checking the patient’s vital signs.

The carry chair needs to be light, tough and able to carry our heaviest patients. There are some terribly complicated chairs out there, chairs that will roll down stairs rather than force us to lift them and the patient.

But we don’t use them because they are too complicated, too heavy and only fit certain types of stairs. It would be impossible to use them safely in most of the locations we find ourselves in. So we stick with the simple.

Blankets are incredibly useful — I once wrote an 800-word ode to them. But there is a way they could be improved: if they could be made antibacterial it would save us a lot of money in laundering them and would help prevent the spread of disease.

The machine for measuring our patients’ vital signs is an incredibly clever and complicated bit of kit. The only problem is that it is heavy — very heavy. This is fine when it is in the ambulance, but try lugging it across a muddy field and you’ll need the oxygen more than the patient does.

We’d like it smaller and lighter, please… and if you can make it like the Tricorder from Star Trek so I don’t have to undress the smelly drunks that make up a large part of my work, then I may well marry you.

Now let’s take a look at the less essential equipment. What would be nice — and is already possible — is to have a PDA containing a complete list of drugs and the drug overdose database. If it also had some language translation ability, it would be worth its weight in gold.

Elsewhere in the NHS, ask A&E doctors and nurses what they would like most in the world and they’ll tell you they want an injection that instantly sobers people up. And it wouldn’t just be for use on the staff — imagine the traditional A&E department without the normal waiting room full of rowdy drunks. Make this and you’ll make millions.

If you can’t make the drunks vanish, then one of the main bottlenecks for patients is the queue for blood tests. Let’s have a magic machine that makes drawing blood quick and pain-free. Then have the machines that process the blood able to work faster, on more samples and still give accurate results.

Imagine nursing a 40-stone patient and having to turn them every half an hour to prevent pressure sores. How about an effective yet cheap way of making manual handling of patients safer and easier?

I should stop stealing ideas from Star Trek, but wouldn’t it be nice if everyone in the hospital could communicate with everyone else just by pressing a ‘com-badge’ and asking for a connection by voice? No more chasing around for doctors’ bleep numbers.

On the other hand, some bits of technology just make our jobs more complicated. For example, some services have taken to having electronic patient report forms, often in the form of a tablet PC. In London we use paper. We like this because we don’t have to worry about power. If we need to add more information, then we write smaller and if we drop it or lose it, the NHS trust isn’t a few thousand pounds out of pocket.

Another over-complicated thing is the contraption that is used when someone breaks their femur. It’s a terrible mixture of straps and pulleys that doesn’t encourage us to use it. And that’s when we can — bits often go missing from it.

I’m just throwing these ideas out there as a way to say that what the rank-and-file worker of the NHS needs is not something that is handed down from on high.

Hospital managers are seldom aware of the things that those of us working at the coalface need. They are concerned with silly targets, or with the current governmental flavour of the week. What the people who design and build our next generation of tools need to do is to talk to the NHS staff who will actually be using them.



Tom Reynolds is the nom de plume of an emergency medical technician (EMT ) for the London Ambulance Service. He blogs at http://randomreality.blogware.com and his book Blood, Sweat and Tea is published by The Friday Project