Finding Comfortable Routes for Ambulance Transfers of Newborn Infants

Abstract

Early inter-hospital ambulance transport of premature babies is associated with more severe brain injury. The mechanism is unclear, but they are exposed to excessive noise and vibration. Smart-routing may help minimise these exposure levels and potentially improve outcomes. An app for Android smartphones was developed to collect vibration, noise and location data during ambulance journeys. Four smartphones, with the app installed, were provided to the local neonatal transport group to attach to their incubator trolleys. An example of route comparison was performed on the roads used between Nottingham City Hospital (NCH) and Leicester Royal Infirmary (LRI). Almost 1,700 journeys were recorded over the space of a year. 39 of these journeys travelled from NCH to LRI, comprising of 9 different routes. Analysis was performed on all recorded data which travelled along each road. For routes from NCH to LRI, the route with least vibration was also the quickest. Noise levels, however, were found to increase with vehicle speed. Ambulance drivers in the study did not tend to take the quickest, smoothest or quietest route. Android smartphones are a practical method of gathering information about the in-ambulance environment. Routes were found to vary in vibration, noise and speed, suggesting these could be minimised. The next step is to combine recorded and clinical data to try and define an ideal neonatal comfort metric which can then be fed into the routing. Roll-out of the app around the UK is also planned. Clinical relevance-Transferring preterm neonatal infants to specialist units lead to worse outcomes. By reducing the levels of vibration and noise the infants are exposed to during transport, we hope to improve outcomes.

Driving the ambulance: an essential component of emergency medical services: an integrative review

“…In addition, the route had to be suitable given the road conditions, weather, and other environmental factors. To decide what route to choose for the mission, technical devices such as navigation systems were used to support the ambulance driver [ 14 ] and estimate the prehospital time, time of day, rush hour, and to decide if there were need for lights and sirens [ 15 ]. To ease passing through traffic and reduce time spent on the road, lights and sirens were sometimes used to decrease total transport time, and the greatest time reduction was seen when conducting transports of critical patients and neonatal patients [ 13 ].…”

“…The way the ambulance was driven (e.g., accelerating, decelerating, turning, and adjusting to speed bumps and other roadblocks) and the quality of the road had direct impacts on the patient’s medical condition. Vibrations, hard or sudden movements, braking, or acceleration caused injuries or severed the medical conditions [ 14 , 18 , 19 ]. Noise did not only directly affect the patient’s condition [ 14 ] but also cause discomfort [ 12 ].…”

“…Vibrations, hard or sudden movements, braking, or acceleration caused injuries or severed the medical conditions [ 14 , 18 , 19 ]. Noise did not only directly affect the patient’s condition [ 14 ] but also cause discomfort [ 12 ]. Ambulance acceleration was found to cause movement in the head and neck of patients, regardless of measures such as immobilizing the patient on a spine board, among others [ 18 ].…”