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Innovation: IV fluids for Land Cruisers
Our teams work in conflict zones, epidemics, and places where no other healthcare is available. This means thinking differently to solve problems that simply don't exist in conventional medical settings.
British nurse Josie and logistician Anup write about an innovative new project that could save vital time in an emergency.
I joined Médecins Sans Frontières/Doctors Without Borders (MSF) after working in the National Health Service (NHS) in the UK.
I was used to following systems. Those systems only changed after years of pleading and trying to convince the powers-that-be that there was a better option.
So, when on my first MSF assignment, I started highlighting certain nursing issues to my boss. When asked what I thought would be best to do, I was kind of open mouthed! My team and I could make certain changes ourselves or with just the permission from my medical team leader. It was so liberating!
To be able to see a problem in the morning, discuss it with the nursing team, find a solution and have it implemented by the afternoon was so satisfying.
However, this satisfaction slowly starts to wear off the more MSF assignments you do, as you find yourself changing the same things, or re-inventing the wheel time and time again.
You get into the habit of thinking certain things you are just expected to think.
This is what happened with IV fluid holders for Land Cruisers.
The problem: where to put IV fluids?
In our projects, we use Land Cruisers – 4x4 vehicles that drive well on a variety of terrains.
They are multipurpose, which means one Land Cruiser can go from being packed with medical supplies, to loaded with sand and wood, to being used for a mobile clinic or to transfer patients, several times in a day.
When on a project there isn't necessarily one Land Cruiser you would use as an 'ambulance' - therefore when transferring patients, you set the car up as you need it, when you need it.
This often meant arriving to the car with a patient on IV fluids - then realising there was nowhere to hang the fluids.
Our emergency patients often need IV fluids to help rehydrate them or to replace the fluid they are losing.
These patients include those suffering from severe diarrhoea or cholera, those with gunshot wounds, and women haemorrhaging after giving birth.
Being able to deliver IV fluids to these patients while transferring them enables us to keep their condition stable. This is until we can get them to a hospital, where they'll receive the necessary treatment.
Not having an IV fluid holder in the car leaves us with a few options:
1. You could ask the caretaker of the patient to hold it.
2. If you were lucky the car had hand rails - then you could use a latex glove, bandage or a piece of string to tie it up.
3. If you didn’t have the hand rails you needed to get a little more inventive and would maybe have to give the technical logistician a call to come help.
Although this whole process of finding how to hang the IV fluids inside the Land Cruisers generally only takes a maximum of five minutes, when you multiply those five minutes for every time you're faced with this problem, you start to realise you're losing a lot of time.
And that’s before you start involving anyone else in trying to find a more permanent solution.
technical logistician anup
As a logistician with MSF, I’ve always felt like I’m a service provider.
I'm the ‘go to person’ for all the departments when something needs fixing or doing.
Requests come by every day, and for the majority of the time issues need to be sorted immediately.
I very quickly realised I didn’t necessarily have to do it myself to get the job done. I have a logistics team of national staff and we work together to meet the needs of the medical team.
There are many requests which are considered emergencies in the field, but some of these would never even be a point of concern back at home. This is because measures to handle them were already in place.
I remember times when nurses asked me to make an IV fluids holder for inside the Land Cruiser.
The first time it happened I didn’t know what IV fluids or a holder for them was supposed to look like, but there was no time to find out as a solution was needed then and now.
The patient and medic were watching and waiting for me to produce something. The patient was unwell, and they needed to get moving. It was tense.
I ran off to get a piece of string and tied the IV fluids to a corner inside the Land Cruiser. I used to wonder: there’s got to be a simpler solution to this.
This did not have to be a ‘quick fix’ and surely, I did not have to deal with this frustration on a regular basis.
Why ad hoc solutions don't work in the long term
There are various reasons why these ad hoc solutions don’t work in the long term.
One of the main issues is that they can’t be cleaned very easily, which means there is a risk of spreading infections.
Since the Land Cruisers are usually a multipurpose car (used for cargo and passengers) the IV fluid holders might be subjected to dust, wear and tear, unnecessary human contact, etc.
On top of the risk of infection, with all the temporary solutions we come up with, the medics often complain that the IV fluid bags are constantly moving about with the motion of the car.
This makes it difficult for them to monitor whether the fluids are running at the right rate or if they are still running at all.
Therefore, these 'quick fixes' never last long and making one ends up being an emergency every time there is a patient referral.
This is how the project to design IV fluid holders for Land Cruisers came about.
So having both spent a lot of time in the field, we now find ourselves on a completely different type of mission – a product design mission – with three weeks to design an IV fluid holder for Land Cruisers.
And yes, we said three weeks!
Our initial thought was: how are we going to focus on only one thing for three weeks?
In our heads, we’d already come up with several solutions and that had taken us about 10 minutes.
Luckily, we had a product design engineering company on our side to explain and guide us. They showed how product design actually works, and we realised that really, we needed three weeks.
1. Myself, a nurse, with MSF since 2010.
2. Anup, a logistician with experience as a supply and technical logisitician with MSF since 2013.
3. Nils, a product design engineer with Fearsome, a product design engineering company.
The project site
For the following three weeks we were based at the Fearsome offices in Glasgow.
It’s an old building that used to be a whisky distillery. Unfortuna,tely there’s no whisky left kicking around, but we did have a large work space surrounded by whiteboards and access to all their product-making toys, including a workshop and a 3D printer.
Nils told us to feel free to write, draw and stick up whatever ideas and information we gathered.
As you can see we did as we were told!
Getting into the product design mindframe
The first things we learnt were:
1. To stop calling it an IV fluid ‘hook’, as this just makes you think of a hook! Think about what this product actually has to do, it has to be able to hold IV fluids upright in a Land Cruiser, so it could be anything that can do that.
2. Stop thinking of solutions! This one was initially a bit of a shock, because, (a) we thought that was the whole point of the project and (b) that’s what we’ve spent the past five years doing when in the field with MSF.
As Anup put it, this was going to be an interesting three weeks!
We'll be forcing ourselves to take baby steps, instead of the usual Usain Bolt sprint towards a solution that happens when we're working in the field.