Cartwright cares

The company putting the customer at the heart of its innovative ambulance conversions

It’s been just two years since Steve Shaw took over as Commercial and Operations Director at the renowned British vehicles manufacturer Cartwright Conversions. It’s hard to believe that so much has already been achieved in such a short time. Below we take a look at some innovative new additions to the Cartwright portfolio and catch up with Steve as he tells us about how Cartwright is staying at the cutting edge of ambulance engineering by ensuring that the focus of their design and build is on creating a 21st century patient treatment space which meets the needs of increasingly highly-skilled frontline ambulance crews – and all this while maintaining their commitment to putting the customer first!

Vehicles built to meet specific clinical needs

Steve Shaw explains: “At Cartwright we are constantly designing and redesigning and trying to develop new products. Our team of engineers are the key to what we do.”

The vehicle needs of emergency services differ greatly to that of the general population, and as such, the design and engineering that goes into an ambulance conversion needs to be bespoke to each service’s needs. Cartwright’s account managers and engineers work closely with their customers, from the design stage right through to the final sign-off, making sure that the end-result fully meets their customer’s unique clinical needs. It’s this careful and dedicated approach to their quality products and aftercare that keeps Cartwrightcustomers so loyal to them as manufacturers.

The range of options available is vast and Cartwright manufactures:

•   Frontline A&E

•   RRV/FRV (Rapid/Fast response units)

•   High Dependency Ambulances

•   Neonatal/Paediatric Ambulances

•   PPV (Paramedic Practitioner Vehicle)

•   ECP (Emergency Care Practitioner)

•   Control Vehicles

•   Special Incident Units

•   Mountain Rescue Vehicles

•   PTS (Patient Transport Services)

•   Specialist and Custom Applications

•   Hire Fleet

Manchester Commercial Photographer Tim Wallace. Commercial photography, car, automotive, aviation, truck, engineering and parts photography

PTS Vehicles

Like many countries, Britain’s demographic is increasingly comprised of an ageing population making the provision of patient transport vehicles more important than ever. PTS vehicles come with a wide-range of options, from specialist bariatric capabilities, light-weight floors and accessibility ramps. If it doesn’t exist yet Cartwright’s team are always up for the challenge of identifying and building the design solution presented by their customer’s individual requirement. Cartwright’s larger PTS vehicles have the option of a High Dependency Unit (HDU) or seated stretcher, while smaller vehicles like the Ford Connect and Custom offer great wheel-chair accessibility within a more modestly-sized vehicle. Cartwright PTS vehicles have the option of a range of loading solutions, from tail-lift to ramps; exclusive flexible flooring systems (see RolliBox below); a variety of base vehicles from a range of suitable vehicle makes/models and wheelbases; and unaided patient entry options including folding side door hand rails.

Full Wipe Down for Improved Infection Control

An important clinical innovation in ambulance builds is the introduction of full wipe down panel sets designed to improve infection control throughout the vehicle by making cleaning easier and more thorough. Cartwright ambulances have smooth, crevice-free interiors, with waterproof finishes that can be cleaned easily to reduce the risk of infection. It’s also important that ambulance interiors are robust enough to keep driver and passengers safe with no equipment becoming loose.

Hire Fleet

Cartwright’s fleet of hire vehicles continues to be a huge success with over 30 vehicles running at around 90% utilisation and further plans to build an additional 45 in the coming financial year. The fleet ranges from small WAV (wheel-chair accessible vehicles) to larger HDUs. One massive advantage of hiring a vehicle directly from such a well-established British manufacturer as Cartwright’s is the resource of after-care maintenance. Vehicles that are hired enjoy the support of both of their build facilities, as well as the support of teams of expert engineers from all over the UK where specialist parts needed urgently can quickly be provided for any Cartwright’s vehicle. No matter where you are in the UK, if you’re driving a Cartwright’s hire vehicle you’re never left on your own.

The Cartwright Team

As such a long-established and well-trusted brand, Cartwright not only attracts loyal customers but also the cream of the crop of the British ambulance build industry. Veterans of the industry will quickly recognise names such as Sales Managers Toby Carter and David Kenyon, Hire Fleet Manager Angela Walker and Quality & Aftercare manager Ian Schofield – to name but a few! Quality recognises quality, and it’s no wonder that so many of the sector’s best and brightest end up at Cartwright. Apart from its innovative range of new vehicles, its world-beating engineering and its unique level of aftercare, what is it that really sets Cartwright Conversions apart from the competition? Steve Shaw insists: “At Cartwright we care! I really believe that. Cartwright really is here to do the right thing. The Cartwright group has been around for over 60 years and we will certainly be around for a long time to come. Our customers truly have confidence in what we are doing and at the end of the day, I think that’s what really matters.”

The RolliBox System

A great example of Cartwright’s continued innovation in the PTS market is the RolliBoxSystem, a seating system produced by German manufacturer, Schnierle, and sold exclusively for the PTS market in the UK by Cartwright Conversions.

The system for PTS vehicles has space for a stretcher, multiple wheelchairs and seated passengers. The layout can be quickly changed on the move without the need to take out seats or use a toolkit. Restraints for each wheelchair are concealed within side panels that can be easily unfolded at floor level. When wheelchairs are not being used, these restraints tuck back away making room for a stretcher or additional passenger seats, all of which can be done in seconds. Head rests and seatbelts can be found at each of the wheelchair positions making this seating system one of the safest and efficient available.

The flexibility of the RolliBox system opens up the potential of PTS vehicles to accommodate many different seating arrangements, potentially reducing the number of journeys needed and therefore contributing to a more efficient and cost-effective ambulance fleet.

To learn more about Cartwright Conversions and their innovative range of vehicles, please visit their website: www.cartwrightconversions.co.uk

Family-run Harrogate company works with region’s ambulance service

Date: 14 August 2019

Harrogate-based Yorkshire Care Equipment has supplied Yorkshire Ambulance Service (YAS) with over 50 Raizer emergency lifting chairs that are now being used by first responders, falls teams and care homes in the Sheffield area.

YAS and NHS Sheffield Clinical Commissioning Group (CCG) have started a project in the city that aims to get people who have fallen back on their feet as soon as possible. The Raizer chairs are part of this joint project which provides staff with appropriate lifting equipment and focuses on residents having an improved experience. The results will be shared with other ambulance services, some of which are also trialling the equipment.

Yorkshire Ambulance Service responds to nearly 800,000 emergencies every year with around 10% of these related to people who have fallen. Many of these calls come from care homes where staff are either physically unable to lift the person back to their feet or are unable to do so because of lack of training and access to appropriate equipment.

Karen Owens, Director of Urgent Care and Integration at Yorkshire Ambulance Service NHS Trust, said:

“Feedback from the care home staff and residents in the project described the Raizer chair as something which will help staff move people safely and with dignity and will give staff the confidence to assess injury prior to making the decision to moving someone. 

“We very much appreciate the collaborative working and funding provided by the CCG on this project.”

The Raizer is completely unique from other falls lifting products because it only takes one carer to operate it. In turn, this saves money and time for care staff.

Steve Ellis, Yorkshire Care’s Raizer Specialist, said:

“When we worked with YAS last year, we knew that the Raizer could make a real difference to the level of care they were providing. Even when I’ve carried out training with their staff, you can see how much more confident the staff feel when they know they have a device that will genuinely improve the quality of care they provide.”


Construction work has begun on the first helipad of its kind in central Manchester

Date: 28 June 2019

Artist impression of the Helipad

Construction work on the new state-of-the-art, £3.9million helipad at Manchester University NHS Foundation Trust (MFT) has begun and is set to benefit four major hospitals in Manchester city-centre.

The new helicopter landing site, being built on the roof of Grafton Street car park on Oxford Road will enable critically ill or injured babies, children and adults to be airlifted straight to four major MFT hospitals.

A high-level patient transfer corridor will connect the helipad landing site to Manchester Royal Infirmary (MRI), Royal Manchester Children’s Hospital (RMCH), Saint Mary’s Hospital (SMH) and Manchester Royal Eye Hospital (MREH).  

Each of the hospitals on MFT’s Oxford Road Campus offer world-leading, specialist services which are not always available at other hospitals within the North West and in some cases, the rest of the UK. The construction of the helipad is expected to see an estimated 312 patients airlifted to the site each year.

Funding for the helipad was raised by MFT Charity’s Time Save Lives Appeal, which raised a phenomenal £3.9million in just 12 months, thanks to the dedication and generosity of its supporters. 

The Appeal was the focus of the Charity’s fundraising, with individuals, businesses and community groups from across the North West all showing their support. This included a generous donation of £1.3million from the HELP Appeal and £1.1million from the government’s LIBOR fines funds in the Chancellor’s Budget.

Building work officially began earlier in June 2019 and the helipad is set to be fully operational by spring 2020.

Artist impression of the Helipad

Robert Bertram, Chief Executive of the HELP Appeal added:“This is one of the biggest donations that the HELP Appeal has given to any hospital. But, we didn’t hesitate in coming to their aid, because as the Major Trauma Centre for the northwest, a life-saving helipad is essential. We are delighted that its construction is now underway because it will save time and save lives.”

Manchester University NHS Foundation Trust Chairman, Kathy Cowell, said: “I am delighted that the construction work has begun and that we will be able to offer this service in spring 2020. It is a very exciting time for MFT and the helipad is an amazing project which will help to save so many lives in Greater Manchester, the North West and beyond.”

The first 60 minutes following a major trauma injury is known as the ‘Golden Hour’ and treatment within the first hour can mean the difference between life and death.

Dr Jon Simpson, Medical Director and Consultant Physician at Manchester Royal Infirmary, added: “The quality and speed of specialist medical care following a major trauma injury is vital to ensuring our patients have the best chance of a full recovery. In these situations, patients need to be transferred to a Major Trauma Centre or an Emergency Department, both of which we have on site at the MRI and RMCH. 

“The construction of the helipad will be invaluable to us and our patients as in some situations; the quickest or most appropriate way to get a patient to these services is by helicopter. The ease of access to these specialist services once the helipad is fully operational will allow our hospitals to save many more lives and increase the chances of a full or improved level of recovery for our patients.”

The 130m-long bridge between Grafton Street car park and MFT hospitals will be suspended 19 metres above street-level with direct access to MFT hospital facilities such as 24 hour Emergency Departments, a Major Trauma Centre for children and a 24 hour a High Dependency Obstetrics Unit.

Construction of the helipad on the roof of the car park has been carefully planned to minimise disruption to MFT staff, patients, visitors and other site users. 

Clinical innovation and technology in medicine and its challenges

Author: Michael Emmerich

Published in: Autumn 2018 Edition of Ambulance Today Magazine

This Africa Quarterly editorial looks at the increasing demand for healthcare across the continent, and the pressures to reduce costs and show increases in value and patient care, including outcomes. Technology addresses key healthcare problems in developing economies and can also in turn add value. Small victories can lead to vast improvements.

Health systems are now rapidly developing and the Fourth Industrial Revolution in healthcare is upon us – wearable internet technology that will monitor our health in everyday life. Practitioners and patients can take full advantage of new and ubiquitous technologies. The smartphone in your pocket can open new avenues in healthcare.

Africa already uses technology to manage human resource constraints, such as text services that enable doctors to support Trained Birth Assistants at a distance. With rising economies and urbanization, noncommunicable diseases (NCDs) present new challenges to Africa’s emerging health systems. We believe that addressing Africa’s “dual-disease burden” of both NCDs and infectious diseases will require developing and adopting low-cost and high-quality medical systems that encourage people to manage their own health. Mobile technologies and new breakthroughs in customized care will help us succeed.

  • Patrice Matchaba, Head of Global Health and Corporate Responsibility, Novartis – WEF AGM 2018

Those of us with many years’ experience in EMS have then been privileged (or cursed) to see significant changes across the board regarding equipment, patient care, protocols and drug therapies. Many of us have actively pushed for change and new equipment; be it about fluid therapy, bleeding control, pain management and airway management. At times we miss the most crucial approach to patient care neatly summed up by Hippocrates (400 BC approx.): Cure Sometimes. Treat Often. Comfort Always.

The classic approach to patient care has always been underpinned by the following:

• Arrive at a diagnosis by patient consultation and physical hands-on examination

• Confirm one’s diagnosis via various diagnostic devices

• Reaffirm one’s diagnosis by means of special investigations

Will technology change this approach, for better or for worse? Looking back at history, we see that not all new technologies have been readily accepted by the medical community. Many were viewed (/are viewed) with suspicion. In the 1930s some doctors doubted an X-ray image of the chest was as reliable as a physical examination. Devices threatened to replace the diagnostic expertise of the traditional doctor. Many doctors have valued their clinical experience over machine-produced information. Other technologies initially failed because doctors or patients found them impractical. The ECG was only useful when it became portable and reliable enough to be used at the patient’s bedside.

Drone carrying blood in Kigali

The entire patient/medical practitioner relationship is changing, as the patient has access to a wider range of medical information. Our patients are possibly smarter (maybe). Patients have access to more medical information with the result that, at times, they might be less trusting and prone to ask more questions of their medical practitioner. As practitioners we must be open to this new questioning patient and be willing to answer more questions than we did in the past.

Taking cognisance of all of the above: what is the healthcare practitioner to do?

There is an acknowledged gap in the “bench to bedside” cycle of medical discovery and its implementation in clinical practice, which can mean a gap of years changing “what we know” to “what we practice”. Hence the treatment of patients in an emergency setting should not only be concentrated on developing new technologies but must also involve proper training and skills development; medical talents needs to be honed. New technologies must always mandate new skill sets, protocols and procedures.

An area of import in medical development is patient information. The more patient information we have at hand, the more appropriate patient care can be rendered. Information and knowledge management is critical in helping with the decision-making process and thereby improving patient care.

Many medical practitioners believe that patients should take an active role in managing their own health information because it fosters personal responsibility and ownership, enabling both the patient and practitioner to track progress outside scheduled appointments and at times of a medical emergency.

Patient smart cards are a way to grapple with this issue of information. They will allow patients to upload their health records via a ash drive and carry their information with them in their wallet.

Information may be accessed through cloud-based storage and encrypted systems anywhere in the world or plugged into medical smart readers. Medical practitioners can update to cloud technology in real time and the patient’s own medical doctor can be alerted to changes in the cloud files. Ultimately, devices with communication and motion/health monitoring functions are expected to be implanted in the body. These changes are expected to help people manage their health more closely, and possibly allow medical practitioners to use this valuable data in emergencies.

Another key area where technology can aid is in having more information at our fingertips via a “differential” diagnosis or problem list, accessed via the cloud and linking to our patient and the further information we input. After reviewing the patient history and examination, the practitioner must then trawl his memory banks and innate knowledge base, or one may need to consult texts/online sources to check-up/confirm their thinking.

Cloud-based technology could aid us and speed up the confirmatory differential diagnosis. There is no doubt room for improvement in the current approach, with many practitioners currently relying on their tacit knowledge base at the frontline which, while mostly effective, is subject to human error. Once the differential diagnosis or problem list is drawn up, then a related treatment plan can be formulated, and treatment in the form of procedures and/or prescriptions for medications may be suggested by our cloud database.

We need to focus on leveraging the information we have and if we do not pay enough attention to building a basic infrastructure, we will be unable to make the Fourth Industrial Revolution a reality.

Emergency Medicine must continue its current academic trajectory, to keep pace with the challenges that technology brings to our patient care. If academic training lags behind the technology curve, our practitioners and therefore our patients will be the poorer. We must ensure that there is no technology/practitioner gap, as we continue to push the boundaries in improving our patient care.

The danger of technology is that it can make us lazy and reliant. It has become noticeable in certain areas of emergency medicine how our reliance on technology has allowed us to forget the three cornerstones of good medicine; diagnosis, confirmation and reaffirmation, of which the diagnosis and confirmation are reliant on us having a hands-on approach to our patients (which is becoming a dying art). Good solid diagnostic skills will always be an essential tool of medicine, especially emergency medicine – we forget this at our and our patients’ peril.

Reducing accidents in the emergency response sector

Date: 22 May 2019

The incidence of collisions in the emergency sector remains high around the world. Emily Hardy, from vehicle safety experts Brigade Electronics, runs through the technology that can help prevent accidents and save lives.  

Collisions involving emergency vehicles are a frequent occurrence across the world. Ambulances, fire appliances and police cars are involved in hundreds of accidents on the road as they respond to emergency situations. 

Figures obtained under the Freedom of Information Act show that in the south east, ambulances were involved in 665 accidents in the year to March 2018, equating to 1.8 collisions per day.   

In Wales, emergency service vehicles were involved in more than 3,500 crashes in the five years to March 2016. North Wales Police recorded the most incidents – 331 collisions in 2015-16, but the majority of these involved minor damage. The Welsh Ambulance Service recorded 735 incidents.

Technology can help

Emergency response vehicle drivers face a unique set of challenges. Travelling at high speeds while weaving through traffic, manoeuvring in tight spaces and operating in dangerous, noisy environments are everyday hazards for emergency responders to negotiate. They also encounter adverse weather conditions and night-time call-outs in often high-risk situations.

Incidents can be costly and distressing for all involved, yet many could be avoided if organisations invested in the use of readily-available vehicle safety systems. Much of this technology can be retro-fitted to vehicles, giving emergency service operators instant results.

Safety camera systems

Retro-fitting vehicles with commercial vehicle safety systems, such as Brigade Electronics’ best-selling Backeye®360, allows drivers to keep a close eye on all possible blind spots of their vehicle so they can instantly see other vehicles, cyclists or pedestrians.

This intelligent four-camera technology is designed to eliminate vehicle blind spots and assist manoeuvrability in challenging situations by providing the driver with a complete 360 degree view of their vehicle in a single image. The system combines images from four ultra-wide-angle cameras, providing a real-time view on the driver’s monitor. The result is a ‘bird’s-eye-view’ of the vehicle and surrounding area.

Ultrasonic Obstacle Detection

Ultrasonic obstacle detection technology can detect stationary and moving objects and are perfect for road-going commercial vehicles, such as ambulances and fire engines. The ultrasonic proximity sensors minimise both vehicle damage and collisions with pedestrians, cyclists, and objects. The detection system alerts the driver with an audible and visible in-cab warning when objects are within a certain distance. 

Mobile recording

When camera systems are linked to a mobile digital recording set-up (MDR), the recorded footage can provide irrefutable evidence in the event of a collision, or any kind of incident, such as vandalism or theft from a vehicle.

One major benefit of MDR is its ability to support drivers who can often be the subject of increased scrutiny after an incident. The latest MDR systems, such as Brigade’s, also have 3G and 4G connectivity, meaning that data can be live-streamed remotely with real time GPS tracking.

Smart Reversing Alarms

Warning alarms are audible devices to alert pedestrians and workers when a vehicle is manoeuvring. Unlike traditional ‘beep beep’ tonal alarms, which can be almost impossible to pinpoint, the latest technology creates a ‘ssh-ssh’ sound and uses smart technology to adjust sound levels in line with the ambient noise in the immediate vicinity. Utilising a wide range of frequencies, smart reversing alarms also enable the listener to instantly locate what direction the sound is coming from. In adverse conditions, for example if rain is pounding down, the warning decibel level will be increased.

‘MDA Teams’ App

Technology applied to the health sector has made immensely positive strides saving lives in the smartphone era – the proliferation of mobile phones within communities has resulted in faster response times than ever before. Emergency services can be notifiedof incidents significantly quicker with mobile phones than compared to landlines. Smartphone applications have offered the ability to pinpointthe location of callers with a clickof a button so that ambulances can arrive on scene as quickly as possible. Now, smartphones can even minimize unnecessary waiting times at the ER during emergencies.

It is only fitting that Israel’s (thestate affectionately nicknamed the ‘Start-up Nation’) national emergency medical, disaster, ambulance andblood bank service Magen DavidAdom (MDA) represents the pinnacleof this trend of life-saving devicesand applications. Dating back even further than the State of Israel itself, the organization continues until today as a global leader in EMS innovation, including through the development of smartphone applications that provide simple yet innovative solutions to some of the greatest challenges of modern ambulance services.

One of the Israeli organization’s most innovative and recent technological infrastructures is the ‘MDA Teams’ mobile application. With the goal of minimizing any unnecessary waiting or consultation times before ST-segment elevation myocardial infarction (STEMI) treatments, the app streamlines direct communication between field paramedics, responding ambulances, Magen David Adom dispatch centers, on-call cardiologists and receiving hospitals.

With the click of a button, MDA Teams transmits ECGs and patient vitals, combining the main methods used to bypass the time-consuming emergency department in cases of patients suffering acute myocardial infarction ECG showing ST-segment elevation: utilizing automated ECG/ computer interpretation of the ECG and easy transmission to the on-call cardiologists.

For an organization that boasts a 7.6 minutes average response time for ambulances (and half that time forFirst Responders) it is no surprise that Magen David Adom is also working to cut down on the vital minutes between diagnosing the patient and transporting them to any necessary procedures. Developed in collaboration with the intensive cardiac care units, the Magen David Adom technology has shortened the time from symptom onset to catheterization by nearly 40.3%.

The technology also represents a better process to record and document events securely and directly via the smartphone application. First, on-call cardiologists activate their app to indicate they are on-call. When a mobile intensive care unit is calledto a patient having a STEMI, the paramedic can choose the receiving hospitals from a list of hospitals with ICCU and cath labs available. Then, the paramedic can take the ECG and send it securely through the system, also eliminating the risk of a wrong ECG being transferred. The ECG is uploaded via cellular connection from the monitoring device to the patient’s file on the server. The app then sends the ECG directly from the patient’s file to the cardiologist.

Listed in the application are on-call cardiologists, event date and time, ambulance number, main complaint, nearest hospital, urgency level, region and address of the call and patient destination. App features also include documented calls between the paramedic, regional dispatch, medical consult centers, hospitals and on-call cardiologists, along with ECG record and mapped ambulance tracking during transport with the estimated time of arrival. In keeping with privacy standards, no phone numbers are shown on the dialing server.

According to Eli Jaffe, PhD, EMT-P, director of training, PR, volunteer activities, marketing and international relations for Magen David Adom, before the application’s development, Magen David Adom paramedics “used mobile phones to orally describe the patient, symptoms and the ECG. Since smartphones are currently widely used, transmission of the ECG is possible through personal messaging applications such as WhatsApp.”

But this method is not without risks, he noted. “The paramedic may accidentally send the wrong ECG from an earlier patient to the on-call cardiologist, or the paramedic could transmit the ECG to the wrong person, which could lead to a breach in patient confidentiality.”

Additionally, photos taken by phone when in a hurry transporting the patient often results in transmitting a blurry ECG. “These methods are neither effective, secure nor documented”, said Jaffe. “For a true reductionin the symptoms-to-balloon time, EMS-to-balloon time should have a secure, well documented and effective infrastructure.”

Given the grave importance of quick coronary intervention during the deadliest type of heart attack, the combination of clinical diagnosis by trained paramedics and streamlined transportation of the ECG and patient makes the process fast and efficient, substantially decreasing the chance of severe complications, neurological damage, disability and death.

With new smartphone technologies such as the MDA Teams application, such infrastructure is now available to emergency medical teams, yet again highlighting the advantages of mobile tech devices in effectively and efficiently saving lives.