Resuscitation trolleys: human factors engineering.

An essential part of nursing education in the early 1950s was to prepare a special " tray " for different procedures. A textbook , " Tray and Trolley Setting " by Helene Dickie, 1 gave accurate instructions and drawings for the preparation of equipment and drugs for the most important procedures such as colonic lavage, mustard plaster application, and many more. On page 138 is an illustration showing the trolley for tracheotomy (see front cover). This is a well designed set up as the operator can see the equipment and has easy access to whatever he needs. Cardiopulmonary resuscitation (CPR), introduced by P Safar in 1964, required only 10 fingers, the knowledge to perform mouth to mouth ventilation, and the proper way for cardiac massage. Advanced cardiac life support was the next step; equipment and drugs were supposed to be handy and portable so that they could be carried to the patient's bed or in the ICU for rapid and easy access. Today the essential equipment for resuscitation includes more than 100 items—drugs, syringes, electrodes, etc—and easy access to electrical power. In the same way that nurses prepared their trolleys in the past, in the operating room all the necessary items for CPR were located in a special place, usually on a " cart " (fig 1). A similar cart was built for the emergency room and for patient wards. All were designed without regard to basic human factors design. The first carts were simple adaptations of the multiple drawer trolley used by mechanics in auto repair shops (fig 2). Careful analysis from a human engineering view showed that, even though it was easy to mobilize the cart, it was hard to locate drugs in the different compartments and at " time crucial " moments one drawer would not let the other one open properly. For those who used this cart for the first time during a CPR event, it was time consuming to locate a 5 ml syringe or to find a drug ampoule. Commercial CPR trolleys soon became available but they were different from the generic " tool shed " ones. The drawers were larger in order to store large items such as a manual bag ventilator and multiple size masks. A lock to protect the drugs and wheels for easy transport were added; but human factors engineering was still neglected. The carts were designed as a simple …