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A Whirlwind of Innovation

At EMSToday 2014, I had a chance to sit and chat with Dr. Nadine Levick, the founder of the EMS Safety Foundation. She is an Emergency Physician in New York and a tireless promoter of many interesting innovations that directly affect our industry and work. We sat down in the booth she had set up on the expo floor. When I say she’s a tireless promoter, I mean it. Several times during our interview, Dr. Levick would jump up to chat with a passerby, excitedly proclaim how cool these various projects are and greet people whom she had taught and lectured before.

Dr. Levick is a constant multi-taker and her almost-manic energy and enthusiasm are clearly driving forces in promoting that in which she strongly believes. During our interview, she wore a Google Glass headset. Being someone who uses a lot of eye-contact when speaking with others, I found it a little bit distracting. Even so, she was engaged and really, really happy to tell me all about the EMS Safety Foundation, INDEMO and, iRescU. I wouldn’t have been surprised if she was also working up another innovative scheme via her headset while chatting with me.

Dr. Levick is the CEO and Chair of Objective Safety, an organization that, according to its website,

… has unique expertise on safety and hazard awareness in the Emergency Medical Services Transport Environment in addition to safety and injury prevention and control in the pediatric setting.

Dr. Levick tours and lectures on these issues, providing useful guidance to EMS agencies in increasing transportation and in-ambulance safety. The EMS Safety Foundation grew out of that. As well as being an emergency physician, Dr. Levick also has a Master’s in Public Health. She has participated in a lot of academic research, and “what was really, really quite very clear to me, and it’s clear to most people in academia, is lots of stuff we know, it’s not operationalized.” She saw a gap between the things she was learning as a researcher and what was being learned and applied at the operational level of EMS and public safety and there was, “…an increasing need for people in EMS to make operational decisions based on state-of-the art technical science.” She noted that many EMS agencies do not typically budget for the research and investigation needed to access that state-of-the art science. Through Objective Safety, she sought to bridge that gap.

As she traveled and spoke, more and more people came back to her asking for more information and starting discussions about safety innovation. Recognizing that EMS as an industry doesn’t have a lot of money to send its people everywhere to have meetings, summits and discussions, Dr. Levick first made all of her presentation material available to anyone via the Internet. She was quickly surprised at the thousands of downloads that her presentations were logging.

Interest increased and, knowing that there is limited budgets for travel in many EMS agencies, Dr. Levick started a quarterly web-seminar that very quickly turned into a monthly regular event. Everyone who came to her with questions and ideas were quickly drawn in by her enthusiasm and enlisted to help with finding solutions and innovative ideas. The EMS safety foundation grew almost organically as more and more people involved themselves in the process, drawn in by Dr. Levick’s positive charisma. “All sorts of people reached out to Objective Safety and asked me really good questions.  They self-selected. I had this whole cohort of really smart people every year to make this a real going sort of a community.  There they were screaming questions, and great questions! Each one of those people who approached me about Objective Safety was asked if they would be interested to be part of an innovation consortium, and that’s how it started.”

She didn’t just rely on people in the EMS industry. Her previous work and research into ambulance safety put her in close collaboration with automotive and ergonomic engineers. She included them in the collaboration to help find real, applicable and scalable ideas to apply to EMS Safety. Dr. Levick also looked outside the USA. She traveled to RETTMOBIL, a rescue and mobility exposition held in Europe every year and came back brimming with ideas on how to design ambulances in the USA so that they are safer for the patient and the provider. “There was a suggestion to bring a European truck over here. I said, ‘Well, yeah, I can, but it’s not sustainable because it’s going to be gone in four weeks. It’s not scalable ’cause no-one’s going to build it ’cause they’re going to say it’s European it’s not American. And it’s not translatable; different areas aren’t going to be able to adopt it.’ SO I said, ‘No, let’s think of another way.’ I thought what we really want to do is physically demonstrate an alternative way of laying out an ambulance that is driven by technical science: the science of automotive safety, occupant protection, and ergonomic factors, all tangible so you can touch it and feel it, but not branded so it was a European ambulance, not branded so it was so-and-so company built it. Have it a generic illustration, a 3-D illustration of how this can work. It’s one thing to look at a blueprint, it’s another thing to sit your butt in the seat and reach for stuff.

And that’s exactly what she did. Using money earned from her speaking fees from Objective Safety, Dr. Levick had a trailer built which has the exact interior dimensions of a typical van ambulance. True to form, she enlisted the help and advice of other experts: Chris Fitzgerald, an ergonomics specialist, and Ronald Rolfsen, an advisor to the Oslo University Hospital’s ambulance service, on more than just where to put the oxygen and the patient. In the design, everything can be moved, adjusted, finessed and reconfigured, in real time. Someone can get in the design module trailer, sit in the chair on the side of the stretcher, and adjust the chair position almost infinitely until it’s in the perfect spot.

Aircraft mounting track in the INDEMO trailer allows a full range of customization. (photo by maddogmedic)

Aircraft mounting track in the INDEMO trailer allows a full range of customization. (photo by maddogmedic)

Likewise for the stretcher, the monitor bracket, the bag storage and more. Furthermore, the walls are completely transparent, making the trailer accessible to all participants while the live design process is going on. What Dr. Levick and her team have created is a tool by which any ambulance service, fire department, transport agency or, even, tiny volunteer department can specifically and personally design their own ambulance to meet their own specific needs and maximize the safety of innovations such as, forward facing crew seats, seat positioning that allow the usage of seatbelts during patient care, ergonomic protection from back injuries and more. “Yeah, you can do it on a computer, but you can’t sit on a computer.

(photo by maddogmedic)

Layout of the INDEMO trailer.

This you can sit in. This is real world. This is ‘rubber-meets-the-road.’ If you want to lay out your ambulance, you can actually do it on this, move everything around just like Lego blocks bu in the real world and have a good sense of how your operational environment’s going to work.”

Photo by maddogmedic

The INDEMO trailer has see-through walls to enable group participation in the live-design process.


INDEMO, stands for Innovative Design Module. The intention is to get a prototype up and working and then, with the help of crowdsourced funding, create a tool that can be deployed to help agencies design their ambulances to be safer and easier to use. She started a campaign on the medical-oriented crowd-funding page called Medstartr to fund the further development of INDEMO. Check it out and pledge to help.

When I asked Dr. Levick about how she thinks ambulance manufacturers would react to this she replied, in her usually enthusiastic manner. “They’re not experts on ergonomics and occupant protection… They want the end user, the purchaser to make a request…. We’ve tried to fill that void…with technically sound information on what is going to give you the best outcomes. So the manufacturers are delighted about this because all of a sudden it’s like, ‘Oh, great! We don’t have to be guided by all sorts of stuff that may or may not be sound.’ It’s actually worked out very well.”

While working with fleet management system designers and simultaneously trying to teach herself how to use a smartphone, Dr. Levick came up with another innovative idea that can certainly save a lot of lives. As an emergency physician, she sees, along with the rest of us, that cardiac arrest survival rates are pretty abysmal. Even in systems that have instituted “resuscitation academies’ Such as Howard County, Maryland, or where “Pit Crew EMS” systems are deployed with aggressive training, the biggest gap in the chain of survival is bystander CPR.

Simply put: not enough of the general public know CPR, where to find the nearest AED or even what an AED is. Dr. Levick saw that companies can use cloud-based databases to keep track of all the minute detail and locations of thousands of ambulances. Why can’t we do that with AEDs? Furthermore, can that information be gathered by and used by the public?

Thus was born the idea of iRescU. Once again, Dr. Levick used her charm and enthusiasm to enlist a team of experts to design a cloud-based database and mobile phone application to locate, propagate and publish AED location data, provide it to any smartphone-using bystander of a cardiac arrest, feed information to responding EMS providers and provide guidance in the usage of the AED and delivery of CPR. This was all conceived and designed using existing, ubiquitous technology. It’s one of those “Why didn’t I think of that?” concepts. Enough people were impressed that iRescU was chosen as a finalist in the American Heart Association’s 2014 Open Innovation Challenge with Medstartr.

This is one of those innovations that pushes beyond the small world of EMS and into that wide border between EMS and the public. There are other applications out there that try to help with early CPR in the chain of survival. One app alerts nearby CPR trained members of the public if there is an arrest in their area. AED location doesn’t seem to be included in some of these apps and early defibrillation is one of the links in the chain of survival. iRescU hopes to build a database that bridges limited government databases of AED locations by having iRescU app users geotag and update other AED locations and sharing them with all iRescU users. Crowd-sourcing. Now what iRescU really needs is crowd-FUNDING. That’s where Medstartr steps in.

Both of these projects are very dear to me as a paramedic. I am all for innovations and designs that keep me from getting hurt and put out of a job such as the INDEMO project. As a paramedic, it goes without saying that I want to save lives. More accurately, I want lives to be saved and I’m in a much better position to do so if CPR and defibrillation are available and deployed as early as possible in a cardiac arrest. I encourage everyone to learn more about these projects through the copious links I’ve sprinkled throughout this entry.

I walked away from my interview with Dr. Nadine Levick feeling a little dizzy and a little overwhelmed by all the things she’s doing. Dr. Levick see’s opportunity for change and improvement everywhere. She’s not driven to make money or become famous. She sees a need and pushes for a solution. She encourages those around her and is a tireless cheerleader for the causes before her.


-Edited for format & style on 2/16/14