Why Australia needs dementia friendly ambulances

Transport by ambulance can be a distressing experience for people with dementia. Noisy, enclosed, and unfamiliar, the environment can exacerbate symptoms, destabilise a person’s psychological health and, in severe cases, cause delirium. This adds an extra layer of complexity to the individual’s healthcare, sometimes overshadowing the initial treatment being sought.

To address this, Paramedic Lindsay Bent was awarded a Winston Churchill Fellowship in 2022 to review work by the UK’s National Health Service (NHS) on dementia-friendly healthcare.

In recent years, the NHS has made a series of advancements in the pre-hospital space, including dementia-friendly ambulances and awareness training throughout the organisation.

In conducting this review, Mr Bent hopes to inspire similar changes in Australia – measures he believes are necessary, given the growing prevalence of dementia, and its high rates of comorbidity with acute conditions.

“We have seen a wealth of amazing developments in Australian pre-hospital care, particularly those that improve survivability for out-of-hospital cardiac arrest, major trauma, or stroke. However, less attention has been given to dementia.

“I feel it is important to address this as a nation, given that people with dementia are such prevalent users of ambulance services; and how much scope there is to improve their pre-hospital experience,” he said.

What makes an ambulance dementia friendly?

Modifying the internal environment of an ambulance to better suit people with dementia is about creating a calm environment. Mr Bent says there are numerous ways this can be achieved – from music, to aesthetics, to distractions.

“As an example, you could play music from the patient’s era or their preferred artist – something that resonates with them. You could also cover the standard internal ambulance blind with an image of a local landmark to provide a talking point and distraction throughout the journey.”

Twiddle muffs – woollen gloves which contain objects for repetitive pulling – have also been found to soothe anxious patients with dementia.

“Sometimes very anxious people just want to get out of the ambulance and can fiddle extensively with their seatbelt restraint – a system that is keeping them safe. Twiddle muffs can occupy their hands and distract their minds.”

As a more elaborate intervention, some ambulance trusts in the UK have also introduced reminiscence therapy, via tablets.

“This is where paramedics show videos from a relevant era, to help the ambulance user recall and share events from their past. They could play soothing things, like underwater or nature scenes, historical news reports, war-time speeches, music videos, films or games. This can be really beneficial when the ambulance ride is prolonged or there is an extended wait for hospital admission.”

Are these adjustments evidence based?

The UK’s dementia friendly ambulances are largely based on lived experience and studies from residential aged care facilities (RACF). Much of this research has been on the use of colours.

“For example, a blue floor in an ambulance can give the perception that a person is stepping into a large pool of water, so it is recommended to use alternative colouring,” Mr Bent said.

“This was initially identified after a former World War 2 pilot with dementia refused to get out of bed in his RACF, because the floor was blue and he thought it was the ocean. It was later identified as a broader issue affecting people with dementia.

“Likewise, yellow piping around seats has been shown to minimise anxiety by helping ambulance users easily identify where seats are located.”

Evaluative work on existing interventions has also helped the NHS develop its evidence base.

“NHS ambulance trusts that introduced reminiscence therapy found them to have significant benefit in relieving anxiety and providing a positive distraction, according to paramedics.”

Organisation wide approach

Mr Bent says it is not just physical assets that need a rethink in the pre-hospital space. In line with the NHS, dementia-friendly care should be built from the ground up and infiltrate the organisation, he said.

“You need to make your whole organisation dementia friendly, by providing awareness training to all staff, including corporate.

“People in the community have various touchpoints with ambulances services. They might need to reach out to head office regarding their account, for example. It’s not just about calling 999 [the UK’s emergency services line] or dealing with frontline workers.”

Mr Bent also recommends that all healthcare organisations formulate a Dementia Action Plan and employ a dedicated dementia lead – whose sole job is to execute this plan.

“When the focus is there, you can increase the level of care for particular patient cohorts,” he said.

Further insight

Sharing more insights into his work on dementia friendly pre-hospital care, Lindsay Bent will speak at the upcoming National Dementia Conference.

This year’s event will be held 12-13 June 2024 at the Crown Promenade Melbourne.

Learn more and register here.

About Lindsay Bent

Lindsay Bent is a Mobile Intensive Care Ambulance (MICA) Paramedic and has worked with Ambulance Victoria for more than 34 years, where he currently holds the role of Clinical Lead, Communications Centre.

Mr Bent was the Operational Lead to develop Australasia’s first mobile stroke ambulance – Melbourne Mobile Stroke Unit – in collaboration with the Royal Melbourne Hospital and the Stroke Foundation. He also introduced Ambulance Victoria’s Motorcycle Paramedic response model.

He was awarded an Emergency Services Foundation Scholarship to study ambulance demand management strategies, and the Ambulance Service Medal (ASM) in the 2023 national honours for distinguished service to Ambulance Victoria. He was also admitted as Officer of the Order of St John (OStJ) for sustained loyalty, commitment, and service to St John Ambulance Australia.