.

I'm not going to clog this up Kelly, except to say good on you for innovative thinking. There are other similar shops around the country that could do same. Preservation content: Lima built Sherman tanks during WWII.

Have your social media person put those questions out on Twitter using the official railroad account with the appropriate hashtags. Make sure your questions show up in the feeds for Andrew Cuomo (@NYGovCuomo), Andy Slavitt (@ASlavitt), Medtronic (@Medtronic) and any other ventilator manufacturers they can find on twitter.

This Cuomo tweet has an email address you might try, but I think public tweets are going to be the quickest way to get answers.

For the UK: https://ventilator.herokuapp.com/

The main responders are hoped to be automotive-type manufacturers with "controlled environments". Once you respond they will send you blueprints if they judge you capable. https://www.theguardian.com/business/20 ... irus-fears

Our decentralized health care system will have difficulty marshaling this sort of coordinated response I think.

Hi Kelly,

This is about masks not ventilators but shows innovative thinking and tooling at work:

https://www.ktvq.com/news/coronavirus/billings-doctor-finds-inventive-way-to-help-with-shortage-of-medical-masks

Sincerely,

Matt

Unless you are set up to bang out CNC production work, I wonder if you will really make the cut? They have a zillion of their own suppliers who are also out of work. But I might be completely off base there.

What you might look into is servicing and refurb of them. There are probably thousands of them out of service in basements and dark corners. The old designs were completely non-electrical, they operated off of the pressure of the O2 supply. These old ones should be perfectly fine for the COVID patients, from what I have read, the new ones are packed with rarely needed features. The medical service techs are about to be completely overwhelmed.

For those who don't know, the basic operation of these things is pretty simple. They pressurize the lungs to a pre-set pressure. (a few MM of mercury pressure, mind you) and then let the lungs vent. The typical rising-falling bellows of the old machines was what set the flow/pressure, the bellows was weighed. So they would fill the bellows, then dump that pressure into lungs. When inhale flow rate dropped, vent the lungs, when the exhale flow rate drops , repeat.

There is a news story on the Internet about a guy in China who kept his disabled son alive for 5 years or more with a home made ventilator.

MIT Research is now running a resource board of various companies and also hosting the crowdsourcing of 3D printing resources for things like masks. Their resources are already full-on in the effort.

My son is part of that, Kelly, you are now posted.

There is a solution to ventilator problem that is ready to go mechanically, but just needs political buy-in. I knew Dr. Bird, saw many of his inventions, and am a member of the inventors club he founded.

Solving the COVID 19 ventilator problem video:

https://youtu.be/ntFQay9cy8Y

Kelly, Check out this site: https://www.projectn95.com/

They seek to connect people who make or can make PPE and medical equipment to support the pandemic effort with organizations that need it. You may be able connect with someone there.

Be very skeptical of anyone who says "the problem is just regulation". Regulation = confirmation. We generally depend on government to regulate, i.e. confirm, that devices, medicines etc that could cause serious illness or death but where the differences cannot be seen by the end customers' eye are produced competently. In the field this board covers, for example, steam locomotive frames are not really regulated, but steam locomotive boilers are heavily regulated. Or on track, ballast is not really regulated, but rail is. Regulation is a solution to the tendency of those who would be paying for doing it right to cut corners to save money, or to use deceptive advertising to sell things that could cause illness or death. As this video notes, there is a fine line between properly inflating a sick lung and damaging it, and we don't want someone's brother in law Clyde building a ventilator using kitchen implements and then damaging someone's lungs.

I’m not familiar with the difference between a regular vent and the fancier types of CPAP. If the patient is a marginal ventilator candidate, would a CPAP be a decent stopgap measure? A lot of CPAPs don’t get used for long because of patient discomfort, choosing surgery or a mouth appliance, etc., while others were replaced with newer models. Clean, service and reprogram might be enough to get the older (bigger, louder, fewer features) machines back in service. Worth a try, or not?

(ETA: Icouldn’t load the video, so if that’s Dr. Bird’s idea excuse me.)

The concern with 'adapted' devices for use in emergency ventilation is that they only work well if other treatment has either stopped or ameliorated the development of ARDS or cytokine storm. In those cases, the combination of symptoms and morbidity require both relatively high positive pressure and good seal against 'expulsion' of virus-bearing fluids -- one of the principal causes, in my opinion, of the high early instance of infection in those tending the 'critically ill'. Much of this is what is expected to be addressed with the hydroxychloroquine/antiinflammatory; more still can be avoided with pervasive early detection followed by prompt prophylactic administration of 3CLpro inhibitors. These are by far the best 'answer' to the ventilator issue in the short run -- in my opinion.

I am interested in an additional class of assistive devices: those that are minimally invasive. Probably the best solution I have seen so far, for subclinical cases requiring assistive support, is a device like the NIOV developed at Dartmouth, which has been commercialized by a company in Irvine, California. In conjunction with a fairly easy-to-source oxygen concentrator and the necessary equipment to heat, humidify, nebulize, etc. the air delivered through the device's specially-adapted cannula, the device already offers reasonable positive-pressure respiration support; it can easily be timed to the patient's own breathing when that is possible (using technology developed for the abortive generation of SIDS monitors). The idea at present is to mass-produce a version of these that can be supplied 'at cost' through Government programs, but not resold except at that cost or lower (with Government right of first refusal to take the device back for the price paid) to eliminate the obvious kinds of profiteering or stockpiling for resale. They have alternate use in CPAP or assistive oxygenation, and perhaps for a version of hyperbaric therapy, once the crisis is over, without cutting into legitimate future sales volume for the full commercial version.

For clinical cases, however, it appears that a high-volume (but mass-flow sensitive) version of oxygen-assisted ventilation is still required. This is where new manufacturing (and perhaps some new technology) is in order. The difficulty with existing kinds of ventilator is that they are highly invasive, and require a variety of medical support including antibiotics for secondary infections due to abrasions in the throat and bronchi caused by convulsions and so forth with the positive-pressure airway inserted. Many patients now have high fever and possibly CNS complication -- see the developing literature surrounding reported anosmia -- and cannot comprehend why the tube is gagging them and they are suffering anoxia from ARDS but confusing it with airway blockage. It may be difficult or impossible to treat this medically without suppressing what remains of the breathing reflex, which implies careful monitoring of the ventilation as if it were anesthesia. This can be done 'electronically' with an expert system ... which to my knowledge doesn't exist yet, although the subsystems to make it do. Any mass ventilator production that only works in a sterile hospital setting, operated by skilled medical personnel, is not going to solve any significant outbreak problems. Likewise, production that isn't completely supported by production and good logistics of all the support products -- the tubes, the lubricant, the cleaning and sterilization for reuse in critical situations, for example -- that are needed to use invasive high-pressure ventilation, let alone use it safely.

I have been working on adaptive reuse of CPAP + oxygen concentration as an intermediate alternative to invasive ventilation. Again more careful control over humidity and temperature is involved, as is the ability to nebulize material. There are difficulties when the typical means of securing and sealing the CPAP mouthpiece have to be used on delirious or semi-conscious patients, and of course where any degree of ARDS is established the pressure may have to be much higher -- and variable to a greater degree -- than in current conventional CPAP equipment. There is, of course, the signal advantage of much lower production cost and a wide market for resale without 'crashing' the market for true medical ventilators.

Kelly: as noted, the MIT resource is probably the best early thing you can do. I had not thought of the 'adaptive reuse' of older respirators, or of new construction of strictly-mechanical devices -- that might, in fact, be something you could undertake directly, or put together your own 'group' of component developers and assemblers to gear up for production. (I suspect that when an actual 'stimulus' bill gets through the weaselry, it will contain lavish finance for projects of that nature; you could easily do the work in project management and development now...

.

All manufacturing is likely to be short on personnel due to the lockdowns and distancing. So it seems like there would be an emerging new market for anyone providing manufacturing services on a contract basis to the many companies that will want to keep some production going during this slowdown. This would apply to all manufactured products and not just medical supplies for the virus. It could be a manufacturing boom for independent contractors, and it's about time.

Article about machinists racing to build ventilators. Has contact info, might be helpful.

https://www.goiam.org/news/territories/midwest/wisconsin-machinists-union-members-race-to-meet-global-ventilator-shortage-amid-covid-19-crisis/