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Sunday, January 6, 2008

The Ventilator is a Lifeboat

The Pandemic Ventilator Project is an effort to try to supply enough ventilators to fill the needs in a pandemic. The original prototype, which you can see elsewhere on this blog is a very basic unit that can be constructed of commonly available materials. It is not a sophisticated design, but with more refinement may be able to provide a very basic level of support.

Lately we have been working on a second prototype. This one we call Vinnie. If you look at my original proposal I had hoped that we might eventually have a more capable unit to offer as well. It looks as if Vinnie may be that more capable unit. We have gone over what we believe is possible to achieve with Vinnie and compared it to the AARC guidelines for mass casualty care, and we hope we can meet these specifications.

The original unit is designed to be built with commonly available components that are expected to be available even with the economic and transportation disruptions that may occur in a pandemic. In order to achieve a design that could encompass the AARC guidelines however, we needed to have more design flexibility. Many of the components in Vinnie are still commonly available components, but some key control components are not commonly available and may have to be custom made. We have made every effort to keep these custom components at as low a cost as possible. Due to this change, it would be required to stockpile some components ahead of time to ensure availability.

Now about the lifeboat story and how it relates. In the early days of seagoing vessels, it was known that travel by ship was a dangerous activity that passengers did not always survive. There was often little that could be done to save the passengers if a ship sank even if they had enough lifeboats, because no one knew the ship had sank and so no one would go to rescue. Some ships had enough lifeboats and others did not. There was little regulation or enforcement. Many ships did not carry enough lifeboats because the owners thought they were ineffective, or the ship was so rugged it could not sink, or they were just too expensive to stockpile.

This changed after the Titanic sinking. After the Titanic sinking, ships were required to have adequate lifeboats and radio communication ability. The regulation changes were not made because no major sinking and loss of life had ever occurred before, but it was because it was then realized that technology had improved so much that it was possible to save a lot more lives than previously.

The Spanish flu of 1918 killed an estimated 50 million worldwide. There was not a whole lot that 1918 technology could do to save the victims. By mid century medical technology had improved considerably. The Asian flu of 1957 and the Hong Kong Flu of 1968 were mild compared to the 1918 pandemic so the loss of life was also much lower. Now with the H5N1 virus, we face the possibility of a severe pandemic similar to the 1918 one. This time however, there is much that modern medical technology can do to save lives. Knowledgeable tracking systems, quarantines and vaccine deployment may reduce the impact considerably. We also have a far greater capability to treat those that are infected.

One of the tools required to treat the infected is a ventilator. Unfortunately, many people say we do not need to have a very large stockpile of ventilators because they believe they would be ineffective, or the vaccines will be so good we will not need them, or they are just too expensive too stockpile.

Having a stockpile of ventilators is like having a lifeboat. Technology has changed. We can save the lives if we want to.

AARC Standard for Mass Casualty Ventilators
Lifeboat Standards

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