The Crisis is Near Now

A High Frequency Oscillatory Ventilator Design

Some of the news items I have been reading say that there will be a particular shortage of high frequency oscillatory ventilators. Many ICU units do not have any or may only have one. This type of ventilator is required to care for patients with the most damaged lungs.

I found a design for such a device in the IEEE transactions on Biomedical Engineering publication. Here is the drawing.















The link to the PDF is located at this link.
The PDF essentially gives instructions on how to build this ventilator.

This device is much more complex than the basic ventilators I have built, but it seems that it would possible to build such a ventilator from common valves, sensors and control systems substituting for some of the components that are listed. The diaphragm actuator for example could be a large bass (subwoofer) type speaker.

It would be great if someone could build one of these unists and get back to me about how feasible it is and how well it works in testing.

Next week an idea for using ECMO.
Don't know what ECMO is?
Have a look.
http://panvent.blogspot.com/2009/09/using-dialysis-machine-to-do-ecmo.html

Now My Rant
Many of the recent reports that I have read indicate that there is a high likelihood that the current H1N1 pandemic will result in very busy ICU units and shortages of ventilators this fall in Canada. Doctors that work in ICU units that have had to treat H1N1 patients with Acute Respiratory Distress Syndrome (ARDS) say that the patients may have to be on a ventilator for a longer time period than they have seen with patients that got lung function complications in normal seasonal flu.

Here is a link to one such news item from CP.
Intensive care units likely to be main battlegrounds in the war against H1N1
There have been many stories like it originating from hospitals in Canada, the US, India, Australia, UK, Brazil, etc.

When I first proposed the Pandemic Ventilator Project two years ago as a means to alleviate some of the needs for ventilators in a pandemic, I expected it might be used for the H5N1 Avian flu. It seemed like a good insurance plan for a pandemic that, if we were lucky, might not even happen. Things have changed a lot since then. Now it is H1N1, people have actualy died from it, and this pandemic might return stronger this fall and winter, killing even more people. The risk of ventilator shortages has gone from a remote possibility to more likely. A lot has changed in the last six months.

Unfortunately, something that has not changed is the development status of the Pandemic Ventilator Project. As I have said several times before, the project has largely reached the limits of what I can do on my own to develop it. I need people with more ideas, more technical knowledge, more clinical expertise and better management and organizational skills than I possess on my own to carry the project further than I have. It would be a shame if we reach the stage where we really could use a ventilator from he pandemic ventilator project, but no one worked on it beforehand to get it ready in time.

Video: Avian Flu: Innovation in Healthcare

11 Sept 12
I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Avian Flu: Innovation in Healthcare
7:19
IBM
IBM collaborated with the Scripps Research Institute and several worldwide government and nonprofit health organizations to help work on developing a vaccine for avian flu by developing tools to assist in predicting the mutations the virus might take and develop vaccines targeted towards those mutations.
The last statement made in the video is very powerful.

Video: On Avian Flu

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

On Avian Flu, Part 1: Is a Pandemic Coming?
8:44
Urgelt
March 21, 2007
Expert virologists estimated that there is a 15% chance of an avian flu pandemic erupting in the next several years, and that the mortality of such a pandemic could be very high.
http://www.youtube.com/watch?v=qcTotoQNUFY

On Avian Flu, Part 2: Vaccines
5:30
Urgelt
March 23, 2007
The flu vaccine industry will probably take many years to provide full protection against any human transmissible strains that may emerge.
http://www.youtube.com/watch?v=gbDift3llvI

On Avian Flu, Part 3: Protective Measures
9:31
Urgelt
March 25, 2007
Some suggestions for protecting yourself against the threat of an avian flu pandemic.
http://www.youtube.com/watch?v=Y-ovLJu6kss

Video: California Pandemic Influenza Preparedness Summit

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

California Pandemic Influenza Preparedness Summit Part 1
University of California Television
March 30, 2006
58:24
This program introduces the need for proactive Pandemic Influenza Preparedness, and highlights the state and federal governments' activities to help protect Californians. The program calls upon citizens to become active partners in the control of a flu pandemic or other infectious disease outbreak. Speakers include Sandra Shewry, Director of CA DHS, Kim Belshe, CA Secretary of HHS, L.A. County Supervisor Zev Yaroslavsky, U.S. Secretary of Health and Human Services, Michael Leavitt and CA Governor Arnold Schwarzenegger..

Video: Davos 07: Pandemics

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Davos07: Pandemics (1/2) monitoring risk
22:42
Pandemics: Monitoring a Risk in Hibernation. After a period of heightened concern, the fear of a new global influenza pandemic has receded from media attention. Yet the risk remains basically unchanged and beyond influenza.



Davos07: Pandemics (2/2) monitoring risk
15:44
Pandemics: Monitoring a Risk in Hibernation. Conclusion of the discussion on the threat of a pandemic at the World Economic Forum in Davos

Video: Emerging Infections: How Epidemics Arise

7 August 15
I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Emerging Infections: How Epidemics Arise
Research Channel and Howard Hughes Medical Institute
1999 Holiday Lectures on Science
Confronting the Microbe Menace Series
57:54
Tackling the complex causes of epidemics, Dr. Donald Ganem explains how mutations in genes and changes in the environment and human social behavior can give rise to new infectious diseases. He cites the influenza virus as an example of genetic changes that have led to epidemics and pandemics. He also shows the impact of weather on a 1993 outbreak of Hanta virus, describes the effect of human migration on the spread of smallpox, and examines what happened when the myxoma virus was introduced in Australia in the 1950s to control the rabbit population.

Video: Avian Flu

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Avian Flu (1): The H5N1 virus
Vetstoria.com
6:49
A veterinarian explains what the H5N1 avian flu virus is all about.




Avian Flu (2): Threat of a pandemic
Vetstoria.com
7:53
A veterinarian explains how the H5N1 avian flu virus may become very contagious and deadly to people.

Video: Protecting the Healthcare Workforce in Pandemic Influenza

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Protecting the Healthcare Workforce in Pandemic Influenza; “Just in Case Curriculum
California Department of Public Health Emergency Preparedness and The center for Infectious Disease Preparedness US Berkley School of Public Health
59:31
How healthcare workers can take care of themselves and their families in a pandemic situation.

Video: Influenza Pandemics: Past and Future

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Influenza Pandemics: Past and Future
Research Channel and The Office of Research and Graduate Studies; University of Michigan Medical School
Third Annual Biomedical Research Symposium; Global Infectious Disease
45:14
Oct 17, 2006

Discussion of the Influenxa Virus, past pandemics including 1918 and how what we have learned can be applied to future pandemics.

Video: Interview of John M Barry author of The Great Influenza

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Interview of John M Barry author of The Great Influenza
KEXL
54:50
February 9, 2005
Interview with John M. Barry author of "The Great Influenza: The Epic Story of the Deadliest Plague in History".

Video: Standing in the Safety Zone

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Video Link Here - http://www.youtube.com/watch?v=pNP9KwFMU6Y

Standing in the Safety Zone
Centers for Medicare and Medicaid Services
25:23
Remembering the 1918 Spanish Flu epidemic and how lessons can be applied to modern flu pandemics
The 1918 pandemic from the perspective of African Americans in Baltimore.

Video: Larry Brilliant: TED Prize wish: Help stop the next pandemic

I have found a few good videos on pandemic planning and ventilators and will be posting these for much of the summer. If you are new to this blog, take a look at the right side of the page to see links to previous articles and the archives.

Video link Here - http://www.ted.com/index.php/talks/view/id/58

Larry Brilliant: TED Prize wish: Help stop the next pandemic
26:02
Larry Brilliant
Feb 2006
Accepting the 2006 TED Prize, Dr. Larry Brilliant talks about how smallpox was eradicated from the planet, and calls for a new global system that can identify and contain pandemics before they spread.

Pandemic Ventilator at Queens Park

Jeff presented his Pandemic Ventilator at Queens Park on June 10. Queens park is the seat of government for Ontario. SciTech Ontario arranged this presentation. SciTech Ontario is the organization that promotes and arranges sponsorship of Science Fairs and participants in Ontario. Several MPPs came to see the display.


Jeff with the Pandemic Ventilator























Showing the Ventilator to the public.




















Jeff won the sponsors choice prize.





















Being interviewed for judging



















Another interested judge


















Jeff with MPP John Milloy

















Jeff was also featured in a newspaper article this week with his Pandemic Ventilator.

Here is a link to the article.

Building a Pandemic Ventilator

On Thursday May 29, Jeff and I gave a presentation about the Pandemic Ventilator Project to some of my friends and colleagues at work. The presentation went smoothly and was well received. We received encouragement from the attendees to continue working on the project. We had the presentation videotaped so that more people could see it. Thank you Manuel for your help and ideas in videotaping this presentation.

The presentation is about 35 minutes in length overall and is divided into 4 sections below as YouTube videos. The title of the presentation was "Building a Pandemic Ventilator”. It is an overview of what we are tying to achieve with the Pandemic Ventilator Project.



Building a Pandemic Ventilator Part 1
9:08
Presented at Grand River Hospital May 29 2008.
The purpose and origins of the Pandemic Ventilator Project and the history of home made ventilators.




Building a Pandemic Ventilator Part 2
6:42
Presented at Grand River Hospital May 29 2008.
A description of how the Pandemic Ventilator actually works.




Building a Pandemic Ventilator Part 3
9:16
Presented at Grand River Hospital May 29 2008.
Some pandemic planning ideas and the future of the Pandemic Ventilator Project.




Building a Pandemic Ventilator Part 4
9:52
Some discussion, questions and a demonstration of Jeff’s Pandemic Ventilator.

Dr. Eric Toner Blog post

Here is an interesting interview with Dr. Eric Toner about pandemic planning with regards to H5N1. Dr. Toner is with the Center for Biosecurity at the University of Pittsburgh Medical Center. I have referenced articles from this group before. There is a lot of useful information available at the UPMC Biosecurity site, and it is frequently updated.

Dr. Toner talks about how severe a pandemic arising from the H5N1 virus could be, and compares this worst case scenario to the projections commonly used by the CDC flusurge software. In case you are interested in alternative projection models to flusurge, check out the panalysis spreadsheet.


Here is the PDF of the Toner interview

If you would prefer to listen to the audio version the links are here:
Part 1 “What is Avian Flu?” (4:23)
Part 2 “The difference in Death Rate Assumptions” (2:50)
Part 3 “Why we need Hospital Interventions” (6:03)
Part 4 “Why Not Enough is Being Done” (8:40)

You can also go to the Health Business and Policy website directly for the HTML version

Health and Business Policy has more pandemic related interviews available here.

Be aware, most of the information on the Health and Business Policy site seems to be older, from about mid 2006.

Pandemic Ventilator at the Canada Wide Science Fair

I mentioned earlier that my son Jeff had built his own pandemic ventilator and entered it in a science fair. At the regional science fair he won; Award of Merit, Gold Medal in Senior Engineering, the University of Ontario Institute of Technology Innovation Award, a Conestoga College Entrance Scholarship, a University of Guelph Entrance Scholarship, a University of Waterloo Entrance Scholarship and a Wilfrid Laurier University Entrance Scholarship.

He also got the opportunity to enter in the Canada Wide Science Fair and compete against the top entries from all of Canada. At the Canada Wide Science Fair he won an Honourable Mention in Engineering and the Engineers Without Borders prize. The Engineers Without Borders prize is awarded to a humanitarian engineering project that can improve the lives of people in developing nations. Jeff will also be invited to the next Engineers without Borders Canada national conference.



Here is a link to the WWSEF awards page.


Here is his project report.



Here is a picture of the ventilator in its case as it was presented at the Canada Wide Science Fair




Here is the compressor





Here is the PLC



This pandemic ventilator design has its own air source so it does not rely on hospital high-pressure air sources. This allows it to be able to be used in settings outside of the standard hospital ICU. It has a link to a PC via LabView software. It has a pressure transducer to measure airway pressures. There are alarms for airway overpressure, line occlusion and loss of air from the compressor. The PC keeps track of minute volume, total volume, respiratory rate, PLC connection status and alarm status. It also shows a real time pressure waveform. The PC could be located outside of an isolated patients room in order to reduce the number of times staff have to enter the isolated room. An external monitor such as this can reduce risk of staff exposure and also reduce personal protective equipment usage.

The video shows the ventilator operating with a lung simulator. The patient overpressure, line occlusion and loss of compressed air alarms are demonstrated.

The Cost of Efficiency

Modern hospitals have become much more efficient than they were in 1957 or 1968 when we had our last pandemics. Today, hospitals are run more like a business than they ever were. Even non profit hospitals and hospitals in countries with socialized medicine or single payer systems have had to run more efficiently. This is not entirely a bad thing. Hospitals have had to become more efficient as the ongoing improvements in health care technology became more readily available. Many more high tech health options are possible today, and they are generally more expensive. We treat heart disease, cancer, trauma, premature birth and organ failure much more aggressively than we did 40 or 50 years ago. We can also routinely save or extend more lives than we did back then. Efficiency is how we afford it.

To make hospitals more efficient we utilize space, supplies and staffing as much as we can. We do not have empty rooms. If too many rooms are unused we close wings and convert them to outpatient departments or offices or close some hospitals. We do not let equipment sit idle, we buy just what we need and rent some extra to get us over the peaks. We use just in time supply systems to reduce excess inventory and waste. We hire fewer full time staff and use temporary staff or pay a bit of overtime here and there to handle the peaks. The average length of a hospital stay has been dramatically reduced.

We no longer have any excess capacity left. We designed it that way. Any hospitals that resisted this change in the past were closed and branded inefficient. This efficiency has a cost though. Our efficient health care systems could no longer handle a pandemic even of the type seen in 1968. Pandemics require far more resources than the ordinary ebb and tide of daily business. Too much efficiency can be deadly.

Quick Review of “Definitive Care for the Critically Ill During a Disaster”

This week the report from the “Task Force for Mass Critical Care Summit, January 26–27, 2007” was published in CHEST. The series is titled “Definitive Care for the Critically Ill During a Disaster”. It consists of five separate articles subtitled:

• Summary of Suggestions From the Task Force for Mass Critical Care Summit
• Current Capabilities and Limitations
• A Framework for Optimizing Critical Care Surge Capacity
• Medical Resources for Surge Capacity
• A Framework for Allocation of Scarce Resources in Mass Critical Care

I quickly read through all these papers this week. I will review each of them in more detail in upcoming postings. You can get all five of the published articles for free at this location. Thank you CHEST for supplying these articles for free. If you are involved in pandemic planning, I urge you to download these papers and read them. They offer many suggestions and solid frameworks for planning your response to a mass critical care incident.

The publishing of these papers has generated a few news reports this week. Most of the newspaper articles were sensational, focusing mainly on the list of classes of people that would be excluded from care. Here are a couple of news links. AP, Globe and Mail.

When you read these news articles you would think that the summit meeting was all about denying care. When you read the actual papers you will see that the summit was really about providing the best care possible under various worsening and even the nearly hopeless conditions that could possibly occur. The sensational articles referred to the list of recommendations of who would be refused care in the most severe crisis. This list was merely a suggestion, and the authors state in the papers that there must be an ethical discussion of these issues by non medical professional people to determine whether society will accept these criteria.

The papers do not focus only on pandemic planning, but stress that plans must be flexible enough to account for many different types of mass casualty incidents. The included charts list nearly every type of incident and the appropriate responses. Still the main focus is on pandemic preparedness. Short of a nuclear war, a severe pandemic is probably the incident that would most stress the existing critical care infrastructure.

Some of the papers I have read before these on pandemic planning were very complex and tedious to follow. Many other papers focus on the numerous problems, give many “what if “ scenarios and concentrate a lot on how little we know. These papers focus more on how to get to a solution rather than moaning about the hopelessness of it all. The planning goals are focussed on three main areas; stuff, staff, and space. Essentially they say you have to have enough of each. If you are well prepared in two areas and short in the third, you are still limited by that area. They focus less on trying to predict the severity of any incident and more on how hospitals can maximize their ability to respond.

Stuff is things like ventilators, medications, PPE and other medical supplies. Staff is the number of staff that are not affected by the event plus the number of addition personnel that can be trained and used as well as how much you can increase the number of patients existing staff can care for. Space is the suitable areas that can be used to provide complex critical care.

In a nutshell, they recommend that facilities aim to increase by a factor of 3, the amount of critical care (including ventilators) they can provide, and also stockpile enough supplies to last about 10 days, with perhaps some additional buffer, and to ensure they can maximize their staffing and space to make this possible. I think these are very good recommendations. They are very similar to the recommendations I posted on the BMG website last year. I also suggested that facilities try to increase their ability to manage ventilated patients by up to a factor of 3 in one of my posts last year.

They warn that manual ventilation will not work. They are very skeptical that sharing ventilators among several patients will work with real patients that have ARDS. They provide an extensive list of requirements that facilities should look for when purchasing ventilators for surge capacity, but acknowledge that is unlikely that anyone will actually buy that many ventilators ahead of time. They also provide a much shorter list of the minimum requirements for a ventilator in suggestion 3.2:

(1) be able to oxygenate and ventilate most pediatric and adult patients with either significant airflow obstruction or ARDS
(2) be able to function with low-flow oxygen and without high-pressure medical gas
(3) accurately deliver a prescribed minute ventilation when patients are not breathing spontaneously
(4) have sufficient alarms to alert the operator to apnea, circuit disconnect, low gas source, low battery, and high peak airway pressures

The pandemic ventilator should be able to meet those short list minimum requirements.



P.S.
My son Jeff is taking his own pandemic ventilator design “Norman” to the Canada Wide Science Fair in Ottawa this week. I will have a more detailed report on “Norman” next week. I think you will be impressed with the work Jeff has done. I am.

How Many Ventilators Does New York Really Have?

A couple of weeks ago, I posted a piece on how hard it is to get good numbers on the quantity of ventilators available. I checked through some documents from the New York State Workgroup on Ventilator Allocation in an Influenza Pandemic. Last year they published some preliminary information and asked for public input on setting up guidelines for ventilator use in a pandemic or similar emergency. I sent in some information to them about the Pandemic Ventilator Project and some of my ideas about how to expand the availability of ventilators and clinical capacity in a crisis, but they never asked me for more details. They recently published some guidelines based on that exercise in Disaster Medicine and Public Health Preparedness. I will have to see about getting a copy of that article and reviewing it.

Anyway, I found two documents by the same workgroup stating the number of ventilators in New York. Unfortunately they quote two different numbers. One is 60% higher than the other. Here are the details:

First we have:
Allocation of Ventilators in an Influenza Pandemic: Planning Document
NYS Workgroup on Ventilator Allocation in an Influenza Pandemic
NYS DOH/ NYS Task Force on Life & the Law
Feb 13, 2007 (listed access date)
Available here:

On page 9, it states:

• the population of New York State is approximately 19 million,
• there are currently 3,981 adult and pediatric ICU beds staffed,
• 15% of the admitted patients with pandemic influenza will require intensive care,
• 7.5% of the admitted patients with pandemic influenza will require ventilators,
• there are currently 6,100 ventilators in acute care settings in New York State,
• at any given time, 85% of the ventilators in acute care settings are in use, and
  
• 70% of deaths related to pandemic influenza are projected to occur in a hospital.

And then we have:
New York State Workgroup on Ventilator Allocation in an Influenza Pandemic
New York State Department of Health/ New York State Task Force on Life & the Law
March 15, 2007
Available here:


On page 1, it states:

a) Community Demographics
New York State has an estimated population of 19,254,630, which represent 6.5% of the total United States population. Approximately 13% of New Yorkers are age 65 or older; an estimated 18%of the state population over the age of 5 is disabled.

b) State & Local Public Health Infrastructure
NYSDOH is empowered to issue voluntary, non-binding guidelines for health care workers and facilities; NYSDOH is also empowered to issue binding regulations for hospitals that would app to standards of care during a pandemic.

c) Health Care Delivery System
There are more than 650 nursing homes in New York State housing 120,000 beds. Of the 240 hospitals in the state, 44 are classified as trauma centers, and 13 are classified as critical access hospitals (CAH) in rural areas. There are 3,981 adult and pediatric staffed intensive care unit beds throughout the state. There are currently 3,861 mechanical ventilators in acute care settings in New York State; at any given time, 85% of these ventilators are in use.


So here we have 2 documents. Both are produced by the same workgroup on ventilator allocation. Both of these documents list Gus Birkhead and Tia Powell as contributors. One of the documents says that New York State has 6,100 ventilators in acute care settings, and the other document says that they have 3,861 ventilators in acute care settings. Both of them say that they have 3,981 ICU beds.

It is hard to know what numbers to believe. As I said before, how can you know how many ventilators you have to stockpile if you are not even sure how many you have now? How can you know how far you can extend your resources and clinical skills capacity if you are not even sure how many ventilators those workers are supporting now? A definitive census is needed with plans that list actual (validated) numbers of ventilators that exist, how many will be added for surge capacity and how far it is possible to stretch clinical support capacity.

Maybe in their latest article, Powell and Birkhead can tell us which numbers are the real ones.

A Home Made Iron Lung for the Hospital for Sick Children

I had some previous postings on home made iron or “wooden” lungs from the 1950s and 1940s. Here is a story of some home made ventilators built by the Hospital for Sick Children in Toronto Ontario to deal with the 1937 polio epidemic. It amazes me how the very same ethical dilemmas regarding shortages of ventilators we may face in an influenza pandemic were forced on these people in the 1930s.

From a Time Magazine article Sept 13 1937:

Toronto during the past fortnight was also the scene of some mechanical ingenuity. Hospital for Sick Children had only one mechanical respirator, and needed at least one more. The only professional manufacturers of this life-saving device are: Warren E. Collins, Inc. of Boston, which makes respirators designed by Professor Philip Drinker of Harvard's School of Public Health; and J. H. Emerson Co. of Cambridge, Mass., owned by John Haven Emerson, inventive son and namesake of New York City's onetime commissioner of health. The two companies long quarreled over patent infringements. Meanwhile, since 1929 only 250 Drinker respirators have been manufactured (price: $1,350 to $2,450), and since 1931 only 30 Emerson respirators (price: $1,000 to $1,600). Neither firm keeps many respirators in stock.

Faced with these conditions, Superintendent Joseph Henry Winteringham Bower of Toronto's Hospital for Children, a civil engineer by training, fortnight ago determined to build a duplicate of a Drinker respirator. All that was required was an airtight container out of which air could be intermittently pumped to inflate the patient's lungs, Superintendent Bower summoned his chief engineer, Harry Balmforth, and his carpenter William Hall. With pine boards, three hinges from a trunk, some metal rings, a rubber sheet, an air hose and a vacuum pump, they did the job. The work took only seven hours The cost was negligible because they used any old thing available. Before this "wooden lung was long in use. Denver set up a wail for a respirator. Two little girls there were taking turns dying without aid of the city's only respirator. Toronto heeded the plea, sent the wooden device. In spite of its use, one of the Denver children died.

Last week Messrs. Bower, Balmforth and Hall, with money provided by the Ontario government, were busily building six steel replicas of their wooden respirators. Final cost for each respirator will be less than $500.



Here is another account, from “The Middle-class Plague: Epidemic Polio and the Canadian State, 1936-37” by Christopher J. Rutty.

The Toronto press focused considerable attention on the need for more life-saving iron lungs as the 1937 epidemic worsened through August. The emergency was leaving "little tots struggling for breath" in hospitals. HSC’s single Drinker machine was used for a small number of mild chest paralysis cases, but on 21 August, a young girl in critical condition was placed in the lung, which happened to be open, but it was clear that she would have to remain in it for a long time. She would then have to be "weaned" off the iron lung when evidence of recovery was clear and periods outside the iron lung could then be progressively lengthened. This situation greatly concerned HSC’s Superintendent, Joseph H.W. Bower. The City of Toronto had ordered one commercial machine for Riverdale Isolation Hospital. London and Hamilton had also ordered lungs. Yet it would be several days at least before Riverdale’s lung arrived, and it would be ten days to two weeks before another one would be available. With this news, Bower knew he would have to build respirators at the hospital for any bulbar cases that might develop.

Meanwhile a four-year-old boy had been admitted with chest paralysis on the morning of 26 August. As the Drinker machine was in use, an experimental respirator for premature infants was modified and coupled with a quickly-built wooden box in which the little boy was placed and stabilized. This "emergency-made ‘lumber lung’" "saved" the child’s life. The boy’s mother then turned to the newspapers to plead for the "wealthy to buy iron lungs," each of which was worth some $2,000. The prominent place of this appeal in the Toronto press reflected the unusual vulnerability to polio among the well-to-do, whose wealth could not protect them from this disease. Two more commercial "lungs" were eventually bought, largely through an "Anonymous Donor." Meanwhile, at HSC, efforts were concentrated on building more lungs. By noon of 27 August, plans were complete and enough parts were ordered and delivered by the next evening to start assembling the first iron lung. Two days later this first lung was complete and placed on HSC’s Infectious Floor; within fifteen minutes a patient was placed in it. By 31 August, four "homemade" iron lungs had been assembled in the hospital’s basement.



Hospital for Sick Children Iron Lung

The iron lung symbolized the disease and its worst possible effects while at the same time it provided the medical community with a specific and hopeful technological tool against them. Still, the limited supply and success of iron lungs, especially during the crisis of an epidemic, frequently raised the difficult ethical dilemma of having to decide who to treat and for how long. Nevertheless, the iron lung also gave the provincial government another opportunity to demonstrate that it was doing everything possible against the worst effects of this disease.


Incidentally, the Hospital for Sick Children (Sick Kids) is a national treasure, I know several people who work there and have had one of my own children treated there as well. They still provide first rate care.


In Australia they also built their own ventilators when they could not purchase enough of the Drinker commercial models in 1937.



Australian made "wooden" Iron Lung

Some Royal Navy men made a ventilator to save the life of a young army officer afflicted with polio in 1944.