Submitted by: Yvonne Drasovean and Dave Wall, Fanshawe College
On March 11, 2020, the World Health Organization declared the novel coronavirus (COVID-19) outbreak a global pandemic. The chaos of news and information from around the world that followed brought on a heightened state of awareness for healthcare workers. There was so much to learn, prepare and provide so that Canada did not experience the challenges of the pandemic in the devastating way other countries did. Healthcare workers became the heroes everyone looked up to with hope. Respiratory Therapists were vaulted into the spotlight overnight. “I can’t stay home, I’m a Respiratory Therapist” profile photo frames appeared all over social media! We took pride in our profession and appreciated the recognition it deserves. From fear of the unknown to the excitement of being able to make a difference for the community, every respiratory therapist stepped up to the occasion. While our full time place of employment, Fanshawe College moved our work into a virtual world, we returned to bedside practice to lend a helping hand to acute care at London Health Sciences Center and St. Thomas Elgin General Hospital. As the pandemic was critically affecting an increasing number of patients there was an acknowledged shortage of ventilators worldwide. The case was likely going to be direr in countries with more limited resources and less resilient healthcare systems.
On March 18, the Montreal General Hospital Foundation , in collaboration with the Research Institute of the McGill University Health Centre , launched a global innovation challenge, Code Life Ventilator Challenge, calling for teams to design a simple, low-cost, easy-to-manufacture and easy-to-maintain ventilator which could be deployed anywhere needed to save lives. The idea was that the wide availability of rapid manufacturing (3D printers, computer numerical control (CNC) machines) combined with low-cost computers (such as smartphone, tablets), will offer the possibility of a simple, broadly available ventilator with sufficient performance to help hospitals get through the pandemic. With the dawn of COVID-19 and the potential of a critical shortage of mechanical ventilators, The-Code-Life-Challenge organizers assembled a committee of expert advisors (ICU physicians, engineers and respiratory therapists) who defined precise specifications for this ventilator challenge and ultimately judged the submissions. Team requirements asked for at least one relevant medical professional with publicized credentials (proof of right to practice) and one relevant technical/engineering professional with credentials to approve safety requirements and each team member was required to provide a short resume of qualifications relevant to the design (engineering degree or industry experience). To say that building a low-cost, simple, easy to use and easy to build ventilator is a challenge, is probably the understatement of the year. As users, we take for granted that when we input our settings and initiate our ventilation strategies the ventilator just works. We often overlook the design and functionality of the machine because what we, as clinicians, are truly interested in is the outcome. We realize that all ventilators used in our ICUs have many hours of research and development behind them to make them inherently intuitive to a trained user. Just because someone knows how to drive a car doesn’t mean they know how to build one. So what were we then thinking trying to build a ventilator when what we really know is how to use one? Lucky for us, Toyota Motor Manufacturing Canada does know how to build cars and it just so happens that we teamed up with an incredible group of engineers that were up to the task of using their car building know-how and applying it to ventilators.
On March 20, we assembled the team and entered the competition with four engineers: Moe Bdeir, Chris Loates, Daniel Adam, Leon Drasovean, and two respiratory therapists: Yvonne Drasovean and Dave Wall. This moment gave us a renewed sense of purpose and pride in our profession. The work began on Monday, March 23 to design a ventilator and meet the deadline of March 31st when the best 10 ventilator designs were being selected to continue to the semifinals. There were more than 900 participating teams with over 2500 participants from about 90 countries in this initial phase of the competition. And so we were off, venturing into this unknown world to give our best effort at a seemingly impossible task to design and build the Covinator-FT (F-for Fanshawe, T-for Toyota).
From the first brainstorming session, we realized that work needed to be completed at a furious pace. Due to quarantine measures, we were unable to meet in person as a team and therefore defaulted to connecting virtually anytime there was a question, a thought, a problem, a change, etc. We started collecting equipment and dropping it off at team member’s houses, as well as reading manuals and educating each other on processes of both mechanical ventilation and engineering. The group quickly adapted and came together. The engineers at Toyota took all of the plans and collaborative efforts and started 3D printing parts, assembling pieces and building a prototype ventilator. When a prototype was completed after only seven days, we finally met as a team under social distancing guidelines for the first time at the Toyota Woodstock assembly plant.
Our challenges were far from over. For example, we realized that standard medical connections we are accustomed to, such as DISS medical gas connections, were not standard in car manufacturing facilities. We adapted to the situation and ‘Macgyver’d’ fittings and connections to make things work (there are very few problems that a 22 mm and 15 mm connector won’t solve).
With all of these challenges, seeing the prototype that was designed and built by our team in such a short time function and ventilate a test lung predictably was an incredible feeling. Bench testing, user guides, manuals, manufacturing processes, assembling instructions and some finishing touches were all that were remaining. The Covinator-FT was then packaged up and sent on a truck to Montreal for judging.
The Covinator-FT is a time triggered, pressure controlled ventilator that has the potential to be used safely on patients in time of need. An incredibly innovative addition that we are very proud to offer is the ability to control the Covinator-FT remotely with a tablet. This can reduce clinician exposure by allowing changes to ventilation without entering a contaminated area. The Covinator-FT also has the potential of using one central controller (tablet) to manage a fleet of Covinator-FT ventilators in the ICU. The user would be able to check the ventilation status of multiple patients and make changes as needed. To be clear, this is not one ventilator with 4 breathing circuits attached, but rather up to 20 independent ventilators with one common controller, including ventilation status display and alarms.
Regardless of the outcome, the rewards of this challenge were never about prize money or exposure, but rather the ability to apply and share our team’s knowledge and innovation to hopefully make a difference. We are proud to say that the Covinator-FT was selected as one of the top nine entries to the Code Life Challenge Semifinals!
The tragedy of this pandemic has taught us many lessons, including the importance of working together to turn challenges into opportunities. We plan to use the Covinator-FT at Fanshawe College for teaching purposes, to inspire innovation and encourage student respiratory therapists to think outside of the box, collaborate in multi-disciplinary teams, and every once in a while try to do the impossible.
The Code Life Ventilator Challenge website is https://codelifechallenge.com with social media hashtag #CodeLifeChallenge