With the UK in lockdown and the NHS preparing for the anticipated rise in the number of confirmed cases of coronavirus, there is now an urgent need for medical ventilators, and prime minister Boris Johnson has called on manufacturers to increase national production of ventilator equipment.
On 16 March, the Department for Business, Energy and Industrial Strategy (BEIS) said it was looking for organisations that could support the supply of ventilators and ventilator components across the UK as part of the government’s response to Covid-19. BEIS has set up a website to enable organisations to register their interest.
But, as a recent post from iFixit observed, manufacturers have production limits. It is also difficult to predict the rate of disease transmission, and the proportion of people who are infected who will have severe respiratory problems and will require intensive care and ventilator equipment.
In the post, iFixit – a global community of people who help each other repair things – said hospitals will also have to factor in the fact that as many ventilators and other medical devices are deployed, the proportion of equipment failures could rise.
“Only a few manufacturers host service manuals for their equipment, and there is no central source of information for biomedical technicians to find relevant and useful repair information,” iFixit wrote in its blog post. “Thus, looking up manuals often requires time that is better used saving lives.”
According to iFixit, Frank’s Hospital Workshop, established by a medical technician, has been the primary source for online information on respirators. The technician behind the website said he has worked for 15 years in developing countries, where he encountered a number of issues in health services, including: a lack of spare parts for repairs and maintenance; no technical manuals; poorly or no trained biomedical technicians; and no technical support from the manufacturers.
Although some of these challenges may not previously have been experienced in the health services of developed countries, the lack of ventilator equipment is a very serious challenge to all health services.
iFixit said it has launched a crowdsourcing initiative to support Frank’s Hospital Workshop, to disseminate information that medical technicians require to keep ventilators operating. The company aims to gather as much publicly available material as possible on ventilators and how to service them. “Please help us find service manuals for medical equipment – we want to mirror this information in case his website is inundated,” it said.
iFixit has called on the medical community to offer model numbers of all of the ventilators in use, bilevel positive airway pressure (BiPAP) machines that can double up as ventilators, and other essential equipment, such as anesthesia machines.
It has also asked medical technicians (medtechs) to give estimates on what parts or pieces of ventilators break, or might break, assuming an increased duty cycle, and advice on what parts will need to be reused but will be in short supply. For example, iFixit said bacterial filters will probably become scarce. It has asked the medtech community to look at whether it is possible to design a 3D-printed case that could be used as a clamshell around an N95 mask, which may work as a DIY replacement.
A spokeswoman for iFixit said: “We have received a huge response for our ventilator manual project, especially from our community. Ventilator repair manuals have been pouring in and we have had dozens of people volunteer to help translate or to upload manuals. The biomedical technicians we have talked to are really excited about it.”
The spokeswoman said that although the complexity of repairing equipment will vary somewhat based on which machine breaks and how it breaks, iFixit’s ultimate goal is to narrow down the most common repairs for each machine. It will then write a guide for the machine in a language that anyone can understand.
“The biomeds will probably be able to read the manuals and understand them, but the key is to have them all in one place,” she said. “We don’t want the biomeds spending their precious time trying to find a repair manual somewhere on the internet when they could be using that time to fix the machine and get it to someone who needs it. We want the hospitals to know that there’s a place online where all the guides and manuals live.”
With many non-medical engineers now finding their normal place of work deemed non-essential, such individuals could potentially draw on the online resource iFixit is making available to support hospitals suffering equipment failures.
“We could deploy an army of engineers armed with our guides to help fix the machines,” the spokeswoman added. “That’s a decision that the individuals and hospitals will have to make – we are just supplying the information they need.”