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How Spec Ops and DHA Teamed Up to Build an Inexpensive DIY Ventilator

Image of Nurse checks up on a patient in a mechanical ventilator. Click to open a larger version of the image. In this historical photo, a nurse checks up on a patient in a mechanical ventilator called an iron lung. During the polio epidemic, patients often relied on iron lungs to keep them breathing when paralysis affected their lungs’ ability to function (Photo provided by the National Museum of Health and Medicine).

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As the nation was gripped with fear in the early phase of the coronavirus pandemic last year, top doctors zeroed in on one particular concern: a potentially catastrophic shortage of ventilators.

The projected shortfall was about 75,000 at the time.

The soaring demand for these life-saving medical devices prompted a group of inventive service members from inside and outside the Military Health System to set in motion a highly unusual - and highly successful - effort to solve that problem.

The "Hack-a-Vent" challenge called for volunteers to create an inexpensive, non-FDA-approved ventilator that could be made with off-the-shelf items available at home supply or auto parts stores, or via 3D printers.

The evolution of the "Hack-a-Vent" program, initially launched under the auspices of Special Operations Command, spotlights the rapid innovation sparked by the pandemic and how the MHS has relied on outside-the-box thinking to meet the needs of the military community.

The challenge, launched in March 2020, was to design ventilators that would be portable, smaller than traditional ventilators, not use any parts from commercial ventilators, and cost less than $300 each. The commercial ventilators that hospitals typically use cost from $10,000 to $15,000 apiece.

The Defense Health Agency's COVID-19 Joint Acquisition Task Force took up the challenge in late March and created a rapid-response team of medical professionals and engineers. The Naval Surface Warfare Center Panama City Division (NSWC PCD) was one group that took on the ventilator challenge. Leveraging the funding and material resources provided by NSWC PCD's Center for Innovation, a team began work on this critical effort right away.

At NSWC PCD, mechanical, electrical, and systems engineers, along with diving and life support subject matter experts, created a functional design within a week.

It "didn't have all the bells and whistles, but was easy to use by doctors," said Andrew Schicho, an engineer and one of the design leaders.

A second iteration was designed by March 31 under round two of the challenge, he said.

On April 5, the project was funded. The designed ventilator by now had LCD displays, electronic feedback control, oxygen-level monitors, and a breathing loop. By late April, the team's prototype was in animal model testing.

"So, we had a functioning medical device in one month," Schicho said.

"We kept ours as cheap as possible in order to honor the original intent of the program and keep the design accessible to low-dollar efforts," Schicho said. The dollar amounts for vent designs were upped from $300 to $500 and then to $1,000 as more features were added.

Ventilators being transported to the Federal Emergency Management Agency
Boxes filled with ventilators are loaded onto a truck at Joint Base McGuire-Dix-Lakehurst, New Jersey. The ventilators were transported to the Federal Emergency Management Agency, the lead federal agency for COVID-19 response. (Photo by: Air Force Maj. Brian Wagner, Joint Base McGuire-Dix-Lakehurst).

"Usability testing began at Walter Reed National Military Medical Center on April 27, and then a commercial manufacturer did a full review and suggested solutions for medical device grade materials, Schicho said.

Schicho's team went so far as to write up the documentation to get the prototype approved by the FDA, but, by the end of the year, there was a pause in the need for emergency ventilators, he explained. This was because of increased manufacturing of standard ventilators, better allocation to patients, and work-arounds such as shared ventilators. "FDA approval was never the intent," he added.

The U.S. military's unique role in developing new technology for life-saving ventilators dates back several generations.

The first modern respirators were developed during World War I and World War II, said Alan Hawk, historical collections manager at the National Museum of Health and Medicine in Silver Spring, Maryland.

These early ventilators increased the air pressure surrounding the patient's chest to push air out of the patient's lungs and decreased air pressure to allow air to flow back into the patient's lungs. But they were bulky and not easily transportable to the front lines. The devices, known as the Iron Lung, were used during the polio epidemic from the 1930's until 1960, Hawk noted.

The next era of innovation owes a great deal to Dr. Forrest Bird, who had been in the Army Air Corps during WWII.

Bird designed positive-pressure oxygen masks for warfighters who could then fly airplanes at levels up to 35,000 feet. He also created pressurized "anti-G suits" to counteract pilot blackout as the military's new jets hit the fleet at the end of WWII.

Bird was responsible for the development and production of the positive air pressure Bird "Mark 7" respirator and its previous iterations. The Mark 7 was designed in 1957, taking place at the same time that anesthetists were adopting controlled ventilation techniques for patients during surgeries, according to the journal "Anesthesia and Intensive Care."

Bird's Mark 7 Respirator and its derivatives became widely used around the world and are still in use in many places today.

But Bird's greatest contribution to military medical history is the "Baby Bird" ventilator, said Dale Smith, a professor of military medicine and history at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

The neonatal ventilator was invented in 1969 at Wilford Hall in San Antonio, Texas, initially to meet the needs of babies born with acute respiratory distress syndrome at the Air Force military complex, Smith said. Bird saw the potential for its use and began manufacturing the product.

The Baby Bird vent was "the workhorse" of the neonatology unit during the period before pharmaceutical solutions to acute respiratory distress syndrome became available in 1990, Smith added.

"Tens of thousands of people born with respiratory distress between 1970 and 1990 are walking around today because of the Baby Bird," Smith said.

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