ventilator production coronavirus

on the midday news pm wants industry to switch production to make these machines as a model engineer with 4 cnc machines 3 mills 2 lathes etc i would be willing to make any parts i can but how do you offer your services

sorry if this in the wrong thread

Geoff

Geoff, This address was provided by our local Chamber of Commerce at the request of the national organisation so suggest you contact them directly.

I agree there are many of us who would be well placed to produce small parts for this emergency - even if it was for out of pockets expenses only !

[email protected]/

Regards John

PS I wonder if the team has any ideas information on how one would make such a device - a simple version - form everyday easily available products ????

Edited By JohnF on 18/03/2020 14:03:20

Makes you wonder. With all the tooling that forum members have, + the knowledge it's a shame your idea could not be used. Even if it was to make a particular part.

With my knowledge I could sweep up & make tea.

Steve.

Edited By Steviegtr on 18/03/2020 14:04:56

Contact the Prime Ministers Office maybe at No 10

The Cabinet Office sent an 'urgent request for resources' that was presumably distributed to companies nationwide through various channels (I received it via the local 'combined authority'

The request is moderately wide ranging but also quite specific - they are looking for people with experience in certain industry sectors (medical devices, pharmaceutical, suppliers and sub-contractors to the above), and also companies that already manufacture/supply 'critical components' that might go into ventilators.

I suspect that things are steered to a large degree by this being a highly regulated area. They don't seem to be looking for general manufacturing capabilities.

Reading between the lines - people with relevant expertise/experience may be diverted from their current jobs into the manufacturing effort.

There is a parallel track sourcing manufacturing/warehousing space.

Edited By David Jupp on 18/03/2020 14:11:32

I wonder where JCB fit into this?

I should think there are quiet a few now idle multi axis machines with things like motorsport on hold or service parts for aircraft not being in such demand the could be put to use. Then there are all the injection mouldings, composite parts and electronics probably better farmed out to Nissan subcontractors who now don't have a factory to supply.

I can't imagine that they were produced at a vast rate and it may be a case of a lot of the existing component suppliers just dropping other contracts an concentrating only on parts for these machines as they would have die, patterns, jigs etc and be able to meet the specifications.

Producing ventilators for whales I should think, nothing smaller.

I had a similar thought when the news came over the radio on Sunday afternoon. I'm not sure to what extent the UK government are willing/able to engage with 'grass roots' offers of assistance - so far the stuff in the media seems to be focussing on big concerns like JCB et al.

Many of you will dislike Facebook but there is a group on there discussing grass roots production of things to help with the outbreak - not just ventilators.

The group is called 'Open Source COVID19 Medical Supplies'. Be warned that sorting out the signal from the noise is a challenge but there is some good stuff on there if you genuinely want to know how practical it would be to make the right kind of ventilator and what else might be useful.

Many of the UK and US folks seem focussed on 3d printing as the main way to make things, stepper motors as the motive power and Aruinos and similar as the controller. There are some folks on there in other countries who are trying to do things with less high tech approaches.

Personally (and I suspect like many), I would be willing use my limited facilities to help but there is also a danger that too many helpful people without any idea of how to help may actually have a negative effect. Unless I can see a definite way to help then I will avoid adding to the noise on the group.

If any of you skilled folks have production capability or expertise that could be applied, you can register here:

https://www.gov.uk/government/news/production-and-supply-of-ventilators-and-ventilator-components

Adrian

(returns to lurking)

+1. The volumes required are vastly in excess of the quantities any exponent group of model engineering techniques or equipment could possibly turn out in the required timescales.

Edited By Mick B1 on 18/03/2020 18:46:58

I would suggest it's not that easy, as modern ventilators are exceedingly complicated.
Germany ordered bucket-fulls some time ago, as did one or two other countries, and have allegedly managed to find some extra (Spanish) nurses from somewhere.
For some reason, we seem to be lagging behind many other governments in a variety of ways.

This Financial Times link contains an embedded letter which sheds some light on the more modern kit.
Essentially, as well as the kit, you need the staff who know how to use it.

I have no idea of the authenticity of Dr G's comments, but they do provide valuable explanation, assuming they are valid.

For the record, I am not an NHS ICU consultant in the South East of England... But if I were to imagine having done ICU since 1986 I might make some observations:

The old ventilators were essentially mechanical bag squeezers that inflated the lungs and then paused to let the gas out, before repeating the cycle. They had little sophistication, but meant that a person did not have to physically squeeze the bag, unlike the medical students who were enlisted to do this in 1952 during the polio epidemic in Copenhagen.

**LINK**

In the early 1980s we were ventilating patients after long operations, cardiac operations, head injuries, sepsis and the like. The key point is that the lungs were not the primary cause of the need for intensive care. Indeed, if the lungs started to fail, with Adult Respiratory Distress Syndrome, as it was called then, the patients usually perished. It was during the 1980s that more sophisticated ventilators were developed. We started to get Siemens machines which allowed alterations in the timings of inspiration and exhalation, they also allowed us to put positive end expiratory pressure into play. This meant that the patient would breathe out against resistance. The effect of this is to hold the tiny airways open and the alveoli, and to push fluid back into the circulation instead of having it sitting in the lungs and reducing oxygenation.

These machines are now the norm. They are smothered with sensors and we can measure most things and record changes that allow us to adjust the therapy. For example we can calculate lung stiffness and how it is changing with our therapies. We cannot do this with bag squeezing.

The sensors make the process less dangerous. If we get it wrong, the ventilator can cause barotrauma. At its most extreme we blow a hole in the patient's (diseased) lung and then we have a tension pneumothorax, which is rapidly fatal unless we stab the chest and insert a drain to allow the lung to re-expand. More often, the barotrauma causes microscopic damage that delays or prevents the sick lung from healing. The sensors also alert us if the tubing kinks or disconnects. Unchecked these simple things are quickly fatal.

So, to run a patient with acute lung injury/pneumonia as their primary diagnosis, to keep the oxygen going to the vital organs, we need all the sophisticated settings and sensors and alarms. We also need a highly-trained ITU nurse who can operate the machine, take the readings from it and alert the ITU doctor to adverse changes. When we introduce new ventilators, it takes several weeks for our nurses to become comfortable with them (think airline pilot and new aircraft type). We start them on simple cases where the ventilation settings are basic and the patient is not needing a variety of drugs by infusion and other time-consuming tasks. Once the nurses are happy with the new ventilators, we start to use them on the sicker patients; the nurses are, by now, more reflexive in their use of the ventilators.

So, imagine the perfect storm of non-ITU nurses being put in charge of a desperately sick patient who is attached to a ventilator that none of us has seen before! Mark my words, there are no spare ITU nurses. We will have to start using nurses who have not got the extra qualifications. They will need to be given reliable machines with good ergonomic fail-safe designs.

(I still remember two patients that we killed in the 1980s simply because their ventilators were not properly assembled; the modern machines would alarm and actually describe the fault on their displays.)

Currently all of our machines are German or Swedish. They have undergone years of development so that the alarms give us information according to urgency, the controls are intuitive, every kind of ventilatory mode is possible. They have been tested and CE marked and the companies take responsibility for their machines, through produce liability.

If the government introduces the Johnson Mk 1, or it arranges for a digger company to copy established ventilators, will Matt Hancock assume responsibility for any deaths due to malfunction, or due to our nurses not knowing about the machine's foibles? At present, we may get these machines (possibly) but we would be very unlikely to use them without assurances from the NHS that individual nurses and doctors would bear no responsibility if the machine malfunctioned and destroyed a patient's lungs, or simply failed to deliver 16 breaths per minute 24/7.

Without the nurses we are just window dressing. Sadly, many of our excellent and numerous Spanish nurses have left, because they only accrue seniority pay on their return to the Spanish system if they are working in an EU country. Our loss, Germany's gain apparently.

Bill

Thanks for a really good clear explination of so many issues.

Steve

I think established industry has the production capacity. It just needs to be redirected from making precision hydraulic control systems, fuel injection systems, engines, etc etc to making medical kit built to existing designs.

I don't think the situation is like WW2 where demand outstripped total industrial capacity so home engineers were recruited to add to the output from their garden shed workshops.

The current situation is a real good argument for governments to subsidise or at least tax-assist the automotive industry. You then have the factories and myriad smaller specialist supply factories in place to be used to make specialist items in an emergency - be they weaponry and ordnance or medical kit.

Here in Australia we just got rid of the last car factory -- along with the rest of manufacturing -- so there is nowhere much left to be swung over into manufacturing medical kit if need be. All we can do these days is serve lattes to each other in the "service economy".

\rant

Edited By Hopper on 18/03/2020 22:50:31

I think the most anyone outside the ventilator-manufacturers themselves can be expected to do is make individual parts, but would have to work under stringent QC measures, at the very least close dimensional inspection, and very likely with full materials-traceability - not to mention extraneous bumph like the ISO9001 management-control scheme.

They would also be expected to make large batches, so probably be given CAD/CAM files for direct use on sophisticated machine-tools; and emergency or not, under conditions of normal commercial confidentiality. To some extent that is made easier by relative anonymity - titling the drawings by part-number alone, for example.

Model-engineers were indeed recruited in WW1 to make parts for shells etc., but modern manufacturing and quality-control methods in fields such as medical equipment are almost certainly beyond all but a few of us now.

Even those of us (well, you, not me) able to take on the work physically may also run up against the problem of insurance. I don't mean of product-liability, because you would be making small parts under rigorous inspection rules from a supplied drawing and possibly supplied materials; but just of household and model-engineering cover. Despite the circumstances this would be a commercial enterprise, outside of what the car insurers call " social, domestic and pleasure ".

So whilst we might all look at our workshops and wonder if we can help, I think wondering is all we can do.

Sadly true. Between 20 and 30% of British shells failed to explode in WW1 mostly due to inaccurately made fuze parts. At the time the professionals struggled to make them correctly, discovering there's a difference between a master-craftsman taking hours to do a good job, and the need to make 60,000 near identical items per day. Amateurs made too few parts and what they made was more likely to be out of tolerance. Amateur work was more useful for less critical turned parts, but it was never more than an adjunct - couldn't do quality fast enough to make a difference. The experiment wasn't repeated in WW2.

My other hobby - amateur radio - has much more chance of being useful in an emergency. HF and VHF radio don't depend on complicated technologies like the internet, telephone networks, mains power, or satellites etc. It's good for sending short terse messages, locally, nationally and internationally. Not very likely to be used in anger because modern communication systems are pretty resilient. We're in big trouble if Boris ever needs my help to talk to the Donald!

Dave

Edited By SillyOldDuffer on 23/03/2020 09:40:55

I'm absolutely sure British industry has the capacity but whether it can be harnessed in time is going to be the big question, hopefully we have some decent facilitators behind the politicians?

Tony

One of the ministers the other day mentioned the specs were online, google has finally found them.

**LINK**

I must admit I was expecting it to be full schematics on how to build one. These specs mean you have to design and test your own, hardly a rapid way to produce them.

Maybe after you register they will allocate component work.

Adrian

I would have thought the lead time to production would be a major problem. The manufacture of the tooling to make the parts required would be a major hurdle. I expect many of the parts would be proprietary so the makers would need to man up to work round the clock 24/7. I suspect that most medical equipment suppliers only work a standard week so there would be a possibility to ramp up production significantly. Even if companies have comparable machinery they will not have the jigs and tooling to make parts. I would think the crises will be over and forgotten before equipment could be reliably supplied.

Mike

Apart from the need for extra ventilators, there is a constant and just as essential need for PPE for the front line staff. The present issue, in a number of cases, is demonstrably insufficient - particularly face masks. Maybe someone has considered the following, but I haven't seen it mentioned. ...

Scattered around UK airports are large (and increasing) numbers of out-of-service airliners. Each one has at least 2 HERO quick-don oxygen masks, plus further similar for the cabins, They are regularly serviced and should be easily disinfected, if required. I would think it would be very quick and relatively simple to 'harvest' well over a thousand such initially, with more and more becoming available (unfortunately), Additionally oxygen facilities may well be suitable for removal and use. The airliners would not be held up for eventual return to service because of the other required servicing constraints Thoughts?

rgds

Bill