Using Manual Ventilators in a Pandemic Crisis

Some of the current plans for dealing with the expected shortage of available ventilators in a pandemic crisis depend on stockpiling manual ventilators (ambu-bags). They would arrange for teams of friends and family members operate the ambu-bags during the crisis. There is some disagreement as to whether this is a viable option. Some experts dismiss this as being totally unworkable in a mass casualty situation as there are three basic problems with this plan:

1. The physical effort of squeezing a bag continuously is too exhausting for a person to manage very long.
2. Infection control issues related to having many volunteers man the bags in an ICU full of contagious flu victims. The number of deaths due to additional infections generated by such a plan could actually be greater than the number of people saved with the manual ventilators.
3. Lack of monitoring combined with minimally trained volunteers will probably result in a very high morbidity and mortality for the patients.

Now of course it is possible for a team of trained experts to keep someone alive on a manual ventilator for an extended time. In 1955, as a result of a polio epidemic, the demand for negative pressure ventilators exceeded the availability of negative pressure ventilators. There was such a shortage in Sweden that medical students, working in shifts, manually ventilated patients to keep them alive. Now a polio epidemic may sound bad, but the number of patients requiring mechanical ventilation in a flu pandemic will probably be many times higher.

Now instead of throwing our hands in the air in a panic and crying doom, suppose we looked for a way to solve these three problems. Number 1 is easy to solve. Just take an electric motor with some gear reduction and a cam arrangement, to make a pair of mechanical hands to squeeze the bag. The operator can now just turn a control knob to speed up or slow down the rate, or press a button for each cycle if you wanted to have some sort of assist mode going. If you solve problem #1, you also solve problem #2 because you do not need that large group of volunteers.

Solving problem #3 is a little harder. You would need a pressure sensor and an electronic controller to analyze the pressure conditions in the ventilator circuit to determine when alarms such a low rate, high pressure and disconnection occur and sound an alarm. A rudimentary but functional device could be constructed from any standard instrumentation pressure sensor and basic industrial programmable logic controller. If someone worked out a good program ahead of time that was well tested, this could be freely shared to run thousands of devices across the country.

Incidentally, if you were fortunate enough to have stockpiled a quantity of pressure driven transport ventilators ahead of time, you do not get problems #1 and #2. The same monitoring system could be used to enhance safety of these devices for unattended operation.

Clarence Graansma
For more information you can visit my Pandemic ventilator Project blog at

February 25, 2007

ALA: 52 Proven Ways To Reduce Stress

I like that ALA:

FFS – Handout 45: 52 Proven Stress Reducers – American Lung Association site : Procrastination is stressful. Whatever you want to do tomorrow, do today; whatever you want to do today, do it now.

January 9, 2007

From the Mailbag: Question About Batch Treatments

Mark Stuckwish sent us a note:

I am a manager w/30 yrs experience and am very concerned about “batching treatments” with masks. Most patients are nose breathers and the turbinates are giant baffling systems.I cannot find a single recommendation for delivering bronchodilators through the nose, neb or MDI.It’s like throwing pills at a patients. open mouth and hoping some make it in! How long would that practice last? Any studies/concerns from CMS, JCAHO, anybody? I could not access the GB study, just the brief article.thanks. Mark

Anyone care to answer?

Maybe this blog needs to turn into something more like a forum?

UK Lung patients ‘getting poor treatment’

The Observer | UK News | Lung patients ‘getting poor treatment’

Thousands of patients with chronic lung disease are being misdiagnosed and receive poor hospital care, according to the Healthcare Commission.

A national study of chronic obstructive pulmonary disease (COPD), which affects up to one in 20 Britons, has revealed that many patients are receiving very sub-standard treatment. The report, to be published on Wednesday, is expected to say that this may be because of a stigma that it is a ‘smoker’s disease’ and because some people feel that little can be done for patients.

I don’t see the report on the UK Healthcare Commissions site: 

June 25, 2006

MD Turbo: MDI Add-on

MD Turbo:

Improper inhaler use is very common. In fact, most asthma and COPD patients use inhalers incorrectly. The two most common errors are failure to coordinate breathing with inhaler activation, and failure to track doses. MD Turbo is a breath-activated, dose-counting companion to metered dose inhalers (MDIs). It is coming soon, so sign up and be the first to know how MD Turbo™ can help MDI users.

Pulmonary Rehab

Relearning to breathe
Kaiser’s pulmonary rehabilitation program puts patients with chronic obstructive pulmonary disease on the path to better health by teaching them to breathe as efficiently as possible. People whose breathing is compromised can take a six-week class that includes exercise and education on nutrition, breathing and medication.

Bird Flu Dossier

SciDev.Net: Bird Flu Resources

June 13, 2006

Women and COPD

Women with chronic obstructive pulmonary disease (COPD) fare worse than men
Women with chronic obstructive pulmonary disease (COPD) fare worse than men both in terms of the severity of their disease and their quality of life. These differences may play a role in the increased death rate seen among female patients with COPD, said researcher Claudia Cote, M.D., Assistant Professor of Medicine at the University of South Florida in Tampa.

The researchers studied 85 women, and compared them with 95 men who had the same levels of COPD severity according to guidelines of the Global Initiative for Chronic Lung Disease (GOLD). They found that female patients were significantly younger than male patients with the same severity of disease. The women had lower lung function, more trouble breathing, and reported a worse quality of life. The women also received a worse score on the BODE index, which looks at lung function, nutritional status, symptoms and exercise capacity in order to measure a COPD patient’s disease severity and predicted survival.

June 12, 2006

Variety of things can trigger asthma | Variety of things can trigger asthma
The triggers for asthma run the gamut from the obvious to the odd — not just secondhand smoke and cat fur and perfumes and pollen but vigorous laughing or a good cry. Anything that irritates the lungs can make a susceptible person wheeze or worse, explains respiratory therapist Valerie Morgan-Wallace.

June 12, 2006

RTs can do resuscitation – Tom Brodbeck – Crisis at Seven Oaks
But the hospital couldn’t find a qualified ER doctor to fill the shift and had to make do with a family physician instead. Because family physicians are usually unable to handle more serious ER cases, the hospital also planned last night to divert all red and amber ambulance cases to other hospitals, Winnipeg Regional Health Authority spokeswoman Heidi Graham said.

An extra ambulance was added to last night’s shift to help handle the load, said Graham.

Meanwhile, the hospital had to staff the ER with a respiratory therapist to handle resuscitation cases because family doctors don’t do resuscitation, according to the WRHA.

Score one for the RTs!

June 8, 2006