The last three weeks have been among the most fast paced in my career, and wanted to take a breather to share what has been highly repeat [free] advice to several groups and individuals who have reached out for sake of not having to continue to repeat these things.
First I’ll set the tone – we are amidst very serious times. People need to be kept alive, and it has very unfortunately come down to the great potential of makeshift solutions. This holds true both in modifying and/or creating new ventilators, and in exposure protection for those on the front lines. Serious, serious stuff. I think it is incredibly exciting to see so many groups coming together to address these issues, but have been continually amazed at how infrequently these groups have someone involved that is expert in life systems engineering, integration, or operations.
Why am I being contacted? Good question – I’m just a dummy diver. Most people think diving entails going flippity floppity on a pristine coral reef. Indeed, that is a highly visible portion of the community. Professional divers can range from ex-convicts to those with PhD. level prowess, and until now perhaps, have had little acknowledgement in the public eye regarding what a diver can lend to these types of emergencies. It should be known and recognized that ‘diving science’ is a field unto itself and there are many highly skilled people in underwater industry sectors that are in the thick of serious life sustaining technology for highly challenging scenarios on a day to day basis – and that includes fast paced in the trenches improvisation as part of the norm.
The overwhelming majority of human population are terrestrial dwellers only, and if asked what the three critical elements are for human survival, they would say “food, water, and shelter”. The rest of us would find a fit for “the ability to breathe”. Divers are stripped of the ability to breathe every day and therefore dependent on technology to assist. The types of technology can vary, but all serve the fundamental purpose of supplying a life sustaining atmosphere to breathe. Facing this every day, divers minds are conditioned to be thinking about challenges in life support – designing, building, trouble shooting, improvising, identifying contingencies, and all of that coupled with how it may impact our own physiology. It is all the very same lines of thought and problem solving rationalization that can be applied in any environment where a life sustaining atmosphere needs to be maintained – underwater, underground, in IDLH atmospheres, in space, and in a hospital. It’s all the same stuff. That’s what we do for a living – so for the groups that have recognized this and reached out, I thank you. For the rest – find someone similar that can throw in their two cents.
For those wondering why they should consider my input with any validity, I have no interest in regurgitating my CV, but will offer a few concise bullets from my career that illustrate the parallels to the problems at hand:
- I have modified off the shelf life support with custom oxygen injection mechanisms that permitted very deep diving below 400 feet of depth, when the off the shelf system presented much shallower limitations. I know a little bit about oxygen supplies, how to plumb them, how to implement for life sustenance under harsh conditions, and have gone on to design/build multiple similar life support systems for underwater use with thousands of hours of keeping myself alive.
- I spent 3 years working with a friend who is permanently dependent on a medical ventilator, and coached him through engineering requirements to put himself underwater while dependent on the ventilator. I am familiar with ventilators, how to (and how not to) modify the ventilator circuit including compatible parts and pieces, addressing flow rates, mitigating carbon dioxide retention, and addressing how factory settings can be pushed to the limits. This is all very dangerous without prior experience and input from a respiratory therapist or pulmonary physician.
- I have design/built and gone on to patent structures for human occupancy with enclosed atmospheres and designed equipment that can sustain life within these environments. This includes fan driven circulation of breathing gasses in response to ventilation rates. I’ve bet my own life on these innovations, and it directly carries over to those trying to modify things like CPAP units for improved ventilation of cov-19 patients.
- I’ve done my share of working within really nasty hazmat environments including wastewater treatment facilities, within underground sewer conduits, and within compost digesters. Yes, I know about Personal Protective Equipment and related hazmat biocontainment. Procedures for entering these occupational workspaces have direct parallels to entering spaces with high density contagion.
Within the emergency management and standard operating procedures for hospitals, everyone is of course doing the best they can with what they’ve got. On the fringes where things are falling apart, those from outside are trying to help, and things are emergent enough that the help has been welcomed in some cases. That’s both good and bad – it depends on where the help came from.
Some groups have reached out to me for advice – some are viable projects that are gaining traction as potential solutions to the ventilator and/or PPE shortage issues, others are not viable. The mere fact that a diver is being asked for help shows how desperate the situation may be. Divers are always called last – even for an underwater problem. The 11th hour calls are always an emergency, and that is how our industry has engineered itself to operate. We invest in a state of readiness to be able to respond emergently, and then someone has to reluctantly pay for it. What we do is serious, highly skilled, has come with significant investments, and is our job – this is what we do.
That said, I will urge caution and lend some general free advice which I’ve provided consistently:
- don’t recreate the wheel
- simple is good
- pick up your head and look around you
- don’t force solutions that aren’t going to work
- be nimble
- engage the help of someone that knows about respiratory circuits, both within and outside of medicine
- yes, we all want to help – help us help you.