From Face Masks to the AmboVent, Makerspaces & Hobbyists Are Rescuing the Healthcare Supply Chain

DIY makerspaces are our new research hubs, test labs, and medical suppliers as hospitals adopt emergency solutions in the fight against Covid-19.

Panel specifications for the AmboVent, a new open source ventilator from Israel being built at makerspaces and manufacturers across the world. Image courtesy of AmboVent.

On Monday, March 23, 26-year-old Lior Trestman attended a virtual meeting with Yale hospital representatives, Yale scientists, and the executive director of the New Haven Manufacturing Association. One item on the meeting agenda was how Trestman and others in the New Haven maker community could help produce medical face shields — crucial pieces of personal protective equipment (PPE) that were becoming nearly impossible to find in the Covid-19 pandemic. Yale received 1,000 newly minted and disinfected face shields the following Monday, March 30. A few miles across the city, the National Guard was staging an emergency field hospital at one of Connecticut’s four state universities.

Hospitals across the globe are facing equipment shortages, and new or rarely used tools are proving helpful in the fight against coronavirus hour by hour, day by day. For weeks, the maker movement has known of its potential to patch the healthcare supply chain. These do-it-yourself (DIY) enthusiasts have not spent the past weeks sitting idly, awaiting the call to action.

With plastic sheets laser-cut at Yale’s state-of-the-art Neurotechnology Core fabrication facility, pieces of closed-cell foam, elastic, and staples, over 1,500 face shields have been assembled at MakeHaven, the sprawling subterranean makerspace and “Fab Lab” (digital fabrication laboratory) where Trestman works as shop manager.

Lior Trestman, shop manager at MakeHaven, with the intubation shield he designed with Yale emergency physician Dr. Reinier Van Tonder. Image courtesy of MakeHaven.

MakeHaven’s downtown headquarters is home to its own laser cutters (medium-sized compared to Yale’s “really big” lasers, according to Trestman), along with metal and wood CNC mills. There’s an electronics workbench, an area devoted to crafting and sewing, and facilities for cooking and brewing beer. Endless high-end pieces of equipment inspire everyone from artists to engineers to seek out a MakeHaven membership, which costs a cool fifty dollars per month.

Trestman’s next project? Designing an intubation shield with Dr. Reinier Van Tonder, an emergency department doctor at Yale. This shield is a clear acrylic chamber placed over the head of patients undergoing intubation (as well as extubation), a rather invasive procedure that provides access to a patient’s airway prior to ventilator use. The shields give healthcare workers additional protection from the mucus, saliva, and various other fluids expelled during this process, and while not a new technology, they are in low supply due to traditionally low demand. Intubation and ventilation procedures have skyrocketed under Covid-19, and the shields are one of the latest pieces of PPE helping to reduce coronavirus contagion in medical settings.

Dr. Van Tonder already had an intubation shield prototype to work with — a crew of Boy Scouts had heard of the shield’s promise and built one for him in a garage. At MakeHaven, Van Tonder and Trestman were able to tailor the shield to accommodate Yale’s tools and hospital beds. The second prototype was tested in an emergency simulation room, and on Friday, April 3, Dr. Van Tonder intubated seven emergency patients with the shield’s protection. A manufacturer 20 minutes from Yale’s emergency room now has the specifications it needs to take orders at volume, and the Van Tonder-Trestman design is being utilized across the United States.

The MakeHaven intubation shield schematic. Image courtesy of MakeHaven.

MakeHaven and its cross-industry collaborators are shifting gears once again. Their goal this past weekend was to finalize a parts list for the AmboVent 1690.108, a ventilator designed by an Israeli collective of Air Force electronic experts, robot technicians, and medical professionals. The AmboVent is listed on MakeHaven’s Covid-19 project webpage as the “Last Resort Ventilator.”

“If you make a ventilator and one of the teensy little resistors or capacitors or batteries stops working? Then someone dies, very quickly,” Trestman told me over Google Hangouts. “It’s a pretty bold proposition for a hobbyist to try to make something like this.”

It was for this reason that MakeHaven affiliates — and many other makers across the world — chose not to focus their efforts on building ventilators when the pandemic first began impacting the medical supply. MakeHaven Operations Manager Kate Cebik has been leading the makerspace’s first distributed project, which allows sewers to pick up raw materials and drop off homemade cotton face masks at unstaffed locations. Research and design is underway on testing swab applicators, and the prospect of converting a CPAP machine into a ventilator (CPAP stands for continuous positive airway pressure. These machines are commonly used to treat sleep apnea).

And as MakeHaven is in collaboration with Yale New Haven Hospital, the neighboring veterans hospital in West Haven, and other medical centers, the organization is also networking with community groups and city institutions to outfit public-facing workers and volunteers with face masks and shields — all while providing vital, open source manufacturing specifications to healthcare suppliers near and far.

Ventilators are 1890 technology in a 21st-century box.

Patients in the neighboring state of New York are sharing ventilators, and the peak U.S. outbreak seems near-impossible to predict. It wasn’t long before MakeHaven joined other makers at the forefront of DIY ventilators. The AmboVent won out over other models due to its buildability and functionality. The design also rates suitably for Covid patients and has high marks for clinician-friendliness.

“Ventilators are 1890 technology in a 21st-century box,” wrote MakeHaven member Dr. Harvey Zar in the group’s ventilator-focused chat. Based in Hamden, Connecticut, Zar is a semi-retired anesthesiologist with a bioengineering background. He estimates he’s intubated 20,000 patients over his forty-year career, if not more.

“We may be able to get some state help financially, and with manufacturing. This would make a great product for the third world and military.”

The AmboVent utilizes a motorized lever arm to mechanically press down on a bag valve mask (BVM), also known as an Ambu bag or manual resuscitator. This handheld medical device sends air into a patient’s lungs when a flexible plastic bulb is squeezed, most often by another person’s hands. BVMs are commonly used by ambulance crews and in emergency settings when patients are not breathing, or not breathing well.

The AmboVent in action. Video courtesy of Ambovent, gif by Gil Morrison.

The U.S. healthcare system is known for extensively tested and vetted medical devices and treatments, and this clever hack may sound alarming at first. But the coronavirus is forcing the medical community to explore new solutions under emergency circumstances. Interestingly enough, even long-term BVM ventilation is no novel endeavor.

“Intensive care was born in the summer of 1952 in the polio epidemic, in Scandinavia,” said Zar. “Teams of anesthesiologists intubated the patients, and people were literally standing there squeezing a bag for as long as it took. That experience is there, it’s just in ancient history for most people.”

There isn’t time for FDA approval of devices like the AmboVent when patients require breathing assistance now and market ventilators are in short supply. MakeHaven’s goal is to build a dependable, working ventilator prototype as quickly as possible. First operation, then optimization.

Zar joined Trestman, MakeHaven Executive Director J.R. Logan, and dozens of other ventilator collaborators in a virtual meeting on Sunday, April 5. Logan had arranged the video conference with a portion of the AmboVent design team. Those on the North American side included Yale’s Director of Neurotechnology, a critical care physician at Montreal’s McGill University Health Centre, and the CEO of a Canadian medical equipment company.

Yuval Eran introduced himself as a paramedic, medical engineering student, and robotics enthusiast. It was day 17 of the AmboVent project, and lung simulated experiments and approved animal testing were both scheduled for the upcoming week.

There was more reason to be optimistic. Eran explained the Spanish car company SEAT (pronounced like “Fiat”) made a ventilator similar to the AmboVent, and promising human trials were underway in an intensive care unit in Spain. SEAT’s design utilizes a windshield wiper motor to press on a BVM, compared to the AmboVent’s snow blower motor. The volume control and pressure sensor chosen by the AmboVent team provided greater opportunity for controlling different ventilation parameters, in Eran‘s opinion.

The biggest hurdle was finding the right people at local hospitals who understood what we had to offer. Once that happened, we were able to build face shields and intubation chambers, and other products they actually need.

MakeHaven also isn’t the only group in the U.S. working on the AmboVent. Another Israeli team member reported there were outfits in L.A., Miami, and New York, plus a Kansas City manufacturer building new ventilator prototypes in partnership with the AmboVent designers.

Mike Kaltschnee, a board member at Danbury Hackerspace an hour’s drive from MakeHaven, was another attendee of the AmboVent meeting.

“We’re on the call because in two weeks Danbury and other hospitals might need ventilators,” Kaltschnee said over email. “We started mobilizing three weeks ago. The biggest hurdle was finding the right people at local hospitals who understood what we had to offer. Once that happened, we were able to build face shields and intubation chambers, and other products they actually need.”

Like MakeHaven and Danbury Hackerspace, many in the DIY community are able to unite against Covid-19 due in part to their proximity. But the plans for a DIY ventilator from Israel are in the hands of U.S. makers thanks to the Internet. The private Facebook group “Open Source Covid-19 Medical Supplies” has nearly 70,000 members and a curated list of engineer and doctor-vetted projects. Localized offshoots of the group exist in Chicago, Nashville, Egypt, Sri Lanka, and Bangladesh.

A spreadsheet comparing the buildability, functionality, and reliability of various open source ventilators. The Medtronic Puritan Bennett 560 scores the highest across all categories, but Trestman said it would take months to build one in a specialized facility.

“The relationship that exists between the designer and management is dichotomous,” writes visionary graphic designer Paul Rand in his 1984 treatise “Good Design is Good Will.” From the 1950s to the 80s, Rand held two long-term teaching stints at Yale, where he was a professor emeritus of graphic design. He crafted the iconically modernist Yale University Press logo in 1985 (phased out in 2009), along with such iconic branding as the IBM, UPS, and ABC logos.

“On the one hand, the designer is fiercely independent; on the other, he or she is dependent on management for support against bureaucracy and the caprice of the marketplace. He believes that design quality is proportionately related to the distance that exists between the designer and the management at the top. The closer this relationship, the more likely chances are for a meaningful design.”

This past Monday, April 6, Trestman and the MakeHaven AmboVent army were busy building their first prototype. The group chat for this project is populated with nearly 30 members. Among them is an MIT-educated mechanical engineer and Yale physician assistant. A machinist. A software engineer. An electrical engineer. The manager of a college makerspace across the state. One could argue this cohort is the perfect image of Rand’s good-design-is-good-will theory, with management and designer working elbow to virtual elbow.

Paul Rand’s Yale University Press logo.

“It took us six days to turn around the face shields, so that’s the bar,” Trestman said. “My hope is we have a kick-ass group that will make a ventilator that never gets used. To be making something over the course of a week or two that is keeping someone alive — it’s otherworldly.”

This six-day timeline would place a working AmboVent in MakeHaven’s hands on April 12. Easter Sunday, which also happens to be Trestman’s 27th birthday. He knows there won’t be a party.

He did imagine some downtime, if only a moment. When it became clear that many establishments would close to prevent the spread of the virus, Trestman thought of an empty shop. With no MakeHaven members making, there was a silver lining: his open schedule could be spent running, playing piano, and relaxing, for a change.

Instead, Trestman is working overtime, one of thousands pivoting from research and design to testing and distribution in facilities founded on dynamism. As manufacturers chug to life in response to Covid-19, the maker community is nimbly supplying the gear, machinery, and mindset the pandemic demands of us.