Repairing ventilators and COVID19 medical equipment – the big challenge ahead

We co-hosted a webinar entitled “Are We Prepared to Repair COVID-19 Medical Equipment” with industry ally ABI Electronics, a Yorkshire-based manufacturer of advanced diagnostic and component-level repair equipment for industries like transport, aerospace. 

Two things bring us together: the underlying belief that our society and economy need to value maintenance and repair, for the economic and environmental benefits they bring, and an urgent concern for what the next weeks and months will bring during this pandemic in the UK.

Together we wanted to explore how we can maintain and service all Covid-19 related medical equipment given it will be put under unprecedented use in the coming weeks and months. 

Even the new ventilators and CPAP machines being manufactured now by Dyson and Mercedes Formula One will need to be repaired and maintained.

Seen from outside the medical and biomedical field, but based on both negative and positive experiences we bring from other sectors, we genuinely wondered: are we ready?

Panelist perspectives

Our panel brought a great deal of insight, from within the biomedical industry, as well as transferrable insights from ABI’s work in other industries, as well as activist perspectives from iFixit and Open Rights Group on the barriers to repair.

Dr John Sandham
Chairman of EBME (Electronic and BioMedical Engineering)

He’s worked in medical industry for 35 years (last 20 as chairman of EBME site). The biggest issue at the moment: unprecedented number of devices being put into service (e.g. in Excel Centre AKA Nightingale Hospital 50,000 devices). We could be looking at 200,000 pieces of equipment UK-wide. Trying to commission all this equipment is difficult. In a usual hospital, one technician looks after around 1,000 pieces of equipment. We don’t have enough qualified technicians to look after all the new equipment, even though lots of engineers are moving from hospitals to field hospitals. The good news: engineers don’t necessarily have to be BioMed specialists, particularly for low-risk equipment. He believes the sharing of service manuals is very important and it seems to be starting to happen now.

Dr Helen Meese
Founder and MD of The Care Machine

A huge amount of equipment will be arriving in hospitals in next few weeks, and lots of effort required to maintain them. Dr Meese is part of clinical engineering team at the Excel Centre, or Nightingale Hospital and has been trying to work with engineering institutions to recruit volunteer engineers to support existing biomedical engineer workforce. They are currently putting together teams for London, Manchester and Birmingham after an overwhelming response of 622 respondents in just 24 hours. All are professionally trained and qualified and can support servicing of devices over next few weeks. The next challenge is to focus on rest of the country – look out for more calls for volunteers for other areas coming soon.

Willian dos Santos
International Sales Manager, ABI Electronics

ABI designs and manufactures electronic diagnostics equipment across many different sectors (defence, aerospace, manufacturing, biomedical etc.) They have been advocating a triple approach on medical equipment: building new ventilators or breathing aids, re-commissioning and repairing older ones and working with biomed engineer networks and offering their technology at subsidised prices and free training. But, lots of biomed engineers have said to ABI that they feel their hands are tied by liability if they adopt new procedures and solutions.

Olivia Webb
Outreach Coordinator, iFixit

iFixit have been creating repair documentation for consumer electronics for consumer electronics for 16 years. They’ve been hearing for years that medical manufacturers have been restricting access to documentation. They are now working to compile a database of documentation (manuals for ventilators specifically at the moment) relating to medical equipment. Lots of people from their large online community have volunteered. They’re organised on the site and soon they’ll create step-by-step repair guides for each type of ventilator, which will be translated into other languages by volunteers. Then they will then move onto other types of equipment, like imaging equipment.

Jim Killock
Director of Open Rights Group

The Open Rights Group is concerned usually with freedom of expression and privacy. But here they are concerned with “digital rights management”, more commonly associated with digital music and e-books, but it is spreading into other areas like cars, tractors and medical equipment. Software (which can be copyrighted) is being embedded into medical equipment, technical restrictions placed on this software, meaning that only the vendor can access/manage the software, including for diagnostics. Use of the equipment often requires cloud software provided by vendor. This is all protected by copyright law. Often, international treaties back up these kinds of measures. Companies may well need to respond by removing their DRM on their devices in order to facilitate repair.

Questions, some answers and the big challenges ahead

We were reassured by Dr Sandham and Dr Meese that we will have the people and most of the critical equipment in place soon. According to Dr Sandham, the UK doesn’t have big  stockpiles of decommissioned equipment like other countries. Also, they believe that CPAP (continuous positive airway pressure) machines currently being produced will contribute significantly to meeting the needs of people hospitalised for COVID19.

However the panel raised real questions about whether the current ways of working and systems and procedures to maintain equipment will be appropriate during this crisis. Professionals on the ground are concerned with issues of regulation, legal hurdles like intellectual property and perceived liability.

Here are some of the take-aways from a really productive Q&A.

People

• Volunteer engineers will be trained up to work under supervision of clinical engineers at NHS field hospitals. They are absolutely up to the task of helping with set-up and maintenance of equipment, especially less critical equipment.
• A culture of risk aversion has arisen among biomedical engineers and technicians – sometimes the fear of liability for changing procedure prevents sensible repairs and solutions. Managers can play a role in changing this.

Spare parts and supply chains

• Service contracts can stand in the way of timely repairs. Leadership is required from engineering management on when/how to break away from service contracts.
• Before a moment of crisis, professionals must be empowered and trained to perform component-level repairs and find new supply chains for spare parts.

Documentation and diagnostics

• The need for new, streamlined test and maintenance procedures became apparent. Again, leadership and management is needed to convey this and reassure biomedical engineers.
• Some manufacturers are moving towards publicly releasing service manuals after a long history of keeping them locked away. This should be encouraged and institutions should bring pressure to bear on those that are lagging behind. The public can help through iFixit’s initiative.
• More clarity is needed on the question of intellectual property “lockdown” on key often-replaced parts and software by manufacturers. There are precedents for the reverse engineering of software, but what about physical components?