One of the greatest challenges facing Maine health care workers in the coming weeks will be ensuring they have enough face masks and other gear to protect themselves from catching the new coronavirus, particularly if there is a rapid increase in the number of patients needing to be hospitalized.
Now, a loose network of Maine doctors, engineers and craftspeople has been working to quickly produce a simple new tool that could give them some extra protection against the contagion: essentially a clear plastic box that’s open on one side and has a few strategically placed holes and flaps.
The box would be placed over the head and torso of a patient lying face-up, allowing a doctor to stick a breathing tube into the patient’s mouth but preventing the pathogens that the patient expels during intubation from landing on nearby health care workers or in other parts of the room.
While those so-called intubation shields do not appear to be widely used, Maine also wouldn’t be the first place to use the concept. According to news reports, some other providers in the U.S. and Canada have been adopting them.
Dr. Jonnathan Busko, the medical director of the emergency department at St. Joseph Hospital in Bangor, recently got the idea to develop the shields after learning on Twitter that they had been used in another country — he thinks it may have been South Korea.
While medical workers would still need to wear personal protective equipment — or PPE — and take a number of other precautions, the shields would provide added protection when they are most vulnerable to being exposed to the virus, according to Busko. Intubation can cause patients to cough and spread droplets of the virus around the room, but the box would contain the virus until it can be decontaminated.
“While we are all trained how to take off PPE properly,” Busko said. “Obviously the less contamination you have, the lower the chances that a slip you didn’t even realize happened can contaminate you.”
Now, a number of Maine groups are working to speed up the development of those shields so they can be deployed in hospitals.
With his colleagues at St. Joseph Hospital, Busko has produced a prototype that includes a frame made of PVC piping and clear plexiglass siding, both of which can be disinfected. It also includes disposable plastic flaps at both ends, including one side with arm holes that would allow a doctor or respiratory therapist to reach the patient’s head. Workers at the Bangor hospital have already produced more than a dozen of the devices.
At the same time, Busko and some of his colleagues have been working with the University of Maine’s innovation and economic development office to develop a more refined, ready-made version of the shield that could eventually be produced by a manufacturer and supplied to hospitals.
Jake Ward, the vice president of that office, said that its engineers and staff have been working with various Maine health care organizations to develop technologies that could help them take on COVID-19, the disease caused by the coronavirus.
For example, the office is working to develop a similar type of shield to be used at Maine Medical Center in Portland. The devices could end up being made out of clear plastic sheets that have been cut to size and glued together.
“We’re building prototypes and letting them test them, then making modifications,” Ward said. “We want to get to a point where we have a product that will work in that hospital setting.” He added, “There is a manufacturer that is in the wings ready to make them.”
After Busko shared the idea for the shields via email with other Maine emergency department directors, it caught on with at least one other physician: Dr. Jay Mullen, an ER doctor who leads BlueWater Health, a Brunswick-based company that provides staffing to hospitals in Maine, Massachusetts and Vermont.
Mullen, who lives in Freeport, is now working with a local carpenter to produce a version of the shield and deploy it in the hospitals his group serves, including Mid Coast Hospital in Brunswick and Houlton Regional Hospital. He said that the shields may also help doctors to provide other critical services that bring a high risk of exposure to COVID-19, such as bronchoscopies and breathing assistance for asthma patients.
With a nationwide shortage of protective gear, Mullen said, the new shields could at least help health care workers to prolong the use of their existing PPE by reducing its direct exposure to the virus.
“Because we can’t buy or make it fast enough, we’re using Yankee ingenuity to provide protection for health care workers without getting in the way of taking care of patients,” Mullen said.
At St. Joseph Hospital, workers have been practicing how to use the new shields, according to Busko. But as of Wednesday, they had not yet needed to use them on any patients.
Busko said that it’s still crucial for Mainers to isolate themselves in their homes to prevent the spread of COVID-19 and buy more time for hospitals to prepare themselves to treat it. But he said the state has been fortunate to learn from other countries and parts of the U.S. that have already seen large numbers of COVID-19 cases.
“There are thousands of physicians around the world who are laying out very clearly what their experiences have been,” Busko said. “It has let us think — outside the chaos of a surge — of exactly what we need to do to be ready.”