Va. ER physician spearheads intubation PPE production

Virginia College of Emergency Physicians President Dr. Scott Hickey turned to the owners of contracting companies in Powhatan — Michael Potter of Village Building Co. Inc. and David Dowdy of Interior 2000 — to produce boxes designed to protect emergency health care workers while they intubate patients with COVID-19. Designed by Dr. Hsien Yung Lai in Taiwan, the protective box is being replicated in the U.S. to shield doctors from droplets that can spread the disease. The builders are selling the boxes to local health systems at cost of materials and labor, $270. The boxes can be cleaned with bleach or an alcohol solution and reused after each intubation. 

Virginia Business virtually sat down with Hickey, the chairman and medical director of emergency medicine for CJW Medical Center in Richmond, to learn more about the protective boxes. This is part of an ongoing series of conversations with Virginians about how their work lives and businesses have changed during the pandemic.

Virginia Business: Where did the idea to produce these intubation boxes come from?

Hickey: [It came from] Taiwan, where they’ve had this epidemic longer than us. In an effort try to augment the [personal protective equipment or PPE] that we currently wear — particularly when we have to put somebody on a ventilator or intubate them — that’s our highest risk time for exposure to oral secretions, nasal secretions and eye secretions, especially when with patients that you’re trying to ventilate by using a bag — a mask held over their face to breathe through them before we put the breathing tube in. Because that’s the highest exposure time, [the box] just another barrier to block all those secretions from coming out onto us, in addition to wearing our full PPE. It doesn’t completely seal the patient down, it just provides an additional barrier to protect everybody in the room — especially the people at the head of the bed. That’s where the most risk is for us getting hit with droplets.

That’s why this doctor in Taiwan made this box. And there’s no commercially available box like this. People around the world have started making these things themselves. And I made a prototype. I reached out to some friends of mine who are contractors in Powhatan, who immediately said, “We’re going to try.” They made the first one the other day. It was made within about eight hours of asking them. Then we talked about doing more, and [they agreed]. I’ve got a bunch of orders and I’m going to send them to some places tomorrow to start with. And then it looks like this thing might get a bit bigger, [because] a big insurance carrier has contacted us [and is] interested in providing [the boxes] for all the emergency rooms in Virginia. It’s blown up kind of quickly.

VB: Where have you been sending the boxes?

Hickey: I’m … meeting someone in Waynesboro tomorrow morning and then I’m going to meet somebody north of Fredericksburg who wants them for the Kaiser System. The ones out in western part of the state are for HCA, and then we have some orders from the Sentara System to the east of us.

VB: Can they be reused?

Hickey: They’re made of a thicker acrylic. They’re completely reusable. They just have to be wiped down with the standard wipes that we already wipe everything down now in the hospital so we can move them from patient to patient. They’re not intended to stay with the patient. They’re just intended to be there as a barrier when we’re putting them on a ventilator. And then we would take them off, clean them off and be able to use them the next go around.  The reason why this is critical now is because in Virginia, because of the social distancing and the closures that the governor has put in place, we’ve been able to control, in a way, the speed at which these cases are ramping up. So instead of getting this massive number of cases like New York is at one time, we’re getting them but they’re a little bit more evenly paced at the moment.

I expect over the next week that things are going to ramp up. And certainly … by the end of the week, we’ll have the rapid point of care test that gives us a [COVID-19 test] result within minutes. So I think you can expect in the news to see that the total number of positive cases is going to go up very high. We hope that as we test more people and we find out how many people have mild disease or are asymptomatic carriers, that that higher denominator is going to help drop down the mortality rate.

VB: How many hospitals will get the boxes and how many do they need?

Hickey: So we need about 110 of them. They’ll have 10 done today and we’re actually talking about how quickly we can get the remaining number of boxes made if we’re going to provide them for every emergency department in Virginia. It would be our hope that we’re able to get that done by the end of the weekend.

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