-The closest comparison I can make is
to what it must have been like to be in the middle
of the London Blitz during World War II.
You know, there are people dying literally every time
you walk out of the ICU.
The projections, just to give you a size of the problem,
were that New York was going to need 20,000 ventilators
at the peak.
We had about 5,000 or 4,000 available to us,
and this was such a big disparity
that we needed a solution.
-As a frontline critical-care doctor,
I don't want to give up on anyone.
If you don't have enough resources, then you say,
"Okay, we will have to figure out a strategy,
because losing is not an option."
-There's a lot of MacGyvering out there,
and some of it is doable, and some of it is not doable.
-Today we are gonna talk about how a specific CPAP
and a BiPAP machine can be converted into a ventilator.
The goal is to save as many lives as you can
with the resources that you have.
-I kind of felt like when I was watching
the movie "Apollo 13"...
-We have a situation brewing with the carbon dioxide.
-...that we're confronted with a life-threatening problem.
That's COVID.
-Those CO2 levels are gonna be getting toxic.
-Well, I suggest you gentlemen invent a way
to put a square peg in a round hole.
-And then, in front of us, we have a box.
And in the box is the BiPAP device.
These are very small but powerful devices
that are used for patients who have sleep apnea
or other respiratory problems at home.
My question was, can we use these devices
to ventilate patients in the ICU?
-We got to find a way to make this fit into the hole for this
using nothing but that.
-And so, what I really needed was for our team to figure out
how to take what we have at Mount Sinai
and come out with a solution.
They went, and they developed the protocol,
a protocol to connect this device
to an endotracheal tube
using supplies that are commonly found
in all respiratory therapy departments around the country.
-And you've probably heard of the effort
to try and put two patients on one breathing machine
at the same time.
Very dangerous and not at all something you would want to do
without having thought out all the aspects of it.
The innovation that's gone there
has made that at least theoretically possible.
And, of course, that doubles the number of ventilators you have.
-Now, the liability issues also in COVID
are covered by the changes in the malpractice law,
where now the standard is gross negligence.
If a conventional ventilator is available, it should be used.
-I'm the one who's looking my patients in the eye
and telling them that American College of Chest Physicians,
American respiratory therapy association,
and American anesthesiologists association
has said, "We can't do this, so goodbye."
And I can't do that.
What I will do is I'll say, "Look,
I have this experimental option,
and this is the last resort.
This is not my first choice."
I actually want to show you
how you can actually use one ventilator
to actually give breathing capacity and help
to not one, not two, not three, not four, not five
but actually seven people.
So, this one outlet is equal to four,
and then five, six, seven patients
are connected to this.
-Putting seven patients on a ventilator sounds great.
There are physiologic problems,
but there are other, much simpler problems.
How do you move seven patients?
How do you get seven beds close enough together?
Two is already overwhelming.
-Really, that splitting protocol,
we would think, would only be entertained
in the setting where there are no conventional ventilators,
no home devices that can be used.
And then one might entertain a split-ventilator protocol.
-The machines that we have are used to make toys.
We design and make prototype of our toys.
We have a factory in Ohio -- Little Tikes.
We have retooled a portion of Little Tikes factory in Ohio
just to make these ventilator masks.
We came up with this mask
that, basically, you put over the face of a doctor.
It has filters on the top.
Then we turn around and made another version for the patient,
where you put these on the patient's face
because the ventilators can damage lungs
because the intubation can damage lungs.
So, what we have came up -- come up with for these masks,
there is no tube going into the lungs of a patient.
And you can force oxygen in her or his lungs,
and when the patient breathes out,
there is a 100% filter
so that doesn't come out to go to the operation room
and affect nurses and doctors.
-Right now, at Mount Sinai,
we have more than enough conventional ventilators.
We've already hit our peak.
-At our end, we're starting to think about
the obvious but forgotten problem,
which is, what happens in Africa, in India,
in places like the Caribbean and in the South Pacific,
where an entire country may have one or two ventilators?
So we're thinking and trying to work with our colleagues
at generalizing this to the point
where we can actually package it for them
when they get hit three or four weeks from now
and try and mitigate what is going to be a disaster
beyond anybody's perception.
-COVID's terrible.
I don't need to convince anybody about that, right?
This is something that never should have happened.
But there have been some changes that have been made
so we could be able to do more with what we have right now.
For example, there is now financial coverage
for delivering telehealth.
This is a program that we're just starting this week,
whereby when patients are gonna be discharged from our hospital
with lung conditions,
they're gonna be provided with this oximeter.
It will flag patients who have a lowering of their oxygen level
or a change in their condition.
And then we contact the patients to follow up.
And so, these are other examples of innovations
that we've been able to now deploy in this setting
that are gonna have utility in the post-COVID world.
There are times in your life when you just have to
give everything you have for as long as you possibly can
because there's so much at stake.
And for us in New York, this is that moment.