firetender
Community Leader Emeritus
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A vision, to be fully realized, requires a coming together of forces. If that doesn’t happen, it misses its moment and dies.
It really wasn’t enough that Kouwenhoven and his colleagues realized electrical defibrillation could restore function to an ineffective heart. What good is a grand concept if no one is going to use it?
And the vision, of course, would be that any stricken person could have access to the life-saving abilities of the technology. When you think about it, the vision was YOU!
It was an incredibly simple mechanical intervention in concept but almost completely useless to anyone other than an experimenter under highly controlled conditions. The machine that made it all happen was just too big and unwieldy to make it practical for use on any but a highly select few; and they were experiments!
But before anything could happen that would be able to go beyond the laboratory doors, you still had to give the experimenters something that THEY could work with.
Researchers like Kouwenhoven the engineer, would make their conceptual connections and have their vision of the mechanical needs of the device. They then would either sketch out the plans or build a prototype themselves from backyard parts and then, once they had the basic components well-defined, take what they had and what they learned to one or more medical-equipment manufacturers and then work along with them to further refine the end-product.
Today, we’d call it a “boutique” manufacturer; one who produces a highly specialized type of product. Enter Levinthal Electronics, a small, California-based company that supplied electronic instruments for medical research. Among their limited line of products were internal defibrillators and in its very earliest experimental stages, a cardiac pacemaker.
This company was the first to begin building production model defibrillators. Its employees were used as consultants for surgeons who used the defibrillators on laboratory animals. Tom Corbin, a man in his twenties and new to the medical industry, began working for the company as a production engineer. He understood packaging.
In his book, Harthrob; the true story of the discovery of CPR and the struggle to get the concept of Emergency 911*, Tom places us into his own skin as he finds himself part of a team called upon to make innovations by researchers like Kouwenhoven and others into useable, practical and safe operating form. You might say, he was the guy that made it all real.
He played a major part in the design of many of the machines that Kouwenhoven used as he and his team came to better understand the bigger picture of cardiac resuscitation. This began a career of innovations in medical technology that laid the foundation for the monitoring/defibrillating equipment you use today and in the process, showed us the way to design an ambulance to be more than a delivery truck.
And every step of the way, he had to overcome the almost overwhelming resistance of the medical profession to embrace new technology. In a nutshell and how this all directly applies to you, it really boiled down to getting the new machines into such portable and useable shapes that the doctor would have to listen to the idea of providing advanced intervention in cardiac emergencies on the street.
During the period from about 1954 through 1960, the time of Kouwenhoven’s publication of his findings Tom Corbin and Elliott Farnsworth, who provided the marketing savvy for the medical products line of Levinthal, were teammates in the realization of a very new way of thinking.
To give you an illustration of what was happening; let’s look at their first major product and failure, the Electrocardiophone.
At the time “monitoring” the patient during operations was a visual and hands-on process, usually undertaken by the anesthesiologist whose business then was literally “passing gas”. Yes, there were electrocardiograms at the time but it was not the business of the surgical team to anticipate cardiac arrhythmias – largely unknown and little understood by most practicing doctors outside of the laboratory. They simply told you the heart was beating!
You couldn’t even bring one of those machines in to the operating suite because they emitted sparks which could ignite the anesthetic gasses which would then fry the patient and everyone in the room!
To solve the problem, Al Morris, Levinthal’s initial designer, transformed the electrocardiographic signal into an audible sound. Corbin’s job, as he described it, was “to take an idea defined by others and turn it into a reproducible product.” In this case, refining Morris' design so it would dependably tip off the surgical staff that a potentially fatal abnormal cardiac activity was occurring with the patient.
Upon hearing the rhythm of the sound change from regular beats into an arrhythmic staccato of noise, the surgical team would know the patient’s heart was fibrillating and then could crack open the chest and begin internal cardiac massage followed by internal defibrillation. The instrument was sealed into an explosion-proof housing.
Nobody went for it.
Just getting the equipment to surgical suites for evaluation by surgical teams was a chore. Besides not being convinced of the need, it was not easy to handle – you actually had to train people in its use -- and the shrill sounds were both “penetrating and annoying”.
No matter. Tom went on to continue to further influence the medical community to utilize monitoring in the O.R. He was learning. He took advantage of the fact that anesthetic gasses were heavier than air, therefore sinking to the lower levels of the operating suite. Tom designed a cart to hold monitoring equipment that was high off the floor and insulated to avoid any sparks from connecting with the gasses! From now on, Tom said, he would “develop products in consort with, not in isolation from, the end user”. And that’s what he did.
Levinthal contracted with the Air Force to build an external defibrillator for use on pilots who were now reaching supersonic speeds and in danger of blacking out and going into fibrillation. There had been successful experiments on small animals and it was felt this technology could be applied to prevent stricken pilots from having to have their chest opened for resuscitation, wasting precious time.
The major problem was that the external defibrillator, because it had to discharge a much higher voltage to penetrate the skin, bones and tissues of the subject was incredibly large and cumbersome. Remember, this technology was all about vacuum tubes!
After producing a number of prototypes for the Air Force, Levinthal was contacted by Johns-Hopkins University School of Medicine and William Kouwenhoven. He contracted with them to build modified production models of the external defibrillators for their use.
What was basically happening is that as the "Space Race" provided new, smaller and easier materials to work with, Corbin and his crew refined and packaged them for ease of application and his reputation was spreading.
Now, Corbin was becoming very aware of the needs of medicine. While with Levinthal he began development of what was to become a “Dual-Trace Cardioscope” which displayed two traces on the cardio-screen, one being heart activity and the other being either a different angle on the heart, a BP tracing, or EEG. Detecting unexpected complications now was becoming something that could be integrated into the development of medicine.
By about 1959 Levinthal’s products were in use throughout the clinical research community and in some pioneering hospitals as well. Since the medical products division of Levinthal has always been secondary to its larger, military contracts, the tide started to turn and by the time Kouwenhoven published his ground-breaking paper in 1960, Tom Corbin and Elliot Farnsworth had swung a deal with the company and gone independent.
Corbin-Farnsworth, though not the only player in the field, pretty much and quickly set the standard for such electronic medical instrumentation in the industry. And Tom Corbin became a master innovator not only in packaging but in laying a foundation for thinking about the applications of technology to medicine. It wasn’t long before C-F became the world’s foremost manufacturer of cardiac defibrillators.
Between the formation of the company, and through its absorption by Smith, Kline and French, Tom spearheaded the development of major products that redefined the industry and, to a significant extent, the practice of medicine. Here is a partial list of some of these innovations:
Even though these specialized units were present it did not mean that patients elsewhere in the hospital would have access to them. They could easily be stricken and before they could be brought to the appropriate room, be dead.
Dr. Joel Nobel designed a highly specialized, self-contained Crash Cart for cardiac resuscitation. It was on wheels and meant to be quickly moved right to the patient’s bed. The patient was moved on to it and worked on by a team.
Carefully laid out and planned for convenience and utility, each team member had easy and immediate access to every tool he or she could possibly need. The doctor designed his prototype with enclosures for Corbin-Farnsworth equipment -- the most compact, well-designed and efficient products on the market. It was about 54 inches long, 26 inches wide and 33 inches high.
For the first time, the Emergency Room was brought directly to the patient, and this was in the hospital! For the first time, the patient was fit into a highly sophisticated equipment system.
Maybe you’ll consider all this the next time you want to call your paramedic unit a rig, bus or truck!
One of the first “Max Carts”, manufactured by Corbin-Farnsworth is currently on display at the Smithsonian Institution. Since necessity is the mother of invention, go visit your Grandma!
NEXT: Man’s Best Friend!
References:
* http://www.amazon.com/Harthrob-Tom-Corbin/dp/0961444398
http://www.nationmaster.com/encyclopedia/Defibrillator
http://protomag.com/assets/cpr-a-handson-history
https://www.ecri.org/40years/pages/max_cart.aspx
It really wasn’t enough that Kouwenhoven and his colleagues realized electrical defibrillation could restore function to an ineffective heart. What good is a grand concept if no one is going to use it?
And the vision, of course, would be that any stricken person could have access to the life-saving abilities of the technology. When you think about it, the vision was YOU!
It was an incredibly simple mechanical intervention in concept but almost completely useless to anyone other than an experimenter under highly controlled conditions. The machine that made it all happen was just too big and unwieldy to make it practical for use on any but a highly select few; and they were experiments!
But before anything could happen that would be able to go beyond the laboratory doors, you still had to give the experimenters something that THEY could work with.
Researchers like Kouwenhoven the engineer, would make their conceptual connections and have their vision of the mechanical needs of the device. They then would either sketch out the plans or build a prototype themselves from backyard parts and then, once they had the basic components well-defined, take what they had and what they learned to one or more medical-equipment manufacturers and then work along with them to further refine the end-product.
Today, we’d call it a “boutique” manufacturer; one who produces a highly specialized type of product. Enter Levinthal Electronics, a small, California-based company that supplied electronic instruments for medical research. Among their limited line of products were internal defibrillators and in its very earliest experimental stages, a cardiac pacemaker.
This company was the first to begin building production model defibrillators. Its employees were used as consultants for surgeons who used the defibrillators on laboratory animals. Tom Corbin, a man in his twenties and new to the medical industry, began working for the company as a production engineer. He understood packaging.
In his book, Harthrob; the true story of the discovery of CPR and the struggle to get the concept of Emergency 911*, Tom places us into his own skin as he finds himself part of a team called upon to make innovations by researchers like Kouwenhoven and others into useable, practical and safe operating form. You might say, he was the guy that made it all real.
He played a major part in the design of many of the machines that Kouwenhoven used as he and his team came to better understand the bigger picture of cardiac resuscitation. This began a career of innovations in medical technology that laid the foundation for the monitoring/defibrillating equipment you use today and in the process, showed us the way to design an ambulance to be more than a delivery truck.
And every step of the way, he had to overcome the almost overwhelming resistance of the medical profession to embrace new technology. In a nutshell and how this all directly applies to you, it really boiled down to getting the new machines into such portable and useable shapes that the doctor would have to listen to the idea of providing advanced intervention in cardiac emergencies on the street.
During the period from about 1954 through 1960, the time of Kouwenhoven’s publication of his findings Tom Corbin and Elliott Farnsworth, who provided the marketing savvy for the medical products line of Levinthal, were teammates in the realization of a very new way of thinking.
To give you an illustration of what was happening; let’s look at their first major product and failure, the Electrocardiophone.
At the time “monitoring” the patient during operations was a visual and hands-on process, usually undertaken by the anesthesiologist whose business then was literally “passing gas”. Yes, there were electrocardiograms at the time but it was not the business of the surgical team to anticipate cardiac arrhythmias – largely unknown and little understood by most practicing doctors outside of the laboratory. They simply told you the heart was beating!
You couldn’t even bring one of those machines in to the operating suite because they emitted sparks which could ignite the anesthetic gasses which would then fry the patient and everyone in the room!
To solve the problem, Al Morris, Levinthal’s initial designer, transformed the electrocardiographic signal into an audible sound. Corbin’s job, as he described it, was “to take an idea defined by others and turn it into a reproducible product.” In this case, refining Morris' design so it would dependably tip off the surgical staff that a potentially fatal abnormal cardiac activity was occurring with the patient.
Upon hearing the rhythm of the sound change from regular beats into an arrhythmic staccato of noise, the surgical team would know the patient’s heart was fibrillating and then could crack open the chest and begin internal cardiac massage followed by internal defibrillation. The instrument was sealed into an explosion-proof housing.
Nobody went for it.
Just getting the equipment to surgical suites for evaluation by surgical teams was a chore. Besides not being convinced of the need, it was not easy to handle – you actually had to train people in its use -- and the shrill sounds were both “penetrating and annoying”.
No matter. Tom went on to continue to further influence the medical community to utilize monitoring in the O.R. He was learning. He took advantage of the fact that anesthetic gasses were heavier than air, therefore sinking to the lower levels of the operating suite. Tom designed a cart to hold monitoring equipment that was high off the floor and insulated to avoid any sparks from connecting with the gasses! From now on, Tom said, he would “develop products in consort with, not in isolation from, the end user”. And that’s what he did.
Levinthal contracted with the Air Force to build an external defibrillator for use on pilots who were now reaching supersonic speeds and in danger of blacking out and going into fibrillation. There had been successful experiments on small animals and it was felt this technology could be applied to prevent stricken pilots from having to have their chest opened for resuscitation, wasting precious time.
The major problem was that the external defibrillator, because it had to discharge a much higher voltage to penetrate the skin, bones and tissues of the subject was incredibly large and cumbersome. Remember, this technology was all about vacuum tubes!
After producing a number of prototypes for the Air Force, Levinthal was contacted by Johns-Hopkins University School of Medicine and William Kouwenhoven. He contracted with them to build modified production models of the external defibrillators for their use.
What was basically happening is that as the "Space Race" provided new, smaller and easier materials to work with, Corbin and his crew refined and packaged them for ease of application and his reputation was spreading.
Now, Corbin was becoming very aware of the needs of medicine. While with Levinthal he began development of what was to become a “Dual-Trace Cardioscope” which displayed two traces on the cardio-screen, one being heart activity and the other being either a different angle on the heart, a BP tracing, or EEG. Detecting unexpected complications now was becoming something that could be integrated into the development of medicine.
By about 1959 Levinthal’s products were in use throughout the clinical research community and in some pioneering hospitals as well. Since the medical products division of Levinthal has always been secondary to its larger, military contracts, the tide started to turn and by the time Kouwenhoven published his ground-breaking paper in 1960, Tom Corbin and Elliot Farnsworth had swung a deal with the company and gone independent.
Corbin-Farnsworth, though not the only player in the field, pretty much and quickly set the standard for such electronic medical instrumentation in the industry. And Tom Corbin became a master innovator not only in packaging but in laying a foundation for thinking about the applications of technology to medicine. It wasn’t long before C-F became the world’s foremost manufacturer of cardiac defibrillators.
Between the formation of the company, and through its absorption by Smith, Kline and French, Tom spearheaded the development of major products that redefined the industry and, to a significant extent, the practice of medicine. Here is a partial list of some of these innovations:
- “Scopette” a smaller, more portable and practical cardiac monitor
- A light-sensitive ear lobe monitor designed to non-invasively keep track of pulse and BP
- Transformation of the cardiac defibrillator from Alternating Current (AC) to Direct Current (DC) allowing much higher efficiency
- Dr. Bernard Lown developed synchronized cardioversion where the machine determined the best moment to discharge the defibrillation shock. Corbin-Farnsworth was the first company to refine and incorporate this into their products
- The use of conductive gels on the “paddles” for external defibrillation to prevent burns
- The “Dropmaster” I.V. pump (largely designed to assist floor nurses) which mechanically monitored and controlled drip rate
- Easy to supply, semi-disposable electrode “cups” for use on monitors to eliminate the use of unwieldy and inconvenient straps
- All of these developments made it practical, if not essential, to develop specialized units within the hospital to provide constant monitoring and access to life-saving equipment for patients. Today they are called CCU’s and ICU’s.
Even though these specialized units were present it did not mean that patients elsewhere in the hospital would have access to them. They could easily be stricken and before they could be brought to the appropriate room, be dead.
Dr. Joel Nobel designed a highly specialized, self-contained Crash Cart for cardiac resuscitation. It was on wheels and meant to be quickly moved right to the patient’s bed. The patient was moved on to it and worked on by a team.
Carefully laid out and planned for convenience and utility, each team member had easy and immediate access to every tool he or she could possibly need. The doctor designed his prototype with enclosures for Corbin-Farnsworth equipment -- the most compact, well-designed and efficient products on the market. It was about 54 inches long, 26 inches wide and 33 inches high.
For the first time, the Emergency Room was brought directly to the patient, and this was in the hospital! For the first time, the patient was fit into a highly sophisticated equipment system.
Maybe you’ll consider all this the next time you want to call your paramedic unit a rig, bus or truck!
One of the first “Max Carts”, manufactured by Corbin-Farnsworth is currently on display at the Smithsonian Institution. Since necessity is the mother of invention, go visit your Grandma!
NEXT: Man’s Best Friend!
References:
* http://www.amazon.com/Harthrob-Tom-Corbin/dp/0961444398
http://www.nationmaster.com/encyclopedia/Defibrillator
http://protomag.com/assets/cpr-a-handson-history
https://www.ecri.org/40years/pages/max_cart.aspx