Iowa-based Sky Factory has turned the acrylic and polycarbonate sheets it uses for its SkyCeiling image panels into a modified aerosol box for endotracheal intubations of COVID-19 patients.

From building the device and delivering it to its local hospital, Jefferson County Health Center, the company is now fielding inquiries from hospitals state-wide, as well as other states like Illinois and Minnesota.

The relief operation began when designer Tim Freeberg-Renwick, from a small town community in Fairfield, Iowa, found plans for an aerosol box for endotracheal intubations (ETT) on the Internet. Tim sent the design directly to friends at local firm Sky Factory, thinking that its manufacturing facility could quickly build them. The company saw a way it could quickly support its local hospital by building and supplying the devices to help protect healthcare staff on the frontline. 

The designs for the aerosol box were supplied by a Taiwanese clinician, Dr Yung Lai, who had registered the protective device under a Creative Commons license, making it freely available worldwide. With the surge in COVID-19 cases expected to hit the US in mid to late April, the company quickly mobilised its engineering operations for production of the device. 

“The widespread shortage of tests and personal protective equipment (PPE) in hospitals across the US and the Government’s inability to secure desperately needed supplies meant any additional layer of effective protection for medical staff was critical,” said Sky Factory CEO Skye Witherspoon. “We downloaded the files, cut the material, assembled a prototype aerosol box, and ran it across town to Jefferson County Health Center (JCHC), our local hospital, for immediate feedback. 

“Bryan Hunger, JCHC’s CEO, and I discussed the use of the box in consultation with Ryan Ford, its cardiopulmonary director, and his staff. We then made adjustments to the original design and had a second prototype in 24 hours.”

The company’s modified aerosol box features a respiratory droplet splatter guard across the top of the cube’s main opening. The guard is said to enhance the device’s ability to sequester the aerosolised particles, which could otherwise drift or “hang” in place, increasing the risk of infection to intubation teams. The aerosol box modified design also features curved shoulder openings, which are said to enhance the comfort-fit around a patient’s upper body, improving the restriction of airflow and making it easier to manoeuvre.

JCHC asked Sky Factory to make four of the modified aerosol boxes (now dubbed ‘intubation shields’). News of the equipment quickly spread via phone and email through organisations such as the Iowa Hospital Association and the Iowa Organization of Nurse Leaders, and demand jumped for further devices.

“At first, we thought we’d make a handful of the shields for nearby hospitals,” said Witherspoon, “but the next day, when I checked my emails and took the first calls, I realised that we’d tapped into a state-wide need. Within 24 hours, inquiries and requests spanned the state, from Keokuk, in the southeast corner, to Sioux City, on the westernmost border – even hospitals as far as Minnesota and neighbouring Illinois wanted intubation shields.”

Cherokee Regional Medical Center wanted six, Iowa Specialty Hospital in Clarion sought eight, and UnityPoint Health – Trinity in the Quad Cities requested a dozen shields to distribute among its four, affiliate, full-service hospitals in Rock Island and Moline, Illinois, and Bettendorf and Muscatine, Iowa.

Witherspoon said his most humbling experience of the whole operation was when he heard directly from emergency room doctors who were literally living at the hospital, working around the clock on preparedness and contingency plans, and taking charge of securing protective equipment for their teams. 

“I’d read the news,” he said, “but it’s not until you hear a doctor’s voice on the other side of the line, or see the time stamp of the email you just received at half ‘til midnight, that it really hits you.” 

He added that within 48 hours of receiving the initial order from JCHC, Sky Factory had received calls for more than 100 intubation shields. And they continue to come.

Robert J Erickson, UnityPoint Health – Trinity president and CEO, said the aerosol box device has given it another tool of protection to help keep its workers and patients safe during the COVID-19 pandemic. He added: “Times of crisis reveal character and we are overwhelmed by our communities coming together in partnership to mitigate the impact of this pandemic and further the common good. Everybody can make a difference and we applaud Sky Factory for joining us in the fight.”

The company says it is making its modified design AutoCAD files available freely to any manufacturer that wants to help its local hospital. Inquiries should be addressed to info@skyfactory.com