Scuba Masks and PPE

Absolutely. There's an issue getting PPE to the front line. From my understanding, centrally we have enough stock — that's the messaging from government and NHS England — but the issue is in logistics and getting it out, which means the kit isn't reaching our frontline colleagues. And the problem with that is that those people are then underprotected when it comes to doing their vital work managing our COVID patients.

So Oxford Inspired is a group of principally plastic surgeons — a mixture of consultants and trainees based at the John Radcliffe Hospital — but within the team we also have researchers and engineers, with a big shout-out to 3D LifePrints, a 3D printing company based in Oxford.

We wanted a solution that meant doctors, nurses, physios, whoever is in these high-risk areas, would have a piece of kit that was theirs and could be cleaned, kept and reused. Because one of the issues is that even if a clinical area has PPE available, if you replace it after every single interaction, you burn through it at a huge rate. So even if you started without a problem, you'd end up with one. We wanted to address both the shortage and this issue around the disposable nature of most PPE.

And we started to think outside the box: what else is done elsewhere in terms of protecting somebody and being able to filter the airflow into it? Sarah Tucker, our consultant — super important — had the idea of using a snorkel mask. Similar projects have been done, so we're definitely not saying we've invented something brand new. I know the Italian doctors created a similar system, but for patients — a kind of ventilator mask, again based on the snorkel.

So we sourced 3,000 full-face snorkel masks. Then we looked at the filter side, speaking to a number of anaesthetic-machine filter companies and getting them to send us various filters. And the final part of the puzzle was how you connect the filter to the mask — this is where our 3D printing engineers came in, designing a conduit to connect the filter to the snorkel mask.

Exactly. It creates a seal around your mouth and nose, so the only air that gets into that space comes down through the snorkel — and that's where we put our filter. We've done our first round of fit testing. That's the process where you put your PPE on, you're placed into a hood, and a spray is sprayed into the hood. The spray has a distinctive smell or taste, and the question is: can you taste or smell the aerosol? Certainly we couldn't when using it. So, as you say, the key principle is: can you regulate how the air is getting to your mouth and nose? And the snorkel mask does that job.

Phase one, which is where we are at the moment, is that we have 3,000 masks ready to go. Once we've hit our crowdfunding target, we have 3,000 filters and we can print 3,000 conduits — so within a week we can get 3,000 bits of PPE out to our colleagues.

Phase two is to look at ways we could start to produce this ourselves — mask alternatives, different manufacturing processes — and see where we go from there. Because if you think about it, we've got the UK-based issue, which is our focus at the moment, but there are a number of other countries yet to be anywhere near their peak that are going to struggle much more than we are, because we've got a well-established healthcare system. Once it hits some poorer countries, you've got to think: how are they going to manage? So we're looking at ways to take this idea and provide a cost-effective solution for other places as well.

It could be that the existing PPE companies step in — and we're not trying to compete, we're not doing anybody down. The PPE companies have all been amazing, but there's just a limit in supply and cost. So phase one: sort out the UK and get this into the hands of NHS colleagues. Phase two: how could we take that IP and expand it to help people elsewhere — always in a not-for-profit manner.

Exactly. We're not out of the woods yet — we're the first priority in terms of getting these supplies out — but we've got to work out how we could help other areas. All the stuff we're doing in phase one, we plan to make open source. So if people get hold of the particular snorkel masks that we have, they'll be able to print their own conduit to link it to the filter. Is there other stuff we can do to help other places that are going to come across the same problems but won't have the resources to manage them?

It is, but we're still mindful and respectful of procurement and the rules each hospital has for how they sanction bits of PPE kit. So we're not completely clear of all the usual routes, but we're trying to see where the frictionless parts of the system are so we can target those.

There's specific PPE regulation, and it's controlled by BEIS — apologies, I can't remember what the acronym stands for, but there's a particular government department that has PPE within its remit. The regulations have been slightly eased and the certification process slightly simplified to try to get as much kit out as possible — but always, always, always making sure it's safe. It's amazing the amount of support coming in generally, from manufacturing, from schools; everyone wants to do their bit. But we've always got to be mindful that whatever we put out — and that goes for Oxford Inspired too — has to actually work.

Really good question. My manufacturing expertise is definitely limited, but I've had a number of conversations with manufacturers and designers over the last few weeks. 3D printing has a definite role, but there are limitations for what we want to produce. To make a composite device — one with a softer plastic sealant — is, I understand, a bit trickier. And the speed at which 3D printing can be done can't match injection moulding. 3D printing has positives too, in that you don't need expensive tools set up to create your product, so iterating and prototyping is simpler — but for mass production, some of the more conventional manufacturing techniques are better.

Two aspects to that. The first is: how do you identify where those areas are? A number of groups have come forward off the back of our campaigns to build a database of need across the country — people like EveryDoctor have a tool sending out questions to try to understand that. We've also been contacting hospitals, focusing around the Southwest, just because it's logistically close to us. London is being covered by Decathlon, who are doing something very similar and supporting London — they've offered all the supplies they have and, I understand, also released their design CADs to certain groups.

So London we think is covered, though we're happy to support anyone there that needs it. And we were looking at the Southwest, but we'll work with people like EveryDoctor to identify where the need is. That's the first thing: where's the need? Number two is: how do you get it to them? Again, the desire of people to do their part is amazing. We've had distribution companies contact us and offer up their warehousing, logistics companies offer vans to get stuff out there. We're hugely grateful for all the offers we've had, and we'll use them all as appropriate.

It's a really good question. I think there are issues with a lot of people coming in with different requests — just the processing to get through that much is number one. And number two, the crisis is now, and government, for all its foibles — any government — finds it difficult to mobilise at speed. So I think they're doing their job, and we're just trying to find another way to get supplies to the frontline. Their promises of open cheques are great, but those things take time to process, and there's a lot going on. This is an international crisis. You can't get every box ticked.

No, but it sounds interesting.

Yeah, I think that's a fantastic idea. Generally in healthcare we all come across very similar — if not identical — problems, and depending on people's experience, their networks and who they turn to for help, they'll come up with different solutions. I think we need to be completely open to anything, and not close off and say, well, we're surgeons, we work in Y, and we know the answers — because we don't. And it's not just about learning from the third world; that's an excellent example you gave. But also: how does industry deal with X? What does the airline industry do about noxious fumes? Cross-pollination across industries, across nations — that's how you innovate, by being able to connect those dots and see how you can use different ideas in different situations.

So Sarah, our team leader — also one of the consultants at the John Radcliffe — took a photo of herself with a full-face snorkel mask, on which she'd tied a conventional surgical mask across the top of the snorkel. She said: the current issue is that surgical masks have a sufficient filter, but the air gets round — there's no seal. So this is my idea. In some ways, that's your MVP.

That was when she reached out to a group of us who enjoy this kind of innovation problem-solving and said, what else can we do? So we started to think: is there a more formal way to do this? Because you don't want to be suggesting to people that they tie masks on the end of a snorkel — how can you standardise that? So we said, let's work out how we get the filter on. The anaesthetic machines have a filter that filters gases to and from the patient — so can we use one of those? Yes. Okay, so now we've got a mask and a filter. How on earth do we get these two things to fit? Ah, I know — I've dealt with a 3D printing company for X and Y, let's see if they've got an idea. So we went to them: here are the two parts of our problem, is there something you can do? And they used their expertise.

So suddenly you've gone from this initial idea, and you've worked as a team, spotted the areas that can be improved, and used your experience from elsewhere to improve it — and you're not afraid to ask for help, as we did. That's what got us to the prototyping phase. And then there were a couple of points of serendipity. One of the other consultants had been shopping in a national retailer and went, ah, they've got an offer on snorkel masks — I wonder how many they've got. So we contacted them at a national level and found they had 3,000, and they've kindly put them aside for us. So now we've got the masks, we've got the know-how, and the conduits ready to be created. Then we spoke to the filter companies about different filter types — factoring in ease of breathing and the percentage of particles filtered out by each type — and constantly optimised and iterated until we got to the product we currently have.