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A bomb explodes — medical devices set to action.
It is only in war that both sides of human ingenuity coexist so brutally. On the one side, it innovates to wound and kill, on the other it heals and saves lives. Side by side, but viscerally opposed.
Dr. Joe Fisher is devoted to the light side of human ingenuity, medicine. His research at Toronto’s University Health Network has made major breakthroughs in understanding the absorption and use of oxygen by the body. Then, based on the results, he developed new, highly efficient methods of delivering oxygen to patients.
In 2004, together with other physicians and engineers, he created a company to develop solutions based on his innovations. He named it after the Toronto neighborhood where he still lives — Thornhill Medical.
Meanwhile, the studies conducted by Dr. Fisher started drawing attention from the U.S. Marines. They had been looking for solutions to reduce the use of large, heavy, and potentially explosive oxygen tanks transported by their medical teams to military operation sites.
“At first, they asked us if we could prove that it was possible to ventilate patients using much less oxygen,” says Veso Tijanic, COO of Thornhill Medical. “We proved it. Then, they asked us whether we could develop a device for this. Finally, whether we could integrate other functionalities into this device.”
The device is currently saving lives in Ukraine, Thornhill Medical having donated a number of them as well as its mobile anesthesia delivery module MADM.
These back-and-forths lasted about five years, gradually combining science and technology. It resulted in a very first product, launched in 2011: MOVES, an innovative portable life support unit.
This cooperation has also deeply transformed Thornhill Medical.
“We used to see ourselves as an R&D laboratory, we have now also become a medical device manufacturer!” says Tijanic.
Whilst the U.S. Marines started using MOVES, Thornhill Medical continued to innovate. In 2017, it launched an enhanced version, MOVES SLC.
Today, the Canadian company employs a staff of about 70. It continues to do research and development with its own team and partners around the world, publishing regularly in scientific journals. It has sold MOVES SLC around the world and launched two other solutions, MADM and ClearMate.
MADM is a portable device (capable of functioning on extreme terrain) which connects to any ventilator to deliver gas anaesthesia. ClearMate is an instrument — also portable and without electricity — which allows to take quick action in case of carbon monoxide poisoning. This is the most common respiratory poisoning, where every second without treatment worsens consequences on the brain and other organs.
An innovative ventilator design
Just like these two products, the heart of MOVES SLC is a technology stemming directly from Dr. Fisher’s research in breathing sciences. It includes a ventilator operating in circle-circuit: It recovers the oxygen expired by the patient, carefully controls its concentration (high FiO2) and redistributes only the strict minimum to the patient.
MOVES SLC operates with significantly less oxygen than required by traditional open-circuit ventilators. This is so little that a small oxygen-concentrator — integrated into MOVES SLC, that extracts oxygen from ambient air — is sufficient. No need for supplies from large oxygen tanks.
Yet, MOVES SLC is more than an innovative ultra-efficient ventilator, says Tijanic: “It is a complete life support device.” In addition to its integrated oxygen concentrator, it also includes suction and several sensors that monitor vital signs and brings it all together via a unique interface that can be operated on the device or by a mobile touch screen.
The MOVES SLC unit includes a ventilator operating in circle-circuit: It recovers the oxygen expired by the patient, carefully controls its concentration and redistributes only the strict minimum to the patient. The device also includes a small oxygen concentrator, suction, and several sensors that monitor vital signs.
The user can intubate a patient and monitor its ventilation (FiO2, ETCO2, SpO2, ABP and other indicators) in addition to the patient’s temperature (two sensors), blood pressure (internal and external) and 12-lead ECG. The evolution of these measurements can be followed over the last 24 hours.
All of this, in a device measuring only 84 cm x 14 cm x 25 cm, weighing about 21 kilograms (including interchangeable batteries) which can be slung across the shoulder.
“MOVES must function in the middle of military operations, and be resistant to vibrations, crashes and shock, continue operating smoothly in sandstorms or in the rain.”
—Veso Tijanic, COO of Thornhill Medical
“MOVES SLC represents no more than 30 percent of the volume and weight of traditional equipment — ventilator, concentrator, suction, monitoring device,” adds the COO. Integrating various technologies in such a lightweight, compact package was, without surprise, a major challenge for the engineers. Still, not the most difficult one.
Making medical device components capable of withstanding extreme conditions will have been even more complex. “Traditional technologies were designed to function in hospitals,” explains Tijanic. “MOVES must function in the middle of military operations, and be resistant to vibrations, crashes and shock, continue operating smoothly in sandstorms or in the rain, in temperatures between -26°C and +54°C.”
Sometimes, the engineers could take existing components and develop protective features for them. Occasionally, they would recast them from different markets (oxygen sensors, for instance) to integrate them into their device. And in other cases, they had to start from scratch, creating their own robust components.
The challenge was successfully overcome: “MOVES is designed under the highest industry standards and has been tested and fully certified by various regulatory bodies.” It has been certified MIL-STD-810G, a ruggedness U.S. military standard, verified by over twenty different tests (acoustic vibration, explosive atmosphere, etc.).
The device is hence approved for use — not only transported, but actually used on a patient — in various helicopters, aircraft and land vehicles. And this makes a world of difference for Tijanic. “Critical care, such as we provide, normally requires specially equipped facilities or vehicles. With MOVES SLC, any place or vehicle — even civilian — of sufficient size, is an opportunity for treatment.”
Thornhill’s fully integrated mobile life support has been used by military medical teams for five years already. The device is currently saving lives in Ukraine, Thornhill Medical having donated a number of them as well as its mobile anesthesia delivery module MADM.
An Introduction to MOVES SLC
In July 2022, the U.S. Army published a report summarizing its medical modernization strategy. The 22-page report confirms the need for ever more lightweight, compact, and cost-effective technology. It also mentions the use of artificial intelligence for more autonomous monitoring of the patients’ medical condition. Thornhill is exploring the AI angle.
“There isn’t always a qualified expert available everywhere,” explains Tijanic. “AI could ensure the optimum settings of the device, and then modify these depending on how the patient’s condition evolves.”
Thornhill is also exploring another solution for cases where no experts are available on spot. Last April, a MOVES SLC was used in a demonstration of “remote control of ventilators and infusion pumps to support disaster care.” Operators based in Seattle successfully controlled remotely a device based in Toronto. Science-fiction thus becomes science, and turns into reality.
The Canadian company continues innovating to heal and save lives on rough chaotic terrain and in the most extreme and unpredictable circumstances. It is driven by medical and technological progress. It is also driven by a many-thousand-year-old trend: Humans will likely never stop waging war.