Michigan Instruments Blog

First of all, let’s define them.  Inside-out development is the act of coming up with a product idea or upgrade within the walls of a company without extensive customer input.  Outside-in development takes a look at how people live their daily lives and identifies a need for improvement, then attempts to create a product that fills that need.

Michigan Instruments has been working with a large number of Chinese customers for decades, but it was only a couple of months ago that we recognized a wealth of enthusiasm for the new coloring of our Model 1007 Thumper® units (see below).  This came as a surprise.  While we had hoped that the red would make the unit a bit more eye catching (which it does, according to customer surveys) we failed to see a very basic outside-in connection:

Red is the national color of China.  If we had seen before that red would appeal to this market segment more than the classic black or grey, we might have been able to make an effective outside-in change, increasing our customer satisfaction.  Instead we got the same satisfaction increase purely through inside-out means, albeit many years later. 

I’ve talked with a few people on this subject and the general consensus seems to be that true acts of genius in manufacturing are inside-out products that no one could have seen coming.  I would argue the opposite.  Truly innovative products like cruise control or the iPod are the result of careful attention to people’s everyday activities.  The genius inventor is someone that can look into our lives and see a need for efficiency that we do not yet recognize and then design a product to fill the gap.  If their efforts are successful we will wonder how we ever got by without it.

This is not to say that inside-out development does not have its’ place.  Many successful companies use this strategy to help streamline the manufacturing process, reduce lead times, and increase product durability.  The reason that outside-in development tends to take the cake of commercial innovation can be summed up in one word: customers.  Customers make or break any product line, and inside-out development does not take them into account.  Customers, however, are rarely involved in the manufacturing process, allowing developers to use this strategy to create products more efficiently.  Both methods of development have their merits. 

On the upper right hand corner of our web page you will notice a button labeled “Product Input”.  Clicking on it will open up a survey that will allow you to share your thoughts about MII’s devices directly with the manufacturer.  If you are a current user of our products, consider taking the time to fill it out.  It’s less than a page long and completing it could revolutionize your own experience with our products in the future.   

 A look into a real life scenario can be invaluable.  For this reason we, along with the help of one of our clients, would like to present this run report to you.  This document describes the successful implementation of our mechanical CPR device during a code. 

Over the last few years a new phrase has been sweeping the Midwest: Pure Michigan.  I wasn’t entirely sure what the banter was about until some representatives of the Pure Michigan group stopped by our offices.  Vic Frigo, a sales expert here at Michigan Instruments, has been working to set up the collaboration for a while now.  He is very enthusiastic about the mission of the Pure Michigan Campaign. “I think that they are an excellent asset to the Michigan economy.  They’re just trying to help businesses grow.”

So what are the major areas that Pure Michigan has been helping us with?

They’ve been helping us with marketing, strategizing, contacting the government and various municipalities, and even with financial support.  Since we began working with them we have been in contact with a number of different individuals, all working to help further the mission of our company. 

How did you originally get in contact with the Pure Michigan group?

We met with them through some of the foreign shows that we have been attending.  When I was at Medica in Germany last fall I met with them for the first time right on the show floor.  When I saw the “Pure Michigan” sign looming in a German convention center I knew that I had to stop by.  Catching them again at Arab Health in Dubai helped to officialize our collaboration.  Since then we have been working together quite a bit.

What qualifications are required to work with the Pure Michigan group?

You need to be a Michigan based business, manufacturing in Michigan, presently distributing overseas, and looking to expand.

Pure Michigan has been a major ally over the last few months.  The networking that they provide can be an invaluable asset to any local manufacturer, particularly in the medical industry. 

Service, maintenance, and repair are three important words in the life of most high-end medical equipment, our own devices included.  Lance Sjoerdsma heads up our service department, and has been able to offer some good insight into the area.

“Some of our customers don’t realize that their Training and Test Lung® (TTL) units need calibration every couple of years.”  TTLs are highly precise by nature and should be checked regularly to ensure accuracy.  All PneuView equipped units will be issued new .pvl (calibration) files upon return to the customer as necessary. Mechanical CPR units should be serviced every 5-10 years or 1,000,000 cycles, depending on use. 

Educated as a heavy equipment mechanic, Lance has always retained a passion for digging into a system to find the root of a problem, which is exactly what he is doing as I start firing off questions at him.  He is hunched over a Life-Stat®, checking its compressions against a test spring.  

So what’s wrong with this one?

“So far?  This is just a million cycle service.  Just some preventative maintenance to make sure that everything is ship shape.  We give all devices a thorough check though, just to make sure.”

 Are Life-Stat owners your most frequent customers?

“Actually our Thumper® models come through about twice as often.  There are just more of them out there after 15 years of production.”

Do you have a favorite part of the job?

“Yea.  I know that when a CPR device is returned to the customer it is going to enhance someone’s chances of survival.  All of us are directly involved with every unit, and for all we know it could be someone that we love under these machines next.”

All Michigan Instruments devices require maintenance.  If you feel that your unit might require calibration, maintenance, or repair contact Lance at service@michinst.com.

If you’re reading this blog I’m sure that you understand the power of the internet when it comes to distributing information.  Since its’ conception, the internet has expanded rapidly and is probably the world’s most important communications network.  As it continues to expand however, it becomes increasingly difficult to navigate.  If you are hoping to share your thoughts with the world you need to find a way to make sure that people can find you.  This is not an easy task.  Fortunately, there are plenty of people out there that can help. 

Over the last few months, the work of Rebecca Dutcher and Jeff Bell (representatives of Mindscape) has helped us to make ourselves more “findable” online.  This was a big decision for our company.  As an FDA and ISO regulated institution we need to be very careful about what we put online.  Turning over our website to an outside firm felt risky, even if they did plan to revolutionize it for us. 

It did not take us long to realize that we had made the right decision.  The web is in constant motion.  There is always a new social avenue to explore or new method of optimization.  Web analytics allow you to track the movements of a customer from hail to sale.  Social media profiles, once set up, provide a permanent asset to any company.  We have been very pleased with Mindscape’s ability to prep our site for the world while still allowing us full control over the content that we put up.  While some of these assets may have been available to us on our own, Rebecca, Jeff, and their coworkers have afforded us the ability to do it with style and ease. 

One thing that we have noticed over the last year or so is that our website is no longer just an information pool.  Rather, it touches every part of our company.  We offer accessories on our online store, gain development ideas through our product input page, find new leads through our info and quote request forms, and keep in touch with clients and friends through our monthly newsletter.  “People need to recognize the shift” notes Dutcher, “It really is the future.”

Simulation is one of the fastest growing fields in the world.  This fact has strongly affected the medical industry over the last few years.  The training possibilities that the associated new technology offers has revolutionized education techniques. 

A couple of months ago I got to experience some of these changes first hand.  I was on the East side of Michigan putting together a demo of our lung simulation software in a local sim-lab for an interested doctor.  After he had been briefed on the Training and Test Lung, I allowed my interest to be drawn to a large table like device in the back of the room.  It was, he explained, a surgery simulator.  Much to my delight and surprise he booted the thing up, began punching away until a large, pink something-or-other showed up on the screen.  Before I knew what was going on I had my hands in a pair of computer tracked controls and was performing my first appendectomy. 

Needless to say, it went poorly (I’m no surgeon) but the three or four simulated patients that I “killed” were just a few in the long line of selfless digital patients that are put at the disposal of doctors, young and old, on a daily basis.  It was an interesting experience, and a terrifying one.  Inexperienced as I am at abdominal surgery (or surgery in general) it seemed decidedly easy to mess up.  It makes me glad that surgeons have this equipment.  In truth I’m not sure how surgeons were able to “just practice” their procedures before this technology was available--cadaver labs and the like are excessively expensive, and there are a few inherent risks associated with learning procedures on living patients.  Being able to perform a mock-surgery was something I never expected to do, but if lowly technical advisors are doing it, doctors are probably getting flooded with experience. 

I am very excited to be attending the International Meeting on Simulation in Healthcare (IMSH) show in Orlando, FL next week.  It’s always fun to see what new and improved technologies have popped up over the last year.  I’ll be in booth 905 if you want a tutorial on our respiratory simulation software or a rundown on basic appendectomy procedures. 

Many people in sales and marketing professions have heard of the “15-second pitch.”  The theory behind this is that you have about 15 seconds to grab a potential customer/client/investor’s attention before they begin to dismiss most of what you say.  Fortunately the internet has done a bit to change this style of advertisement.  Web traffic is an example of what some people refer to as “inbound” interest.  Sites like You Tube allow both companies and individuals to put together visual and auditory “pitches”.  More and more searches are starting on the internet and this fact has made it increasingly important to have a product video available online.  The fact that these people are looking for your product (or products like yours) makes them much more receptive to your pitch, buying you valuable time to explain yourself.  For years, Michigan Instruments functioned off of lower-end productions that ran through the basics of our devices.  A major commercial production did not seem like the sort of thing that could be accomplished on our business budget.  Fortunately our original assumptions were false.  We began to get feedback implying that our product videos were inadequate and began a search for a local firm to help us produce a new video.  After receiving several quotes we found a group (DVS Creative) right down the road from us that fit our price range.  A couple phone calls, a couple meetings, and a couple months later we were holding a flash drive that contained the master copy of our product video.  Within hours it was up, online, and effectively expanding our pitch window from 15 seconds to almost 3 minutes. 

Here are a few things that a good video can offer any small business, particularly in the medical field:

• Visual placement of a product performing in the field
• Demonstration of proper setup and use, especially for complex devices
• Flattering images of the product itself
• An introduction to your business and its mission

If you’re looking for an example of what small business video production looks like you can find our
Life-Stat® video at http://www.youtube.com/watch?v=K2HEfezFqZA.   

A side note: through the video production process we learned quite a bit about the availability and usefulness of voice acting.  If a video is out of the question for you at this point an audio demonstration might be a good option.  We have put together several professional recordings since producing the video to help supplement our marketing efforts. 

The world of respiratory care is wide and expanding quickly.  Ventilator technology has changed significantly over recent decades with the addition of devices that support variable PEEP (positive end expiratory pressure), jet and oscillatory ventilation, and many other new/interesting options.  One thing remains the same, however, and that is that all of these units require testing—in development, in the field, and in between.  A question: how do we properly assess these devices?  Manufacturers tend to be interested in assessment to ensure that their devices are mechanically sound.  Therapists test their equipment to understand its capabilities and limitations, as well as how effective it will be.  Biomedical personnel will often test units to ensure they are within their calibration ranges.

Previously, all of these parties were more focused on the comprehensive treatment that a device offered and trend testing was a common practice to ensure that a given unit could function as expected over a long period of time.  Modern technology, however, has allowed for higher sampling rates in test equipment, allowing the analysis of data many times within a single second.  This has helped experts to break ventilation tests down breath by breath, but this is only useful insofar as it allows professionals to see the facets of a procedure that add up to a successful treatment.

Technological advances have shifted the interest towards the analysis of smaller, more specific points of data.  With the addition of high frequency ventilation techniques theses points have become even more specific and costly to track.  Conversely, little is understood about why these ventilation techniques work the way that they do in the long term.  Until we fully understand what makes an effective modern breath for a specific patient it should be our priority to track the comprehensive effectiveness (effective minute volume, total flow, tidal volume, etc.) of a treatment before its instantaneous characteristics. 

I believe that there is still plenty of room for general trend testing in modern practice.  While it may be an older method of analysis, it is by no means outmoded.  There will always be benefits to stepping back and seeing the larger picture of a treatment method.  It is certainly important to make sure that all of the mechanics of a device that determine individual breath parameters are working properly but, as long term success is the goal of any ventilation treatment, it is the long term process that we should be focusing on. 

We have gone over a few trade show related topics in the past—booth setup and marketing strategies among others—but we have not yet taken it upon ourselves to discuss the event itself.  For those of you that have been waiting, wait no more.  We’re finally diving in. 

Anyone who has been involved in theater knows that live performances will vary (sometimes greatly) from show to show.  I have found it useful to think of trade shows in this light—while your product (the production in our metaphor) stays the same, separate presentations (performances) can vary greatly.  Some will go better than others.  Your appeal will hit each visitor differently and you should brace yourself for a rejection (bad review) every now and then.  The good news is that this is normal.  If you feel like a visitor did not quite get the message that you were trying to send, don’t worry, you’re in good company.

Fortunately there are a few things that you can use to back yourself up should the show get overwhelming.  Here’s a quick checklist:

Props—Just as a play can be appreciated for more than just the acting (props, production tone, etc. play a large role) business cards, product literature, and displays can help you quite a bit.  If you find yourself lost for words in the middle of an explanation of a product or option you can cover it up by handing your listeners a brochure or business card.  Take some time to explain the physical object to them while you collect yourself and re-rail your train of thought. 

Programs—Read them!  Know the “cast” of a trade show before it starts and you will most likely find a few people/companies that you know.  References are great material at a trade show, and if you have been present in your industry for any amount of time it is likely that there are some right around the corner from you.  KNOW THEIR BOOTH NUMBERS.  If someone has been using your product you can send potential customers over to their booth for a reference.  The reps will appreciate the extra traffic and your future clients might even get to see your product in action.

Performance—Engage your audience.  Sometimes it’s not as important to get your visitors to relate to your product as it is to get them to relate to you.  Most actors know that there is more than one theater, cast, producer, etc. putting on Merchant of Venice this year, so why do they pick the one that they do?  Convenience?  Cast?  Prestige?  What separates you from your competition?  Sometimes it is as important to step away from your product as it is to show it off.  If you feel that a visitor could make a good friend/contact, but is not going to buy, trust your instincts.  Drop the product talk for a minute and enjoy their company.  You never know what will come of it.

Michigan Instruments has manufactured its own devices since its founding back in 1964.  We are proud of this and fully intend to continue to do so.  But what does this entail?  Let’s take a look under the hood and see what Michigan Instruments’ machine shop has going for it.  One of the first things that a visitor to the area would notice is a set of six CNC lathe and mill machines.  These are the backbone of the manufacturing operation here at MII.  Two of our most experienced machinists, Mark and Chuck, (Pictured on page 3) both consider themselves experts in the creation of aluminum valve bodies—a primary product of the shop for more than 45 years.  “Some of the units are held to a standard of plus or minus 0.0002” claims Mark, a 30+ year veteran of the MII Shop. In truth, when it comes to CNC manufacturing, they are masters of most things aluminum. The valve bodies are just something that they can brag about.  While many of the products that Mark and Chuck spend their time creating are similar to those that MII has produced since its founding, they are always working toward optimizing their processes in whatever ways they can.  Many of the products of the shop are anodized or hard-coated, and while these processes are not done on-site at MII, the products are created here and finalized locally.

Michigan Instruments is an FDA regulated company since the Life-Stat® device and all Thumper® devices are considered class III medical devices.  This being the case, all of the products of the machine shop are held to very high quality-assurance standards.   We use a single sampling technique based on the ANSI/ASQC Z1.4-1993 sampling acceptance system.  An acceptable quality level (AQL) has been established at 0.01% to assure that consistently high-quality products are produced.  The shop is temperature controlled to ensure accuracy and to make results reliable.  It is also worth noting that our shop can hold to the specifications put forth in ISO 13485.  We are, as a company, open to the idea of contract manufacturing.  If you feel that our shop could be of use to you give us a call at 1.800.530.9939 extension 322.  We will be happy to provide you with any details you might need. 

Tim Nagi is one of our newest employees here at Michigan Instruments, but as a production engineer his mark can already be seen in a few places around the company.  Sporting BS degrees in Chemistry and Physics, Nagi is able to offer some good insight into the production methods of the future. 

Nagi has been the first engineer at MII to fully take advantage of computerized 3D drafting techniques and feels that it will offer the company a lot of good options in the years to come.  Interestingly enough, these drafts have created a larger sense of community through the office as employees that are not familiar with traditional production notation can visualize what different parts will look like prior to physical production.  This technology has also made it easy to “preview” products in various colors—an invaluable asset.

Most recently Nagi helped to test a new coating method for Life-Stat® columns, making their production more cost-effective and ensuring that the price stays low for customers.  “I like hands-on stuff,” replies Nagi when asked about his favorite part of the job “though efficiency improvement is very satisfying.”

Nagi has been with the company for about 6 months now and he notes that “a lot of our parts are very well designed.  I’d like to keep that tradition going.”

Cardiac arrest is the leading cause of death in America, but it is an event that is survivable.  Last week I had the pleasure of going down to Greensboro North Carolina to talk with Julia Sims and her family about her true, complete recovery. 

Julia Sims has experienced a perfect day.  On March 19, 2011 she suffered a massive cardiac arrest, months in the making. It came as a complete surprise even after an EKG/Stress test and a professional cardiologist consultation one month prior.  A perfect combination of first-responder manual CPR, AED defibrillation, mechanical CPR, and modern rescue techniques helped her to survive the incident, but not without 12 field defibrillations and 45 minutes of uninterrupted mechanical CPR.  “It really was a perfect day.” remarks Julia at an award ceremony honoring her rescuers.  “By the grace of God I came through.”

The heart attack was preceded by vomiting, indigestion, intense back and shoulder pain, exhaustion, and more. 

• “I had had the symptoms for months.” 
• “I tried every home remedy I could find.” 
• “After two doctors told me I was fine I stopped worrying.”

The Symptoms of Cardiac Arrest in Women

Julia walked away from the experience intact and on a mission.  She had not previously been aware of the classic symptoms of impending cardiac arrest in women.  Today her goal is to educate others in this situation.  Imagine you are having a heart attack.  Most of your minds will jump immediately to a sharp pressure, perhaps even a pain in your left arm, heaviness in the chest, a feeling of extreme exhaustion, etc.  These are the classic symptoms that arise in men.  Julia’s previously mentioned symptoms (pressure/pain in the upper back, exhaustion, insomnia, vomiting, etc.)  are equally as classic in women, but seldom mentioned in standard health education courses or talked about in day to day life. 

Most people would not recognize these as being the symptoms of a heart attack.  In truth, not even Julia’s family recognized them.  After multiple health consultations they believed it to be a simple case of the flu and continued to go on about their daily lives.  Fortunately, when Julia’s arrest hit her husband and daughter were in the room and their response was immediate.  Jeff (her husband) dialed 911 and was instructed on how to deliver CPR.  Brett Sims (Julia’s Daughter) assisted.  An ambulance unit arrived on the scene four minutes later. 

The Outcome

According to the AHA, about 8% of cardiac arrest victims survive. It is even rarer for someone to survive without any adverse effects.  The EMS in Greensboro proudly holds a save rate high above the national average.  Julia believes that her outcome is due largely to their competence and knowledge.  When she says that deaths caused by cardiac arrest could be further reduced by educating people about the symptoms that lead to heart attacks I am inclined to agree with her. 

Keep your eyes peeled for a more in-depth report on Julia and her mission in our October newsletter.  You can sign up for our newsletter by joining our mailing list below!

Michigan Instruments is proud to be an American company, but a significant amount of our business comes from overseas.  Taiwan in particular is a large importer of both of our product lines.  If you were looking to purchase a Michigan Instruments device in Taiwan you would eventually run across the name Hydan Chang.  Hydan and his wife Ruby Wu have distributed our products in their country for 23 years.  Their work with MII has helped to define their careers and revolutionize medical treatment in Taiwanese hospitals.  I had the pleasure of meeting with them last week to interview them on how our devices are employed in their country.  Hydan and his wife were proud to help me out.  “In the beginning there was nothing at all” they explain.  “Today mechanical CPR is a very common treatment in our country.”  The timeframe of a CPR code in their local hospitals pretty much demands mechanical CPR. 

So how long is CPR performed in Taiwan?  “Patients are on the unit for many hours.”  Most patients that receive Life-Stat® CPR in Taiwanese hospitals are on the device for more than four hours and, believe it or not, some of those patients come back.  CPR rescue attempts in the United States usually last between 8 and 30 minutes.  There are, of course, exceptions to this statistic but most agree that this is the norm.    

Many medical devices are, by their nature, versatile.  We are glad to have long term friends like Hydan and Ruby pushing the product in more than 20 countries across the world, each working to adapt the technology to their own situation. 

James Quinn is an independent sales representative.  He is also a member of the Michigan Instruments Board of Directors.  Educated at Central Michigan University in the fields of Biology and Health Sciences, Quinn originally aimed to become a biology teacher.  While he never taught, his emphasis on human anatomy led him to a career in respiratory therapy.  His enthusiasm for new technology and procedures drew him toward existing MII technologies, and when he learned that the company was looking for a clinical liaison he signed on in 1988. 

By opening communication with hospitals around the country Quinn was able to lay the ground work for our instrumented TTL line.  This move revolutionized the company’s niche, transforming a product that sold less than 30 units per year into a viable investment.  “The addition of software to the system quickly led to sales.”

Quinn eventually rose to VP of sales for the company, a position in which he was able to make good use of his clinical expertise.  In 1996, he helped Metron, a Norwegian manufacturer of biomedical engineering test and simulation equipment, set up their initial operation in the USA until they were purchased by Fluke in 2005, after which he stayed on as an independent sales representative.  Today, Quinn runs his own distribution company that contracts with many organizations throughout the region.  His clinical know-how along with his constant calling for technical improvement have truly defined his career thus far. 

Quinn believes that the hardest part—establishing the infrastructure of the company—has already been done here at MII.  “The cogs are still in place” notes Quinn “The name is established, now we just need to build it up and bring the products to market.”  He looks forward to seeing new and interesting product lines put out by MII in the coming years. 

What is a business regulatory consultant?  Jim Maatman. A man who has been in the business long enough to appreciate the value of wearing many hats.  A graduate of Hope College, Maatman started his career as a teacher (5 years) before opening a private business (12 years), moving into city government (16 years) and serving as the mayor of Lowell Michigan (12 years).  When he began working for MII, Maatman was named Director of Operations and made responsible for the oversight of all production, assembly and engineering projects done on the company grounds.  “I was a coordinator of sorts.” 

His success in this position quickly led to his promotion to vice president and eventually president of the company, a position with obligations that forced him to end his involvement in city government.  He stepped down after several years and now works for the company on a part time (20 hours weekly on paper, but usually more) basis.   

“I still feel passionate about the company,” Jim responded when I asked him what his favorite part of his work here at MII was. “I have no favorite, but I’ve been in regulatory since day 1.  I enjoyed putting together [Microsoft] Access databases for the company.  It was an interesting challenge…I feel like it payed off.”

Regulatory work at any company requires a deep understanding of business, company relations and product specifications as well as a willingness to lead when necessary.  We are glad to have Jim with us amid such a long and interesting career.

Eric Hadesh, the Document Control Manager here at Michigan Instruments, has been with the company for more than 30 years.  The ninth of ten children, Hadesh attended Davenport College and earned an associate’s degree in computer programming—a field that has not only changed greatly over his tenure here at MII, but one that has revolutionized the company. 

“When I first started here we kept our records on seven pound disks.” Remarks Hadesh, sitting behind a 21” monitor that links him in to the 20+ node, dual server network the company sports today.  “Seeing a project come full circle is always fun.”  While we have come a long way towards a full circle project in terms of our network, Hadesh believes it to be an endeavor that will never be completed.  “I very rarely take any long lunches.” He responds when asked about his favorite part of the job. “I always look forward to finding the solution…I’ve seen 7 presidencies and 14 FDA audits here at the MII offices.  There’s always something new and interesting to work with around here.” Eric started in data entry, and his analytical nature and ruthless work ethic quickly led to his contributing to design control and development projects.  Today his knowledgebase contributes to every facet of the company, from the products made to serve EMS, Emergency, Biomedical, and Respiratory Care personnel around the world right down to the data filing system (which is updated constantly). 

“My mother always worked a minimum of three jobs.  She gave me my work ethic.”  Hadesh’s attention to detail and devotion to the company have lasted decades and will help the company for many years to come.  When you’re working with medical equipment it is very important to stay organized.  MII’s record system is based off of hard copies, but to look at Eric’s filing system one would not think that 48 years of paperwork stood before them.  When I asked him for the manual of one of our products that was more than 11 years out-dated he dug up its containing folder without a second thought.  “I try and be efficient in as many areas as I can,” He explains as he scans the document onto the computer system “and proficient at a few of them, too.”

Debbie Grube is a clinician, but that does not keep her from sitting on the Board of Directors at Michigan Instruments.  Since she officially joined the professional world as a Respiratory Therapist in 1978 she has seen herself as a hands-on professional.  Initially the recipient of a Bachelor of Science degree in Respiratory Therapy (BSRT), from the University of South Alabama, Debbie chose to expand her education by pursuing a Masters of Science in Management degree (MSM) from Cornerstone University right here in Grand Rapids Michigan. 

Respiratory therapy has been a focus of Michigan Instruments since our test lung line first hit the market back in the mid 70’s.  Biomedical departments in hospitals, ventilator developers, and respiratory therapy departments have all found good uses for these units and before joining our board Debbie had seen them used in the field time and again.  Debbie values this sort of hands on experience quite highly.  As a registered respiratory therapist in the state of Michigan and a clinical specialist she has gotten her fare share of this. 

“Clinical work and experience are so important.”

Comparative studies done in the past originally turned Debbie on to MII.  Our devices filled a niche in her workplace but never really went beyond that until recently.  While she is confident in the product, she firmly believes that further innovation is necessary. 

“[I’m interested] in continued product development in the neonate, infant, and pediatric world…people don’t always realize how many patients this category applies to…nearly all premature neonatal patients require some form of respiratory assistance.” 

Needless to say, we’re excited to realize Debbie’s vision.  We are proud to have her as the newest member of our Board of Directors.  What do you think some of the most important steps will be toward the future of respiratory simulation?  Leave your thoughts in a comment below!

If there is a medical emergency one of the most important steps a person can take is to step back and let the professionals (paramedics, EMT’s, etc.) do their job.  Having said that there are a number of things one can do before these people arrive on the scene.  Bear in mind that the suggestions that follow require both competence and confidence if you are to employ them properly.  These are all steps that bystanders and first responders can take to help out at an emergency scene, though many of them require some amount of training.  I would encourage all of you reading this to follow the links that I have provided, as they will help you find out how to carry out the procedures that I mention in an easy, effective way.

• Plan to Act—It is not uncommon to see an emergency scene, and there are usually a good handful of people standing around watching the proceedings.  Chances are that one or more of these people could make a significant difference in the outcome if they had put together a proper response plan.  The first step toward helping out in an emergency situation is to know the steps that you will take.
  
  
• Remove the Victim from Danger—As long as you can do it without endangering yourself.
  
  
• Reassure the Victim—most victims of a serious injury will be in a state of shock and or panic.  This can exacerbate any situation.  Introducing yourself, telling them that everything is going to be ok, and keeping a cool head yourself can go a long way toward grounding the situation.  Walk them through what you are doing as you are doing it.  Do not surprise or sneak up on the victim.  Try to keep them from probing their injuries.
  
  
• EpiPen—Chemical imbalances that lead to emergency situations are very serious but can often be temporarily stabilized with an epinephrine shot.  Most people who suffer from these conditions know of their presence and will carry an EpiPen on their person, which they may require assistance in deploying.  For more information on who to properly deploy one of these devices check out: http://www.epipen.com/how-to-use-epipen
  
  
• CPR—You’ve probably heard of this one.  Cardiac arrest is the leading cause of death in the world and the most effective response treatment that we have for it is Cardiopulmonary Resuscitation.  If available this treatment should be coupled with an automatic external defibrillator (AED).  To get started on a course that will teach you proper CPR or to refresh your skills you should check out: http://www.heartrescueproject.com/bystander/index.htm
  
  
• C-Spine Control—This should only be attempted by responders properly educated in its execution.  While this procedure requires training it is a very important one as it helps to prevent debilitating secondary injuries from many common accidents.
  
  
• Control Bleeding—Blood is an intimidating substance, but if the victim is experiencing significant blood loss it is mandatory that the flow be stopped as soon as possible.  For a description of techniques used to slow common blood loss refer to: http://health.allrefer.com/health/bleeding-first-aid.html
  
  
• Provide info to Emergency Personnel—When emergency personnel arrive on the scene it can be quite helpful if you sum up the situation and treatments that you have employed.  Do not hassle them, however, and do not get in their way.  If you are a first responder it is easy to become emotionally invested in the situation.  Remember that your goal as a first responder is to take care of the victim until medical personnel arrive on the scene.  When they do you have done all you can.  It’s time for you to back off and let them take the next steps.
  
  

I’d like to reiterate the fact that the basis of all of this is proper education and emergency preparedness.  Most people who prepare to respond will never have to, but it is always a good to be ready for it. 

Anyone that frequents this page would have noticed a big change last week: the addition of an online store.  You’ll see a lot of these on the web, sure, but that does not mean that putting one together is an easy feat.  For those of you thinking about putting a web store together, this article is for you.

What you’ll need:

• A Platform—The first step toward having a web store is, of course, having a website.  All sites are capable of housing a store and nearly all paid services have a built-in template for it.  It may seem like a convenient option to hire a company to put together a solid platform for your store (there are a number of services that will do it quite cheaply) but I believe that it is best to try and set it up yourself.  This will familiarize you with the inner workings of your own store and enable you to modify it on a moment’s notice if need be.  If you hire out this task you will almost always have to put in a request and wait for your contractor to respond before your store can be modified.
  
  
• A CNP Merchant Account—A CNP or “Card Not Present” merchant account is almost mandatory when setting up an online store.  This will allow you to process payments using a credit card numbers alone rather than having to swipe the physical card through a processor.  Since web stores are all about convenience and saving time the ability of your customers to make a quick, remote payment is key.
  
  
• An Online Processing Service—Ok, so you have your platform and your merchant account, but how can you process the money?  This is a difficult question, but fortunately there are a number of online “brokers” that can help small companies achieve this.  Services like Google Checkout, Authorize.net, and PayPal offer excellent options with minimal fees.  If I were to go into all of the details on the specifics of how these processes work I’d have you reading a novel.  To find out more, click on the links that I have included and let them give you a quick walkthrough.
  
  
• Products!—This may seem like a silly thing to include, I mean, why would you be creating an online store if you didn’t have any products?  What I mean when I say “Products” is a combination of sizeable store volume with frequent calls to action.  Introduce your online customers to as many products as you can.  Provide them with as many products as you can muster and make it easy for them to buy.  Make your store as large as you can without getting disorganized.  This will up your web presence by quite a bit and help to impress some shaky customers.
  
  

Something that often gets overlooked in this recipe is enthusiasm.  While the elements of the store itself are relatively simple it is necessary to do quite a bit of processing to create a store with a professional feel, which is really the key to success on the internet.  Regardless of your business you want your clients to shop comfortably and at their convenience.  This is the most important function of an online store: the people buying your goods never have to leave their chair or even pick up a phone.  Take advantage of this by creating a store page with a comfortable, targeted feel and it will serve you well. 

Danielle Rodabaugh is the chief editor at SuretyBonds.com, a nationwide surety bond company. SuretyBonds.com runs the Surety Bonds Insider, a publication that tracks developments in the surety industry. As a part of the company's educational outreach program, Danielle writes to help leading industry professionals better understand the roles that surety bonds play in their respective markets. You can keep up with Danielle on Google+.

***********************************************************************************

The last thing patients and their families should have to worry about is working with fraudulent health care professionals who might try to take advantage of their positions. As a stakeholder in the health care industry, you know that the government takes a number of preventative steps to keep unethical health care professionals out of the market. But there's one risk mitigation tool most people know little about: surety bonds.

Surety bonds are specific insurance products that are used to ensure health care professionals follow licensing laws and other industry regulations. They function as lines of credit that can be tapped into when health care professionals behave in ways that harm patients and other consumers. Surety bond regulations affect those in the health care industry in a number of different ways.

Patients

First and foremost, surety bond regulations protect patients. If a bonded health care professional breaks the terms of his or her bond, then the harmed individual can make a claim to gain reparation. If the claim is found to be valid, the surety will use the bond's funds to pay for any losses the harmed party might have incurred. Secondly, the surety bond application process keeps risky applicants from getting the financial guarantees they need to work in the health care industry. This, in turn, keeps unqualified individuals form gaining access to positions through which they might take advantage of patients.

DMEPOS Suppliers

In 2009, the Centers for Medicare and Medicaid established federal surety bond requirements for manufacturers and suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS). These bonds are used to limit medical fraud and malpractice within the DMEPOS market, which had been an increasing problem prior to 2009. DMEPOS suppliers in all states must obtain a $50,000 surety bond for DMEPOS purposes if they intend to bill Medicare for equipment. However, there are a few instances in which the amount could be higher.

Pharmacies

Pharmacists also need to provide DMEPOS bonds to ensure compliance with the industry's DMEPOS regulations. Some states, such as California, also require bonds of businesses that broker, distribute or transact retail sales or returns of dangerous drugs/devices to other wholesalers, pharmacies or practitioners. This type of surety insurance is frequently referred to as a pharmacy bond. These bonds essentially protect against pharmacies or other companies that might mismanage drug shipments and/or sales.

Nursing Homes and In-home Care Facilities

Nursing homes and other long-term health care facilities typically need to provide a special surety bond type called patient trust bonds. These bonds ensure patients' funds are managed appropriately. If an employee of the facility should steal or otherwise misappropriate funds from a patient's trust, the bond amount can be used to reimburse the patient and/or the patient's family for the lost funds. As with pharmacists, long-term care facilities must also maintain DMEPOS bonds if they intend to bill Medicare for DMEPOS supplies delivered to patients' homes.

The financial protection surety bonds provide consumers cannot be replaced. Bonding requirements can be confusing for those required to purchase them, but with a general understanding of their purpose, the application process becomes much more manageable. Hopefully this guide has helped you better understand the different roles surety insurance plays in the health care industry.

Preparation is the true mother of invention, but what is preparation?  Filing the proper paper work?  Brushing up your skills before the big meeting?  Taking a satisfying, sunny walk on a Saturday to get your mind off of your job?  In truth everything that we do is preparation.  The hard truth, however, is that some steps that we can take are just plain better than others.  Here are a few steps that I take before heading off to a trade show to help ensure a good turnout at my booth:

1. The Social Media—Some people say that Google knows everything.  This is untrue.  Google knows a few things and it’s exceptionally good at locating the rest.  Twitter and Facebook, on the other hand, can know everything.  There is quite a bit to be gained by making sure that these sites know your booth number and theme, as prospective customers WILL check them before the show.  They are free and easy to manage, so take advantage!
2. The News Blast—This step is very much up to your interpretation, but it is always a good move to send out some specific, targeted advertising a day or two before the show.  This will help people to, at the very least, recognize the company name on your booth if they should wander by during the show.  If they do recognize your name but not your product they will be very likely to stop and ask for info.  The most common news blasts take the form of mass emails, but some companies also use postcards, text reminders, or even billboards.  Experiment and find what works best for you. 
3. The Calendar—First rule of social media: if it’s on your media pages it had better be on your company website.  This will lend credibility to your advertisements and give you another place to offer easy, useful information to your visitors.  Calendars are an excellent tool for this, especially when it comes to trade show setup.  By creating a running calendar that is easily accessible on your site you can tell interested parties where you are going to be months in advance.  Seeing a booth advertised on your site can make the difference between an interested customer and a passerby. 

Proper trade show execution is an art and I will not claim to be the one true authority on the subject.  What I can claim is that I take these three steps before I ever walk into the show hall, and that they have worked for me. 

Have a tip of your own you’d like to share?  Comment below!

A good machine lasts only as long as the parts that make it up.  We are proud to say that the parts we use in our devices are under constant scrutiny by a true specialist.  Mark Karas has been working with Michigan Instruments since 1975.  Originally hired at the age of seventeen, he started his tenure in inventory control and assembly.  Some time later a machinist retired and Mark was asked to stand in until a new employee could be found.  The time that he spent in the machine shop was so enjoyable that he opted to stay on as a permanent machinist.  He has been there ever since. 

While Mark has been a reliable, effective part of our shop for more than thirty years many physical aspects of his domain (the shop room) continue to change.  Just three years ago new CNC machines were brought in to help streamline our manufacturing process.  “It took a while to get used to the controls, but I’m grateful for the new technology.  Everything was manual when I started…[now] with two guys we can do what six or seven used to.” Mark’s favorite part of the job is designing new programs to create new and more efficient parts with the machines.  He considers many existing protocols “works in progress.”

Today, Mark spearheads our machine shop operations.  He takes pride in the fact that the consistency of quality in our products has increased over the years.  “I just really enjoy making parts.  I started as a senior in high school.  Now I have four grandkids.”  In the realms of respiratory care and emergency response it is mandatory that equipment providers stay ahead of the curve.  The basic ideas of many Michigan Instruments’ devices have not changed since they first appeared years ago, but unit integrity is always on the rise.  Mark and his associates play a huge role in the modernization of our products.

Mondays are busy days, and especially so if you  are in charge of maintaining a
company’s international relations.  You may go home for the weekend, but that does not mean that there is no business being done.  Fortunately, here at  Michigan Instruments, it is not uncommon  for a gentle, encouraging bark to break the air:

“Don’t Panic!”

Angie Kulesza, our office administrator, customer service representative, secretary,
treasurer, corporate officer, and general fixer-of-problems, has taken the case.  Currently, she is calmly explaining the shipping process to several stressed
employees while transferring a few calls over to the sales office.  Angie considers herself a customer service specialist, and 15 years of human resources experience back up her claim.  “ I handle most of the government and foreign accounts...it is very important that they be carefully maintained.”  She is quite right.  The medical industry is nearly unique in that many of our customer/client relationships are
decades long.  It can sometimes take years to turn a potential customer account into a bona fide buyer, but to Angie it’s always worth a little extra time investment. 

“It’s important to keep a cool head,” she explains to me, “[even though] when we get a government order it’s always a rush.”

Angie is very enthusiastic about the customer relations aspect of her job, and this serves to highlight the fact that many of us here at Michigan Instruments wear
several hats.  Angie has been an employee here since 2003 and has grown to cover domestic government relations, international relations, and many things in between.  She’s come a long way from the farm that she was raised on, but the principles are the same: finances, shipping, receiving, and customer relations.  All of these need to be accounted for and balanced out.

“It’s about helping people.”  She concludes.  If you can satisfy a potential client you’re just a small step away from making them a customer. 

Medical technology is a highly competitive field that demands attention to detail at every turn.  When a device fails it can result in lost lives.  This is as true in the manufacturing and development sectors of the industry as it is in the clinical realm.  In order to maintain the integrity of both our products and our mission it is mandatory that we communicate well. 

This might seem like an easy goal at a small company like Michigan Instruments, but in truth it remains an issue.  Many MII employees have been with the company for more than a decade and have grown to see the others around the workplace as a sort of family—a family that they may be hesitant to distance themselves from by bringing up touchy subjects.  So what do they do?  They avoid the topic.  When people fail to bring up these ticks that bother them communication suffers.  Dodging a given subject can, in time, lead to outright avoidance.  Employees avoiding each other is a problem for any company, particularly one as small as we are. 

In an attempt to head off such problems, a few communications experts from Creative Solutions Counseling were brought in to our headquarters.  During their visit I, along with the rest of the MII workforce, got a full rundown on the importance of good communication in the workplace.  We were given tips on how to recognize poor communication as well as advice on how to foster good communication.

The question that most people would ask is simple:  “Did it work?”  In truth, only time will tell.  I would not say that I have become a communications expert from attending their help sessions, but I would say that talking about possible communication issues brings the topic to the front of people’s minds, making it a less-awkward subject to broach.

Let’s get one thing straight—there are going to be some companies that show up at trade shows with $10,000,000 booths that have entire sections of their company devoted to analyzing exactly how they will appear best in the exhibit hall.  This is not a list of recommendations for those companies.  Most of us find ourselves stuck with a semi-comfortable 10x10 with a rock-hard floor that we may or may not be sharing with another exhibitor.  This can make the larger companies seem intimidating at best and insurmountable at worst. The fact of the matter is that you can get scores of people flowing through your booth without breaking your budget.  Here’s how:

• Bring your product!  A picture will not suffice.  It doesn’t matter if you are selling disposable breathing hoses or a 10-ton MRI.  People like to be able to put their hands on something.  If you’re selling software put it on a tablet and let people mess around with it.  It’s not always easy to get your product on the show floor, but it’s always worth it.  If you have been working with a product for a number of years it is very easy to assume that attendees just know what it is and how it works.  This is almost never the case!  The best way to let them learn is to have the unit there for them to play with. 
• Make sure that your booth can be spotted/located from across the hall.  Not every person that walks past your booth will be a potential customer, but everyone that walks through has the potential to know someone else that might be interested.  Impress someone enough and they will start to advertise for you through word-of-mouth.  Now, being easily spotted from across the hall does not mean that you have to have a million-dollar kiosk that hangs from the rafters.  I remember seeing one innovative exhibitor take a $200 projector, set it to music visualization, and point it toward the ceiling.  No one had trouble finding his booth, and I’ll bet a fair number of people stopped by his table just to see what was going on. 
• Make sure that the people that you talk to remember you.  One of the best ways to do this is to give something away.  Now, putting a bowl of candy on your table doesn’t count.  It has to be something that they will have to come back later for, preferably involved in some sort of competition.  Recently, I have been running a contest at various EMS shows to see which attendee can do the best bag ventilation, offering a free net book as the grand prize.  Now sure, the computer costs a bit of money, but the added interest that you will get will certainly be worth your while.  At the EMS Today show in Baltimore last month I must have had 30 people stop by my booth for a second time just to see if they were leading the competition.  Most of them stayed to chat about the products.  Some only turned into leads after their second visit. 

Make sure that you are eye-catching in an appealing way.  Wear a smile and don’t be too zealous about your product.  Make sure they see you and that they remember you.  You may not look like the biggest fish in the pond, but a good strategy will get your company and products stuck in the heads of attendees like a song.

International distribution is both an obstacle and an opportunity for many modern companies.  Michigan Instruments has been doing business with Beijing Ji Yuan Electronic Co., LTD. (BJY) since 1996 and it has been a mutually beneficial relationship.  Finding a good distributor can be difficult, especially in the medical field.  Launching a product for the first time in a new region further increases the challenge.  Neither BJY nor Michigan Instruments backed down from the challenge, however, and it has worked out for the best. 

How did you get started in the field of medical distribution?

BJY was originally a manufacturer of medical supplies.  This allowed them to create roads into the market that have been key to the success of the product launch. 

How are the market segments of medical simulation and emergency response divided in China?

Emergency response is certainly the larger of the two.  BJY sells emergency response equipment to many major hospitals.  Simulation equipment sales are closed only at several major universities.  Simulation exists almost exclusively within the field of higher education. 

What types of changes would you like to see for continued success in the Chinese market?

BJY hopes to see mechanical CPR become the national standard.  Now that our mechanical CPR products have been launched successfully we would like to see the market continue to grow. 

How is the respiratory care market changing in China?

The market is expanding.  Whereas the USA has more than 200,000 trained respiratory therapists China registers less than 2,000 per year.  Demand for RT's and training equipment is expected to grow quickly over the coming years. 

We are very proud to be working with BJY.  Our companies have been working together since 1993.  It has been an extremely beneficial partnership.  For anyone looking to market their product in China the first step is to realize that it is almost impossible to do alone.  Successful international distribution requires a partnership. 

Every modern, for-profit company has a salesman of some sort, and it is important that that body be both approachable and savvy.  One of the worst things that a salesperson can do is to misinterpret the value of his or her product.  Where does a product’s value come from?  Materials and labor, sure, but that is only a small part.  Convenience and applicability certainly play a role.  Demand is a factor to consider, also.  In short, if your product is needed and handy, it’s going to be worth considerably more than the raw materials that are put into it.  It is possible to have a million dollar idea—the problem is making sure that your potential customers don’t overlook the value of it.  Victor Frigo works to ensure that Michigan Instruments’ products are not overlooked.

What is your title here at Michigan Instruments?

Outside Sales Representative.

Please describe some of your previous work experience.

I have been responsible for sales growth and new business within the Midwest in companies such as Hallmark and TY over the last 31 years.  I have worked with large and small customers throughout my career. 

What are some “key factors” in getting a sale?

1. Overcoming objections—no matter what you are selling, prospective customers are going to have questions and  concerns.  Reassuring and encouraging the customer is always the first step.  Make sure they know your product.
2. Value—with any product there will be some items that don’t come in the box, and these are often the most beneficial.  What values does your product offer the customer?  Make sure they understand these.
3. Having the best item at the best price—This does not necessarily imply that you are selling the cheapest product, but rather that you offer the best dollar-to-value ratio. 
4. Success is based off of finding customer needs and adapting to fulfill them. 
   
   
   

“Added Value” is a term that is becoming increasingly popular in modern marketing speak, especially in the medical realm.  What is an approach that you use to help show the value of your products?

At Michigan Instruments customer service and support here are excellent.  All repairs are done here at the office/factory, right where the units are made.  The fact that we are a single-location company lets us keep a close eye on all of our units and ensure that repairs are accomplished effectively. 

As a sales representative, what is the best part of your work day?

Discovering a new market and expanding our sales base.  If I find more shows to attend and more channels of distribution I am achieving my goals. 

How could Michigan Instruments foster a better sales department?

By working more closely with distributors.  We need a solid distribution network.

Medical science has exploded over the last 100 years and it can be difficult to find all of the places that your unit can fit.  The search for new markets for mechanical CPR and lung simulators is unending in the truest sense of the word—as the industry expands new uses keep popping up.  The more widely applicable a device is, the greater the “added value” that it generates.  The greater the added value, the more imperative it is that its usefulness be clearly communicated to the customer.  Medical sales requires personnel that are able to adapt to an ever changing marketplace. 

Quality assurance is an integral part of any medical manufacturing company, and the term does not always mean a review of the company’s finished product. A word that may not always be associated with a quality assurance unit is “infrastructure”. Joseph P. St. Martin IV heads up the quality branch of our company and fosters a very unique view of what such a position entails.

What is your official title here at Michigan Instruments?

Quality Assurance Inspector

Before becoming a quality overseer, what was your previous position?

I was in construction management, responsible for overseeing the day to day operations of several job sites and ensuring that all installations of infrastructure were performed according to print specifications and industry standards.

What is the most enjoyable part of your day?

I think that the best part of every day is the fact that I get to work with a team of people that are dedicated to producing products that are built to very specific details and regulations, ensuring that the products that we ship are the best in the industry and that they perform flawlessly for those in the medical field that use them every day. For that to happen a business has to have avenues of information that are easily accessible to Quality personnel. At Michigan Instruments the door is always open for us to these information avenues, be that a document control issue, a regulatory issue, an engineering issue, a production issue, or the fact that the President of the company, my direct supervisor, maintains an open door policy at any time for any reason. By taking all these avenues and putting them together, Michigan Instruments has enabled not only its Quality personnel to be able to perform to the highest level, but all managers and supervisors to have access to these resources for their specific departments, thus strengthening the company as a whole.

What, in your opinion, is the most important part of a quality review?

The important part of a Quality Review is to assess the effectiveness and efficiency of the department based on current standards and regulations, and in doing so you identify areas to improve the process within the department.

What is a sure sign of a good Quality Control policy?

That the department is meeting all the requirements as stated in the company’s Quality Control objectives and company manufacturing certifications.

What advice would you offer to a person considering a career in quality management?

I would say that most everything in quality relies on multi-departmental teams working together to accomplish the company’s goals and objectives. To this end a Quality Manager must have good customer focus, good leadership, and good people skills and possess the knowledge and technical skills of the products being produced. You may not have 100% knowledge in all of these areas when you start, but if you are motivated to continue to learn and improve your skills you will do well in Quality Management.

A good quality assurance system can be identified by happy, efficient employees combined with a clear, concise inspection. Joe believes that good policy begets good product. Medical devices fulfill niche roles and are thus manufactured to very demanding standards—ensuring their quality is well worth the cost and effort.

There are many situations in which the performance of ventilators or similar respiratory care equipment must be tested.  Perhaps the most common is in the Biomedical Engineering department of a hospital, where preventative maintenance testing is routinely performed for a wide variety of medical equipment.  But there are many stages in a device’s life cycle at which testing is warranted.  Development engineers need to test new ideas and mechanisms as new ventilator technologies are developed, and Production and Quality Control engineers must calibrated and assure the performance of the machines during manufacture.  As wear and tear from use take their toll or problems otherwise develop, service personnel need to troubleshoot the systems in order to locate any problems and effect appropriate repairs. 

In practice, many different types of equipment are used to test or otherwise assess the performance of ventilators and similar respiratory care equipment.  These range from simple flow measuring devices, to electronically instrumented, flow meter based “ventilator analyzers”, to fixed and variable volume test lungs, and finally all the way to instrumented, computer controlled, spontaneously breathing lung simulators(1).  While each has their own advantages and disadvantages in terms of capabilities, convenience and cost, for most testing applications it is essential that at least the basic parameters of pulmonary compliance and resistance are realistically simulated. 

A realistic compliance load, in particular, has profound effects on gas flow, the action of many ventilator components and on the performance of ventilators and similar devices in general.  In fact, standard-setting organizations like ASTM and ISO mandate that ventilators be tested under conditions simulating actual use, and using realistic compliance and resistance loads in particular (2).  Gas is a compressible substance, and even at the relatively low pressures used in Respiratory Care, volume and flow rate measurements are very sensitive to changes in pressure.  This characteristic affects ventilator testing in a number of ways; here are a few examples:

1. In order to test the accuracy and reliability of flow and volume sensors that are so frequently part of modern ventilators, pressures and changes in pressures must be realistically simulated during testing of such machines. 
2. Gas output as part of a breath delivered by a ventilator, but which ends up compressed in the breathing circuit, never makes it to the patient.  While many ventilators include sensors and software systems designed to compensate for this common phenomenon, complex mechanisms like this must be tested frequently to ensure their continued integrity and patient safety.  Only by realistically simulating the compliance and resistance characteristics of use conditions is it possible to test such systems. 
3. Many components of ventilators, and especially many components of breathing circuits used in conjunction with ventilators, are designed to work with and respond to specific flow and pressure conditions in order to function properly.  Only by realistically simulating the conditions under which these components are designed to operate can they be made to work correctly.  Testing under any other conditions will cause these components to function differently, which can affect the apparent overall performance of the ventilator, and which denies the technician the ability to accurately assess the performance of the components themselves.

Pulmonary compliance changes throughout the inhalation and exhalation phases of a breath; this is as true for test lungs as it is for real, human lungs.  The Training and Test lung and PneuView system (both produced by Michigan Instruments) correctly and accurately model the dynamic compliance characteristic, in addition to upper and lower airway resistances.  Each lung is calibrated individually, and each installation of the software system is tuned to specifically match the lung it is connected with. 

The Michigan Instruments, Inc. TTL is designed to simulate the pulmonary characteristics of patients of all ages, sizes and conditions.  With the addition of the Breath Simulation Module, these devices may also be used to simulate the spontaneously breathing patient.  The package of hardware, instrumentation and software provides an unparalleled capacity for testing all types of respiratory care equipment under conditions simulating those of actual use. 

In a clinical setting, the concept of “ventilator performance” takes on a larger meaning.  Even ventilator systems functioning exactly to specifications perform differently depending on the particular patient or other use conditions presented in various real life situations.  Even within a specific ventilator system many different modes of operation may be available, and the modes most appropriate for use in a given situation may be subject, at least in part, to certain patient or use conditions.  Realistically simulated patient loads can be invaluable in these situations, and care givers can make effective use of test lungs to allow the widest possible range of treatments to be investigated before application to the patient. 

For training and teaching applications, use of a realistically simulated patient is also essential.  Training the use of ventilators and the employment of various respiratory care techniques to medical professionals requires fidelity of the training scenarios, equipment and materials to the real-world, clinical setting.  Training and test lungs provide the ability to simulate a huge variety of normal and pathologic pulmonary conditions, and cover the range from very small infant/pediatric to very large adult settings.  Training and test lungs can also be used to simulate the spontaneously breathing patient; it is only through such simulation that some of the more advanced modes of ventilation, such as assist/control, IMV/SIMV and pressure support can be taught. 

(1)    Anderson, JA: Ventilator Testing Comes of Computer Age.  24x7, June 2003, 35-39.

(2)    ASTM: F1100-1999 Minimum Performance Specification for Critical Care Ventilators.

Medical equipment is almost universally classifiable as “niche hardware.”  Most devices only attempt to cover one area of use, but these tend to be ideal for application in that field.  That being the case, they are often a hard sell.  It’s a matter of getting the equipment into the right hands and having the ability to communicate to the end-user the scope of the benefits of the product, which may not always be obvious.  For these reasons and others field experience in salesmen is a much sought-after qualification in this industry.  Dave Keister, a Michigan Instruments sales representative, worked as a field paramedic for years before moving into the sales realm and attributes much of his success to his previous experience. 

What position did you hold prior to your current one in sales?

I was hired at MII in February 2005 as a service technician.

How long were you in the industry before moving?

I worked as an “active” Paramedic for about eight years here in Grand Rapids.

Why did you pursue the career change?

After working as a Medic I was offered a position with a Plasma Center as the Medical Supervisor. The company I worked for was sold to another Plasma donation company and the new future of the company looked rather bleak and I started looking into medical manufacturing.

What advice would you give to an EMT or RT considering a career in sales?

To keep your current license up to date and stay on top of continuing education in your field.

On a scale from one to five, how helpful has your clinical experience been in sales?  (Please explain your answer)

Five-I feel that all medical professionals have great disdain for sales rhetoric and appreciate a sales professional that knows the field they are selling and like a “peer” level approach from their sales person.

Talent in the sales realm is also a prominent factor, but the medical field is an area in which knowledge of product application is particularly valuable.  It can help to eliminate miscommunication between consumers and manufacturers in a way that books and seminars alone would never allow for. 

Pseudo-stratified, ciliated, columnar epithelium with goblet cells might sound like a mouth-full, but when you break it down all that that really means is: tall cells packed closely together with microscopic hairs on top, and nuclei at different heights interspersed with mucus-producing cells.  So….why is this important?  These cells litter the human respiratory tract and are among the ones most damaged by smoking, the common cold, and improper ventilation.  As members of the medical industry it is absolutely mandatory that we account for as many scenarios as possible, for instance knowing that a smoker is going to have decreased airway resistance due to the death of the microscopic hairs on the top of these cells.  Some major tissues in cardiopulmonary treatment include:

• Cardiac Muscle—easily distinguished from other bodily muscles by the thick bands that cover it (striations).  This muscle tissue is rich in mitochondria, allowing for fantastic rates of aerobic respiration (energy production requiring oxygen) resulting in negligible muscle fatigue.  IMPORTANT TO NOTE—anaerobic respiration (energy production without oxygen, aka lactation) produces lactic acid, which will fatigue the heart.  Fatigue becomes critical for cardiac muscle at an anaerobic respiration rate around 10%.  To avoid excessive lactation during CPR, make sure that the patient is well and properly ventilated.

• Arterial Vascular Tissue—Blood vessels leading away from the heart that carry oxygen rich blood used in aerobic respiration.  IMPORTANT TO NOTE—arteries function off of blood pressure.  If an artery has been severed extreme discretion should be used when applying CPR to the patient, as the profusion pressure created by the treatment may result in additional blood loss and damage.

• Vein Vascular Tissue—Blood vessels leading to the heart.  Carry waste rich blood excreted by the pulmonary system. IMPORTANT TO NOTE—profusion in veins is not controlled by the width of the vessel but rather by muscle action.  A paralyzed patient may have decreased venial profusion due to decreased muscle action.

These are only small examples of the effects that tissue quality has on the cardiovascular system, but they help to illustrate how delicate the system can be.  Thousands of different tissues exist.  In any case, the most important factors in the success of any medical undertaking (including CPR) are knowledge and an ability to adapt.  Through the use of mechanical CPR, adaptations can be quickly and accurately made in accordance with the instruction of a qualified user.