Editor's note: This story is part of Southwest Michigan Second Wave's On the Ground Kalamazoo series and our ongoing COVID-19 coverage. If you have a story of how the community is responding to the pandemic please let us know here.

Intubation is the process of inserting a flexible tube into a  person’s airway, typically to connect to a ventilator that helps the person breathe.
 
If the patient coughs or sneezes during the process he or she can spray aerosolized droplets and germs into the air. That is particularly hazardous for doctors, nurses, and other medical team members using the process to treat people during the current coronavirus outbreak.
 
But two Kalamazoo area men, working with a forward-thinking local business, have improved the design of a product that can lessen front-line workers’ exposure to harm. 

Nurse anesthetist Brady Beauchamp and mechanical engineer Andy Bornhorst have redesigned the intubation box, a clear Plexiglas-like box that is temporarily placed over the head of patients to protect healthcare workers when patients are being intubated. It has two armholes that allow staff to reach the patient and another opening to allow tubing to be attached to the ventilator.
 
In collaboration with Schupan Aluminum & Plastic Sales, about 100 of the boxes have been produced and donated to hospitals here and across the country. Beauchamp says Ascension Borgess Medical Center has received seven. Bronson Methodist Hospital has received 20. Others were donated to facilities in Tennessee, Texas, Florida, Iowa, South Dakota, South Carolina, Minnesota, Ohio, Arkansas, Delaware, and Louisiana – all places that expressed a need through a network of nurse anesthetists that Beauchamp has maintained since college.
Kalamazoo nurse anesthetist Brady Beauchamp shows the Aero-Guard intubation box.
“Our whole goal has been to get out as many as we could,” Beauchamp says, “and to give the care provider the option to use the Aero-Guard intubation box as additional personal protection equipment to handle the expected pandemic waves of the coronavirus.”
 
The original intubation box was designed by a Taiwanese anesthesiologist, Dr. Lai Hsien-yung, of the Mennonite Christian Hospital in Taiwan. He decided to share his design last month, so others who were fighting the coronavirus (COVID-19) outbreak could quickly construct their own boxes and put them to use, according to information provided by Bronson Healthcare. But his boxes are constructed with glue and are not collapsible. Beauchamp says that makes them easy to break, hard to clean, and difficult to store.
 
Bornhorst’s design has interlocking parts and can be disassembled into six pieces. When collapsed, it has a thickness of about two inches, which allows it to be stored in a corner or against a bookshelf. Beauchamp says storing the devices for use down the road will become a factor if COVID-19 impacts the United States in waves. He says epidemiologists expect the virus to come in as many as five different waves.
 
“Hospital storage has been a hard thing to deal with,” Beauchamp says. “The intubation boxes, if you have six or eight of them, where do you store these?”

Partnering with Schupan, the new design has been quickly taken from prototype to production, and are all produced in Kalamazoo at Schupan Aluminum & Plastic Sales, which distributes aluminum and plastic mill products.
 
Beauchamp says there is a patent pending on the redesign of the device. Each is 24 by 24 by 18 inches and is to be marketed as the Aero-Guard intubation box. Each is set to sell for about $385, with one donated for every 10 that are purchased. That donation is made to the organization of the buyer’s choice.
 
Beauchamp recruited his friend Bornhorst to help improve the original intubation box design. The two met through their children, who are friends, attending the same elementary school.
 
Bronson, which worked with a design team to ensure the proper size of the boxes and its armholes, also collaborated with Schupan and Beauchamp to produce an instructional video that will be used to train staff. It expected to put the boxes to use immediately. The design team included Beauchamp, Bornhorst, and John Barry, president of Schupan Aluminum & Plastic Sales, a division of Schupan & Sons Inc. Their work benefitted from feedback from nurse anesthetists and anesthesiologists in Kalamazoo, Beauchamp says.
 
He says he struggles with the for-profit nature of what appears to be a business venture with the potential to grow. But he says he knew, “We could only give so many away. We can only donate so many. But if we’re able to sell them, we can donate more.”
 
He says selling the devices has been necessary to cover the cost of the polycarbonate material used, the manufacturing, and other related costs.
 
“Once we had the patent fees, the legal fees associated with that, (and) the website to take orders, the bills started adding up,” he says. Positive feedback from others in the anesthesia community indicated there is a need. And, he says, “We’re still trying to actively donate.”
 
Because everything is produced locally, he says, the turn-around time is a matter of days for people who make orders (here) 
“It has been interesting,” he says.

He, Bornhorst, and others are considering adaptations of the Aero-Guard to allow its use by cardiologists and gastroenterologists, whose patients are typically situated differently when they have to be intubated. Beauchamp recruited his friend Bornhorst to help improve the original intubation box design. The two have children who are friends, attending the same school.

Beauchamp says helping to redesign and produce the intubation box is very different than his work as a nurse anesthetist where he says he meets a patient, chats with him or her for five to 10 minutes before a surgical procedure, then works to keep them safe during the procedure.

“When I leave work currently, it stays at work. I don’t take anything home with me,” he says. “With this, we’ve had meetings in the evenings. We’re asking, ‘What can we do? How can we make it better?’ It’s been a work and home project – to make sure we’re putting out a good, valuable device.”