[schuetze]

Agreed. BiPaP to ventilator already seemed like a somewhat questionable transformation, and now we're going

CPAP ----questionable software hackery ----> BiPaP --- questionable hardware hacking ---> Ventilator

This is hubris. Ventilators are not iPhones circa 2010. It's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks. A significant portion of medical device RnD is related to creating technology that is hard to misuse and won't result in accidental death, and I just don't see that here.

[jauer]

> it's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks. A good portion of medical device RnD is related to creating technology that is hard to misuse and result in accidental death, and I just don't see that here.

This is simply wrong, both from a user perspective and a general research perspective.

Positioning a jailbreak like this as a solution to general vent shortage may be irresponsible if it leads to people trying to treat others instead of relying on doctors, but going beyond that is ignoring the good that's come from work like this.

Hacked up and jailbroken insulin pumps have been a thing for years, often to get increased safety over what manufacturers can provide: https://medium.com/neodotlife/dana-lewis-open-aps-hack-artif...

There's also a history of people unlocking and altering settings in CPAP/BiPAP devices in response to data (many providers treat them as set and forget devices and don't bother reviewing logs except for initial patient compliance).

Beyond people hacking their own devices, we've seen that security of medical devices wouldn't improve without independent researchers highlighting the flaws and driving them to fix them: https://www.cnbc.com/2018/08/17/security-researchers-say-the... and https://www.darkreading.com/vulnerabilities---threats/lethal...

[schuetze]

Perhaps this is aimed at non-American healthcare systems, but I have not seen a single report of American hospitals running out of ventilators, let alone BiPaP machines. In order for this to be a responsible hack — used under the guidance of medical professionals — we would need to have run out of both.

If anything, at least in the American context, I'm more worried about running out of the sedative necessary for ventilation.[1]

I have nothing against hardware hacking in non-pandemics. If you want to hack your own insulin pump or create epi-pens on your own (non-crisis) time, that's fine by me.

But I think the cost-benefit-risk analysis changes in pandemics, because people are too hungry for easy fixes and make ill-advised decisions under pressure. For example, even doctors (ostensibly medically-literate professionals) are prescribing themselves hydrochloroquine [2], which does not seem to be a miracle cure and sometimes, itself, dangerous (and also leaves lupus sufferers at risk of a disrupted supply chain).

[1] https://www.vox.com/2020/4/6/21209589/coronavirus-medicine-v...

[2] https://www.nytimes.com/2020/04/12/health/chloroquine-corona...

[hombre_fatal]

> but I have not seen a single report of American hospitals running out of ventilators

Are you really not going to just google "USA ventilator shortage"?

Also BiPaP machines require the same hack as CPAP machines. And of course a further hack for invasive intubation (which ventilators can do out of the box), though you aren't going to do that to your nightstand CPAP machine either.

Anyways, rest assured that the few people who can be bothered to jailbreak their CPAP machine are not the same kind of people who drink their koi pond cleaner. I think this kind of fear about people hacking their gadgets is misplaced.

It also reeks of what I can only register as this weird "doc knows best" subservience to the medical system. This is probably the weirdest meme I see on HN. And, as people upstream point out, nobody out there is paying attention to your insulin pump or CPAP machine settings. They just leave it on whatever default setting. It's all entirely on you to do the research to improve things for you.

[tptacek]

The search you propose doesn't rebut their comment. We're all aware of the concern about shortages. Their claim was different.

There are stories about NYT hospitals doubling up patients on ventilators, but those stories are explicit about the fact that those hospitals have not run out of vents, and are instead working out the protocols for sharing them when/if it becomes necessary.

[gowld]

To be clear, your position is that we should eschew self care so that we can bankrupt ourselves by only getting care from doctors, who as you note are either hoarding critical medicines for themselves or using wrong medicine for treatment?

[shawnz]

I think it's irresponsible to not be donating our full talents as engineers to assisting those medical researchers in getting a head start on such developments. We have the ability to offload trivialities from those researchers like developing a firmware flashing process, so that they can focus on ensuring the reliable operation of such hacks.

[janoc]

The problem is that those talents are being used to solve totally wrong problems because of engineers going gung-ho and starting to "engineer" before they understand the subject. The problem is not lack of designs or ideas for ventilators.

This sort of hack still requires that someone makes those things at scale. That's a supply chain issue, same as taking an existing, proven and actually certified design and manufacturing it at scale. Hacking up a few CPAP machines really doesn't solve the problem when the hospitals need tens of thousands ...

Even if we ignore the legal and medical bits (only in an extreme emergency with no other options and where the alternative is an inevitable death would anyone even contemplate using something like this on a patient), this machine isn't really a ventilator suitable for people with failing lungs. Patients that have to be intubated and the machine actually breathes for them, filters, humidifies and warms the air, allows sucking of phlegm without spewing virus everywhere ... And those are the machines that are in short supply. This hack doesn't do anything from that.

And finally, it doesn't address the issue of having enough trained staff that will operate and supervise the ventilators - these things have to be supervised 24/7, sometimes for weeks. One ICU nurse is commonly supposed to handle up to 6 patients, tops. You can't just add ventilators without adding nurses, because if anything goes wrong, people will die - and where do you get those nurses from? Especially if they have to deal with a gizmo that isn't as failsafe as a real ventilator (because it wasn't meant to be)? If you need more staff to run fewer ventilators/beds, then you haven't really solved anything, have you?

And the lack of trained staff is not something a jailbreak or an Arduino can solve.

People should stop messing with building "ventilators" and focus on things where they can actually make a difference - e.g. the production of face masks, face shields and similar gear, which are in extremely short supply and don't require much sophistication to build. That would make a much bigger difference than pretending that we are somehow solving the lack of ventilators with hacked CPAP machines ...

[gfodor]

Classic false dilemma.

[sokoloff]

In a scenario where people are certain to die if there is a lack of ventilators, I’m willing to take a lot of risk that they instead might die from an alternative course of treatment that doesn’t meet a normal standard of care.

If that means taking already made CPAP machines and modifying them, that’s in bounds as far as I can judge.

[jnwatson]

This isn't a significant redesign of an existing device. It is essentially a DRM bypass.

[birdyrooster]

Agree with your sentiment. Now to nitpick: the first iPhone jailbreak was achieved days after the iPhone was released way back in July 2007.

Source: https://www.cultofmac.com/192850/the-history-of-jailbreaking...

[gvjddbnvdrbv]

This is a real adaptation being used by real doctors in real hospitals to save real people's lives. There is a pandemic on.

[wayoutthere]

I actually have yet to hear any reports of improvised ventilators being used outside of ventilating multiple patients from a single ventilator. A big reason is that doctors and nurses simply aren't trained to use improvised devices in a way they can trust to be safe.

First, do no harm.

[gvjddbnvdrbv]

https://www.nytimes.com/2020/04/14/nyregion/new-york-coronav...

The Italians are using adapted CPAP machines as well.

[shawnz]

They describe such usages in the first sentence of the article. Mt. Sinai researchers are actively working on converting BiPAP machines into ventilators.

[cjbprime]

I mean, it's also irresponsible for societies to have fewer respiratory therapists and ventilators than are needed to support their patients, but here we are.

[MrStonedOne]

>It's irresponsible for non-medical researchers to not only pursue, but also disseminate, these jailbreaks.

The reason for the underbelly trend of certain types of people to not trust doctors and scientists is a lack of trust in the system (medical system, science system, etc). The root of this for some people can be tied to this exact condescending attitude towards people.

Nobody responds to being told something is a bad idea, they only respond to understanding why it could be a bad idea and being allowed to decide for themselves, and your attempt at preventing them from deciding in a way you don't like how they treat their own body only furthers the rift that powers essential oil huns.

Me personally, If my local hospitals are out of ventilators and i'm showing signs of URD i'm gonna hack my autoset with this firmware to get the higher pressures needed for peep therapy and not bother going in. There isn't anything you can do to stop me. I might even do it even if they aren't out, as i would be able to start therapy sooner and potentially heed off snowball effects from a lower blood oxygen level on my immune system.

Attitudes like yours create, feed, and recruit anti-vaxxers and essential oil huns, and harm that does, is far greater than somebody hacking their own cpap machine for whatever ends.

[mschuster91]

> A good portion of medical device RnD is related to creating technology that is hard to misuse and result in accidental death, and I just don't see that here.

The people relying on these hacks would be definitely dead without the hacks, that is the point. Even if the chances of this working successfully are only 10%, you just saved 10% of the patients compared to 0%.