It Could Happen Here - 3D Printing Tourniquets for Gaza

Episode Date: July 8, 2022

James catches up with Tarek Loubani, an emergency medicine doctor who has volunteered in  Gaza, Egypt, and Ukraine. We talk about Glia, an open source medical device company that arose from his experience working in resource poor medical settings.See omnystudio.com/listener for privacy information.

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But hurry, submissions close on December 8th. Hey, you've been doing all that talking. It's time to get rewarded for it. Submit your podcast today at iHeart.com slash podcast awards. That's iHeheart.com slash podcast awards that's iheart.com slash podcast awards all right podcast uh it could happen here it's a podcast about the terrible things that are happening all around the world and the wonderful people who are trying to fix them. What it is today is a podcast with Tarek Loubani of Glia. What really inspired me about his story and made

me want to share it with you is that it came out of a really dark place. Tarek was on the ground in Gaza treating gunshot wound victims and a lot of gunshot wound victims. I remember reading his field testing of the device and just being appalled by the number of people who had been shot, lots of them children. And some of the reporting he was doing, right, like, oh, I had this tourniquet and we were reusing them and they don't work very well in a pediatric

application because kids shouldn't be shot right but instead of getting down he was able to make a solution and i think that's really important and i really like that even through like this dark and terrible stuff that we've all had to experience and he experienced in gaza he was able to see a positive solution, a way to look after people, to move forward, in this case, to prevent death and preserve life. And I think it's easy to focus on the dark stuff. There's enough of it happening. But I think it's important to focus on the great people who are doing great things to protect and care for other people as well. So that's a little bit of what we got today. and I hope you enjoy it.

So I'm here with Tarek Loubani. He's from Glia. They're a company I came across when I was writing about 3D-printed tourniquets. Would you like to introduce yourself? Tell us a little bit about Glia and what you do there. Thank you so much for having me. My name is Tarek Loubani, as you had mentioned. I'm an emergency physician. I work in Canada, in a city in Canada called London, and I also work in the Gaza Strip

as an emergency physician as well. Glia was really an answer to a problem. The problem being that when I see patients in Gaza, they don't get the same quality of service that I can give to my patients in Canada. the same quality of service that I can give to my patients. Of course, that's multifactorial, but a big part of that has to do with the way in which we, as the medical profession, have medical devices that we don't release, that we don't give access to other people to use. And so, Glia's purpose was to take the most important medical devices that doctors use and to make sure that they were accessible and available to doctors all over the world.

Okay. Yeah, yeah, that's very cool. And you make a number of devices, right? Like I know that I first talked to you about the Tornike, but you make also a stethoscope, is that right? You make also a stethoscope, is that right? The stethoscope is the calling card of medicine. And so it was the first project that we started working on to test out the theory. I mean, we started with the theory that, hey, we can probably make a device that's just as good as a $300 device, but the costs, let's say $3 or even $30. And that was the stethoscope. We tested it, we published the results, we proved it was as good as the gold standard, the Littman Cardiology 3 at the time. And using it both in

our own practices, also making it available to other people to make for theirs. Okay, yeah. And so that's what's really interesting about your company as opposed to other companies, right? You're not necessarily like manufacturing and distributing. You are providing the designs that allow other people to make them, right? And so can you talk about some of the like, I know that you use 3D printing and I want to talk about that. But also, like I remember seeing that the tubing and the stethoscope comes from a Coca-Cola machine, right? Some of those considerations yeah absolutely the purpose is to make these devices available to other people

for the lowest possible but also like actually be available it's no good if you can make it for 20 cents but the parts that are required are nowhere so that's why we went with a basket of items that are more or less universally available, and we made the stethoscopes out of that. For example, you can probably get the very specific kind of earpieces that most stethoscopes have, but they are naturally going to be less available and less abundant than if you were to use regular earbuds that come on

headphones. There are way more headphones out there than there are stethoscopes. Therefore, those parts are more available. Of course, they are less expensive, but even if they were slightly more expensive, it would be worth it. What we really take away is the monopoly and the profit motive. And so by doing that, or rather, let's say the exorbitant profit that medical device companies are making, and by doing that, we're really able to realize the promise of patents. All of the devices that we make were patented at one point. The promise of patents is that when the patent is over, you'll get a cheap device. But that promise is not realized. The stethoscope is a 300-year-old device, basically. And the fact that it is not available at the highest quality except for $300

is kind of nuts. So that's why we started there and, of course, moved on to more and more complicated devices, much more complicated even than the tourniquet by now. Okay, yeah. Can you, I remember reading, because you kept a blog, I remember, on Medium where you talked about testing the tourniquet when you were in Gaza. And it just, A, if you read medical literature,

this was just the shocking, I remember being absolutely shocked by the number of casualties you were encountering. And then also, like you were saying, like the lack of available tools. So perhaps you could explain like a little bit of what you saw there and then how these tourniquets have been able to help you address that massive disparity in access to care. The tourniquet project really started in Gaza because we noticed that after one of the wars, the war in 2014, that we had a particularly high casualty rate, of course. But of that, there were many deaths that we would classify as preventable. Deaths where we felt that had tourniquets been available, those patients

likely wouldn't have died. When we started working on it, of course, we knew at some point there'd be another war. It is very common in Gaza for there to be attacks by the Israelis. We didn't anticipate for it to happen so fast and for it to happen in a way where the tourniquet was so necessary. That, of course, was what's called the Great March of Return, where Palestinians protested en masse. And one of the Israeli responses was to shoot live fire at the protesters, often targeting about 80% of the hits were targeting the arms and the likes, which is where tourniquets are the most effective. So the high number really is owing to the way in which the Israelis decided to deal with this protest, the fact that it was a

protest rather than a specific war. And that meant also that we could predict with a relative degree of accuracy where the injuries would be, which meant that it was even more important to have the right equipment and the right training. It was part of an overall strategy. So of course, it's not like tourniquets were the thing that saved lives. Tourniquets were part of a campaign to train paramedics and to train doctors in how to stop bleeding and these kinds of injuries. to train paramedics and to train doctors in how to stop bleeding and these kinds of injuries.

And they were one of the most important tools in that campaign, but only part of that campaign. Yeah, of course, of course, you need other tools and obviously the education and you can't just slap it on and then the person's fine, right? Obviously, there's a lot of care afterwards, which is important too. Can you maybe talk us through, you talked about like the promise of patents right and i think this is important in in exactly what we're talking about in tourniquets because it's a little different to uh like uh medic medicines right it's a little different with medical devices um so there are existing tourniquets on the market right and i I think the sort of market leading one is the cat. Can you explain why are those not getting to people who need them desperately in these areas?

The problem with the tourniquets that are available right now kind of falls into a few different categories. North American Rescue, the makers of cat, have two key patents on the cat. and Rescue, the makers of CAT, have two key patents on the CAT. And as far as we can tell, just based on the posture of the company, if anybody else were to make exact CAT replicas, they will be sued. The people who are willing to then make exact CAT replicas tend to be people who are unaccountable and largely have not much to lose. And so that's why we saw a glut initially, for example, with the Ukraine campaign of tourniquets that were relatively low quality. And so you can't just make the device. You also have to know that the device will work because you don't want to discover that when you put it on an arm or a leg and then it fails. Gaza is an acid test of all of these things because not only are devices generally

not available or expensive, it's kind of at the bottom of any purchase list, for example, but also in Gaza, there's a complete international blockade, Israeli-led, of course, but there are other countries that are contributory. And that blockade means that equipment can't get in so long as the Israelis deem it to be of military value. This is where things like dual-use devices and so on come into play. The tourniquet is a medical device. It can only be a medical device.

There is no second use. And so it should be exempt. However, even if the Palestinians could afford 50 US dollars per unit, which would be the cost to get one in, the Israelis won't let them in. So de facto, even though they shouldn't be banned, they are de facto banned. And that means that not only can we depend on cheap Chinese retailers, let's say, to give us replica tourniquets, we actually have to manufacture them ourselves. When we open sourced our designs, it was with an eye to two things. One, making it available so that the replica makers can make higher quality replicas. They're already making replicas. We may as well give them a legal replica rather than a patent-busting replica. Not that I think there's anything wrong with that in these

cases where there's emergencies, but just the same, Glia's tourniquet doesn't break any patents. And at the same time, in addition to giving them the ability to make high quality tourniquet doesn't break any patents. And at the same time, in addition to giving them the ability to make high-quality tourniquets, we can also make high-quality tourniquets locally and domestically. Because of course, national liberation, as it were, in the medical device space can't come if you can't make your own devices. We discovered that during COVID. The Palestinians have known that for decades now. And we're kind of rediscovering it in Ukraine, where there just aren't enough tourniquets. And so they are forced to improvise or accept tourniquets that they don't want to accept. Right. Yeah. I think COVID was this great example that we can't continue to rely on the sort

of whims of global capital to provide things that we need to survive. I think your manufacturing is fascinating. Because you're using essentially commonly available materials in a 3D printer. Is that right? Yeah, that's correct. I mean, we're not against using other things. They just have to be very simple. For example, our electronics use PCBs. You can't 3D print electronic circuits just yet. So we use PCBs. But when we design our PCBs, there are a couple of ways to design it. You can design an eight-layer board that can only be manufactured in one or two places in the world. Or you can design a board that's three times the size but can be manufactured anywhere in the world. And when you're talking about credit card size devices, if it's notebook size instead of credit card size,

it doesn't really matter that much. For example, the example I'm thinking of here is an electrocardiogram, where we took a device that had failed in the sort of market that the makers open sourced, and they had intended it to be a fitness device. And then it didn't work, their company went bankrupt, and so they open sourced it. So we looked at their schematics, all of the problems that they had already solved. We said, okay, the problem we're going to solve is to make it so that this can be manufactured in a high school electronics lab. And we were able to achieve that. It was bigger. It was twice as big. But who cares? The old one was half the size of a credit card. Who cares?

You make it a little bit bigger, but at the same time, you make it much more accessible. Twice as big, 20 times more accessible. Welcome. I'm Danny Trejo. Won't you join me at the fire and dare enter Nocturnal Tales from the Shadows presented by iHeart and Sonora. An anthology of modern day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters

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and breaking down barriers in all sorts of industries. Don't miss out on the fun, el té caliente, and life stories. Join me for Gracias Come Again, a podcast by Honey German, where we get into todo lo actual y viral. Listen to Gracias Come Again on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. I know some of your stuff, like your tourniquets, there's not much or any really of a performance trade-off from what you've seen, right? Indeed, they might be better for some pediatric applications, if I remember correctly. That's right. So when you think of the way in which corporate devices

are made, they are made to the specifications of particular buyers. And the buyers are the people who have the money. Who's the buyer for tourniquets? When you think about who needs tourniquets consistently, who has money to give you tourniquets, who should you market to? There's only one sane answer, and that is first world militaries, especially occupation militaries or militaries that are engaged in ground-level warfare, who are expected to take small arms or IEDs. And so there are not many children who you have to sell to in that particular market. There aren't many small women or even women at all that you have to sell to in that market. So I don't think that North American rescue engineers would have any trouble making

sure that their tourniquets worked amazingly well for children. But why? Why would they spend $1, $2, $20, $30 million doing that work and research when that's not their audience and that's not their buyer? For us, the normal person, the civilian is the, in quotation marks, buyer. They're not the ones buying, but they're the ones who are the main consumer. And so they're the ones who we target. In Gaza specifically, 45% of the population is under the age of 14. You'd have to be crazy to go out there and put a tourniquet out that only works on big, burly men. on big burly men. So that's why we were driven to do that. And as for the performance trade-offs, yeah, you're right. What we learned about spec sheets on lots of these devices is that they're made up. There isn't really a great way to know how well a tourniquet works, unfortunately. There isn't a really great way to know how well a stethoscope works. And so some of the first work we did was actually designing some tests so that we can say, okay, well, here's how you prove that this stethoscope works as well as that stethoscope.

Or here's how you prove that this works as well as that. And those testing protocols, we made them open source and easily available too. For example, if you want to test a stethoscope, you can do that with a pair of headphones, a microphone, and a Hello Kitty balloon. That's how we did it originally. Could we have spent $10,000 making that test rate? Yeah, we could have. But that wouldn't have helped us in terms of helping other people make stethoscopes wherever they are. Yeah, that's very cool. And then by open sourcing that test, you allow for other people who have ideas or sort of models for their own improvements or different designs that they can then use that test, right? And then continue to improve and

share their improvements with others. I do not want to work on stethoscopes anymore. I want people to take it up. And it doesn't mean that I won't. Of course I will. But my favorite thing is when somebody sends a message and says, hey, I like what you've done. Here's how I think it could be better. I love those messages. I love them. And you know what? Nine out of 10 of those ideas don't work out.

They don't pan out. But 10%, like our stethoscope since 2017, all of the improvements have been from other people because we haven't had the time and money to work on it. But we have been open-minded, have incorporated lots of design changes that other people in the community have suggested. That's a good thing.

It's good for everybody. Yeah, and I think it does an excellent job at getting the fundamental conceit of our uh drug and device development model right which is that uh the which isn't true actually that there's massive r&d costs and those r&d costs have to be recouped by charging a massive amount for a period of time and making access to that medicine or device a privilege not right and then eventually the cost will come down which they often don't and then everyone will have access to this thing. And it's been my experience that it doesn't work that way. But what you've shown is an alternative, right? That people want to help and that there's

not a need for this price gouging to facilitate the improvement in this technology. Is that fair? We're not taking a purely altruistic model here. People are generally improving the stethoscope for their own uses. So there is a self-interested aspect if you want to present it that way. What we realized is that actually the most useful way to develop a device is to make it as good as possible and release it, and then have other people who want to improve it have a capacity to share back to you. So as much as I believe in altruism, and I do think every time that I've seen people collaborate, I've seen a tremendous amount of it, this more resembles the open source software model, which is actually the world I came from. I came from the free software model where, yes, you do things just for the fun of it, but also very large corporations

are involved. For example, some of the stethoscopes improvements happened because a lab needed to use it for some experiments on animals. And so they made modifications and they fed them back. Amazing. That's fantastic. But that was totally self-interested, that they knew that it would cost them significantly less to build on our work, and it would cost them nothing to share back their contributions. they're trying to prove that everybody is good at heart, even though I do actually think that's fundamentally true. What we're doing is showing through this model that devices can advance with relatively little upfront costs and with the contribution of many, many members. Yeah, you phrased it really well, I think.

People have this self-interest which also serves other people's interests. I've seen it in all kinds of open source communities. We've reported before on 3D printed guns, which is obviously a different end of the spectrum. But it's fascinating to see this global exchange. And I'm sure you have people... You've mentioned that there are people in Myanmar who are printing your tourniquets, right?

We were amazed when people from Myanmar had reached out and said that we've seen your tourniquet and we want to implement it. We have a situation that's very similar to Gaza. We thought that's exactly what we want. What they did was two things. One, they took our instructions and they used them, but then they also fed back to us how those instructions were incomplete, how they could be relationship, the kind of solidarity that we've seen whenever other people have used our devices.

We've noticed that they take, and it's not a problem if people in Myanmar had just taken and not given anything back. That's fine too, because it doesn't take anything away from us to share. This is a kind of sharing where the more you share, the more there's potential for benefit, but there's never a loss. You never lose by sharing. In that sense, we're not also trying to present it as though we need people to share for us to feel that this model works. We don't. But we're already making it anyway.

We're already using it anyway. We're sharing. And some people help out by contributing back and some people don't. It seems to me to be the most effective way to develop devices for low cost and make sure that they get out to where they need to be. Yeah, because in the 21st century, people who need them can find them, as you found out, right? Like people across the world. Do you have a sense of where else they're being used?

The tourniquets right now are being used in Gaza, in Ukraine, and in Myanmar. If they're being used in other places, we're not really aware of it, but people aren't compelled to make us aware of it. And all three of those locations have moved forward the project tremendously. For example, for Ukraine, the Ukrainian support people weren't really able to contribute so much their own ability to construct and make, but they were able to contribute really important research, financial, and testing capabilities. And so, of course, a project like this costs money. They're like, hey, look, we don't have farms, print farms, but we do have some cash that we want to put into it. And we were able to use that money very, very effectively, more effectively than if they would have bought the pieces to then create the capacity for them to go and make their own tourniquets.

Okay. So yeah, let's talk about that. That's fascinating. And we could maybe contrast it to sort of another model, right? Because I understand you're able to go to Ukraine and help them set up if um because you i understand you're able to go to ukraine and help them set up uh as opposed to yeah it would have taken months i imagine to do that with uh i don't know how they make the cats but they they like wrote they molded or something but with with a non sort of with a non-open source non-printed model like to set up a tourniquet factory in ukraine or poland would take months right yes absolutely but you're not going to, there's two reasons why North American Rescue, I'll just call them NAR from here on out, won't do that. One of them is that that conflict at some point will end. It's very expensive to set up production lines. And the other thing is the

more tourniquets you put into the market, the cheaper tourniquets get. Supply and demand, we learned that one pretty well from capitalism. And so they have an inherent disincentive, whether they recognize it or not, whether it's conscious or not. North American Rescue and all these companies have an inherent disincentive in flooding the market with tourniquets, whereas we do not. For us, it's the opposite. We lose pretty much, Glia loses about $10 to $20 per tourniquet that we manufacture. We have no incentive to keep doing it. We want other people to do it because we want as many tourniquets to be provided as possible. What we do then is we heavily subsidize the tourniquets using our own internal funds and fundraising that we do

with the goal of getting them out there so that deaths can be prevented. And so we want other people producing. When I go there, every tourniquet somebody else makes instead of me is less headache for me, is less pain for me, and is less financial loss for me and for Glia, of course. So our incentives are different. They want a shortage, consciously or not,

and we want an abundance. We want everybody to have a tourniquet in their pocket. That's our goal. That's our goal. Welcome. I'm Danny Thrill. Won't you join me at the fire and dare enter Nocturnum, Tales from the Shadows, presented by iHeart and Sonora. An anthology of modern-day horror stories inspired by the legends of Latin America. From ghastly encounters with shapeshifters to bone-chilling brushes with supernatural creatures.

I know you. Take a trip and experience the horrors that have haunted Latin America since the beginning of time. Listen to Nocturnal Tales from the Shadows as part of my Cultura podcast network available on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Jack Peace Thomas, the host of a brand new Black Effect original series, Black Lit, the podcast for diving deep into the

rich world of Black literature. I'm Jack Peace Thomas, and I'm inviting you to join me and a vibrant community of literary enthusiasts dedicated to protecting and celebrating our stories. Black Lit is for the page turners, for those who listen to audiobooks while commuting or running errands, for those who find themselves seeking solace, wisdom, and refuge between the chapters.

From thought-provoking novels to powerful poetry, we'll explore the stories that shape our culture. Together, we'll dissect classics and contemporary works while uncovering the stories of the brilliant writers behind them. Blacklit is here to amplify the voices of Black writers and to bring their words to life. Listen to Blacklit on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Hi, I'm Ed Zitron, host of the Better Offline podcast, and we're kicking off our second season digging into how tech's elite has turned Silicon Valley into a playground for billionaires. From the chaotic world of generative AI to the destruction of Google search,

Better Offline is your unvarnished and at times unhinged look at the underbelly of tech from an industry veteran with nothing to lose. This season, I'm going to be joined by everyone from Nobel winning economists to leading journalists in the field. And I'll be digging into why the products you love keep getting worse and naming and shaming those responsible. Don't get me wrong, though. I love technology.

I just hate the people in charge and want them to get back to building things that actually do things to help real people. I swear to God things can change if we're loud enough. So join me every week to understand what's happening in the tech industry and what could be done to make things better. Listen to Better Offline on the iHeartRadio app, Apple Podcasts, wherever else you get your podcasts. Check out betteroffline.com. Hola mi gente, it's Honey German and I'm bringing you Gracias, Come Again, the podcast

where we dive deep into the world of Latin culture musica, peliculas and entertainment with some of the biggest names in the game. If you love hearing real conversations with your favorite Latin celebrities, artists and culture shifters, this is the podcast for you. We're talking real conversations with our Latin stars, from

actors and artists to musicians and creators sharing their stories, struggles, and successes. You know it's going to be filled with chisme laughs and all the vibes that you love. Each week, we'll explore everything from music and pop culture to deeper topics like identity, community, and breaking down barriers in all sorts of industries. Don't miss out on the fun, el té caliente, and life stories. Join me for Gracias Come Again, a podcast by Honey German, where we get into todo lo actual y viral.

Listen to Gracias Come Again on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts. Can you talk a little bit about your experiences in Ukraine? You were there pretty recently, right? Ukraine is a very, very complicated subject when it comes to tourniquets, because the tourniquet wasn't this... I'm going to mind my words very carefully. I'm not Ukrainian. I'm not a Ukrainian doctor. And my experience there is very limited. I am in solidarity with the medical community in Ukraine. And part of being in solidarity with a medical community is recognizing that even when there are weaknesses, it is not my place to insert myself into their processes.

And so the way that the Ukrainians have approached tourniquets is at the outset to ban all 3D printed tourniquets and to basically make it so that only what they considered to be high-quality tourniquets, mainly the CAT and another one or two models, were available in there. This, unfortunately, created a tremendous shortage. And the other thing that functionally happened was a disconnect between the policymakers within the medical community and the people on the ground. The people on the ground, of course, are doing whatever they can to provide care wherever they can. And the policymakers are a little bit more disconnected from that and so have different considerations. The shortage then creates this difficulty.

You know, there are, of course, 3D printed tourniquets aren't accepted officially in Ukraine, but there are an abundance of 3D printed tourniquets in Ukraine because the people on the ground are accepting them. And what we see is a kind of grassroots experimentation with how it is that we can prevent deaths. The other difficulty is that tourniquets are a tool, and in bad hands, this tool isn't going to work, even if it's a great tool. And so one of the things that I realized, and I think everybody at this point, I'm not saying anything that's new or unknown to the community, we all realize that without appropriate training and how to use a tourniquet, they're not going to work. And so even high quality tourniquets

out there in the field are failing because they're being used improperly and it's causing unnecessary deaths. So I don't know how deep you want to get into that experience in Ukraine, but I think what we can say is that it's important to be in solidarity with that community. And as such, we're providing them all of the experience that we have and all of the capability that we have to produce tourniquets that the Ukrainians themselves, both officially and in the front lines, are able to use and feel are actually safe for their patients. Yeah, that's a difficult situation. I think obviously a lot of what's happening in Ukraine has been necessarily rushed and it's somewhat, perhaps chaotic is the wrong word,

but it took a while for people to fully sort of understand the necessities of the scale and the scale of the conflict. Or perhaps understand is still the wrong word. But yeah, to come up with the most of the way to do the least harm, I guess. That's such a great way to frame it. And I think even from your experiences, you see that very often in these situations that's the name of the game it's not even doing what you know is best but rather figuring out what the least worst scenario is yeah yeah so often i think uh and it's very easy i think to um to like backseat drive these things right from from uh our positions of safety uh and and plenty, you know, to say,

oh, well, should have done this, should have done that, which I think you did very well to explain that the first and most important thing is to be in solidarity with the people there and to hopefully allow their experience to guide us in how we can best help them to prevent death, prevent harm. And so can you talk about what you were able to do there? What sort of interventions could you make to hopefully help prevent more dying?

The main thing that we did in terms of, so I kind of was there with two hats on. One of them was the tourniquet manufacturing hat. And the other one was as an emergency doctor. Because remember, fundamentally, what brought me to medical devices in the first place was that I was an emergency doctor having problems actually caring for my patients. As a tourniquet manufacturer, basically, it was about engaging with other people who are making and using tourniquets to understand some of the roadblocks and problems. with other people who are making and using tourniquets to understand some of the roadblocks and problems. One of the biggest ones is that there isn't a great way to test units of tourniquets. So

traditionally, tourniquets are tested by design. NAR says, here's our design and here's how we tested it. And then we accept that this particular company will make this particular device to this particular standard. But in the Ukraine, especially with the presence of replicas and 3D printed tourniquets, there became a new problem. How do you test each unit rather than a specific line? And working on that, I don't know how into the weeds you want me to get,

but working on that is still a problem that is unsolved, but has been one of the biggest issues that we've been dealing with. On the emergency medicine side, of course, when I provide direct care to patients, I was in a hospital on one of the communities on the front line on one of the fronts. And so providing direct care became important. And working with the doctors, many of whom didn't really experience that much, have that much experience with trauma patients. So working with them to share our experiences from Gaza in low-resource trauma medicine, and also to gain from them their experiences,

because of course, their scenarios and situations are different. It's more artillery-based rather than small arms fire or sort of bombing-based. So there are different scenarios. I had a lot to learn from them, and I did. And I tried to contribute some of our experiences as well. The training, I think, is probably the number one problem right now. But that's my personal opinion as one doctor who is there for a limited period of time. right now, but that's my personal opinion as one doctor who is there for a limited period of time. So that individual unit test that you're working towards is, because I know in theory,

at least a cat is a single use device, right? So in theory, if you just slapped it on something that could measure pressure and tightened it, that device is then being used and shouldn't be used again to provide care. Is that the bottleneck you're running up against? Or is it sort of making a way to test things that's replicable and cheap and accessible? Reusability was the number one problem that we tried to tackle in Gaza because we couldn't print tourniquets as fast as they're being used. And so we reused them up to 10 times. And when I was in the hospital, I walked by this IV pole with a bunch of tourniquets hanging from it, and I instantly recognized what I was looking at. That was a tourniquet rewash station in which tourniquets

that came off of patients who were being rewashed, dried, and then sent back out into the field. Whatever you think the standards are for a tourniquet, when there's this level of shortage, that's what's going to happen. That's what happened in Gaza, and that's what happened in the Ukraine. That's what I saw with my own eyes. Of course, we don't need to stretch that far anymore to recognize this. What were people doing with N95 masks two years ago in my hospital? We were holding them, storing them, washing them, reusing them. So this is something that we see whenever there's a shortage. And it makes the unit testing that much more important. Because if you could take an already used tourniquet and assure that it will succeed the next time it's being used, that is so valuable.

So valuable. And it cuts down every tourniquet you can reuse as a tourniquet. You don't have to import. You don't have to buy. You don't have to package. You don't have to ship over all of these lines. Yeah. Yeah, of course. I think it's probably we should probably address like the the ways in which they can fail because i think uh like just people in the united states actually in an extremely like resource rich setting right uh will probably have knowingly or unknowingly acquired a tourniquet on amazon or somewhere else ebay that that might not be a real one um so oh i went it's real uh but it might not be a reliable one. Can you explain how they fail and what the consequences of that failure are? There are two kinds of failures when we talk

about tourniquets. One of them is what we would call a technical failure. And the other one is a clinical failure. A technical failure is the easiest one for most people to spot. The tourniquet literally breaks in your hand and that's it. You hear a crack, you see something crack, you see a break, things fall apart, the end. And so one of the things that we want is to minimize these by over-engineering. So for example, the first glia tourniquet was engineered to spec. You're supposed to be able to turn it three times, and so we made it so you could turn it three times. And then what I realized is that even I, who is super well-trained, I would be in the field running while my eyes were full of tear gas, while people are shooting. And I'd forget, did I turn it two times, three times? So we started over-engineering the tourniquets. At a certain point, of course, every tourniquet is going to break. You turn it enough

times, every tourniquet is going to break. But that's not necessarily going to be the case if you have even a moderate amount of training. I'm going to turn it four or five times, but I'm not going to turn it 20 times. So the technical failures are one kind of failure. The other one is clinical failure. Now, here's something that I wonder if you knew. About 35% of tourniquets from the gold standard company fail. They fail on application. And that number goes up to 50% if you were to check 60 seconds after application. So what does this tell us? What this tells us is that clinical failure is actually the important marker here. Because we know tourniquets break and we know tourniquets fail in general, especially tourniquets that have been in some GI's pocket in Afghanistan for six months. Those ones, their failure rate can go even higher. And so what we train people to do is to recognize clinical success. Put on a tourniquet.

Did the blood stop? No. Put on a second tourniquet. Did the blood stop? No. Try a third one, if you have them, obviously. And so the routine training involves applying a second tourniquet. obviously bittersweet, but was when I saw a patient who was brought in by a medic who I had been in the training for, and he had applied two tourniquets to a guy who certainly would have died had he not had the tourniquet applied to him. It was exsanguinating so much, injury so severe, that he needed a couple of tourniquets to really get it under control. he needed a couple of tourniquets to really get it under control. So it's where we have to recognize that there is no magic tool. This is part of an overall program. There's no 3D printer that's going to train people. It's just going to make you stuff. Then you have to do the rest of it. Right. Yeah, yeah. So I think if we should look maybe at the fact that, like, I live in the United States and you're in Canada.

I think there were like three mass shootings yesterday, right? The threat of violence is certainly at a high for recent times for a more diverse range of people, right? There's always been violence in this country. There's always been violence against certain groups of people disproportionately in this country. But people are probably more concerned with treating gunshot wounds than they would have been 10 years ago.

So if someone was looking to make one of your devices, how can they do that and do their best to ensure that they are doing so in a way which gives them the best chance of success? At the moment, I would say to the individual maker, don't do it. Not for a life-threatening situation. If individual makers want to make tourniquets, then they're going to have to be proficient at three big things. One of them is plastics, 3D printing, ensuring that the quality of the plastic is good. The other one is sewing, that is to say, assembling sewed stuff. And the third one is quality assurance, because even done perfectly, a certain number of tourniquets aren't going to make it. And that quality assurance is

both at the moment of manufacture and then over time, because of course, all devices deteriorate over time, but tourniquets have such an important role that you have to check them periodically to make sure everything's okay. So I would say to the individual maker, don't. Or if you do, do it as an exercise rather than as an actual tool. If somebody is in an emergency situation, there's nothing they can do except to do it, then be in touch with us. have been in touch and have said, okay, look, I have to do this because the situation here is bad. We support them as best as we can. We try to send people out to them or we try to have them ship units to us. We try to get them up and going. Glia is not a medical device manufacturer. Glia is an access to medicines, an access to medical devices company. And part of that is making sure that people who are making medical devices are doing them to the highest possible quality. So if you are forced to make them be in touch with us,

we will help in any way that we can. However, there's another category of people, and that is manufacturers who already know how to make medical devices. To those people, we say, take our stuff. Please use it. Please. It is there for the taking, and it is high quality. It works really well. And if it's missing something, tell us. We'll make it better for you and for us. missing something, tell us. We'll make it better for you and for us. Yeah, that's great. I think that's really excellent advice. And perhaps a good note for us to finish on. Where can people find you if they want to get in touch, if they want to look at some of the devices? Making a stethoscope, I imagine, could be like a fun project and a lot less potential risk there. So where can they find that stuff? Absolutely. The stethoscope is such a fun project. It's fun because everybody has a heart in general and you can listen to your family and friends and loved ones. It's one of my favorite things

when I'm in practice and I listen. Sometimes a patient will be there with their son or daughter or child. And I'll tell the kid, you want to listen to mommy's heart or daddy's heart? It's one of the best things. So the Stethoscope is a great, fun, low-risk project. Please go ahead and do it. Make it. You can find our stuff anywhere you can find printable stuff. It's on Thingiverse. It's on printables. It's basically everywhere. basically everywhere, or through our GitHub, or on the Glia site. So that's glia.org. And if people want to participate, they're very welcome to. We always want, need, and love help. And of course, it's a community. You can never have too many friends.

So we're always looking for more friends and love to see more people. We have a Mattermost. Obviously, it's not just our devices that are open source. We try to make our entire stack open source so people can join and chat with us and hang out with people who are doing really, really cool and super impressive stuff. At this point, I love to recognize the fact that I'm one of the least productive, least impressive people at Glia. Really, the work that I'm one of the least productive, least impressive people at Glia. Really, the work that's happening is amazing. And it's led by lots of smart, dedicated, visionary people. Yeah, that's great to hear. That's really cool that you can, we can work with people as well. So hopefully people do get in touch. I'm sure there'll be someone who's

interested in what you're doing or has something to contribute in some fashion. Yeah. Thank you so much for giving us some of your evening. Is there anything else you'd like to say before we finish up? I think the most important thing to say is that there's this mystique that people develop. You alluded to it earlier. There's a mystique people develop around medical devices. Medical devices are solutions to problems. And they were made by people like me who don't know what the hell they're doing sometimes. And so let's not aggrandize or separate ourselves from the people who are doing this work. Yes, we have to be cautious. Yes, we have to be rigorous. But at the same time, we can all contribute and be a part of this.

Very cool. And can people find you personally anywhere? Do you have social media that people could follow? Yeah, if people look up my name, Tarek Labani, I'm on all the socials, as is Glia as well. So you can contact me or Glia and participate in anything that you want. And like I said, we always welcome friends. Great, wonderful. Thanks so much, man.

Thank you so much. That was such a pleasure. Great. Wonderful. Thanks so much, man. Thank you so much. That was such a pleasure. It Could Happen Here is a production of Cool Zone Media. For more podcasts from Cool Zone Media, visit our website, coolzonemedia.com, or check us out on the iHeartRadio app, Apple Podcasts, or wherever you listen to podcasts. You can find sources for It Could Happen Here updated monthly at coolzonemedia.com.

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