The Wolf Of All Streets - Dr. Richard Melker, Renowned ER Physician and Inventor on Inventing Life Saving Devices, COVID-19, Politics Vs. Medicine, Inventing the Transport Ventilator, Being Head Doctor for the NASA Shuttle Program, Life in the ER in a Pandemic and More

Episode Date: April 30, 2020

Dr. Richard Melker, world-renowned ER Physician and Inventor and Scott Melker, discuss the early days of emergency medicine, being the head doctor for the NASA Space Shuttle Program and the Challenger Explosion, the politicization of COVID-19, life on the front lines in the ER during a global pandemic, fake news, inventing the transport ventilator, inventing the world standard device (The Melker Cricothyrotomy Set) for intubating patients in an emergency, the importance of hand washing, making the leap from physician to inventor, social distancing and much more. --- ROUNDLYX RoundlyX allows you to dollar-cost-average into crypto with our spare change "Roundup" investing tool, manage multiple crypto exchange accounts in one dashboard and access curated digital asset content and services. Visit RoundlyX and use promo code "WOLF" to learn more about accumulating your favorite digital assets when making everyday purchases and earn $4 in free Bitcoin. --- VOYAGER This episode is brought to you by Voyager, your new favorite crypto broker. Trade crypto fast and commission-free the easy way. Earn up to 6% interest on top coins with no lockups and no limits. Download the Voyager app and use code “SCOTT25” to get $25 in free Bitcoin when you create your account --- If you enjoyed this conversation, share it with your colleagues & friends, rate, review, and subscribe.This podcast is presented by BlockWorks Group. For exclusive content and events that provide insights into the crypto and blockchain space, visit them at: https://www.blockworksgroup.io

What's up, everybody? This is your host, Scott Melker, and you're listening to the Wolf of All Streets podcast. Every week, I'm talking to your favorite personalities from the worlds of Bitcoin, finance, trading, art, music, sports, politics, and basically anyone else with an interesting story to tell. So sit down, strap in, and get ready, because we're going deep. Let's go. I'd like to thank my sponsors, Round the X and Voyager, for making today's episode possible. We'll hear much more about them later on in the episode. This podcast is powered by Blockworks Group, the only events and podcast production company I trust. For access to the premier digital asset conferences and in-depth podcast content, visit them at blockworksgroup.io.

I promise you will not be disappointed. As a musician and DJ, I've performed in front of stadiums full of people. I've rubbed elbows with celebrities. I never really felt nervous at all. But strangely, I couldn't sleep last night in anticipation of today's conversation, thinking of every potential question I could ask, hoping that I would get it right, so to speak. The problem is that I came up with probably a thousand hours worth of ideas. I think it's rare to have the opportunity to speak with one of your heroes on a podcast,

and even more rare that you have the opportunity to speak with that person a few times a day. But here we are. Today's guest is none other than my father, Dr. Richard Melker. While it may seem strange to bring on my dad as a guest, he's likely the most well-informed and qualified person that I've ever had on the show. He's a world-renowned physician who spent the bulk of his career saving lives in the emergency room at the University of Florida. In that time, he also introduced the emergency helicopter program, served as the head doctor for the NASA Space Shuttle program, and invented countless devices that are used to save

lives around the world on a daily basis. He has 68 issued patents in the United States, from disappearing sunblock to a universally used emergency airway device, the Melker cricothyroidomy set. He's also an expert on three things that are incredibly important with regard to the current global pandemic, those being ventilation, intubation, and hand washing. While he's a giant in the medical field, I think you'll find that he's also incredibly humble and that he cares deeply for his fellow man, so much so that his career and life decisions have been dictated by the need to help as many people as possible. So without further ado, hi, Dad. Thanks for coming on the show.

Good to talk to you. So by the way, you're the first guest in well over a month who I don't have to apologize to for the inevitably screaming kids in the background since they're actually your grandchildren, which is nice. Usually I have to give the disclaimer. So let's just start from the beginning. You had endless career options. What inspired you to become an ER doctor in the first place? Actually, it was purely by accident. I did a residency, which is where you train to become a physician after you've completed your medical school training. And I did mine in Los Angeles at Harbor General Hospital. And at the time I was training to become a pediatrician, I spent a significant amount of time in the emergency department and was troubled by the fact that the paramedics didn't

have as much training in the care of children as they did in adults. So I actually spent my last year of training riding with the LA County EMS system every Friday. And of course, that generated a lot of interest in the care of children in what's now called the pre-hospital arena, basically the care of patients before they arrive in the emergency department. I then moved to Gainesville, Florida, where the University of Florida College of Medicine is. And I did a fellowship, which is what you do after you're a licensed physician. And my fellowship was in pediatric cardiology and critical care medicine. And it just turned out that while I was finishing up my fellowship, the part-time director of the emergency department had moved on and they were looking for a full-time director of emergency medicine. And because of my interest in emergency medicine, while I was in Los Angeles, I took the opportunity to become the first full-time medical director of the emergency department in Gainesville at the University of Florida. And this was a period in which emergency medicine was

really in its infancy. The first thing we had was the pre-hospital arena, but there were very few physicians trained in emergency medicine. While I was in Los Angeles, one of the first emergency medicine programs was being developed in the LA County hospital system. And there were a couple of other places in the United States, particularly in Seattle, Washington. And the focus of those systems at the time was mostly on cardiac arrest and cardiac rehabilitation. So I took the job as a full-time director of emergency medicine. And along with that job, I became the full-time director of the Alachua County EMS system. So, although I trained in critical care medicine, I gravitated towards this opportunity to become an ER physician

before it had really become a specialty of its own. I have to ask, what happened to people before emergency medicine if they had a stroke or a heart attack at home or they had some sort of acute emergency? Did they just die? The answer to that is much more frequently. Believe it or not, if you go back and you study the history of pre-hospital care or emergency medical services, the funeral homes actually ran the first EMS systems, which one would consider quite a conflict of interest. But since they had vehicles that could transport the patient along with somebody caring for the patient, those were really the hearses that were used to take people to the cemetery were also used to bring patients to emergency departments. And you have to remember that a lot of hospitals didn't

really have an emergency department. Basically, they had an area in the hospital where patients could be brought in. And depending on what was wrong with them, a doctor from some specialty would come down and take care of them. And there were limited facilities at that time. They really weren't emergency departments. They were just an area in the hospital where the patient could be brought to, cared for, and if necessary, admitted to the hospital. It really wasn't until the 1960s that pre-hospital care, the EMS systems developed, and that was largely due to federal funding that was used to develop the first programs. And then out in Los Angeles and a few other areas, they realized that once the patient arrived in the hospital, there was a need for people who could care for a wide variety of medical issues,

anything from a heart attack to major trauma. Of course, this was the era of the Vietnam War, and military medicine played a large part in the development of both the methods that we use to transport patients to hospitals and also to care for patients with major trauma, which up to that point was very poorly cared for. So the University of Florida itself is a bit of a unique environment, right? Because it's a hub for a huge rural area surrounding. I mean, I remember as kids, you talking about patients coming in from hours and hours away because it was the closest hospital. And I know that had something to do with developing the closest hospital. And I know that had something

to do with developing the helicopter program. Can you talk a bit about that? And then also about how you ended up as the head doctor for the NASA shuttle program? Sure. So you hit the nail on the head. And it's one of the ironies of EMS systems that the original systems were developed in big cities. And so, obviously, those cities had more resources. They also had academic medical centers, basically, where doctors were being trained to become physicians. And the irony is that in a lot of big cities, the time from, let's say, either a heart attack or a trauma situation from an automobile accident, the time to get to the hospital was relatively short. And most of the initial funding and initial efforts to develop EMS systems and emergency departments was in the big cities. So the time from an accident or from a heart attack to arrival in the hospital was relatively short. time, people in rural areas didn't have access to the academic medical centers, nor did they have

access to the advanced EMS systems. And so, in the late 60s and early 70s, a number of institutions around the United States realized, again, because of our experience with the Vietnam War, that the way to bring these patients from these rural areas or areas that are further from these academic medical centers was by helicopters. And so the first aeromedical transport systems developed in the late 60s and early 70s. And being in Alachua County, which is where Shands Hospital is and where I practice emergency medicine, we were in the hub of a large rural area where if an ambulance picked up a patient, it could be over an hour to arrive at our facility. And about the same time that we were starting our system,

the Maryland Shock Trauma Unit was developed at the University of Maryland, which became a famous center for doing research in the care of trauma patients. And the development of that center was really key in the focus on the care of patients with major trauma. And of course, the state of Maryland decided to use the state police and to have them actually pilot the helicopters that brought the patients to their shock trauma unit. And again, all these things occurred very quickly in the late 60s and the early 70s. That's interesting. So talk about the shuttle program was nearing the point where they were seriously considering putting astronauts in space in the space shuttle. So the University of Florida was approached in 1979 to become the East Coast Medical Support Facility for the Space Shuttle Program. And being the medical director of the emergency department,

I was the obvious choice to lead the program at the University of Florida. And so, again, a lot of serendipitous things occurred in my life in the late 60s and early 70s. And of course, that was one of the really exciting ones was the opportunity to first go to Houston and train to prepare for the care of astronauts should there be an emergency during the launch or landing of the space shuttle at the Kennedy Space Center. And because we had developed our own helicopter-based program in the early 70s, we also had the means to transport patients from Kennedy Space Center to Gainesville, Florida. Of course, NASA also had helicopters, but in the early days, they were basically helicopters that had been used in Vietnam and some of the very early models. And so those helicopters served multiple purposes for NASA, not only for medical care of the astronauts. And so that led to a lot of thinking, brainstorming between us and NASA on how to convert those helicopters quickly for the care of astronauts in emergency situations.

But because we had developed our own helicopter program at the time and looking at the programs around the state of Florida that could support the shuttle program, we became an obvious choice. And so starting early in the history of the program, we would send a team of physicians down to Kennedy Space Center for each launch and each landing.

And obviously there was a lot of fun in going down there. I'm sure you as a young, you today remember as a young child often being down at the Kennedy Space Center to watch a launch or a landing. And it obviously was one of the great thrills of my life and a unique opportunity to become involved in something that I had always been interested in. my summers in the Ocala National Forest, we often saw launches of missiles and satellites from the Kennedy Space Center. And whenever we had the opportunity, we would drive over to Cape Canaveral to watch launches. Obviously, there were no landings in those days, but by the time the space shuttle program had matured, NASA was bringing the space shuttle back to the Kennedy Space Center rather than landing at Edwards Air Force Base. I always got to go to all of the launches and I remember getting autographs from the astronauts and we had the patches for every single launch. And that was like the core of my show and tell for the entirety of my childhood. But actually speaking of my childhood and remembering shuttle launches, one of my most vivid memories from childhood in general is the day that the

Challenger exploded. I think probably anyone my age or my generation was, you know, at a time where they rolled a TV into the room and everybody in America was watching the launch because of Krista McAuliffe. It was putting a teacher into space. It was this huge sort of PR event. And of course, we know how that inevitably ended with everybody, including small children like myself, watching it live. Now, I have to say, I don't know if this is something I should discuss, but that's the only time I remember as a child seeing you cry was when you picked me up from school that day. And actually, I don't remember the specifics, but I believe that you were not, that was the first launch where you were not a part of the program. Is that correct?

Yeah, you bring up a very interesting point. So prior to the Challenger accident, NASA had a series of, they had a very aggressive program, but they had a series of cancellations of launches. And because of that, a decision was made that the program had matured to the point that there was no longer the need to have medical involvement from the University of Florida. And so, believe it or not, that was the first launch of the space shuttle where our team was not at the Kennedy Space Center. And so I was in the emergency department in contact with the team from NASA down there. And obviously, we were watching on television. And it was really a very difficult day for everyone. Obviously, NASA follows protocols when there's an incident and I will never forget the phone call that I received to prepare the hospital for, for the astronauts. And obviously watching on television,

we knew that it was extraordinarily unlikely that there would be any survivors, but we went ahead and did our preparation. But I'll never forget the voice of the person who I had known quite well down at the Kennedy Space Center when she called to tell us to prepare the hospital for the astronauts and talk about somebody who was upset and having to do a job, which was incredibly difficult. That was a day that none of us will ever forget. Yeah, I definitely never will. And that touches on, I guess, the human side of being a physician

in general, but especially, I guess, an ER doctor where you're dealing with death and telling people what has happened to their loved ones on a very regular basis. And now we're in this extremely unique situation with COVID-19, obviously, where our doctors, healthcare workers, even the people who just work in the hospital, are at tremendous risk. It's almost like they're on the front lines of a war. What do you think it would be like if you were still practicing to be in the emergency room now? Obviously, I've thought about that quite a bit. And this really is a war. And it's a war with an unseen enemy. So when patients come in, we know that they might have the virus and they

might not. And particularly in the large cities that were hit first, like New York, one has to wonder the courage of all the people, the doctors, the nurses, all the ancillary personnel who go to work every day, knowing very well that this virus could kill them. Being retired now and in my 70s, obviously, I would probably make the decision not to be directly involved. But obviously, I think about all the people who are, and I think about what I would have done if I were younger now. And my personal solution would be to isolate myself at home from my family, which a lot of physicians are doing.

In other words, they're living in their home, but they isolate themselves from the rest of the family. One of the things that I read about recently was a family where both physicians were ER doctors and they had to write a will because there really is a tremendous fear that somebody who's taking care of patients is going to die. The impact of COVID-19, I don't think is going to be really felt until this acute phase is over. And just like, you know, there's been a number of studies of what happens to physicians who work in combat zones and physicians who are in the military. And it takes a tremendous toll on them, particularly when there's nothing that they can do to save

somebody. And I believe that we're going to see very similar occurrences with all the healthcare workers, the EMS people, all the people who are on the front lines. And obviously, there's this tremendous frustration with the fact that the United States has done such a poor job in preparation for it. Some of it are things that are beyond our control. Some of the things are within our control. And we've seen that even in other countries, how overwhelmed they become. But this was inevitable. The epidemiologists in the United States after the first SARS outbreak in the early 2000s and after the MERS outbreak were warning our country and our leaders that it was only a matter of time when we had a pandemic similar to the flu pandemic in the 1918-1919. So one has a variety of mixed feelings And I'm frustrated and angered

by the fact that we are unable to provide the healthcare workers with the equipment that they need to keep themselves safe. It also seems to some degree that they're not armed with proper data or information on how to care for these patients to some degree. To me, it feels like that's accelerated by the media, of course, and the velocity of news. And, one day there's this miracle treatment and the next day that treatment is completely debunked and they don't even do FDA studies anymore. I mean, how as a physician do you deal with treating patients when there's all of this false information, I guess, being thrown at you on a daily basis? That is an excellent question. And I think the best answer that I've heard was from Richard Besser, who had been at the CDC. He, for a short time, was the director at the CDC on a temporary basis. And his answer is the answer that I believe. The

only people who should be providing information to the American public are scientists. And among those scientists should only be the people who really have expertise in epidemics and pandemics. And to mix politics with what's going on in our country right now, to me, there are no words. When you talk about anger and rage, I cannot watch television very much anymore because of what's going on. And one would think that our country, of all the countries in the world, as we accuse every other country in the world of, you know, foisting this on us by not giving us the proper information, would have been more prepared. And, you know, we have seen on television experts, and we saw a speech by President Obama where he said it was only a matter of time before this occurred and we had to be prepared.

And obviously nobody heeded that warning from the epidemiologist. So the second part, the second answer to your question is, obviously, I spend a lot of time every day reading what's online coming from the medical community. And what's coming from the medical community, obviously, is quite different than a lot of what we hear from the press. And I think the fact that we now live in an era of 24-hour news cycles, and everybody has to fill their airtime. And when you're doing that, you're finding anybody who you can to all of a sudden become an expert in the care of patients involved in a pandemic is really disgraceful. You and I have talked previously about the fact that I can remember the day when most news outlets or most news channels had a physician who really had a lot of expertise and could explain in lay terms what was going on with, you know, any epidemic,

be it the flu or any other issue that involved a large proportion of the American public. Today, with the way that news is disseminated, everybody needs to be the first one to get it out either on the airways or via the Internet or whatever. And a lot of the people who are disseminating that information really don't have a good background in order to do that. In other words, very few news outlets have people who are trained and have the expertise to be able to tell the American people what is really going on. I find it kind of ironic in a way that Italy was one of the first countries because, you know, we have on the television screen every hour or constantly the number of people who are infected and the number of people

who are dying. And then there's also a worldwide death rate. But what I'd like to point out about Italy is that because they were one of the first countries to really be severely impacted by this pandemic, their physicians, their emergency and critical care physicians were almost on a continuous basis feeding information to the medical community around the world. And although we talk about the United States being, you know, the premier country in the world when it comes to research and development, I happen to have been involved in the development of ventilators towards the end of my career. And it became clear that Italy was one of the premier countries in the world of having researchers who were working on improvements in ventilators. And so, you know, I thought there was this irony that here was a country that was completely overwhelmed by the virus, and yet their medical community was on a continuing basis publishing or writing up everything that they were learning. And really, a lot of the people in the United States who've recovered from the virus

have done so because of what the Italians have told us about the unique lung injuries that are occurring from this virus. And their recommendations on how to treat these patients, because they're different than what most critical care physicians are used to caring for, have probably saved innumerable lives. And so this is not a United States issue. This is not an Italy issue or an English issue. And it's very disturbing to me that we're not treating this because it is a pandemic, which means it's occurring all over the world. And there are parts of the world where it is just starting now that we haven't had more cooperation and interaction with medical communities around the world. And there's plenty of blame to go around, but there's also a lot of heroes around the world. to single out specific organizations and to pretend that anybody was prepared for what we're seeing now and that there are people out there who haven't made mistakes is just unconscionable. I can tell you that the hospitals in New York, which are overwhelmed by this, had one to two patients on a worldwide level.

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Play Store and get $25 in free Bitcoin when you use the promo code SCOTT25. That's investvoyager.com, promo code SCOTT25 for $25 in free Bitcoin and start trading today. Yeah. And you touched on ventilation, which seems to be one of still the hot button issues of this entire thing. And you even touched on the fact that later in your career, you worked on ventilators, but isn't it true that actually very early in your career, you had something to do with developing ventilators, particularly for transporting patients? Yes. So when I did my fellowship, I was fortunate to be at the University of Florida and learned a lot about the treatment of patients in the intensive care unit because several members of our faculty were world experts on ventilation. As a matter of fact, several of our faculty were involved in the development

of the first ventilator for caring for neonates. So when I was in medical school, which was in the early 70s, if a baby weighed under about 1.5 kilograms or 1500 grams, which is about three pounds, the babies very frequently died. The death rate, I think at that time in premature infants was about 85%. After the development of the first ventilators, specifically for neonates and newborns, that dropped to 15%. So many of the people who were involved in the development of that ventilator, which interestingly was developed, obviously, by a private company run by a interesting individual who was both a pilot in the Air Force during World War II, but also was one of the early developers of ventilators. His name was Forrest Bird. He worked with a group of intensivists at Lackland Air Force Base. So the first ventilator for neonates called the Baby Bird was actually developed by people who were in the military, but had a lot of expertise in

ventilation. So those people were at the University of Florida. So I got very rigorous training in how to care for patients in the intensive care unit. But as I became medical director of the EMS system, and after my experiences in Los Angeles prior to moving to Florida, it became apparent that the equipment that was being used to care for patients prior to their arrival in the hospital was not, you know, anywhere as sophisticated as the equipment that we had in the hospital that dramatically reduces the eventual outcome of the patient, even with superior care in the hospital. And so I became interested in looking at the devices that were being used outside the hospital. Now, in those days, there were EMS systems that had paramedics, but the majority of EMS systems just had EMTs, emergency medical technicians. So the advanced systems, which were in the big cities, the people were trained to intubate. In other words, to put a tube into the trachea of

the patient outside the hospital. And so it was easier to adequately ventilate their lungs because you now had a tube with a direct link between the device that they were using to ventilate them and their lungs. But in a large proportion of the settings in the United States in those days, they were ventilating patients without this tube in their trachea. And when we started studying some of the devices that were being used, we realized that most of the gas that was being delivered and the gas that we used in the pre-hospital arena was 100% oxygen, was going into their stomachs rather than into their lungs. And so there were not only physicians, but respiratory therapists at the University of Florida at the time who were very interested in developing ventilators for the transport of patients to the intensive care unit. For instance, moving a patient from the operating room to the intensive care unit or from the intensive care unit to an MRI, which is a huge machine and you can't bring it up to the intensive care unit or to a CT scanner. We had some respiratory therapists who developed transport ventilators for use

in the hospital. And so obviously, I built on their knowledge and started to work with companies to develop ventilators for use outside the hospitals. And over the years, we did a lot of research looking at these different ventilators, determining what specifications one needed for a ventilator for use outside the hospital. And we either participated in the development or the research on many of what are now known as transport ventilators. And transport ventilators today have become extremely sophisticated. The military has funded a huge amount of development because of the need to ventilate soldiers,

war fighters prior to their arrival at a hospital or a field hospital. And so we have fairly sophisticated ventilators that I believe on a large number of patients that are being treated in the hospital could be used in that setting as well. And I'm sure that people are well aware of that and that some of the hospitals that the military has set up are probably using that type of ventilator. Now, the ventilators have become such a big issue with COVID-19 because it's the lung injury that's primarily responsible for their deaths. COVID-19 has also had a tremendous impact on heart disease, neurological injuries. I'm sure most of those listening know about the fact that one of the way a patient suspects that they may be infected is that they lose their sense of smell and taste. And so this is a very virulent virus that needs to be taken extremely seriously.

And, you know, a lot of patients now are recovering and being sent home, but that's really only the first step in their true recovery from this illness. And I think we're going to learn a lot about how viruses affect humans. And I am hoping and praying that as this pandemic starts to wind down, that we are going to be far more prepared than we presently are in the future, you know, in the future, we'll be much better prepared. Now, ventilators that are used in the intensive care units are extremely expensive. And so, you know, it's virtually impossible to suddenly ask companies to dramatically increase the number of ventilators that they build. As we know, we are now a global economy, and many of the components of those ventilators are coming from other parts of

the world, and they're being used in other parts of the world. The United States is not the only country that's being affected by this pandemic. And, you know, so far, the majority of countries that are involved in this pandemic are in the developed world. But this pandemic will spread all over the world. And there will be countries and regions of the world where they do not have the sophistication or the resources that we have in the United States. And I find that extremely, extremely troubling. And it's really important that we continue to support the organizations that normally provide the resources to those countries in the world. So you can't really just ask GM to go make a bunch of ventilators, basically, is what you're

saying, because they can't get the parts anyways, which are in demand everywhere all over the world. So basically, we need simpler solutions for these other places where they don't have $50,000 ventilators sitting in an ICU. Exactly. And we need ventilators even in the United States to stockpile. And, you know, I believe, and I don't practice anymore, but I believe that we have the expertise to, and we have the solutions today to develop ventilators that could be used, for instance, on about 75 to 80% of the people who are being ventilated in hospitals in the United States. the future is to learn our lessons from this pandemic and decide, okay, we can't afford $30,000, $40,000, $50,000 ventilators to be stockpiled and only used once every decade or even longer, but we could either have components immediately available or simpler ventilators. And my personal opinion, and it's only my opinion, is that we need to stockpile simpler ventilators. And you've made

probably the key point. I keep in touch with friends who actually have a company and they make ventilators. And obviously, the government immediately contacted them and asked them to, you know, make 10 times, at least 10 times as many ventilators as they were selling in a year. And the problem for most companies in the way that we do product development and manufacturing today is just-in-time assembly. So whether you're building a car, you're building a ventilator, or you're building an air conditioner, the world is predominantly a just-in-time world where we don't stockpile because it's extremely expensive to do that. And you just plan ahead, you know, maybe a year or two in advance. But certainly for pandemics, for these types of infections where lung disease is usually the issue that determines whether a patient survives or not, we're going to have to have a different solution because that company

realized right away that it would be very nice to be able to manufacture very quickly additional ventilators, but the resources just didn't exist. They don't stockpile the components that they need. And so, you know, some of the solutions that we hear in the news, such as taking General Motors and having them build these sophisticated ventilators can't happen because even if they had the engineers who could do it, they don't have the components to do it. Now, we know from the Second World War and other wars that companies that do one thing normally can very rapidly change because these companies have very smart engineers and their skills could be used for

development of other products that we no longer do what we did during the Second World War. And I'll just give you a quick aside that may only be of interest to you and me, but I think some of your listeners will find it interesting. At the start of the Second World War, my father had just graduated as an aeronautical engineer. And his first job after he graduated from college was to work on a glider, which was used for the Normandy invasion. And the company that was chosen to build the glider was a piano company because they had all the wires that you use in the piano to create notes. And they had a lot of experience with wood and, you know, fabricating wood in the shape of a piano and a glider, believe it or not. Similar. Very similar.

They had the wire, they had the wood. And so the first company he worked for developed gliders that we use for the Normandy invasion. And there's actually a scene in Saving Private Ryan where they're standing next to a glider, and that glider didn't glide very well because they put metal plates in the glider to protect the general who was going to land during the invasion. And so, you know, the normal characteristics of the glider were destroyed by the fact that, you know, they changed the design of that one glider and it crashed. I learn something every day. I never, never knew that about grandpa. Right. So, you know, you see these things from time to time, or you watch certain things, older movies on television. And, you know, some of them involve EMS, and only people who were around at the time would get the irony of it. I mean, when you asked me to talk about this, I realized that it was over 40 years ago that I first became involved in pre-hospital care. And it was 40 years ago, you know, when the space shuttle program started, you know, 1981 was the first launch of a space shuttle. And you go, where has the time gone?

And look at all these tremendous improvements in healthcare and in every other phase of our life. And the fact that we're sitting here in two different locations, recording on the internet, a podcast is mind boggling at one time, you know, and at the other time for the younger people, it's just assumed to be the way it's always been. Right. Well, it's mind boggling to me in another regard, which is that we're less than two miles apart, but have to do this over the internet due to the way that the world is right now. But we can talk about that in a minute. I wanted to touch on something you said about intubation, putting a tube down a patient's trachea to open an airway. So one of the things you're probably most famous for is the Melker cricothyroidomy set, which I talked about in the introduction, which to my understanding is an emergency airway when there's a blockage and you

can't get that tube through their mouth, you have to basically cut into their throat and open an airway. Is that correct? And what led you to invent that device? Well, that's absolutely correct. So if you think of somebody in an auto accident where their face impacts against the windshield or a variety of other instances where you can't put that tube down the trachea so that you can ventilate them. And ventilate them means you push oxygen into their lungs and then carbon dioxide comes out of their lungs. So that's ventilation. And so it was really related to an incident that occurred while I was in my fellowship training at the University of Florida, an athlete who had a neck injury was operated on. And in those days, they put them held their head in position so that there was time for their vertebra to heal. was moved, I don't know how many days after his surgery, but he was moved to a regular floor bed in the hospital. And he was eating and he choked on the food. And I was called because I was on

call to try to intubate him. Well, in the device that he was in, it was impossible to position his neck in a position where I could see where to put the tube or to at least remove the food that was obstructing his airway. And, you know, I called for backup help from people with more expertise than I had, and none of us could do anything about it. And if we remove the device, which is what eventually was done, then his neck was unstable, and he died. And I, that, you know, that was just an extremely profound impact on me for quite a while. You know, I realized that there was nothing anybody could do to save him and that, you know, removing the device, it was called a halo in those days. I still think we call them halos today,

but you'll occasionally see either in a movie or on a television program where somebody's in a halo and their head has been completely immobilized so they can't move. So anyway, that was a profound event in my life is that this young athlete died because nobody was able to secure an airway. It turned out that there are a lot of people over the years who realized that there were other places where an airway could be established, but most of them were surgical. They took a long time. There was a lot of bleeding involved in doing it.

And when they were done in emergency situations, the outcomes were rarely very good. And so I had learned a technique for putting large catheters into blood vessels over a wire. Here we go back to the wire again, like the wires that they use in pianos. Well, there was a brilliant physician by the name of Seldinger, and he realized that you could put a really big tube into a blood vessel if you first fed a little wire into the blood vessel through a needle and then dilated the vessel so that you could put in this large catheter, which were used in the operating room when they expected a lot of blood loss or in trauma patients. So having been familiar with that technique, I started working in the laboratory on animal models,

and you had to find an animal that had a trachea, very similar, and a larynx very similar to a human. And we did that. And we did some experiments in the laboratory. And they were successful. We were able to adequately ventilate the animals for prolonged periods of time. And by pure serendipity, there was a company that had a sales representative in the hospital. and we were working on another technique called intraosseous infusions, which was a way to resuscitate predominantly children, but eventually adults, when you couldn't establish an IV by putting a needle directly into a bone. The inner portion of the bone has bone marrow in it and you can infuse fluids. But anyway, the sales rep was in the hospital and we, you know, we told them about our intraosseous needle. But I also said, by the way, you know, we've developed this way to secure an airway in a patient when you can't

intubate them. And he said, well, you came to the right company because we're working with another physician on a way to do a tracheostomy in the intensive care unit rather than having to move the patient to the operating room. And your techniques are very similar. So I had filed the patent at the University of Florida, which is another interesting sidebar here. But anyway, this company built me a couple of prototypes. And very shortly after that, your brother, my other son, who's an EMT actually used one on a patient. You said it was the most nervous movement of his entire life. Because everybody was watching and it had his last name on it. Exactly. And I'm, as I'm sitting here,

I'm looking at the operative report that he dictated afterwards, but that wasn't the first patient. That was one of the first patients. Ironically, the first patient was a friend of ours and his, he was involved in an automobile accident. He was in high school at the time and was involved in a head-on collision. And I happened to be in the hospital and one of the pediatric surgeons inserted the device. And he, interestingly, he had also broken his neck. And so the story came full circle to where initially a patient with a neck injury died because there was no alternative way to ventilate him.

And then several years later, another patient who happened to, we happen to know personally, was involved, developed a neck injury, and the ability to ventilate him through this cricothorotomy tube saved his life. It's funny when you mentioned the halo, that's who I thought of because he had to wear one. I remember that, the broken neck. That was the image that came to my mind. And he wasn't only a friend for it to even become more full circle. He played soccer with my brother, Jeremy, for years.

And Jeremy also was one of the first to use it. It's pretty, pretty incredible how that all kind of converges. And I'm sure there are a lot of other physicians who are inventors who have similar stories. I mean, you know, why one would focus on a particular area to invent new medical technology probably, many instances has to do with, you know, something that was very painful and something that did not turn out well. Right. It's funny. Here we are in the same situation, different disease, different problem. But, you know, I wonder about these, particularly the intensive care physicians who are having to turn off the ventilators on patients who, you know,

who are dying in the intensive care units, and there are no loved ones there when it occurs. It has to be just horrible for these people, for the families and for the people who are caring for them. Yeah, it's really unimaginable, to be honest. So sad. I have to, on a brighter note, about all the patents and inventions, I'll never forget my wife, Emmy, your daughter-in-law, of course. She said that for her, the most intimidating moment of her life was when she met you and first walked into your study because you had all the patents framed all over the walls. Basically, the entire room was just patents and patents and patents and pictures and articles. And the interosseous needle made me think of that because you always had the picture of it in the x-ray inserted into the bone, which was prominently displayed in your office.

But it leads me to ask you, you know, there's thousands of doctors all over the world. They confront problems in the emergency room, in the ICU, all these places. What made you the type of person, what compelled you to always be the type to, you know, find the better mousetrap and go that step beyond just being a physician and actually try to find a solution for these things? I think it goes back to the personality that we have in our family. And I credit my maternal grandfather as being the person who probably I modeled myself after in this regard. And he would look at something that he was using or, you know, something in everyday life. And he would say, they could make that better.

I could make that simpler. Why are they making this so complicated? I would like to develop this or that. And I would sit there and I would look at this man who was a furrier, spent his whole life, you know, doing one thing. He had gone to college, you know, in the 1910s, before 1920. And yet, you know, he spent his life doing one thing, and yet here he had this ability to look at things and say,

that's not done as well as it could be. And I think somehow I have that trait of looking at something and saying, it could be designed better, it could be made better. Or you have a situation like I did where a traumatic event led you to think about, okay, this is never going to happen again in my life if I can prevent it. Now, I spent a lot of my time in the intensive care unit and also in the operating room. And I would watch physicians every day say, this isn't designed time, but the great idea is only the first step in an extremely complicated process of getting an idea to eventually become a product. And I was fortunate enough to be at the right place at the right time. In 1981, which was the year of the first launch of the space shuttle, the Bayh-Dole Act was passed in Congress. Dole Act did was allowed universities to patent intellectual property developed with federal funds used to do research. So before 1981, out of it, an idea that had the potential

to be patented, you disclosed that to the federal government and it was the federal government's responsibility to file for the patent. Now, guess what happened to all those great ideas? Nothing. They had shelved, I'm sure. Exactly. And so what happened with the Bayh-Dole Act is the universities now had the opportunity to take that intellectual property, those ideas, and to file for patents. And I was one of the first people to make a disclosure to the University of Florida after they established the Office of Technology Licensing. And so being

the right person at the right place at the right time had a lot to do with it. And I became very interested in understanding what a patent was and what the process was from going from an idea to the actual manufacturing and sale of a product. So a lot of things fell into place. Number one, the University of Florida is known for Gatorade. And the University of Florida, along with Dr. Cade, who was, you know, the inventor of Gatorade, was making a lot of money off of that product. I mean, that one was pretty easy to develop, but the concept was, you know, fantastic. And so the university was incentivized to take intellectual property

and develop it very early in the game after the Bayh-Dole Act was passed. So that was number one. Number two, remember I told you I met the sales representative, and he worked for a very unique company that realized that doctors had all these great ideas, but they needed help in developing prototypes. And then if the product had potential to actually manufacture and sell it. And so, my involvement with that company, which today is one of the largest privately held medical device manufacturing companies in the world also had a lot to do with it. So there were many things that fell into place for me

that the average physician would not have, you know, the time or the expertise to draw on in order to patent and have their products manufactured. Now, there are physicians around the United States and around the world who patent and develop lots of products. And, you know, it was just something that I found extremely exciting. Obviously, when you patent your first product and it actually gets out on the market, you go, well, that was just luck. I just had one good idea. Well, turns out that I think people, you know, who have that, this isn't optimized, I can make it better, who have that type of a personality and are in the right environment are the people who keep moving medical technology and medical advancements moving forward. And another one of your inventions had to do with handwashing, which is the third thing. We talked about ventilation, intubation, handwashing, which are three huge, important topics with what's happening with COVID. I guess we can touch on it quickly. I mean,

to my understanding, there's a lot of hospital-borne infection, generally bacterial, not viral. And that's usually spread by physicians and nurses not washing their hands. Is that correct? That is absolutely correct. And so you had an idea, which is something that you invented, and it came to market, which has been hugely beneficial to humanity, of a way, I guess, to make doctors and nurses wash their hands. Can you give us the brief synopsis of that? Yeah. So that technology was actually eventually licensed to another company and it's part of their product line. But the idea was, so I'll take you one step back. We all talk about CMS, which is the Center for Medicare and Medicaid Services. And during the Obama administration, the idea was that hospitals that were having poor outcomes would not get the same reimbursement for the care of Medicare and Medicaid patients as

hospitals that had better outcomes. Well, that makes sense. So if you went to a hospital and they put a catheter in you and you ended up with an infection, well, that was not related to why you were admitted to the hospital. That was a result of, you know, somebody not using the proper technique for insertion of that catheter. So the idea was that by penalizing the hospitals that didn't have as good an outcome, and you can find these hospitals, you know, pretty easily by looking at their charges. So if a hospital was treating a patient for a catheter-related infection, and you found that they were having 10 times as many infections per, you know, patient in which

they put in the catheter, well, you could say, you know, there's something wrong with the way they're doing that. And so, the idea came up to reimburse hospitals based on these untoward events, and hopefully, it would stimulate the hospitals to improve their techniques. That never really happened for a wide cause of all of these infections. So these are hospital-based infections that the patient didn't come into the hospital to be treated for, but developed in the hospital. And our idea was that wherever there was a hand, a dispenser for either, you know, a alcohol-based product or a soap product, that the healthcare worker would wear a badge.

And every time they came in close proximity and activated the dispenser, it would record that they had washed their hands. So green light means you washed your hands, red light means don't let that doctor touch you. Exactly. And they were wearing it. So as they approached the patient, it was, wait a second, please go back and, you know, wash your hands. You haven't washed your hands since, you know, you saw the last patient. And we actually, the product went out on the market. There were other companies that also realized that this was a unique opportunity.

And, you know, products like ours are being used in hospitals today. I must say that I was at times shocked by the resistance to documenting that you had washed your hands. Yeah, doctors want to be blamed, right? They don't want to be blamed for giving a patient an infection and they don't want a trail of their bad habits. Right. And unions, a lot of health care workers in big cities are in unions and the unions resisted it because it would identify individuals often who were not practicing good hand hygiene. So all of these, and the most ironic part about it is that because CMS never implemented these penalties to hospitals, if a patient developed an infection in the hospital, the hospital could charge Medicare, Medicaid, or their private insurance for the treatment of the infection. So we actually

found that in certain hospitals, they resisted it because it was... Bad for the bottom line? Back to the bottom line. It was, you know, the world is very interesting and medicine is very much like the rest of the world. And one of the topics we didn't have and won't have time to really touch on is that there are academic institutions, you know, where doctors are trained and they play a very important role. And then there's a lot of private hospitals. And unfortunately, reimbursement and making enough money to keep your institution alive has become the bottom line. And so everybody's in competition.

When I was in training, if you were in an academic institution, you got your funding from your state or from the federal government for a large portion of your health care that you provided, whereas today everybody's in competition. So the bottom line has really, like in virtually every other industry, become the key measure of success in healthcare. Are we ever going to change it? I don't know. Would I like to see a change? Certainly. I think there's a role for academic institutions and that they should get some of their funding, particularly for the physicians, for teaching and all the other things that they do. But that's not the way the world has evolved since I was in training.

It's been just the opposite. And I think it's to the detriment of health care in the United States. I mean, we don't even need to talk about it, but you saw it coming when I was probably 1990, 1991. Jeremy was graduating high school and I was probably finishing middle school. And I remember you sitting us down and telling us never to become doctors. He didn't listen. He didn't listen. He didn't listen.

I did. But you told us, and it was for basically that very reason, was that you saw it becoming more of a big business and the insurance companies and all that. It's not, like I said, we don't even need to talk about it, but I can actually remember, you know, over 20 years ago, 30 years ago, you hinting at that to us as your kids. I want to pivot just slightly to social distancing and the situation that we're in now. As I said, you and I are having this

podcast via Zoom from two miles away. I haven't seen you in six weeks. This situation is, I mean, it feels untenable and crazy. And everybody wants to get back to work. They want to, you know, get back to opening up the economy, all these things that you hear. But first, you're the perfect person to speak on it. You're part of the at-risk population just by virtue of your age. You're also immunosuppressed. So even if the world opens back up and people go back to life, what does that look like for us as a family and for you as an individual? So, you know, obviously my wife,

your mother and I have discussed this and we are going to have to remain isolated or socially distanced for the foreseeable future until there's a vaccine that can confer herd immunity. And that is a long way off. Or a drug is developed specifically, or a drug that has been developed has been shown to really be effective in early treatment of patients who are infected. In other words, yes, it would be nice when a patient is critically ill and on a ventilator to give them a drug which would cost tens of thousands of dollars per patient and save their life. But what we really would need is something like Tamiflu or Zofluza or the drugs that, you know, are now available for influenza.

But there's a lot of really brilliant people out there and there's a lot of really brilliant people who understand coronavirus infections, but it's going to take time to do it right. And obviously we all feel horrible for all the people who've lost their jobs and all the people who've, you know, had small businesses that have had to close down. But we have no choice. We really don't. There's going to probably be an experiment which starts on Friday in the state of Georgia because their governor has decided that the present guidelines are untenable and that we have to open businesses. So, the experiment was already tried in England, and they almost lost their prime

minister. But here in the United States, everybody points out that we got 50 states with 50 governors, and the president's learned that he really can't tell them what to do, that that really is a states' rights issue. And so, we have a state, and we probably have a couple of states out in the West that are going to try the experiment for us. I know what I'm doing, and I think I know what that experiment is going to show. And the big problem is, is that you don't see it right away. Right. It's going to be too late by the time everybody reacts. Exactly. And so it's, if they really do go ahead with what they're planning to do in Georgia, it will probably be a month before we see that curve just spike again. And then when enough people die,

we'll say that really wasn't a very good, that wasn't a good experiment. We probably shouldn't have done it there's really not a lot that individuals who are impacted by it and didn't want to be impacted by it can really do about it in other words uh uh the legal system is not going to be the way to resolve this issue. It's going to be deaths of more people. Now, I hope somehow I'm wrong, but all the experts, you know, I listen to podcasts after podcast every day from the CDC and from NIH and from other experts, not only in the United States, but in other countries. As draconian as somebody, some individuals may think these methods are, what's really draconian is to know what to do and not do it. And so I hope I'm wrong, but there's very little chance that I'm wrong. But it's a lack of resolve, right? I mean, it's people get bored, they're sick of looking at the numbers. And eventually, they just basically

give up mentally and cognitive dissonance kicks in and they say, ah, whatever will be fine. But meanwhile, like your generation and your parents went to war for the world and were being asked to stay home. That's correct. And, and, and, you know, I've also heard, as you know, the famous congressperson from Texas, I think it was the Texas legislature, not, you know, the government, but he said, Well, you know, I'm over 70 years old, and certain people are going to have to just make a sacrifice. I'm not sure there's many of those in my age group who would agree with that. Yeah, let me die for the economy. Right, die for the good of the economy. So the bottom line is, you know, the only silver lining in all of this is unlike influenza, for some reason, really young children are not being affected

very much. So normally with influenza, you have a U-shaped curve where the very young and the very old die. And most of the people in the middle get sick and are at home for a week or so and feel lousy and wish they never got the flu and, you know, are happy that they now have Tammy flu and other drugs to shorten the course. So, you know, that I would say is the only silver lining. I understand where some of these people are coming from. And obviously, in our country, people are getting mixed messages. There are other countries that have been much more specific, clear, and...

And steadfast. And explaining it. Right. Steadfast is probably the best word. They're going to wait this out. But we live in the United States of America. And that has its really good points. But I think we're seeing one of the potential downsides of having complete freedom. Yeah, I mean, the thing that keeps me up more nights than not, honestly, is this inevitable decision that's coming.

I think this is probably for anyone my age who has a family, is that eventually they're going to tell whether I want to or not, and that'll be my decision, but that our kids can go back to school, that it's safe. And in my mind, that ends up being a decision between seeing my parents or letting my kids go back to their normal life or us. I mean, I know how I feel about that decision, but it's just a brutal and unprecedented situation, I think, for everybody. I mean, everybody has their own unique decision and will have their own sort of situation that they'll have

to make decisions about. But I still can't even wrap my head around this. And I can imagine that even being in your 70s that you probably never foresaw this as the way you'd be spending your time now. Obviously not at all. I mean, if eventually they figure out the serology and, you know, there's some really weird stuff coming out in the press like everything else in the press. You know, they jump on any news they hear and some of it just doesn't make sense. So I'll wait a while and let the experts kind of explain why 80 times more people in California have antibody than the number of people who tested positive for the virus. That one just has me completely stumped. But it's based on only a few hundred people when you actually read the study. And also, we know that the tests are inaccurate.

And there's a lot of questions. So that was the key point, is that we have to develop tests that are accurate, have good sensitivity and specificity. And we have to develop a vaccine. And one of the downsides of relaxing the requirements to show that kind of data in the rush to come up with better testing, and if there was a country that was caught with its pants down, it's us. I mean, you know, if we were in a room with 150 countries that have been affected by the coronavirus and you ask, okay, who did a really crappy job? If there was a person in the audience who was willing to tell the truth,

our hands would be raised. I mean, we, we have. Completely blown it. A very good job. And I, I think anybody who's honest, you know, such as Dr. Fauci would tell you that. Yes, he tries. A single voice in the forest, in the wilderness. And that makes it very difficult for people. many different, you know, outlets and media and ways of getting information and determining who you trust and knowing that people are pushing news to you that is based on your preconceived notions is extremely scary. But that's the world we live in now. And when many people felt that it affected presidential elections, well, there are a lot pandemic that's affecting the world, then we really can't ignore it.

I don't know what the solutions are. I think we've opened Pandora's box. I'm not sure we can close it again, but somehow somebody, and I think we've lost that opportunity in the United States, you know, needs to tell the American people where we're really at. I agree. I think that's a good place to start to wrap it up since we've been talking now for over an hour and a half. No, I mean, you know, so many of the stories that it's been pretty easy. Well, I could say, I mean, I'm looking at, I was taking notes as we were going and there's probably 30 more lines of things that I wanted to ask you about and talk about, but you know,

I guess we'll have to save it for another day. I mean, it's really amazing. Every time I ask you questions, but not for podcasts in general, I learn things that I had no idea about. And every time I hear you on someone else's podcast, I hear another story of something. And it's just really incredible to me that a person can accomplish so much in a single lifetime. I can only hope to do half of it. I think you definitely need to start your own podcast or at the very least, we should start one together like we discussed. What do you think? It certainly is enjoyable to talk to you about these topics. I certainly, as you can tell, like talking about these topics. And I think you'll get feedback from the people who listen to your podcast, whether this is something that they would like us to talk more about. And if that's the kind of feedback you get, I'm in my house every day.

I know you're available. Well, we'll discuss it. You'll know I'm available. Well, thank you so much for taking your time and coming on the show. I love you. Thank you. I love you too. Pleasure.

Let's go. Hey, everyone. Thanks for listening. New episodes go live every Tuesday at 7 a.m. Eastern Standard Time. Links to our Apple and Spotify channels are in the show notes. You can also follow me on Twitter at Scott Melker to continue the conversation. See you next week.