Many people are surprised by the cost of deploying a standby team and intervening after cardiac arrest. This summary is a quick attempt to provide a minimal introduction to the subject.
Suspended Animation does not cryopreserve patients or maintain them in that state. We are "first responders" whose work begins when a patient is considered terminal and ends when we complete our procedures and transfer the patient to the custody of a cryonics organization such as The Cryonics Institute. Our only source of earned income is from the fees we receive for standby-transport work.
If this was a typical business, we would price our procedures high enough to make a reasonable profit after covering all of our costs, including not just the cost of the procedures themselves but also employee salaries, rent, utility bills, and R&D. Bearing in mind that we have handled an average of about two cases per year since the creation of the company, we would have to charge more than $500,000 per case to cover our annual budget. Clearly, this is impossible.
Fortunately our shareholders have their own personal motives for wanting Suspended Animation to refine existing procedures and develop new ones. Thus, patients for whom we intervene are actually benefiting from an R&D subsidy. In the future, the company may move toward being more self-sufficient, especially if it develops equipment that can be licensed (probably outside of cryonics). Until then, our business model is unlikely to change.
Preparation for cases can be divided into two parts: Designing, building, and maintaining equipment, and insuring that personnel are fully trained and available.
We have about 500 lbs. of equipment in "Pelican" brand containers which are molded from reinforced resin and are designed to withstand rough handling while protecting their contents. The containers alone are relatively expensive, costing between $100 and $200 apiece. Each kit consists of eight containers, and we expect to maintain four complete kits. Our "A" kit is for primary response, the "B" kit is for backup, a "C" kit will be deployed in California, and we have a "T" kit for training purposes.
The equipment inside the containers includes standard medical items (such as a pulse oximeter to measure oxygen levels in the blood) and laboratory equipment (such as hand-held data logging devices and thermocouple probes, to record patient temperature). In addition we use custom-fabricated hardware such as our portable ice bath, which required substantial development work. The ice bath uses a vinyl liner and a vinyl privacy cover and is protected in a heavyweight, custom-made nylon carry case. In addition a specially modified Michigan Instruments "Thumper" is clamped onto the ice bath to apply chest compressions. Each "Thumper" costs more than $5,000, and we have four of them, one for each of our standby kits. We also maintain medications that we believe are effective in mitigating ischemic injury after cardiac arrest. The meds are licensed from Critical Care Research, a California laboratory.
Since the equipment is useless without people who know how it should be applied, we maintain a call list of approximately 20 people, including paramedics, nurses, an MD, two research surgeons, and people who are experienced in cryonics standby work. We have developed training and reference materials for these personnel, and we have hosted two familiarization and practice sessions, which we pay our team members to attend. More sessions will take place during 2006.
At our facility we have six employees, ranging from a crafts person who specializes in metal work and welding, to an engineer who has done a lot of work with tubing circuits. We are planning to develop on-site vitrification capability, and we are about to start converting a step-van to serve as a customized transport vehicle. The van's purchase price is approximately $20,000 and conversion will cost at least another $20,000 in materials and equipment alone.
Our readiness also depends on work that seems only tangentially relevant, yet is unavoidable. We pay legal fees, for instance, to attorneys who have advised us on issues of general relevance to cryonics.
Ideally, we hope to be called to a standby when a person's condition is serious but legal death has not yet occurred. In this scenario a typical case might unfold something like this.
The coordinator of the standby will usually remain at our facility, from which he will organize the logistics. He will make airline reservations for the standby team, and will be in constant contact with the primary care physician, relatives of the patient, other interested parties, and independent medical advisors who will attempt to predict the timeline of the case. The coordinator also will compile a map showing the location of the patient, off-street parking (if any), nearby motels or hotels, car-rental and truck-rental offices, the nearest cooperating mortuary, the nearest airport, and a source of supply for oxygen. The standby team members should be able to focus their entire attention on the patient while all logistical issues are handled for them.
The team members will move our containers of equipment as baggage on a scheduled air carrier, and will use one or more rented vehicles to deploy the equipment as near as possible to the bedside. Team members also will establish a personal relationship with hospital or hospice staff, the cooperating mortician, relatives of the patient, and others.
Depending on the location, the available time, and other factors, the team may rent a van and do an "instant conversion" so that it can be used safely for local patient transport after legal death.
When the equipment has been set up, with at least 100 lbs of ice in ice chests nearby, the waiting period begins. Experience suggests that we need at least four people to run a remote standby. The personnel will work 12-hour shifts in pairs, one pair resting while the other pair remains as close as possible to the patient.
We use the word "transport" to include all procedures beginning immediately after legal death and continuing to the point where we deliver the patient to a cryonics organization.
Three forms of intervention are necessary. First, we apply rapid cooling by immersing the patient in ice-water. Second, we administer medications. Third, we use cardiopulmonary support (chest compressions) to circulate the meds, enhance cooling, and ventilate the lungs in an effort to sustain metabolism. Since every second counts, at least two people are required to perform these procedures. Additional personnel will place temperature probes and start logging temperature data, and will compile a written record of the case as it happens. We also use lapel microphones attached to voice recorders which time-stamp each verbal annotation. If photography is permitted, we will take pictures to document our work.
The patient is moved as quickly as possible to a vehicle for transport to a location where surgical procedures can be performed. If we are out of reach of our facility, we will probably use a cooperating mortuary. Cardiopulmonary support should continue while the patient is being relocated, and some higher-volume meds may be administered along the way.
If circumstances permit, before the patient experiences legal death, a team member will have set up our portable perfusion equipment at the mortuary so that it is ready when the patient arrives. A surgeon will raise and cannulate the femoral vessels, which are located in the upper thigh. The perfusion equipment then washes out the patient's blood and substitutes an organ preservation solution. The solution is chilled and a closed circuit is maintained until the patient's temperature drops below 10 degrees Celsius.
The patient is packed in bagged ice, inside a heavyweight body bag. The body bag is then placed inside a steel shipping container. The container is insulated with sections of foam board that have been obtained locally from a Home Depot or a similar source. The insulated case is then moved onto a shipping tray, and the patient is taken as quickly as possible to the nearest airport, for transport to a cryonics organization such as The Cryonics Institute.
At least one team member will accompany the patient while others remain to clean up the prep room at the mortuary, repack equipment, dispose of items which cannot be re-used, and transport everything else back to Florida. The standby-transport kit will be replenished and refurbished during the next week or two, during which our "B" kit will maintain our readiness capability.
A full standby, followed by transport, will incur expenses such as air fares, excess baggage charges for transport containers, car rental, van rental, oxygen cylinder rental, motel room charges, meals for personnel, fees for consultants (including our two MD advisors in addition to paramedics and/or nurses who participate in the standby), mortuary fees, and shipping charges. Costs of items which are used one time only will include medications, tubing, oxygenator/heat exchanger and filter, reservoir bag, thermocouple probes, body bags, icewater recirculation pump and tubing, ET tube, and many sterile, disposable items ranging from syringes to rubber gloves. Some pieces of medical equipment, such as reservoir bags, are significantly expensive. Equipment to be cleaned and refurbished will include ice-bath, liner, and privacy cover, Thumper, perfusion kit container, meds kit, perfusate container, data logging equipment, surgical scrubs, surgical instruments, and any other items which may have been contaminated during procedures. We will have to mix 30 liters of organ preservation solution under sterile conditions, for the next case.
This is not an exhaustive list. There will be other expenses ranging from phone calls to the possibility of rotating team members, bringing some home and sending out replacements if the standby lasts more than a week.
Currently I lack the time to provide a more specific and detailed itemization of expenses, but perhaps this summary provides at least some insight into the sources of costs in standby-transport work.