4 ms·

"I spoke with Daimler over the weekend. They would also like to help. But it’s unfortunately not so simple..." It would be interesting to hear more precisely w

by pyb 7y ago

"I spoke with Daimler over the weekend. They would also like to help. But it’s unfortunately not so simple..." It would be interesting to hear more precisely why. We've heard more than a few well-respected industrialists essentially saying "Scaling up ventilator production ? How hard could it be?" Edit. Of course I am not suggesting that car assembly lines are suitable to build ventilator parts. That's clearly not what Daimler suggested either. The question is 'what are the actual bottlenecks to ventilator production?', and nobody seems to really be willing or able to say.

eternalban 7y ago
Precisely what I was looking for in the article as well. Outside of logistic planning snafus, parts situation, and post production operator issues, it was silent as to why we can not scale up cranking out these machines.
- deleted 7y ago
  [deleted]
justnotworthit 7y ago
Next line is "We can’t build cars either." It would be interesting to hear industrialists explain how car assembly lines make them able to produce any particular hi-tech equipment. Or are you saying "why not just equip the buildings next door and quadruple everything"?
- pyb 7y ago
  The second option, of course. The industrialists I mention are not just in automotive, but oil and gas, etc
agumonkey 7y ago
Someone on reddit makes daily summaries for r/france and reports a lot of ~stupid issues blocking help. - health laws forbidding veterinarians to help (animal standard != human standard) - companies not allowed to help because some administrative formality Many systems are not ready to switch gears fast in times of crisis.
- oaiey 7y ago
  The FDA is already relaxing administrative control and vets will have their time coming. However, project management and engineering setup takes a long time.
scandox 7y ago
I am fascinated by the notion of factories just changing what they make. In my imagination a factory is a highly specialized machine for making one thing alone...
- Udik 7y ago
  I guess that factories have workers, space, skills, and networks of suppliers. And maybe a few machines that can produce parts by design (injection molds, 3d printers). That's it: they're not going to set up automated production lines for ventilators instead of cars or washing machines.
- the8472 7y ago
  At least car manufacturers consist of more than one production line. They make smaller series and prototypes too. And they have lines (and suppliers) that supply parts to other lines. Remember they also have to build the ECUs, dashboard and AC plumbing. If you squint that might be about what you need for a ventilator.
de_Selby 7y ago
He gives an analogy in the next sentence that explains exactly why "We can't build cars either". Production lines are not general purpose. There are also extremely high standards to be met for medical devices.
- dna_polymerase 7y ago
  Exactly. Also looking at German car manufacturers, their production lines are almost completely automated and rely on robots. Reprogramming them, if they would fit the job in the first place, would require weeks of testing and calibration alone.
- pyb 7y ago
  Of course, but that's surely not what Daimler's CEO was suggesting. What he might have been offering may be assembly workers, or factory space, or privileged contacts with Daimler's supplier base, or something else. My point was that it would be interesting for the general public to understand the actual issues. Right now we're all left guessing a bit.
WJW 7y ago
We also regularly hear (otherwise very sensible) software engineers saying stuff like "Clone twitter? How hard could it be?". It's not very hard to see how manufacturing life-saving medical equipment in a rush without proper testing could go catastrophically wrong. Even if you get known-good schematics from another company, retooling (say) a car production line to make something else needs a lot of planning to make sure all the supply lines and trained workers are in place.
- smoyer 7y ago
  That analogy is only partially accurate. For instance, injection molding machines are pretty flexible these days, parts are almost exclusively drawn in CAD and molds are commonly cut with EDM. Every injection molding house has to have the ability to maintain those molds too. So if you wanted auto manufacturers (or more likely one of their suppliers) to produce a plastic part, it could almost be hands off. Send them the CAD files and specifications, produce a short run with heavy QA and once they're started, you can almost have as many parts as you need. Modern cars have such a huge variety of parts with varying materials and characteristics that I'd guess almost all the ventilator parts could be out-sourced. I don't know enough to say what the specialized skills or parts could be but let the ventilator manufacturers build those, do final assembly and QA and you'd at least increase production to some degree. My guess is that the quoted manufacturer has ramped up their existing parts manufacture beyond their ability to do final assembly were Daimler to provide more parts.
  - lqet 7y ago
    You are assuming (edit: actually you aren't, see below) that the car manufacturers are producing these parts themselves. It is a lot more complicated for Daimler to produce plastic parts for ventilators (for example) if small plastic parts in Daimler cars have been produced in China for the last 25 years and delivered just-in-time to the assembly line in Stuttgart.
    - helij 7y ago
      Europe is full of plastic moulding factories, big and small. Capability is there. Not everything is made in China. My friend has a small plastic moulding factory back home with 15 machines and his father is a tool maker. They themselves could produce 50,000 plastic parts a day if needed.
ThePhysicist 7y ago
Machines that produce raw materials for cars, like frames, can't simply be repurposed to produce ventilator frames (to my knowledge) as the tools that are attached to the machines (e.g. the stencils) are specialized, intricate parts themselves, so designing one for a new task can take years. The assembly lines / workstations also look very different, in general. You can see in the picture how the ventilators are assembled, it's not a factory line but more a workshop. Then you have all the supply chain issues that the article discussed. Companies like Dräger have been optimizing their supply chains and processes for literally over 100 years (the company was founded in 1889), so to think another company could just replicate all of that within a few months or weeks is unrealistic. Even with Dräger's help this would be challenging, as building up a new factory location usually takes several years as well. I think we have a strong bias to think that all problems can be solved with technology or engineering. Some need to be solved on a social and political level though, at least initially as technological developments take time. For Covid-19 we need to change our behavior now to allow technology to catch up.
Gravityloss 7y ago
It's a good question. Probably would also need the automotive parts suppliers to change to ventilator parts. And their sub-suppliers etc. Controlling quality would take time. It would be hard to make reliable properly working machines fast. Faulty ones would kill patients.
Nokinside 7y ago
(Not an expert on ventilators, but I have been working on software side of medical devises.) Producing semi-mechanical Bag-valve-masks (BVM) would be relatively easy, but you need professional to sit there and monitor the patient. That's not ICU ventilator. BVM is very crude tool for short term use. If the rules and legislation are relaxed so that hospitals could use non-certified crude devises that help. You would almost certainly see ventilator-induced lung injuries. Ventilator-associated lung injury https://en.wikipedia.org/wiki/Ventilator-associated_lung_injury https://en.wikipedia.org/wiki/Ventilator-associated_lung_inj... Ventilator-Induced Lung Injury Review (Part 1 of 2) https://pulmccm.org/review-articles/ventilator-induced-lung-injury-review-nejm/ https://pulmccm.org/review-articles/ventilator-induced-lung-... If the system is automated life support, it generally has to maintain homeostasis of the patient and _dynamically_ adjust. If you are just tiny amount off from the optimal and there is drift in the dynamical adjustment it accumulates over time and you can kill the patient or cause immense pain or discomfort. Oxygen is poison if you get it too much and if you get it too little, you die. Pushing air into the lungs can damage them and the oxygen mix should adjust. If lungs are filling with fluids, you might need more oxygen and less volume. The system must be connected to instrumentation that monitors the patient's state continuously. There is the question of medical staff using the thing correctly. Medical UI/UX is safety critical in the same level as it is in aviation. If just 5% of users use it wrong it, can negate all benefits from using the device. Generally you need deep knowledge transfer to scale up production of critical components or testing and calibration, just emailing the specs is not quick enough. You need to test it with real environment and refine the device to see how it works in practice. I'm sure that ventilator manufacturers have already outsourced every component that is easy to manufactured and produce to others. There are some bottlenecks that involve testing, special machines, materials and calibration that is not easy to scale quickly. (edit: the time-frame of ICU overflow seems to be between May-Sep in the most countries in most models If you ramp up deliveries 3 months from now, you could catch the tail end of the need)
rb808 7y ago
Thanks, I'm interested too why people think car manufacturers are the best place to make ventilators. What are the difficult/bottleneck parts to build?
- freeflight 7y ago
  I think that choice wasn't based on any particular logic, but rather the fact that car manufacturing is one of the few manufacturing industries that haven't been completely outsourced by most countries, and is somewhat compatible with the demands of building ventilators.
hef19898 7y ago
A friend of mine is coordinating Airbus effort to build ventilators. I know Airbus manufacturing base, and theoretically possible. Getting a design together that works, and can get certified for medical use, is the difficult part as far as I understood. But they are in contact with various universities and so on. One big issue can be IP. Dräger put a lot of money behind that. Just opensourcing the design and specs would kill the company. But why not negotiate liscense agreements or sub-contracting production out. Could be a solution. Just shows how everybody is still trying to adopt to the new reality.
- pyb 7y ago
  I am also concerned that Draeger refusing to share crucial IP might be an unspoken bottleneck. Of course, if that's the case, the right solution is for the government to acquire said IP for a large amount of money, but it may fail to happen for purely bureaucratic reasons.
  - hef19898 7y ago
    I would just liscense it out for a certain amount of time. Fees can be paid for by the government. But I understand that Dräger might be concerned. No idea if that's the case so. Bureaucracy can be a bitch.

by pyb 7y ago

eternalban 7y ago

Precisely what I was looking for in the article as well. Outside of logistic planning snafus, parts situation, and post production operator issues, it was silent as to why we can not scale up cranking out these machines.

deleted 7y ago
[deleted]

justnotworthit 7y ago

Next line is "We can’t build cars either." It would be interesting to hear industrialists explain how car assembly lines make them able to produce any particular hi-tech equipment. Or are you saying "why not just equip the buildings next door and quadruple everything"?

pyb 7y ago
The second option, of course. The industrialists I mention are not just in automotive, but oil and gas, etc

agumonkey 7y ago

Someone on reddit makes daily summaries for r/france and reports a lot of ~stupid issues blocking help. - health laws forbidding veterinarians to help (animal standard != human standard) - companies not allowed to help because some administrative formality Many systems are not ready to switch gears fast in times of crisis.

oaiey 7y ago
The FDA is already relaxing administrative control and vets will have their time coming. However, project management and engineering setup takes a long time.

scandox 7y ago

I am fascinated by the notion of factories just changing what they make. In my imagination a factory is a highly specialized machine for making one thing alone...

Udik 7y ago
I guess that factories have workers, space, skills, and networks of suppliers. And maybe a few machines that can produce parts by design (injection molds, 3d printers). That's it: they're not going to set up automated production lines for ventilators instead of cars or washing machines.
the8472 7y ago
At least car manufacturers consist of more than one production line. They make smaller series and prototypes too. And they have lines (and suppliers) that supply parts to other lines. Remember they also have to build the ECUs, dashboard and AC plumbing. If you squint that might be about what you need for a ventilator.

de_Selby 7y ago

He gives an analogy in the next sentence that explains exactly why "We can't build cars either". Production lines are not general purpose. There are also extremely high standards to be met for medical devices.

dna_polymerase 7y ago
Exactly. Also looking at German car manufacturers, their production lines are almost completely automated and rely on robots. Reprogramming them, if they would fit the job in the first place, would require weeks of testing and calibration alone.
pyb 7y ago
Of course, but that's surely not what Daimler's CEO was suggesting. What he might have been offering may be assembly workers, or factory space, or privileged contacts with Daimler's supplier base, or something else. My point was that it would be interesting for the general public to understand the actual issues. Right now we're all left guessing a bit.

WJW 7y ago

We also regularly hear (otherwise very sensible) software engineers saying stuff like "Clone twitter? How hard could it be?". It's not very hard to see how manufacturing life-saving medical equipment in a rush without proper testing could go catastrophically wrong. Even if you get known-good schematics from another company, retooling (say) a car production line to make something else needs a lot of planning to make sure all the supply lines and trained workers are in place.

smoyer 7y ago
That analogy is only partially accurate. For instance, injection molding machines are pretty flexible these days, parts are almost exclusively drawn in CAD and molds are commonly cut with EDM. Every injection molding house has to have the ability to maintain those molds too. So if you wanted auto manufacturers (or more likely one of their suppliers) to produce a plastic part, it could almost be hands off. Send them the CAD files and specifications, produce a short run with heavy QA and once they're started, you can almost have as many parts as you need. Modern cars have such a huge variety of parts with varying materials and characteristics that I'd guess almost all the ventilator parts could be out-sourced. I don't know enough to say what the specialized skills or parts could be but let the ventilator manufacturers build those, do final assembly and QA and you'd at least increase production to some degree. My guess is that the quoted manufacturer has ramped up their existing parts manufacture beyond their ability to do final assembly were Daimler to provide more parts.
- lqet 7y ago
  You are assuming (edit: actually you aren't, see below) that the car manufacturers are producing these parts themselves. It is a lot more complicated for Daimler to produce plastic parts for ventilators (for example) if small plastic parts in Daimler cars have been produced in China for the last 25 years and delivered just-in-time to the assembly line in Stuttgart.
  - helij 7y ago
    Europe is full of plastic moulding factories, big and small. Capability is there. Not everything is made in China. My friend has a small plastic moulding factory back home with 15 machines and his father is a tool maker. They themselves could produce 50,000 plastic parts a day if needed.

ThePhysicist 7y ago

Machines that produce raw materials for cars, like frames, can't simply be repurposed to produce ventilator frames (to my knowledge) as the tools that are attached to the machines (e.g. the stencils) are specialized, intricate parts themselves, so designing one for a new task can take years. The assembly lines / workstations also look very different, in general. You can see in the picture how the ventilators are assembled, it's not a factory line but more a workshop. Then you have all the supply chain issues that the article discussed. Companies like Dräger have been optimizing their supply chains and processes for literally over 100 years (the company was founded in 1889), so to think another company could just replicate all of that within a few months or weeks is unrealistic. Even with Dräger's help this would be challenging, as building up a new factory location usually takes several years as well. I think we have a strong bias to think that all problems can be solved with technology or engineering. Some need to be solved on a social and political level though, at least initially as technological developments take time. For Covid-19 we need to change our behavior now to allow technology to catch up.

Gravityloss 7y ago

It's a good question. Probably would also need the automotive parts suppliers to change to ventilator parts. And their sub-suppliers etc. Controlling quality would take time. It would be hard to make reliable properly working machines fast. Faulty ones would kill patients.

Nokinside 7y ago

(Not an expert on ventilators, but I have been working on software side of medical devises.) Producing semi-mechanical Bag-valve-masks (BVM) would be relatively easy, but you need professional to sit there and monitor the patient. That's not ICU ventilator. BVM is very crude tool for short term use. If the rules and legislation are relaxed so that hospitals could use non-certified crude devises that help. You would almost certainly see ventilator-induced lung injuries. Ventilator-associated lung injury https://en.wikipedia.org/wiki/Ventilator-associated_lung_injury https://en.wikipedia.org/wiki/Ventilator-associated_lung_inj... Ventilator-Induced Lung Injury Review (Part 1 of 2) https://pulmccm.org/review-articles/ventilator-induced-lung-injury-review-nejm/ https://pulmccm.org/review-articles/ventilator-induced-lung-... If the system is automated life support, it generally has to maintain homeostasis of the patient and _dynamically_ adjust. If you are just tiny amount off from the optimal and there is drift in the dynamical adjustment it accumulates over time and you can kill the patient or cause immense pain or discomfort. Oxygen is poison if you get it too much and if you get it too little, you die. Pushing air into the lungs can damage them and the oxygen mix should adjust. If lungs are filling with fluids, you might need more oxygen and less volume. The system must be connected to instrumentation that monitors the patient's state continuously. There is the question of medical staff using the thing correctly. Medical UI/UX is safety critical in the same level as it is in aviation. If just 5% of users use it wrong it, can negate all benefits from using the device. Generally you need deep knowledge transfer to scale up production of critical components or testing and calibration, just emailing the specs is not quick enough. You need to test it with real environment and refine the device to see how it works in practice. I'm sure that ventilator manufacturers have already outsourced every component that is easy to manufactured and produce to others. There are some bottlenecks that involve testing, special machines, materials and calibration that is not easy to scale quickly. (edit: the time-frame of ICU overflow seems to be between May-Sep in the most countries in most models If you ramp up deliveries 3 months from now, you could catch the tail end of the need)

rb808 7y ago

Thanks, I'm interested too why people think car manufacturers are the best place to make ventilators. What are the difficult/bottleneck parts to build?

freeflight 7y ago
I think that choice wasn't based on any particular logic, but rather the fact that car manufacturing is one of the few manufacturing industries that haven't been completely outsourced by most countries, and is somewhat compatible with the demands of building ventilators.

hef19898 7y ago

A friend of mine is coordinating Airbus effort to build ventilators. I know Airbus manufacturing base, and theoretically possible. Getting a design together that works, and can get certified for medical use, is the difficult part as far as I understood. But they are in contact with various universities and so on. One big issue can be IP. Dräger put a lot of money behind that. Just opensourcing the design and specs would kill the company. But why not negotiate liscense agreements or sub-contracting production out. Could be a solution. Just shows how everybody is still trying to adopt to the new reality.

pyb 7y ago
I am also concerned that Draeger refusing to share crucial IP might be an unspoken bottleneck. Of course, if that's the case, the right solution is for the government to acquire said IP for a large amount of money, but it may fail to happen for purely bureaucratic reasons.
- hef19898 7y ago
  I would just liscense it out for a certain amount of time. Fees can be paid for by the government. But I understand that Dräger might be concerned. No idea if that's the case so. Bureaucracy can be a bitch.