Abstract
My technical and STS research projects are connected through the shared focus of emergency airway management and examining how design impacts clinical outcomes. My capstone group’s technical project involved designing and improving the bougie, a guiding device used during intubation, by integrating steerability with suction and oxygen delivery capabilities. My STS research project examined cases of unnecessary patient injury from the GlideScope videolaryngoscope, another emergency airway management device. Both projects focus on the same question: what happens when an emergency airway management device is designed without adequately considering a broad range of potential users? The technical project addresses this current gap through engineering, and the STS project assesses the consequences of this gap through critical analysis.
My technical work explores the design of a hollow, steerable bougie that integrates fine and gross motor control and allows for suction and oxygen delivery. Current designs lack adequate steerability in difficult airways and require additional tools for suction and oxygen delivery. My team’s design addresses these gaps through steerability in the distal tip and subdistal region, as well as a hollow inner lumen, allowing for connection to a Y-connector for oxygen and suction capabilities. The design was created using computer-aided modeling and 3D printed using flexible plastic and resin pieces. Moreover, it was further validated through finite element analysis and mechanical testing to assess its technical viability. This improved design aims to increase difficult intubation success rates and improve patient outcomes in emergency airway management.
My STS research explores emergency airway management through the examination of GlideScope patient injuries. Through it, I argue that these injuries reflect assumptions embedded into the device’s design, and not isolated instances of user error. Using the framework of user configuration, I analyze how designers embedded assumptions into the device, creating a configured user that did not accurately represent the real-life users. I argue this through three assumptions: that clinicians possessed advanced coordination skills to manage the device’s blind spot; that clinicians would only apply limited forces; and that patient anatomy would fall into narrow windows. When real users, both patients and clinicians alike, fell outside these narrow expectations, failures followed.
Working on both projects simultaneously greatly added to my understanding of each. The STS project made me more attentive to the embedded assumptions in my group’s bougie design, especially regarding anatomical variability in patients and the range of techniques employed by clinicians. Conversely, working with engineering constraints on our bougie design gave me an appreciation of why designers have to make certain assumptions regarding use, making my STS analysis more nuanced and focused on the specific design assumptions that contribute to failure. Together, these projects reinforced that successful medical devices, particularly those focused on airway management, require a balance of both engineering design and attention to a potential array of users who will utilize the device.
