Plan C: The Montana Mask opener

Dr. Marlin “Dusty” Richardson is a neurosurgeon in Billings, Montana. In the first week of March, the Billings Clinic, where Dusty Richardson works, sent out a memo to its staff. Shortages of masks would necessitate a change in policy — medical staff were now told to reuse masks, and the new policy was to use one mask per day. “For neurosurgeons and others who do what I do, we use a mask for each case”, said Dusty. “There’s blood spray on them during surgery…” He didn’t have to say much more. If masks weren’t going to be available, Dusty thought it was a problem that could be solved. “This is 2020,” he said. “We have technology; we have to be able to come up with something.”

Dr. Dusty Richardson

Dr. Dusty Richardson

His initial insight was:

Why don’t we use a single surgical mask for multiple uses, but only use a piece of the mask?

Read more articles about Plan C: What makers are doing to combat Covid-19

 

He sketched out a design for a mask on the back of a receipt, took a picture of it and texted it to his friend, Spencer Yaugg, a dentist who uses CAD and 3D printing in his practice and whose son, Coulton, is a 3D printing enthusiast. The task fell to Coulton to develop a design for a fitted mask that allowed filters to be replaced. Over a couple days, he created a digital design using Fusion 360 and began printing different versions and sending more ideas and prototypes back and forth. Soon, Dusty Richardson began using the mask himself and he also tested it. Eventually, he introduced it to his hospital, which was happy to have the masks. They posted the design files on Dr. Yaugg’s dentistry website and Dr. Richardson’s wife, Lauren, posted a link to the design files in a Facebook group for the wives of physicians. It all happened very fast. Dusty had contacted the Zauggs on a Thursday night and the files were posted online by Sunday morning.

Dr. Richardson wearing the Montana Mask

Dr. Dusty Richardson wearing the Montana Mask at the Billings Clinic

That’s how the Montana Mask came to be. Several months into this Covid-19 crisis, the Montana Mask is one of the more successful and widely used PPEs and dare I say it, a recognizable brand name in a category that has no brands.

So Many Questions

As the interest grew, Dr. Richardson had other things to care about such as patients. However, a big reason the Montana Mask is widely known is not just the inventors themselves but two women, one in Redwood City, CA and the other in Bethesda, MD, who had worked together previously as communications consultants but now found themselves at home with children and out of work. They were both wives of military service members. At the beginning of the crisis, the two of them were on Facebook in a group for wives of service members and one of them saw the Montana mask post that was originally posted in a group for wives of physicians.

Corie Hawks and DeEtte Chatterton both have husbands in the Air Force who are physicians. Corie and DeEtte started talking to each other about the pandemic: “This is a problem,” said Corie, describing the conversation. “And we’re not going to just sit here and wait for another country to come to our aid. We have so many brilliant people here in our country. There’s no reason to just sit around and wait for someone to solve the problem. So we started looking at all sorts of different PPE designs.” When they stumbled upon the Montana mask, they liked that the design was simple with not as many parts as other mask designs. “We thought if we’re going to put all our volunteer hours behind a design, this was the one,” Corie told me.

Corie Hawks

Corie Hawks is a volunteer with Montana Mask

Corie and DeEtte reached out to the three inventors in Montana, and she recalled that the conversation went something like this:

-We want to give this idea legs.

-Oh. For free?

-Yep, that’s the gig. Because the more people that have this design and the more people that have these files, the more solutions we have out there, right?

That purpose became the mission of Corie and DeEtte, expanding the reach of Montana Mask and helping out by meeting the growing demands of an emerging community. They set about building a team. “It’s about putting together tinkerers, makers and communications people, and media people,” said Corie. “Only when all of these people are working together, do you get a movement.” They built the website at makethemasks.com. They were able to host the files on the website, moving them off Dr. Zaugg’s dentistry site and the Billings Clinic website.

The Montana Mask

Front and Back views of the Montana Mask

Screen shot of MaketheMasks.com

The MaketheMasks.com website

In late March, CNN did a story on the Montana Mask. “From our end at the hospital, we had an enormous response,” said Dusty. “We had thousands of phone calls, emails, with people asking questions.” He said they were getting so many questions.

What percentage of infill do you use for the mask?

That question might be asked in 60 different messages a day. “Our entire nursing staff in neurosurgery was fielding questions for a whole day,” said Dusty. I asked him if they blamed him and his mask for creating work for them. “Yes,” he replied. “I was in big trouble with them.”

To respond, they built “a really robust FAQ site to address many of the issues around 3D printing,” Corie said. “There were a lot of microconversations that needed to happen.” Dusty said that it was important to have Corie and DeEtte to deal with the “onslaught of questions.”

Can I print it for a larger or smaller face size?
Can I use a resin 3D printer?

Corie and DeEtte also began to organize a network of volunteers through the website. There were groups in all states in the US except Alaska and they found people in each state to organize local community groups. Then they began developing regional coordinators.

James Turner in Derry, New Hampshire became one of them. An IBM employee who builds apps used by airline pilots, Turner began making masks for medical facilities in and around his hometown. “ I am always looking for ways I can help out, “ said James. “That sounds self serving, but it’s true. I try to provide services where I can to the people who need them, but also I seem to have a knack for organizing. I like to try to help enable other people. It gives you a feeling of empowerment if you can help.”

James Turner

James Turner is the lead coordinator for the Montana Mask.

Earlier, because he had a 3D printer, James searched for mask designs and found the Montana Mask through Facebook, which had a link to the design files. “I started printing it, but I also saw that they needed coordinators for states and there was nobody for New Hampshire,” he said. However, even though he signed up, he hadn’t heard much from the Montana Mask team. Then, what he called a “tech failure” produced an unexpected gift. Corie sent out an email to all the coordinators but instead of Bcc’ing everyone, she copied all the organizers as recipients. “All of a sudden everybody is responding back with comments,” said James. Soon, he created a Slack group to get the interactions out of email. A community around the Montana Mask was born. And James was asked to be the “Lead Coordinator.” In his new role, he set up processes to manage the community and a Github repository to store the design files.

Corie, who was new to the technology of 3D printing, learned on her feet while running and quickly picked up how to talk about a 3D printed mask and how to talk to the volunteers in many different communities. As a result, more masks were made and more found their way into hospitals around the US and abroad.

Made in Montana

“We’re Montana,” said Spencer Zaugg, the dentist. “We didn’’t think that we were going to get the coronavirus, but we did get it. It affected me because dentistry was put on hold. We couldn’t do anything. Because of the PPE shortage, they didn’t want dentists to start using masks on elective cases.”

He called it a perfect storm that the mask was made in Montana — “because we had the idea and we had the time.” When Dusty Richardson called, Spencer and his son had the time to do prototypes and time for thinking — “what we could do and how it was going to look.” Dr. Zaugg was familiar with 3D printing from his dentistry business where it is used for “guides, aligners and models.” But Coulton had the real know-how, tracing it back to a 2012 engineering class in high school where he learned about 3D printing. “I’ve just been sticking with it and have been keeping up with 3D printing and the 3D design software such as Fusion 360,” said Colton, who has a degree in microbiology from BYU.

As Coulton started the design process, he began by looking at mask examples on Thingiverse and elsewhere. “None of the masks had a real good filtering system and that was the most important part,” he said. “What made the mask work is that you can just cut a filter patch and press-fit it in.”

“We printed a bunch of versions,” said Coulton. “Most of them, I just put them on my own face. There are better ways to go about it, but the quickest way for me at least was to design it, 3D print it, put it on my face, and see where it felt too much or too little and then make the adjustment.”

Dr. Zaugg has a scanner in his office and scanned Coulton’s face. “Coulton was the model,” he said. The fit to the face is really important, not just for comfort but for safety. “The plastic itself does a really good job,” said Spencer. “But to get a higher quality fit, we use some weatherstripping.” It works as a gasket and it fits most faces,” said Spencer.

Corie says of the Zaugg family: “They love making and printing things as hobbyists. They have day jobs but they really liked doing what they did.” Making is a process and an adventure.

“The crazy thing about it is you send a design to the printer” said Spencer, “and then you wait for two-and-a-half to three hours. During that time, you’re already developing a new design.” He said that there were times when they stopped a printing job after an hour and a half because they knew it needed to change and that version wouldn’t work.

Once they had a fitted filter mask they liked, Dusty took it to the Billings Clinic around the 21st of March. “I showed it to the hospital and they said ‘wow, this seems like a really good solution to extend our existing supply.” The team began getting out the word to the local maker community in Billings and shared the design files. “We had a tremendous response from the local community here,” said Dusty. “That’s the real story and the miracle of the thing,” said Spencer. “Everybody wanted to do something significant — and the average printer takes three hours or so to print a mask – and that’s a long time. You wouldn’t think it would make a dent but …”

“I’ve used the analogy of raindrops,” Spencer said. “The raindrops come and then they make small streams and they go into bigger streams. Every person makes a huge difference.” He added: “The maker community really did step up.”

Testing

In a matter of weeks, the Montana Mask had grown from sketch to design to prototype and then into digital blueprints that were distributed widely and made in many places. A fledgling organization had grown up to support it. “We are like a research and development organization on steroids,” said Corie. More and more questions kept coming from makers and health care workers.

Does black weatherstripping work as well as white?

“A lot of the questions that got fielded by me,” said Dusty, “were either technical or required some level of medical expertise to answer.”

Does carbon dioxide accumulate in the blood when you’re using the mask?

To answer that question, Dusty was able to use the Billings Clinic’s Sleep Laboratory. Once again Colton was the model. “Colton had to sit there for an hour straight with the mask on,” said Dusty. “We put different patches in there and then measured his end-tidal C02. That helped us understand that carbon dioxide did not build up when wearing the mask.” They also looked for changes in oxygen saturation.

Can the mask itself be sterilized?

“PLA is very porous or that there’s pores between the layers,” said Dusty. “We know that. That’s true, but they say it can’t be sterilized. So we had two nurses who worked the same OR shift in the same OR wear two different masks – one wore a regular surgical mask the other wore a 3D printed mask. Then we took a bleach wipe and wiped them down and we did the culture tests on them to see if we could eliminate the bacterial colonization of the mask. The truth was that we could. We used two different types of wipes on two different masks. We were able to show that with a bleach wipe or with the commonly used saniwipes, which are just kinda like a Lysol wipe, those masks cleaned up very nicely.”

Making Changes

One of the frequently asked questions is:

Can I change or modify the mask design files?

James set up the GitHub repo for the Montana Mask so that people could post modifications. “We have remixes of the designs and improvements,” he said. The Montana Mask design files are now available under the GNU General Public License v3. So anyone can modify and tweak a design and do their own version. But it brings up another question: when is a Montana Mask not a Montana Mask? That is to say, if a particular design has been subjected to testing and passed, then will the variant designs pass the same tests? Can the mask be trusted, which is the essence of a brand name?

“You have to look at a variant and ask, ‘are the tests still valid?’” said James. “I was just on a call tonight where we were talking about what you can and can’t do without invalidating the testing and having to go through another round of testing.”

They have determined that as long as the fit to the face isn’t changed, and the filter end isn’t changed then the new designs should be fine. “We’’ve actually got a divide on the github between the designs for which the testing is valid and ones which need to have testing,” said James.

Recently, a new version of the Montana Mask replaced the original, and it incorporated changes submitted by the community. One of those who modified the mask was Dan Robles, an engineer and high school STEM teacher in San Diego. He has been printing masks on eleven printers in his living room. He said he had to stack 3D printers “vertically” to accommodate them. “The following picture is from a few mornings ago when I was starting all the printers up in the morning. We had to stop running through the night when we got up to 8 or more printers because it was keeping our one-year old up.” Out of the living room, he’s putting out 30-40 masks a day.

Dan Robles's Living Room

Eleven 3D printers on shelving in Dan Robles’s living room

As the local coordinator for FindtheMasks.com, Dan has set up Free3DPPE.com for coordinating efforts in San Diego. There are six other people printing masks in their homes or offices. Dan’s modification was to change the size of the eyelets to make it easier for threading elastic through them.

J.Scott from Los Gatos CA heard about the Montana Mask from a neighbor who sent him a link knowing that he had a 3D printer. He thought the one’s lips were rather close to the center piece where the filter is and thought it might be a problem. “So I designed some relief in the filter piece,” he said. It was about a 5mm difference but the fit was a “world of difference” to him.

James urged the designers to work together so that the several different modifications could be combined. This happened with Dan’s and J.Scott’s changes, which became features in the new version.

Tom Joseph from Pittsburgh also began printing masks but he stepped up to help source supplies, trying to locate sources in China for masks and elastic.

A Mask Made in Montana

The next phase is having an injection molded version of the Montana Mask. “Once we saw that that the mask had a lot of merit,” said Dusty, “and people started making them, and people started using them, we saw the demand go up.”

They decided to explore injection molding, not just to scale production but also to improve the product. “We could have a highly repeatable product that could be sterilized in a formal sterilizer, said Dusty. The three of them redesigned the mask for injection molding and partnered with Spark R&D in Bozeman, Montana, which makes snowboard bindings for split boards. It seems like a more flexible, softer mask. As of May 12, Spark has sold over over 30,000 of the injection molded masks. So the mask is now made in Montana.

Spencer and Coulton Zaugg

Spencer and Coulton Zaugg with Spencer holding an injection-molded version of the mask

“Our Montana Dental Association purchased 3500 masks,” said Spencer Zaugg. “They gave them to all the dentists, assistants, hygienists, and said ‘here’s your masks and here’s your patches” so you can go back to work.”

Injection-molded mask at Spark R&D

Injection-molded mask made at Spark R&D

“We’re getting feedback such as “this is MY mask,” said Spencer. “They’re putting little beads on it and decorating the mask because this is MY mask and this is MY mask for months. It’s a reusable mask.”

“I think American ingenuity is so unharnessed,” said Corie Hawks. “Let’s just solve our own problems. My hope is that when all of this is said and done, when Covid-19 is behind us, we will have proven to ourselves that when we come together, we are the American brain trust.” It’s like exercising a muscle that has been underused.

The Montana Mask, which was designed out of necessity when a neurosurgeon learned about the shortages of masks, might actually find a life of its own as a better mask than the type of mask it replaces. A reusable mask with replaceable filters is an innovative solution and it is more sustainable than disposable N95 masks.

Meet the Makers of the Montana Mask

Here directly from the Montana Mask team, which was featured on Plan C Live on May 8, 2020.

Links: makethemasks.com

Images provided by Makethemasks.com