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This text was dumped from the document file which was used to create the hardcopy version of CryoCare Report. The text was reformatted for transmission online. We doubt that any errors were introduced by format conversion, but this possibility does exist. If in doubt, please refer to the hardcopy version of CryoCare Report as the definitive one.
| Effective 1996 the new address is: |
|---|
| CryoCare Foundation |
| Suite 3410 NorthEast Hercules Plaza |
| 1313 North Market Street |
| Wilmington, Delaware 19801-1151 |
As of July 21st, 1994, the total number of CryoCare members, fully signed up, was 53. Total number of people in the process of signing up: 83. Number of additional people who requested sign-up documents from us: 55.
In our last newsletter, we reported 38 members fully signed up, 60 people in the sign-up process, and 35 others who had requested sign-up documents.
In the space of two months, the number of people who have requested paperwork has increased by almost 60 percent, while the number who are in the middle of completing the paperwork has increased by about 40 percent. During the same two-month period, the number of people successfully completing the paperwork has also increased by 40 percent.
This indicates two things: first, we are still in a period of very rapid growth, and second, the sign-up process is turning out to be more of a bottleneck than we had expected. One reason for this is that everyone always tends to put off tackling cryonics documents. A greater problem, though, is that even our simplified paperwork requires great attention to detail, and even the most meticulous people make mistakes. When a new member's documents come in, 19 times out of 20 there's an error or omission -- a witness signature missing, a form that was skipped, or financial arrangements that aren't satisfactory. Paperwork has to be sent back. Phone calls must be made to explain what needs to be done. This is why Brenda Peters, CryoCare's president, currently finds herself processing new memberships full-time.
Paul Wakfer, president of CryoSpan, reports that after extensive consultation with earthquake damage experts, he feels confident that he can provide good protection for dewars on an individual basis. In other words, CryoSpan hopes to build vaults for one dewar at a time rather than one larger vault that would store many dewars.
Meanwhile, as reported in the item above, CryoCare is negotiating to offer its members storage with The Cryonics Institute in Michigan. This will be an option in addition to CryoSpan, which is currently our sole storage provider.
Courtney Smith reports that details of a specific proposal are being finalized as we go to press.
It's traditional for cryonics publications to run behind schedule, and CryoCare Report is no exception. This issue is 2 weeks later than planned. We do expect to continue on an approximately bimonthly basis. Our next issue should be created on new computer equipment, including a 600 dpi laser printer and a slide scanner which will enable much better reproduction of halftones (photographs).
In keeping with our belief in competition among service providers, we are hoping to offer our members the option of storage with the Cryonics Institute (CI). CryoCare director Brian Wowk has reached a tentative accord with Robert Ettinger, the founder of CI, and in our next newsletter we hope to have final details.
Currently, it looks as if the CI storage option will be slightly cheaper than CryoSpan (our only current storage provider) for neuro cases, and substantially cheaper for whole-body cases. Another advantage of CI is that it is located in a safer seismic area than any other cryonics organization (see map).
The storage issue is quite complex, especially when we get into the legal and financial details. We urge our members not to jump to any conclusions--certainly not until we have the final contract worked out.
We thank CryoCare director Brian Wowk for pursuing this, and we thank Robert Ettinger for being receptive to our requests.
On Friday, June 10th, CryoCare received a call from a man in New Jersey wanting to arrange for cryopreservation of his mother, who was ninety-eight years old and appeared to be dying. We will refer to him as Richard and to his mother as Clara.
Richard has been actively interested in cryonics for many years. Four years ago, he talked extensively with Alcor about signing up. For some reason, though, he never managed to follow through. When he called us, he wanted desperately to have his mother frozen (so he claimed), yet neither he nor Clara had ever joined a cryonics organization.
We judged from her reported state of health that there were only days -- maybe hours -- in which to make arrangements. We were naturally tempted to do whatever we could for Clara in the hope of preserving a remarkable intellect, a unique personality, and a rare store of memories stretching back over the entire twentieth century. Richard told us that he could raise $30,000 with credit cards, and to cover the rest of our fees he pledged to sign over to CryoCare a beautiful piece of farmland in New Jersey. He estimated that the land was worth between $200,000 and $300,000.
Our choice was not an easy one. If we decided to accept Clara's case, we would commit CryoCare to some substantial risks and obligations. BioPreservation (our care provider) would immediately rush to the airport with its full array of emergency supplies and fly to New Jersey to conduct a standby -- at our expense. CryoCare would hope to recover this money from Richard when he formalized his membership and payment arrangements, but until then, we would only have his promise to reassure us. CryoCare would also have the responsibility to receive and protect Clara after her legal death -- although there were no signed documents, yet, to give us the right to do this.
After weighing the case very carefully, we said "no." This is never a happy situation, and we'd like to explain some of the factors involved.
On the phone, Richard sounded painfully sincere; yet we were not totally convinced that he would be willing or able to honor his commitments. When we checked with cryonicists whom he had dealt with in the past, they all agreed that he was a procrastinator -- which explained why neither he nor his mother had signed with any organization, even though Richard had said he was desperate to have her frozen. His behavior seemed contradictory, which made us nervous about entering into an agreement with him, especially since we would have had to risk our resources before he really risked his.
Second, Richard's pledge of $30,000 from his credit cards could not be verified in any way -- at least, not till the following Monday, which we were afraid would be too late.
Third, Richard's offer of his land seemed unrealistic. Did he really understand the magnitude of this offer, or was he so distraught with grief for his ailing mother that he would pledge just about anything, with no thought for the future? Once his mother was safely cryopreserved, would Richard change his mind about the land and wish he hadn't lost it? Would be blame us for allowing him to make the decision? Would he even try to sue CryoCare to get the land back on the grounds that he had signed a document when his judgment was impaired? Would he turn out to have some relatives who would object to what he had done, and take us to court? (This has happened in a number of cryonics cases.)
Last but not least, the land was problematic as a means of payment because we had no way to verify quickly how much it was worth and whether it was unencumbered.
Jim Yount of the American Cryonics Society (ACS) seemed willing to go a little further with Richard than we were. Apparently, after we turned down the case, Jim sent some cryonics membership documents to Richard. Three days later, we learned that Richard still hadn't signed them -- which confirmed our fear that he was liable to procrastinate even in an emergency.
At the time of writing, almost a month later, we understand that Clara has defied all expectations and is in much better health. Richard has signed preliminary documents with the Cryonics Institute, but is now reported to have said that he "has no money" to pay their up-front fee.
Suppose we had sent BioPreservation to perform a standby. The team would have returned home after a few days without accomplishing anything, and we doubt that Richard would have paid their standby fee (which could have been easily as high as $10,000).
A paramedic (who is also a cryonics activist) visited Richard on June 11th and stayed for a few days on the understanding that he would receive a very small daily retainer for his expect advice. We are told that even this trivial sum was never paid.
We still feel unhappy that we were unable to help Clara, but we feel we made the right decision in this case.
There is another thread to this story. The paramedic who visited Richard was not acting alone; he drove to New Jersey with two other New York cryonics activists who took with them a portable ice bath (to cool a cryonics patient immediately after legal death) and various emergency medications. The local activists seemed to feel that if CryoCare wouldn't take the risk of helping Clara, they would do it themselves. They hoped to do a full blood washout using an embalming pump in a local mortuary. After that, they hoped to pack Clara in dry ice and drive her to the Cryonics Institute, in Michigan, for long-term storage -- assuming CI would accept the case.
We admire the spirit which led these volunteers to donate their time. We are concerned, though, that an impromptu action of this kind can lead to unexpected consequences. When the activists arrived in New Jersey, we understand that Richard tried to persuade them to help him keep his mother indefinitely in dry ice in a barn on his property. This could have caused a real crisis with local authorities. When a similar case occurred recently in Colorado, the local municipality banned cryonics outright.
Cryonics has an unfortunate history of lay people taking a "do-it-yourself" approach that ignores local regulations, orthodox medicine, and (in some cases) plain common sense. Our care provider, BioPreservation, employs qualified medical staff and uses equipment worth several hundred thousand dollars. The goal is to conduct emergency standby, perfusion, and cooldown on a properly controlled, properly monitored basis, to minimize tissue injury and enable some objective evaluation of the success of the procedure.
It has taken almost thirty years to reach this level of professionalism and sophistication in cryonics, but everything we've achieved can be jeopardized by one person acting impulsively on an amateur basis, with the potential risk of public scandal, scientific ridicule, and legislation that would control or even prohibit cryonics.
To the credit of the New York activists, they withdrew some of their support from Richard when they heard of his desire to maintain his mother in dry ice in the barn on his property. Still, the emergency equipment was out in New Jersey for more than four weeks altogether.
We understand the impulse to try to help someone who's in need, but we feel that cold, hard rationality must also play a part, no matter how painful this may be. People in the New York area who have signed up for cryopreservation should always have the first claim on emergency equipment, and CryoCare is now planning to establish its own standby kit in New York (with generous help from BioPreservation) for the use of our members.
We draw three conclusions from this story.
Some years ago, the Alcor Foundation established a set of guidelines to encourage rational decision-making in last- minute cases. Mike Darwin, who coauthored the original document, has refined and extended it in the light of subsequent experience. Charles Platt has reorganized and rewritten the text. The final result is printed below.
These are the guidelines which CryoCare proposes to follow in future, though we remain open to other viewpoints, suggestions, and objections. Please remember that we are not merely trying to protect ourselves from bad debts or litigation, here; we are also trying to protect our members and patients for whom we bear the primary responsibility.
There are four potentially catastrophic consequences if a cryonics organization feels tempted to accept an Emergent (i.e. "last minute") Patient:
The cryonics service provider must possess all these capabilities before it can even consider taking on an Emergent Patient:
All of the following conditions must be satisfied. The term "the client" is used below to mean any person(s) seeking to contract for cryopreservation. The client may be the patient or may be other(s) acting on behalf of the patient.
It may be impossible to determine how much identity- critical information remains in the brain. In such cases, we should be conservative, remembering that negative publicity could result from cryopreserving a patient who has severe brain damage. Also, borderline cases may require longer storage times and higher resuscitation costs, and may put the cryonics organization in a difficult position if it is involved in litigation or is forced to debate its policies in the scientific community.
A patient should not be accepted for cryopreservation if any one of the following conditions clearly exists:
At -100 Celsius and below, indefinite periods of storage are considered acceptable.
The client must be able to understand, accept, and reiterate the following theoretical concepts of cryonics:
The client must also be told, and must be able to understand, the following practical details about the procedure of cryopreservation:
When evaluating Emergent Patients for cryopreservation, the main concern should be to accept only the safest, most promising cases. The cryonics organization should never be tempted by arguments such as, "If we don't take this case, our competitors will," or, "we need the income that this case can bring." Cases that involve snags on a biological, financial, legal, or personal level are more likely to result in lack of payment, legal action, negative publicity, or backlash from relatives who subsequently decide that they were tempted by unrealistic expectations.
We must be especially cautious when dealing with friends or relatives who arrange for cryopreservation on behalf of a loved one and have little prior knowledge of cryonics. These people are most likely to cause the most trouble. They will want to control the situation, since cryopreservation was their decision and (probably) they are paying for it with their own money. At the same time, they will be uninformed and ill-equipped to make good decisions.
An excellent way of testing a client's suitability is by bluntly and exhaustively laying out the problems and drawbacks of the cryonics service provider and cryonics in general. This tactic has proved invariably effective at chilling unrealistic enthusiasm and filtering out cases where people are not properly committed to the concept. Clients who survive such negative salesmanship are likely to be good candidates (provided, of course, they satisfy the other conditions listed above).
When we are dealing with a prospective client who is not involved in a health crisis, it may be legitimate to be optimistic about the future of cryonics and the possibilities for resuscitation. A healthy prospective member is not under any stress and can take sufficient time to think about the issues, discuss them, ask questions, and seek additional information.
The patient who is near death (or a relative who is acting on the patient's behalf) has none of these luxuries. Therefore, we must attempt to discourage such cases. If relatives who arranged for cryopreservation reflect back on their discussions with cryonics representatives, they should be left with the overwhelming impression that they had to "fight to get in." They should never feel that they were "sold" on cryonics at a time when they were in desperate need of hope and reassurance.
In 1990 a bizarre report appeared in the medical literature. It described a medically untrained man who had attempted to resuscitate a case of cardiac arrest by using a toilet plunger. (JAMA 1990;264:1661). Perhaps the most surprising aspect of this case was that the resuscitation was successful!
Since that initial report in 1990 there has been a considerable body of research done on "Plumber's Helper CPR" which goes by the more formal (although less descriptive) name of Active Compression-Decompression CPR (ACD-CPR). When I first read about it, I quietly filed it away among my thousands of articles on cardiopulmonary-cerebral resuscitation and decided to take a stance of watchful waiting. I have seen too many "new modalities" of CPR come and go. In fact, I have a set of criteria which I use to evaluate any new modality for real worth:
1) There must be well documented evidence that a technique which was effective in a laboratory or clinic has been repeated by more than one other outside investigator.
2) There must be at least one good clinical trial showing improved acute resuscitation and neurological outcome.
3) There must be laboratory confirmation that the modality increases cerebral blood flows significantly compared with conventional closed-chest CPR.
I continued to accumulate papers on ACD-CPR and finally decided to build a protype manual unit. Subsequently, clinical and laboratory data came online which not only met but exceeded my expectations. ACD-CPR was effective at significantly improving blood flow to the heart and brain during CPR in animal models (Circulation, 1993;88:1254) and doubled the rate of acute resuscitation (restoration of spontaneous circulation) in humans during clinical studies.
More to the point, ACD-CPR increased the rate of 24-hour survival following cardiac arrest to 45 percent, compared with 9 percent under conventional CPR. (NEMJ. 1993:329;1918). Not surprisingly, and perhaps most importantly, neurological outcome was dramatically improved in the ACD-CPR group; patients had Glasgow Coma Scores of 8.0 versus 3.5 in the conventionally treated group. Further, ACD-CPR was successful in allowing the acute resuscitation of refractory cases where conventional CPR had been ongoing without success for an hour or more (JAMA, 1992;267:2916).
The reason for the success of ACD-CPR is simple: a suction cup enables the operator not only to push the chest, but also to pull up, creating negative pressure in the thorax which causes the heart to fill far more than under normal CPR. Moreover, the negative pressure also induces three- quarters baseline ventilation of the lungs -- which doesn't occur at all under conventional CPR.
The lead investigator developing ACD-CPR was Todd Cohen of North Shore Hospital on Long Island, N.Y. Working in cooperation with Ambu International (one of the world's largest manufacturers of resuscitation equipment) Dr. Cohen developed a lightweight (about 24 ounces) hand-held device called the Ambu CardioPump, capable of administering ACD-CPR. Early in 1994 the hand-held units became commercially available in England, and they were approved for use in Canada near the beginning of this year. Currently, however, they remain unavailable in the United States.
Can you guess why?
Early on we contacted Ambu and asked if we could obtain one or more of the hand-held devices for laboratory investigation. Yes, we had a research protocol, yes we had two physicians in charge of the project, and yes we had all the necessary permits and licenses to conduct the work. But the answer was still "No," and the reason (as you may have guessed) was the FDA. When the FDA took over regulation of medical devices a few years ago, it gave itself the right to control all testing of new devices. Further, possession of an unapproved device became a felony.
This created no end of hassles for Ambu. In fact, Ambu got a warning letter from the FDA merely for allowing one of the devices out on the marketing director's desk. The FDA demanded that the manufacturer carefully account for all devices (or parts of devices) on US soil and store them in a safe!
So restrictive are FDA regulations that Ambu is not allowed to ship the devices from Denmark, where they are manufactured, into Canada via their normal New York distribution hub. The units must go directly from Denmark to Canada. As a result, delivery to Canadians was delayed for months while Ambu set up entirely new shipping arrangements. The FDA has thus extended its enviable record of killing Americans to the point where the delays it has caused have killed Canadians as well.
In our early tests we were forced to use toilet plunger heads, which are not nearly as effective as the special silicone rubber head developed by Ambu. Still, even a makeshift device produced encouraging results. We discovered, however, that ACD-CPR rapidly exhausts the operator. It is much worse than conventional CPR in this respect, since the operator has to pull up with 18kg of force as well as push down with about 30 kg.
Clearly, if ACD-CPR was to be effective it was going to require a machine to do it. So, we started working on the problem and developed our own solution. In the meantime, we finally obtained approval to purchase a genuine Ambu suction cup, which is now fitted to our specially modified high- impulse CPR unit.
And it works great! Recently, I had the opportunity to try the unit in a cadaver model outside the US. It performed even better than expected on three patients (all were failed resuscitations with an average of 25 minutes of post mortem time). We increased our end-tidal CO2 readings from 0.5% with conventional CPR to 2.5% with ACD-CPR and increased mean arterial pressure (measured femorally) from 33 mmHg to 68 mmHG. (In addition to ACD-High Impulse CPR, we were also using high-dose epinephrine (0.2 mg/kg)).
Another advantage of our mechanical system is that it is computer controlled. Thus, we can vary just about any parameter of CPR. For instance, we can change the duty-cycle from the normal 50% compression, 50% relaxation to any arbitrary numbers such as 30% compression, 70% relaxation. Ventilation times, frequencies, and pressures can also be controlled automatically.
The on-board computer contains an EPROM which allows us to store up to ten preset CPR protocols so that we can select the one which is optimum for any given patient. For example, patients who are dehydrated require a different protocol from patients who are normally hydrated. We are now in the process of patenting this approach of combined modalaties for use in cryonics patients.
Accompanying this article is a photograph of the new unit. As you can see, we pay a price for its extra capabilities. At first we thought the biggest price was going to be the increased number of components: computer, battery pack/charger, and controller. But the real price has been the need to increase (dramatically) the column height in order to get sufficient negative intrathoracic pressure. This means that there isn't room to use it on thick-chested patients while they are on our MALSS (Mobile Advanced Life Support System) cart in the ambulance. This should not be a major handicap since we usually discontinue CPR and initiate cardiopulmonary bypass (blood oxygenator support) before loading the patient into the ambulance.
Based on our cadaver study, we are reasonably optimistic that we are going to be able to deliver something approaching 50% to 100% of resting cardiac output in a typical cryopreservation patient. This should go a long way to ameliorate ischemic injury. It should also decrease cooling times, since better circulation enables faster heat transfer.
We want to be very careful to point out that while this equipment is available to BioPreservation clients, we cannot guarantee its use. Currently we have only one of these units and it will be deployed only in cases where we have adequate notice.
There is another possibility, however, which is that individual cryonicists may consider purchasing hand-held Ambu units from England or Canada for about US$400 apiece. If I were at risk of sudden cardiac death (already diagnosed with heart disease) I would place Ambu units in my home, my car, and my workplace, and I'd make sure that people around me knew how to use them. Of course, under FDA regulations, ownership of these devices would be a felony, but some people might feel that it's better to be in Club Fed than Club Dead.
Meanwhile, when does Ambu expect the FDA to approve the hand-held Cardio-Pump for use in the United States? Three to five years. Maybe.
Suppose that the Ambu pump increases survival from sudden cardiac death by only 20%. This means that 65,000 people a year will die while we wait for certification.
Your tax dollars at work.
Last month's CryoCare Report contained a lengthy description of recent advances in BioPreservation's standby capability. We don't want to bore you, but we do want to keep you informed. We've now upgraded our capabilility further by adding a Kodak Ektachem DT-60 to the MiniClinical Lab in the standby kit.
The Ektachem will allow us to do a variety of critical clinical chemistries in the field, which will help us to assess the patient's likely time-course to cardiac arrest and evaluate the subsequent efficacy of CPR. The Ektachem will allow us to measure serum ammonia, amylase, creatinine, glucose, hemoglobin, total bilirubin, urea nitrogen, and lactate.
Urea nitrogen and creatitine are particularly important since they are sensitive indicators of renal function and of dehydration. Since many cryonics patients elect to arrest via dehydration, it is important to be able to monitor these values.
Lactate levels are a sensitive indicator of the development of shock as well as a good indicator of the effectiveness of tissue perfusion in CPR and bypass. During a standby, it's not practical to take blood samples and send them back to the lab to measure lactate levels, since the only way to do this is to mix the the sample with iced perchloric acid in the field and then immediately spin it down. The airlines do not like perchloric acid. We do not like perchloric acid. Thus, the Ektachem provides an indispensable service.
Our unit was acquired used and reconditioned for a modest expenditure (they cost about $5,000 new).
Near the beginning of June this year, CryoCare member Billy Seidel came bearing gifts. In exchange for stock in BioPreservation, Billy equipped us with two video cameras, a monitoring console, and a professional-quality 3/4" VCR.
One camera is designed to be mounted on a wall or ceiling, and its zoom and focus can be remotely controlled. The second camera is a studio-quality Sony on a massive tripod.
Two monochrome monitors show the output from the cameras (a third monitor is available if we acquire a third camera). Any of the signals can be switched through to a high- resolution color monitor, which displays the image currently being recorded. Billy has made himself available as in-house videographer during cryopreservations performed by BioPreservation.
We can now record the entire operating room tableaux, including readouts on some of our monitoring equipment. We can also record our endoscopic images, and we will have much improved documentation of human cryopreservations, canine- cerebral resuscitation, and canine total body washout research. Our thanks to Billy Seidel for the investment!
The first complete case history prepared on a patient cryopreserved by BioPreservation has just become available. The history consists of 27 pages of text, tables, and illustrations plus 31 pages of graphic data. This is a technical summary of the cryopreservation of a patient who was signed up with the American Cryonics Society (ACS). It documents our techniques and examines the problems associated with cryopreservation. A second portion of the report, discussing implications of the data and possible future improvements in technique, will be ready shortly and will be mailed to anyone who purchases the full report.
A version of this case history, minus illustrations and graphs, was recently posted in three parts on CryoNet. The hardcopy version is available from BioPreservation at 10743 Civic Center Drive, Rancho Cucamonga, CA 91370 for $10 including first-class postage. Make checks payable to BioPreservation, Inc.
We mention this report here because it will provide a complete, detailed answer to various questions that we've received about the specific procedures that are used by BioPreservation.
A report on our second cryopreservation patient (also an ACS member) should be ready shortly.
On Memorial Day weekend Jim Yount of the American Cryonics Society (ACS) and Naomi Reynolds of BioPreservation, Inc. (BPI) drove down from the Bay Area for a weekend of intensive training. Our facility was deliberately emptied of everyone but myself, Jim, and Naomi. The objectives were tough ones: Jim and Naomi would perform four jugular cutdowns on a dog, and two femoral cutdowns. They would pass small and large bore cannulae on the jugular cutdowns to simulate getting vascular access for administration of transport medications during human cryopreservations. They would then (using the femoral-femoral approach) go on cardiopulmonary bypass, hemodilute the dog to a hematocrit of less than 20 (diluting its blood by about half), and finally come off bypass. They would do all of this without any significant physical assistance from me. (I didn't even scrub in; I just stayed in my street clothes and put on a mask and cap.)
We started at noon on Saturday. By 4:30 PM they had two jugular cutdowns done. The long hours of performing the femoral cutdown and going on bypass still lay ahead.
At this point I proposed that we should abandon the jugular cutdowns and go on to working on the femoral cutdowns and getting on with bypass. To their credit both Naomi and Jim immediately said, in effect, "No, we've come all this way and we damn well intend to get all the practice we can!"
So, they did two more jugular cutdowns, picking up considerable speed in the process. Then they went to work on the femoral area. About twelve hours after they had started work, the dog had been put on bypass and cooled to 13 degress Centigrade, at which point hearbeat ceased. At about 15 degrees I left the facility to buy food for man, woman and beasts. When I came back over an hour later, Naomi and Jim were rewarming the dog.
Aside from a close call where Naomi almost pumped air while I was away (a valuable learning experience) and a blow- off on the arterial line where it joined the cannula (this should not have happened and was an even more valuable learning experience) bypass was uneventful. The dog's heart started beating on its own and she (the dog) came off bypass with minimal bleeding and an activated clotting time of 130 seconds (prebypass was 80 seconds).
By 7:00 AM, she had kicked out her endotracheal tube. By noon, she was standing up. At 5:00 PM, she was waiting for me by the door of the facility. She has done very well, required minimal pain medication, and has suffered no complications from three hours of cardiopulmonary bypass surgery/perfusion conducted by two "rank amateurs" who did pretty darn well.
In addition to serving as a training dog she also served as something of a control on our basic bypass technique (pretty darn good too!).
The dog's name, by the way, is Gouda. She got this name when the kind soul who originally brought her in from the airport let her out of the shipping crate and fed her some cheese. She vomited this half-pound of cheese all over the interior of his brand new Nissan Pathfinder. He has of course learned his lesson: let air-shipped crated dogs lie -- and don't feed them gouda cheese en route.
Also by the way, Gouda is a very sweet collie mix dog who weighs about 40 pounds and would love to have a home. Any takers out there? We try to place all good-tempered, surviving research/training animals.
Early in June, one of CryoCare's independent care providers needed to contact us urgently. For almost two hours, he was unable to do so.
Our unavailability was due to a conjunction of exceptional factors. A cellular phone wasn't working properly, and Brenda Peters was in transit to a vacation home. As things turned out, when contact was reestablished, we handled the situation satisfactorily. Still, there is no excuse for CryoCare being "offline" even for two minutes, let alone two hours, and this event prompted us to reexamine our whole emergency response capability.
As most of our readers know, CryoCare is a service organization which employs other companies to do the "hands- on" work of cryonics. We feel that this organizational structure guarantees better performance and long-term stability than the traditional model in which one company tries to do everything.
Since CryoCare is a management company that owns virtually no cryonics "hardware" itself, we have no need for a centralized HQ where people work/reside on a full-time basis and are always available to answer the phone. Our directors and officers are widely dispersed--which gives us an advantage in maintaining active contact with local groups, but means we have to be very careful about maintaining reliable communications. We are now establishing the following new emergency procedures.
Two CryoCare directors and one of the officers will carry nationwide pagers at all times. Any one of these people will have the authority to make decisions in an emergency.
At least one CryoCare officer will carry a cellular phone.
We have set up a computer which will store all personal records and will be instantly accessible (by qualified personnel only) from any telephone in the world. This miniature database will have its own dedicated phone line. To maintain strict confidentiality, access will be password-restricted to the following individuals: Billy Seidel (a vice-president of CryoCare, who is providing the system); Brenda Peters (president of CryoCare); Brian Wowk (director); Peter Crowley, MD (director); Charles Platt (vice president); Mike Darwin (cryopreservation team leader); and Steve Harris, MD (cryopreservation team member).
The system will function like a file server on a local area network in an office. The only difference is that access will be via modem from any outside location. If the BioPreservation standby team goes to a patient's bedside in an emergency, the team leader can use any local phone to dial in to the database and view the medical history, cryopreservation preferences, names of relatives, and funding arrangements. This can be vital in dealing with local authorities and making correct, life-protecting decisions.
Thanks to Billy Seidel for providing the phone line and purchasing the software and hardware which is making this possible.
Currently, our 800 number is answered by a system which asks you to punch in your phone number and then forwards your call automatically to the appropriate person. This means we have a reliable 24-hour service. In an emergency, however, we wonder if a human operator might be better able to talk reassuringly to an anxious caller and obtain information.
We have considered using an answering service for this purpose, but have been warned that even the services used by doctors are not totally reliable.
We are looking into the possibility of remotely reprogrammable call forwarding, so that incoming calls can be routed automatically to whichever person is currently on duty, without the caller having to press any numbers. In the meantime, we've upgraded our original automatic system so that it will continue to function in the event of a power failure.
In an emergency, (800) TOP CARE is still the number that you should dial. But to provide maximum redundancy, here are some backup numbers which you should keep in a safe place:
Brenda Peters (president of CryoCare): (604) 246 3600 or cellular phone: (312) 623 9559.
Charles Platt (vice president of CryoCare): (212) 929 3983 or pager: (800) 908 0470.
The annual Venturist festival was held this year on June 10th through June 12th at the Arizona ranch owned by Alcor member Don Laughlin. I am not actively involved with groups such as the Venturists or the Extropians, because I feel that the issues which need to be addressed immediately are more pressing than issues which relate to the future. Still, I remain an interested bystander, and since I was driving through Arizona anyway on June 11th, I dropped in to socialize and pay my respects to the guest of honor, Robert Ettinger, whose book The Promise of Immortality spawned cryonics as we know it today.
The Laughlin ranch is south of Interstate 40, at the end of a six-mile dirt road that winds through beautiful, uninhabited country. The ranch is equipped with a helicopter pad and a landing strip, and it overlooks a long, unspoiled valley. Mr. Laughlin provided a buffet consisting of steaks from his own cattle and the largest baked potatoes anyone had ever seen. While I ate, I talked with Mr. Ettinger and his wife, Mae, neither of whom I had met before.
I was pleasantly surprised to find that Mr. Ettinger is less formal in person than he sometimes seems in print. We talked about the "market penetration" of cryonics, and he joked that he had assumed, originally, it would take no more than a couple of years for the cryonics concept to be accepted and adopted worldwide. He remains convinced that sooner or later there will be a massive shift in public values, but by their very nature, such sudden social changes are unpredictable.
Mr. Ettinger mentioned that he has never felt comfortable inviting journalists to visit the building which the Cryonics Institute currently occupies. Soon, however, he hopes to be moving to a new building, which will be much more impressive. At that point, CI will start actively seeking publicity. (This has been confirmed in the most recent issue of his magazine, The Immortalist.)
I believe CI could be quite successful at attracting attention. After all, Mr. Ettinger has a unique position as "the father of cryonics," and he is still the only person who has managed to write a best-selling nonfiction book about it. In the 1960s, he appeared on some nationally networked talk shows. His civilized, erudite manner makes cryonics seem more like a respectable science than a pseudoscience.
This means that in the near future, there will be even more competition in cryonics than there is today. At CryoCare, we think this is a healthy trend, since there are substantial differences between the four main cryonics organizations and the consumer can only benefit from a wider range of choices.
Mr. Ettinger's speech at the Venturist meeting described the factors which originally prompted his interest in cryonics. Since he has already written about this in some detail elsewhere, I won't recap the story here.
Others who were present at the Venturist meeting included Alcor personnel such as Steve Bridge, Dave Pizer, Michael Perry, Linda Chamberlain, Fred Chamberlain, and Scott Herman.
I met some people who have not yet signed up with any organization, and they asked me about CryoCare -- in particular, why the founders of CryoCare had chosen to leave Alcor. I prefer to avoid this question, especially when I'm at a semi- public social event. The split of CryoCare from Alcor is best understood by reading the letter columns in issues of Cryonics magazine published by Alcor in the first half of 1993, where the opposing positions were stated very clearly. I believe these back issues of Cryonics are available from Alcor for a small fee.
Mr. Laughlin made a short speech in which he thanked everyone for coming to such a remote location and said he hoped he would have a chance to see us all again--in the near future, and also in far future. He sounded, in fact, like a diehard cryonicist. When I interviewed him a couple of years ago for a book that I was then writing, this one-time blackjack dealer (who is now worth hundreds of millions and has a town named after him) told me that he had signed up for cryonics because he "liked the odds." The question, of course, is why other wealthy people haven't reached the same seemingly obvious conclusion. This is just another aspect of the basic mystery which Robert Ettinger had discussed with me previously.
I left the Venturist meeting early (before the end of Mr. Ettinger's speech) because I had to travel on to New Mexico. But it was a relaxed, friendly affair, and I was pleased to see that most of the members of the competing organizations were coexisting on an amiable basis.
On Sunday, June 19, the monthly meeting of Southern California cryonicists was held at the home of Marce and Walt Johnson. Dr. Steve Harris spoke on the subject of life extension. There were many questions, and most people in the audience took notes.
Surveys have shown that most people don't sign up for cryonics until they have had personal contact with a cryonicist. Yet meetings of local groups seldom attract many people; twenty is considered a large crowd. It occurs to me that a seemingly non-cryonics talk like the one given by Steve Harris could attract a much bigger turnout if it was more widely promoted, and could segue into cryonics on a "bait and switch" basis.
The conference that is being organized by Saul Kent for November this year could work this way, and will be publicized through The Life Extension Foundation, the mail- order vitamin business run by Kent and Faloon. Even if the potential overlap between life extensionists and cryonicists is small -- if only one percent of members of the Foundation are potential cryonicists -- this could still represent a very significant increase in the cryonics population.
At the conference in November, we'll have a chance to find out whether this is a path worth pursuing, or whether it's just another case of wishful thinking.
Recently, Alcor had the unhappy task of removing one of its patients from cryopreservation and turning her over to next-of-kin for conventional burial. The termination of this patient's cryopreservation occurred because the sister of the patient was able to produce a photocopy (the original was never found) of a will that the patient had executed about two years prior to her legal death. In this document, the patient stated that she wished not to be frozen or cremated, and preferred a Christian burial.
Her husband had made cryopreservation arrangements on her behalf because she fell ill suddenly, before executing her paperwork. In fact, both husband and wife had been sitting on incomplete cryonics paperwork for many months.
The husband was able to show fairly substantial evidence that the patient wanted cryopreservation, including a copy of a signed but unwitnessed subsequent will. Even so, the court ruled that the patient must be conventionally interred.
Why?
This is very important: the court ruled that even if the patient had chosen cryopreservation, she could not have given informed consent because there was never any evidence presented that she had read and understood the paperwork. The judge did not dispute the legal status of cryonics as a scientific or experimental undertaking under the definitions of the California Anatomical Gift Act. His ruling was much narrower: he felt that the standard of informed consent considered necessary for medical experimentation on legally living patients was also applicable to those undergoing cryopreservation.
As narrow as it is, this ruling has profound implications for cryonics. It would seem to mean the following:
1. Informed consent must be given by anyone undergoing cryopreservation (or by someone legally empowered to give such consent on their behalf--conservator, guardian, durable power of attorney for health care).
2. Cryonics organizations absolutely must have evidence of informed consent.
3. Last-minute cases where informed consent is not possible or where the next-of-kin do not have legal authority to give informed consent may be successfully challenged in the courts -- perhaps on even flimsier grounds than this one was.
The take-home message here is extraordinarily simple. You had better fill out your paperwork. If you count on someone to make these arrangements for you, or if you expect to make arrangements for relatives, friends, or loved ones, it probably won't work and may be illegal -- at least, in California.
Take heed.
Charles Platt has designed a framework for a portable ice bath (PIB) that would fold up small enough to stow in a closet. These photographs show a 1/5th-scale wooden model opening out in four stages, from fully folded to fully extended. Of course, a watertight vinyl liner would have to be added, and this would need to be folded and stored separately.
Assuming the model can be scaled up successfully, it will be fabricated out of square-section aluminum tubing.
The current design for a PIB does not disassemble quickly or easily, is inconvenient to move, and is a problem for local cryonics groups who lack storage space.
Ideally, every local group should have its own PIB to minimize warm ischemia by providing prompt cooling after legal death. The new collapsible model was designed to meet these needs.
Everyone who signs up with CryoCare automatically gets up to $10,000 worth of emergency standby service from BioPreservation, our current care provider. No other cryonics group includes this level of service in its regular fee, and we think of it as a great source of security.
Realistically, however, the standby team can only be useful if they are able to reach you in time. Fortunately, most health problems tend to develop gradually rather than catastrophically--but what if you suffer a sudden heart attack thousands of miles away from BioPreservation personnel and equipment? In that case, you will depend on locally administered first aid while the team flies in. Will the first aid be effective? Will it be competent?
Below is an abridged version of some text which we found in a news group on the Internet. It should serve as a powerful reminder that most of us are not properly prepared for a health emergency, and we would all benefit from learning Cardio-Pumonary Resuscitation (CPR).
CPR has recently received a negative reevaluation, because if it's done ineffectually or too late, it saves only the lower brain functions, and a patient may end up technically alive but in a persistent vegetative state.
However, prompt, competent CPR can reduce ischemic damage (injury to cells caused by lack of blood flow), which is vital for all cryonicists, no matter how strong their faith is in nanotechnology. If the CPR is administered with the newly developed Ambu CardioPump (see Mike Darwin's articl [REMAINDER OF FILE MISSING]