The Alcor Podcast

Deployment and Recovery: Inside Alcor's DART Team - Part 1

• Alcor Life Extension Foundation • Episode 4

Share episode

Episode Overview

In this very important episode, Alcor pulls back the curtain on one of its most critical operations: the Deployment and Recovery Team (DART). Join medical response director Shelby Calkins as she provides an in-depth look at the DART team's crucial work. This is the first part of a two-part series that offers unprecedented insight into the inner workings of Alcor's medical response team, providing a comprehensive understanding of the complex and critical role the DART team plays in Alcor's mission.

Key Topics Discussed

  • The history of Standby Stabilization and Transport (SST)
  • Creation and evolution of Alcor's DART model
  • Alcor's strategic shift towards in-house SST operations
  • Insights into team recruitment and training
  • Addressing common misconceptions about the DART team

Alcor Members: Don't forget to take our member readiness survey by clicking here.

Support Alcor with Directed Donations:

Stay Connected:

SPEAKER_01:

Welcome to another episode of the Alcor podcast, where I will take you behind the scenes of the Alcor Life Extension Foundation. And as most of you listening already know, Alcor is one of the oldest and largest nonprofit chronic organizations. My name is Daniel Walters. I am the community outreach coordinator here at Alcor. And today I will be joined by Shelby Calkins, Alcor's medical response director. Shelby is the lead coordinator for Alcor's deployment and recovery team, commonly referred to as the DART team. Shelby, welcome, and thank you for joining me on the podcast.

SPEAKER_00:

Thanks, Daniel. It's really great to be here. Looking forward to it.

SPEAKER_01:

The reason why I wanted to do this specific podcast is because I feel that there has been a lot of education that still needs to be imparted to the Chronix community. specifically on the topic of deployment and recovery, don't think there's a bigger category amongst chronicists that I've witnessed more confusion about. In fact, as you know, up until recently, and even now, I still personally have a lot of misconceptions about the whole process. So with this podcast, I'm hoping to remedy some of that ignorance. During this conversation, I'd really like to do a deep dive on this. This is a dense topic, so we're definitely going to have to get into the weeds here. So let us just jump right in. We have Alcor's DART team, and for those who don't know, that stands for the Deployment and Recovery Team. But generally speaking, the DART team is responsible for carrying out something called standby, stabilization, and transport, referred to as SST. So Shelby, I just want to start off with some of the the basics, what is SST and why is SST so important in cryonics?

SPEAKER_00:

Yeah, so as you mentioned, SST stands for standby stabilization and transport. It's a critical process that begins the moment legal death is declared. It's absolutely essential to maximizing preservation quality. So the goal is to reduce warm ischemic time, which is the time the brain is without oxygen at normal body temperature. because that's when significant damage can occur. So by cooling the patient quickly and starting stabilization procedures immediately upon legal declaration, we can help preserve brain viability until cryoprotective perfusion can occur either in the field or back at Alcor, depending on the member's choice of type of cryopreservation. Essentially without SST, the chances of getting a good quality preservation is much lower.

SPEAKER_01:

Just to give people a more practical view of what this would look like, could you describe what a very typical Dart team deployment would look like during, you know, starting with the standby and then the recovery?

SPEAKER_00:

Sure. Well, an ideal case starts well before standby. We have what's called the member watch list. And that's something that as the MRDI manage, And so this is a process where I can check in on members and just really keep tabs on their health status. The deployment starts when I'm notified or someone else on the team is notified that a member is critically ill or very rapidly declining. We then confer with the deployment committee, which is made up of myself or my role, the MRD, the chief and medical advisor, which is Dr. Tom Wolvos, and our senior administrative director, which is at the moment, Sarah Kelly. And we all confer, we decide that a deployment is necessary. And once a standby is authorized, we mobilize DART and we send out all of the necessary equipment and they try to the patient's location. After legal death is pronounced, we begin the cooling process immediately with ice in the patient ice bath. We administer medications. We start the cardiopulmonary support. Once stabilized, we then transfer the patient to a specifically designated location for field surgery if it is a neuro and field washout if it is a whole body. Then the patient is transported back to Alcor. If they received field cryopreservation as a neuro, they go directly into cool down. And if they were whole body, then they complete the perfusion process here in the OR with Dr. Wolvos and myself, and then they go into cool down after that. Every case is unique. Flexibility is key, but that's the general structure.

SPEAKER_01:

Okay. You mentioned perfusion, but what's the difference between perfusion and straight freeze? And under what circumstances do you do one or the other?

SPEAKER_00:

So a straight freeze is avoided at all costs. A straight freeze is a term that we use for a member who did not receive any cryoprotectant perfusion. You may hear interchangeable terms of CPAs, perfusates. These are all in regard to M22, which is our chosen CPA or cryoprotective agent. This is what preserves the body tissues on a cellular level to reduce the amount of fracturing that happens when they plunge into ultra low temperatures for long-term storage. So without the perfusion, cells are highly at risk for damage during that process.

SPEAKER_01:

To me, this answer is obvious, but is SST really needed? Is there some reason people are advised not to do this by themselves?

SPEAKER_00:

Yeah, no, that's a great question. It's a fair question, but realistically, SST is a highly technical process. It requires trained personnel, specialized medical equipment, rapid cooling technologies, and an understanding of logistics and legal compliance as well that goes along with the entire process. So even well-meaning medical professionals or family members, they're just not fully equipped to perform what we do. Think of it like trying to perform a trauma surgery in your living room. It's just not feasible or safe. Our DART team is trained extensively to do this work properly, respectfully, and with the highest standard of care and quality.

SPEAKER_01:

So let's kind of go backwards a little bit in time for historical context. I know you can speak To some extent, there are other people at Alcor who have been around for, you know, even during the early years. And at some point, I'll have them on the podcast and we can kind of do an even farther back look at the very, very early attempts at SSD. So we won't go back that far. But generally speaking, to your knowledge, could you discuss the kind of earlier external contract model that Alcor had prior to the DART model that Alcor currently has.

SPEAKER_00:

Before the development of the in-house deployment and recovery team, Alcor primarily relied on external contractors for standby stabilization and transport. What this meant is that when A member was approaching clinical death, Alcor would contract with outside professionals or companies to perform the SST procedures. These teams would deploy on a case-by-case basis, often flying in from different states, different regions, and it depended on availability, location, things of that nature. But this model allowed Alcor to extend its reach both nationally and internationally, but it came with a lot of variables, especially when it came to consistency and quality control as far as being able to fully control the performance of the SST being done. I

SPEAKER_01:

want to... get a little deeper into the challenges inherent in that external contractor model. But even before then, I just want to thank all of the earlier contractors, volunteers, anybody who had been working in Cryonics prior. This is in no way criticism of your devotion to the cause. We wouldn't be here without them, but the model is evolving from here. but we do have to kind of understand why, what were some of the kind of inherent flaws for Alcor in that model to understand why Alcor did a shift to the in-house contracting model.

SPEAKER_00:

Yeah, I will talk about that, but I do wanna take a step back and also just expand a little bit on what you were saying. So our early responders, both volunteers, and professionals, they do deserve enormous credit. They were the ones showing up often on short notice, working through intense environments, figuring things out in real time. Many were cryonisists themselves, so their motivation came from a deep belief in the mission, and it paved the way for everything we're doing now. You had mentioned geographic limitations, and one of them is that our contractors were often based in only a few locations. So this made rapid deployment to further locations or further regions of our members difficult or delayed. So response times could be longer, especially for international or rural members. that are farther away from where our contractors are based. And that's one of the reasons why with our Dart model, we created a system where we could have a Dart member essentially stationed anywhere in the world. So wherever their home base is, we strategically hire specific individuals based on their location and based on their proximity to the larger membership areas around the country and around the world. So that's really the geographic limitation on that. There was some things with equipment and standardization issues. And I don't necessarily want to say issues, just more complexities. And we wanted to maintain our own in-house equipment that we could ensure was being checked properly and maintaining consistency with our course protocols. So part of that was just equipment and standardization. Communication and coordination, everything that we do is a pretty complex process from start to finish. And so when you have an in-house team, coordinating between different team members becomes a lot simpler when they know exactly what's meant to be done and where they need to be without having any sort of outside interaction. influence on that and what i mean by that is really you know when when we have a contractor model and this is no offense to anybody but you're running a business right and as as a business owner you're going to have different considerations than an employee who has a job description that they can just simply follow right so communication becomes clear and the just the quality control of it plays a huge part in that. We also, we wanted to move away from being beholden to a third party, right? So ultimately as an organization, especially an organization that's a nonprofit, we are member focused, we are member funded, and we didn't have full control over our deployment process, which is kind of the meat and potatoes of what Alcor does, right? So we, if cryopreservation is what we're promising, we want to ensure that our members are getting the highest quality preservation possible. So, you know, being beholden to a third party, if they're unavailable or if contractually they're not obligated, then, you know, there really was no backup to those systems. So, you know, In the instance where one of our contractors, especially when I first started at Alcor, if our contractors weren't available, it was me having to jump up, me and Sarah or other staff members having to jump up and kind of last minute go and take care of our members and ensure these preservations were being completed. So there wasn't major issues or major problems, but there were holes in the process that needed to be plugged. And I think that we're working well on our way towards having a really solid recovery process here at Alcor.

SPEAKER_01:

So it seems like having that in-house process puts the onus on Alcor, gives Alcor more agency. So I think, I mean, if you go back even farther, when you had even just volunteer corps, I mean, then it was really out of your hands. So I could see this kind of evolution from the very early days to more and more kind of Alcor having control of its own destiny, so to speak, when it comes to SST. And I think probably for Alcor members, that translates to just stronger redundancy, to higher levels of security that you're actually gonna get a good cryopreservation. If we can go over, I guess, a little bit of the timeline of the DART model, starting from when you were hired, what did it look like back then when you first started?

SPEAKER_00:

So when I, I'll back up a little bit further than when I started as the medical response director, because I actually was hired as a SST team member a few years prior to coming on as MRD. And I went on a few cases and got a little bit of experience, at least an introduction to what these teams were required to do and the logistical complexities of what was required back when I was on the SST team. As far as starting as the MRD, I started back in September of 2022. And we did not have any in-house SST members. So we were fully reliant on outside contractors. And one of my very... first strategic goals was to develop and operationalize a true in-house medical team capable of deploying anywhere in the world for SST for our members. At the time, we were starting from scratch. Like I said, we had no one on the team. We had no reserve team. One of the initial challenges that I ran into was limited personnel availability so there there's just not many people in the world both with both the medical skills and the mindset for this kind of work so um that and the availability right to deploy on a on a whim um and drop everything and go. So cryonics, you know, it requires not just technical knowledge, but also the ability to handle high pressure situations, often emotional situations. And we have to be able to manage these with both empathy and professionalism, while also having that goal oriented mindset of our goal is good quality car preservation and that has to be met every step of the way while also managing split decision-making, empathy, professionalism, dealing with family members, hospital staff, things like that, legal entities, funeral directors, all of the coordination between all of these people has to come together with that end goal in mind, right? Um... After I was hired and I was struggling to find available personnel, we hired James Arrowood as our CEO, co-CEO at the time. And he brought in some logistical and tactical experience to the team when it came to this notion of having our own in-house SST. When I first brought it up to him that this was like strategic goal, his first idea was, well, why don't we hire military veterans and you know he he said they need to be from elite units they need to be special forces these individuals you know they're highly trained they're used to this type of work operation operating under unpredictable environments. Um, they have the adaptability, the discipline, um, that, that cryonics demands. And that was kind of a game changer for us. Um, that idea of James, uh, bringing in special forces. And so only three months after that, um, we held our very first start training with five, um, X special forces, Navy SEALs, um, It was a comprehensive, hands-on event that combines our medical education. We had, and it's still the model how we run it now. So we have a medical education portion, simulation of logistics, and then the surgical aspect. That was the beginning of something completely new for Alcor. And today the DART team has grown into a specialized unit made up of not just special forces, but nurses, medics, firefighter captains, and of course our veterans who are not only skilled, but aligned with the mission of getting the cryopreservation done with the most efficient and top quality work.

SPEAKER_01:

This is where I want to get into the weeds. I want to know more about the education, but even before we jump into these training programs and such, I want to know more about what Dart was looking for. But let's just start with you, because you're at the top directing all this. Could you tell us a little bit about your educational background and your experience?

SPEAKER_00:

Sure. Um, I Started out in healthcare right out of high school. I obtained my EMT license and I actually at the same time obtained my firefighter one and two certification because my goal was to be a firefighter paramedic. So I had my EMT and I was looking for a job to kind of fill in the gap until I was hired on with the fire department because they weren't hiring at the time. And I ended up in the ICU at a level one trauma center And this is back in 2015. And that's where I attribute all of my foundational knowledge was in that critical care unit. And it allowed me to build just a strong and deep knowledge of all the aspects that go into critical care. So I did that for about five years as the CNA in the ICU. I earned my nursing degree in 2020. with my BSN and I jumped headfirst right into the deep end because if you all remember 2020, especially around May, was right at the height of the COVID-19 pandemic. So, you know, As a new nurse in the ICU, working in the COVID unit, these were very high acuity patients. We were often very limited with our nurse to patient ratios. You know, patients that should have been like a one to one, one nurse to one patients were like three to one, three patients to one nurse. And so it was it was very intense and it was a high level of responsibility. It was a high level of skill required to take care of those patients. So I gained a lot of experience and knowledge during that. I continued in the ICU, but I also started working part-time and nights with home health and hospice. And that really helped kind of round out my experience, right, on both ends of the life care spectrum. So on one end, I was dealing with trauma management, very critically ill patients, all ages of adults, so anywhere from 18 to 99. And then home health hospice, it was slower. But it helped me gain a lot of appreciation for the kind of those soft skills, the empathy needed to work with, you know, different patients and different medical conditions. But really, we're focusing on comfort and care, right? Empathy with family members, that sort of thing. So it really just helped round out my experience. And I love that.

SPEAKER_01:

As I understand it, you are also going into even higher education. You are getting your DNP at some point. I looked it up. So a DNP is a doctoral level degree. And I guess it differs from a PhD in that the DNP is more about clinical practice and leadership, whereas a PhD is more about research and academia. So is that a correct way to think about it?

UNKNOWN:

Yeah.

SPEAKER_00:

Yeah, that's correct. So I earned my master's in nursing leadership and administration. I just finished actually January of this year, and I started yesterday in my DNP program. So it's about a year-long process, but I'm working on becoming a doctor of nursing practice.

SPEAKER_01:

Awesome. When you had first been introduced to Alcor members, I had heard people kind of musing about with concern about the newness of the situation. A few people were kind of concerned that a nurse was the medical director at Alcor. There seemed to be misconception about qualifications of a nurse. Could you help dispel some of that? Because this is not small time stuff, you know, working at an ICU, pretty hardcore. I guess for those who just don't have good understanding of where a nurse fits into this.

SPEAKER_00:

Sure. Yeah. So, I mean, it's a common misconception is that, oh, you know, she's just a nurse or he's just a nurse. And I get it, right? So you think of medical care, you're going to be thinking of a doctor. But in reality, nurses are often the coordinators and the lead of interdisciplinary teams. And what that means is, you know, a nurse is in charge of not only the direct care of the patient, but also coordinating the doctors, all of the doctors, right? So if we're thinking ICU, you have a nephrologist, a cardiologist, a pulmonologist, a gastroenterologist. You have all of these teams that are taking care of this patient so that we have a holistic view, right? The nurse is responsible for coordinating those teams. You also have physical therapy, occupational therapy, respiratory therapy. And again, the nurse is in charge of coordinating all of these interdisciplinary teams. Um, especially in high acuity environments like the ICU, um, or even, you know, emergency departments, uh, medical flight crews, um, things like that. So the RN is typically the team leader. Um, unless there's a physician directly present, the, the nurse is the boss of that patient. Right. So, um, And there's specific things. Obviously, we need a doctor's order to do. But as long as we have those orders, especially if we have standing orders, the nurse is the leader of the group. We manage complex workflows. We ensure protocols are followed. We ensure ethical and legal standards are met. especially as a bachelor's level RN going into bedside, we're highly trained on things like evidence-based practice, patient-centered care. And these are all terms that any nurse is going to recognize, but really what it means is that ensuring that all of the patient's needs are being met. And that's the nurse's job. That's the nurse's job is to coordinate all of those things. When a doctor comes in, they're not looking at the whole picture if they're a cardiologist they're looking at the things that focus on the heart right um so the nurse has to make sure that all of the systems are flowing together so um and and even you know not just bedside nursing i do have some experience when i when i was in the icu when i was in the hospital um i was being trained as a team lead so I was working nights in the ICU and I was a stand-in charge nurse. So you have the nurse, the bedside nurse who's in charge of one to two patients. And then you have the charge nurse who's in charge of all of those nurses. So, you know, we're coordinating transports, labs, if patients need to go down for CT, things like that. We're assigning patients. the nurses to the patients that they're going to have for that shift. We're also coordinating the assignments for the oncoming shift, things like that. So, you know, it's not a small job to be a nurse. And this is ICU, but it's really on any floor and any nature of the job. When I was doing home health and hospice, we're known as nurse case managers because we are managing the entire case of the patient from start to finish. And that's essentially what I do here. I get to know my members usually, except for in the emergent situations where I'm notified kind of last minute. But we can get into that a little bit more later. But, you know, I build relationships with my members. I know their health histories. I know their last doctor's appointment. I know their last procedures. I know all of their recent lab values. And I'm able to coordinate that with Dr. Rovos, as well as any other teams that are involved in the matter, communicate that to the DART team, because all of these things can implicate their cryopreservation. If we know somebody's had a stroke in the past, that definitely changes maybe the techniques that we're going to use for car preservation. And so having an understanding of those basic kind of foundational coordinating efforts of things that it directly translates from being a bedside nurse, being a team lead nurse, being a hospice case manager into the MRD role. It's, it's helped me out a lot to be able to do this effectively.

SPEAKER_01:

Yeah. I, I, I love that. I want everybody to kind of understand that this is a role where you have to spin a lot of plates simultaneously. And this would make most people's heads spin, honestly.

SPEAKER_00:

Right.

SPEAKER_01:

Just as kind of an inside thing, you know, probably one out of every three times I interact with you, Shelby, you have to go somewhere for an emergency. And that kind of on-call life requires these special abilities, which to some extent you kind of are a custom fit for. And you're also very easy to get a hold of. A lot of members don't take advantage of this, but if you have questions or concerns when it comes to the medical side of things, you can reach out to Shelby directly. Over time, we're going to kind of try to push this to let members know that they can be more active. Quite frankly, we're encouraging them to be more active in letting you know when they have medical issues, when they're, you know, if they have something upcoming that they're concerned about to reach out to you.

SPEAKER_00:

Yes, for sure. I try to be as responsive as possible. Of course, I, you know, I call it my red phone. It's actually green, but it's my red phone. And, you know, it's my Alcor number. And when it rings, I answer. I don't care if it says spam likely. I don't care if it says unknown number. If that phone rings, I answer. If I get a text message, I respond right away. I have my email open 24 seven. And so I try to be available as much as possible to our membership. And And luckily, right now, I'm able to do that pretty, pretty effectively. But as membership grows, it's going to be even more important that members take the initiative to reach out to me. I try to I've tried to put in standards and protocols and procedures that help me try to get to know my membership and, you you know, like the health survey where we're trying to get responses so that we can kind of get at least a baseline of where our members, you know, health status is or their readiness status. But as membership grows, it's going to be important. It is important, but it's going to be even more important to, as a member of Alcor, take the initiative to reach out to me. Let me know if you have an upcoming procedure. Let me know if you have any diagnoses that are, you know, important to either, you know, your lifespan or the effectiveness of your car preservation, or even if you're unsure, um, just please reach out. Um, I have my email, uh, which is just shelby.calkins at alcor.org. We also have medical at alcor.org, which goes to me and a couple other team members and our phone number, my direct phone number. Um, I'm available anytime.

SPEAKER_01:

Great. And I will, I will link to the, uh, survey, the readiness survey in the show notes as well. So people want to take that and you should. So moving on a little bit, I want to talk about the DART team and some of the skill sets you're looking for there. I guess starting with the non-medical skill sets.

SPEAKER_00:

So I wouldn't necessarily say that military would be considered non-medical. And I know technically it is, but the specific level of military experience that we're looking for are special forces medics. So we do require some form of medical background as far as the people we handpick for our DART team. And we prefer paramedic or higher. And that's for those reasons that we've already talked about. This is a very complex and logistical heavy job. And that type of training just already has that background, right? Of being able, that mindset that kind of grained into them, ingrained, I should say, into them with their previous training. So paramedics, nurses, nurses, We do have firefighters, but they usually are paramedics. And then the military veterans are those special forces medics. But there are non-medical skills that are required, right? So we talked about it earlier. It's those soft skills, right? Being able to kind of manage people. And that's not necessarily a skill people would think is important to this, but you do. You have to be able to manage people. You have to be able to be a people person. Think of if somebody were to just come to your house and say, hey, I have this contract that says I get to take that person when they die. and I'm gonna come stand by his bed until he is legally declared deceased, that's probably not gonna go over well, especially if they've never even heard of you. So things like walking into a medical facility, your posture plays a part, your appearance plays a part, your attitude plays a part. And that's why we look for nurses, firefighter, paramedics, military veterans. They have a stature and just kind of already the behavior and attitude that we're looking for to be able to handle not just the complex, medical heavy, critical situations, but also the other side of it, those soft skills of people managing. And I'm not sure if that's a good term, but I'm hoping people are taking it well. You know, we need to be able to manage end to end. So that's what we look for when we're looking for DART members.

SPEAKER_01:

And so there's those soft skills, I guess, with the military and I'm kind of curious the tactical skills, the traditional things someone might associate with military. I guess it's not obvious how those would translate into deployment scenarios for cryonics.

SPEAKER_00:

Sure. Yeah, I guess people don't always realize, but cryonics deployment can feel a lot like a military tactical operation. They're urgent, they're complex, they're logistically demanding, and oftentimes emotionally charged. Many of our team members have that elite military background, including our special operations medics who are used to working in the high stress environments with limited resources. I mean, we're talking about specialized trauma care, field logistics, mission critical decision making. All of that is directly relatable to what we do with cryonics deployment. It's the ability to get up and go now on rapid fire, right? Mm-hmm. we need that kind of mindset. We don't need people who have to sit there and think about things for a long time or who have to sit and research something for a long time. And yes, all of these people are required in cryonics, right? Because we have our researchers, we have our scientists, we have those people working on developing our protocols. But when it comes to actually applying them in operations, I need the rapid fire goal getters. And that's where that tactical experience comes in.

SPEAKER_01:

To your understanding, just for context, because when I first heard about this, I didn't really know the differences between standard military training and something like these special forces training. I guess, how big of a difference is there? From what I understand, this is not like a little bit of additional training. These are like the best of the best in the world.

SPEAKER_00:

So we do particularly pick out special forces and most special forces will have the TCCC. It's a tactical combat medic training. And so this is specifically for trauma management training. in a tactical situation, people getting shot at, right? So it's that rapid, just stabilizing and getting them out of there. So it's like, it's basic life support, but for tactical teams. So that includes, you know, wrapping a bullet wound, things like that. As far as special forces go, they have a program called the 18 Delta, which is a special operations training that not only is the tactical combat medical training but also translates into the civilian side so um they're not just available to go out and go on these special operations and deal with um you know those critical situations in the field but they actually go through it's like I believe it's a year-long process, and they actually do an extensive residency following a physician. So they can do things in the field and in the hospital, and this is all military-based, right, like cannulation, femoral cutdowns for cannulation for rapid infusion of medications during an emergency. So they have– an extensive, even in some instances, higher than what a nurse can do, especially in the civilian world. They have all of this extensive training, advanced medical interventions, crisis management, but it also translates into the civilian side.

SPEAKER_01:

Yeah. And that's important to know because, you know, I guess one of the themes of this podcast is it's not just about pure medical training. It's about the confluence of skills. From what I remember, especially for the Navy SEALs, a pretty large percentage of them, people who apply and train for that, either don't make it or drop out because of how grueling it is. Yes. it might not be one for one with how someone is thinking about chronic SST in their mind, but I mean, remember you have a short amount of time to accomplish something. Literally every minute that goes by without proper care is more damage to your brain. So all these skills, you know, together actually do make a difference on top of, you know, the medical training.

SPEAKER_00:

Yes. That, you know, it reminds me of a saying that, know our special forces say all the time it failure isn't an option it's a no-fail mission so when they go on deployment um and they're you know going out and doing these things every minute every decision counts they're trained to succeed in an environment where failure is not an option right so no matter what happens no matter what obstacle or roadblock gets in their way they're going to succeed in giving our members the highest quality preservation possible. And that's the mentality we need on DART. That's the mentality we have on DART. And that's our standard.

SPEAKER_01:

There was another aspect that I guess surprised me a little bit, but I thought it was interesting. You had mentioned to me a while back about chain of command and how it's kind of more important than you would think for a situation like that. Could you elaborate on what you meant by that?

SPEAKER_00:

Yeah, so... Like in time critical cases, you can't have too many people trying to make decisions at once, right? It's like too many chefs in the kitchen. And having a clear and structured chain of command ensures that there's a clear structure of roles, that that structure is respected, and it just makes things get done efficiently. It eliminates confusion, especially when you have diverse backgrounds working together, you know, we have medical, military, technical people on our team, making sure that we have a clear understanding of chain of command, having one person responsible for the coordination of all these efforts, while everyone else executes within their specialty, right? It prevents chaos, it improves patient outcomes, and it just makes things run more much more smoothly and efficiently.

SPEAKER_01:

I'd like to pivot a little bit back towards training. You had mentioned a little bit about that before, but I'd like to get into more detail with that. Could you describe the steps for the initial training curriculum for DART team members?

SPEAKER_00:

Yeah, absolutely. We do... know we handpick our applicants um and we value a combination of former medical certifications and practical emergency experience so this includes like you know we've said it over and over registered nurses paramedics um and then military veterans um so once they meet those qualifications they're invited to training now one of my First things, when I'm emailing or calling someone and letting them know that they're invited for training, I let them know right off the bat that this is part of the interview process. So they're not even hired before they come to training. We provide the training as part of the interview process. So how they interact with other team members, how quickly they pick up on skills and processes. and how well they present themselves in not just the office setting or the classroom setting, but the simulation setting for real world experiences. We do simulation and demos. So all of this is part of us making very well informed decisions on who we're gonna have on our team. But once they're invited to training, there is about 20 hours of online education that they have to complete And I created this training with, you know, in coordination with Dr. Wobos, of course, who read through and approved everything. But I really mimicked it after my background and knowledge as far as the types of training that I went through and the types of training that I think works well for the people of this mindset. And I how that is, is, you know, you, you provide the knowledge and the information and that's the online portion. So it goes through history of Alcor, um, the history of our processes, the importance of our processes, and, um, it goes through all of the procedures that take place during SST all the way through surgery and cryo-perfusion all the way down to long-term care, uh, long-term storage, I should say. So it's kind of like a end to end intro, uh, like to what we do and what they're going to be doing. And then once they are completed with that online training, they get invited to the in-person training. The in-person training for initial certification with DART is five days long. And it includes an overview of everything they learned online, as well as, like I said, simulations, demos. We do hands-on work. We do real-world scenarios, case studies. And then we do a cadaver lab with Dr. Wobos, where he teaches the surgical skills required. We assess everybody. on their ability to independently do the entire procedure start to finish. And then we go over all of the perfusion steps, heavily focused on neuro field cryoprotection. And that's something that DART is capable of handling in the field from start to finish for neuros only. And I don't know, I don't think we talked about this much, but I don't know if you have questions about this later on in the podcast, but as of right now, we are only able to do start to finish perfusion in the field for neuro members. And that is due to a lot of different logistical factors, but mainly because of the time constraints that it takes to get a whole body to back to Alcor and the time after you start or after you complete the perfusion. So it's something we're working on. It's definitely something that we're very, very close to, but But yeah, we heavily focus training on the neuro preservation, but we also do introduce the whole body procedure as well as the whole body field washout that does occur in the field before they're transported back to Alcor. And that is, you know, we still contract with suspended animation to complete those cases. And so we want to make sure that our DART team is introduced to um you know the team that they're going to be working with because we do deploy usually one to two dart members on essay cases just so they they can get the experience and help out essay where needed um but after after that week is complete on the very last day they have to do a um demo skills check off which is going through an entire deployment start to finish um verbally just to ensure that they know all of the steps and they know all of the steps in order and then they actually have a written examination and it's 50 questions of of very complex um you know processes that they have to know by the end of training um and they're tested on it so um Once we confirm that they are competent to perform the skills and have the knowledge required for these processes, then they are officially certified as a deployment and recovery team member, and then they are hired, or they are offered employment, I should say. After that, it is required to do field training as well. So we're not done yet. They have to go on at least three cases where they are observing only. They can be hands-on in some aspects of it, but obviously we don't throw them right into performing their surgery all on their own or being the lead on that. So Um, you know, they have to observe a certain amount of cases and once I'm comfortable and once they're comfortable. So it is kind of like a feedback loop, uh, after, you know, getting at least three cases and I'll sit down with them, you know, Hey, are you comfortable with these procedures? If I'm comfortable with them performing the procedures, then, um, they're officially a full active dart team member. Yeah. It's, it's very extensive. Um, the whole process, depending on caseload, you know, it takes time, but we want to make sure that I guess personally, I'll speak, I'll speak for myself when I say this, but I think that, you know, most of our leadership here at Alcor will agree, but I want to ensure that the people I'm sending out are fully confident in performing the skills required and the procedures required for this. But I want to be confident. and who I'm sending out. Because if it were my mother, my grandmother, myself, needing these processes completed, then I want the best of the best, right? And so I'm not sending anybody out in the field to perform these procedures that I am not fully confident in. If

SPEAKER_01:

you're listening in this kind of portion of the training, particularly interest you on the podcast episode previous to this, I actually sat down with Jeremy Wiggins, team lead for the Alcor Canada dart team. And we did talk about his kind of early training and even before he went on cases alone, him just observing. So if you find getting into the weeds on that specifically, go back an episode and listen to my conversation with Jeremy. It's quite interesting. You'll have some more context now from this conversation as well. So it should be even more interesting. So after the initial training, is there, I guess, continued education going forward aside from, you know, obviously there's continued education from going on actual cases, but is there more formal continued education, recertification, anything like that on a regular basis?

SPEAKER_00:

Yeah, absolutely. So because we consider this a certification of skills and knowledge, it does require recertification annually. So And it's kind of– it's a little bit fluid because if they have a certain number of cases, right, they don't have to go through like a refresher course or anything like that because they've done the work, right? But if maybe they haven't gone on a certain number of cases in– in that timeframe. Um, we do a refresher course and, um, I will say because, you know, Dart is in its inception phase really still. I mean, it, we just started this, um, not that long ago. I did, I have done, I have required refresher courses for every single one of my Dart members, um, from the beginning. So, um, it's an annual recertification. They go, we go through just a one day refresher. It is virtual. And then anytime we have training, so like if we're hiring new dart members I, I mandate the old, I have mandated the already active dart members to come join training and they have to go through it as well. So I mean, they don't have to be necessarily tested on it for like certification purposes, but Most of them have taken the test just to test their skills and knowledge. And I think it's been fantastic so far seeing the improvements from initial training to getting the experience and then coming in for training when we have new hires. And most of them are able to jump in and help teach and guide people through it. But we do require recertification at least annually.

SPEAKER_01:

Beep boop. Okay. Coming to you from the future. This is the end of the first half of this podcast. Our conversation was almost three hours. So this current episode will be cut into two. The next episode will be the part two. We get into transferring institutional knowledge. how Shelby builds the different Dart teams for specific cases, her current operational procedures, the challenges and limitations of Dart, quality control, Shelby addresses misconceptions, and then she jumps into the future development of Dart and where this is all going. So I hope you enjoyed this half of the episode and stay tuned for the next one. Until then.