The Alcor Podcast

Deployment and Recovery: Inside Alcor's DART Team - Part 2

• Alcor Life Extension Foundation • Episode 5

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This is Part 2 of our DART series with Alcor's Medical Response Director, Shelby Calkins. If you haven't listened to Part 1, you should --> listen to it here <--  before continuing.

Episode Overview 

In this essential continuation of our DART series, Alcor's Medical Response Director Shelby Calkins dives deep into the operational realities of the Deployment and Recovery Team. This second part explores how DART executes their critical no-fail mission, from team composition and strategic positioning to equipment deployment and regulatory navigation. Discover the dramatic growth in case volume, the meticulous planning behind each deployment, and the vital role members play in ensuring optimal cryopreservation outcomes.

Key Topics Discussed

  • DART's successful transition from contractor model to in-house operations
  • Strategic team positioning and recruitment priorities
  • Dramatic increase in case volume from 5-7 to 23-24 annual cases
  • Comprehensive equipment deployment 
  • Emergency notification protocols and member communication best practices
  • Regulatory challenges and compliance across different states
  • Post-case debrief processes for continuous improvement
  • Essential member preparedness recommendations and health monitoring


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SPEAKER_00:

Welcome back to part two of my conversation with Shelby Calkins, Alcor's Medical Response Director. Before we dive in, I highly suggest you go back and listen to part one, if you haven't already. This conversation we're gonna have on this episode really builds upon everything we covered in part one, and you'll definitely want that context. So again, if you haven't listened to part one of this episode, I suggest you stop this recording go to the show notes where I'll have a link and listen to the first half of this conversation before this one. So if you're sticking around, just to catch you up very quickly, in the first half, Shelby and I got deep into the weeds on Alcor's DART team. So that's the deployment and recovery team responsible for standby, stabilization, and transport for when members are approaching legal death. We talked about why SST is so critical for good crowd preservation, how Alcor evolved from using external contractors to building their own in-house team, and what that transition looked like when Shelby first came on board. We also explored the skill sets they're looking for in DART members. Turns out it's not just medical training, but a combination of a lot of things, including medical expertise, elite military backgrounds, tactical thinking, and a lot of important soft skills that you need when you're dealing with families and hospital staff. Shelby walked us through her own experience as a ICU nurse and how that nursing coordination experience kind of translated really well into being part of Alcor's complex deployments. And we also covered Alcor's extensive training program for DART members, which was really cool. So that's where we left off. Now, in the second half, we're going to dig even deeper into how Shelby actually builds and deploy these teams for specific cases, the operational challenges she faces, quality control measures, and where the DART program is headed in the future, and much more. So let's jump right back in. When James had first announced this gradual and continuing shift towards the in-house Dart model, I did talk to multiple people who had concerns about how the institutional knowledge would transfer from the previous operators to the newer system and the newer people. Talked to you about it previously, and you weren't particularly as concerned as I imagined you would be about it. But I guess, could you just quickly underscore why you weren't that concerned with that?

SPEAKER_01:

I wouldn't say that I am not concerned about it. I guess I'm just confident in my skills and knowledge that I have. And I'm confident in the training that I received. You know, it's an important question. I understand it. And You know, when you transition from a longstanding contractor model to an in-house team, or you're changing something as drastically as what we did, there's always that concern, right? And I mean, I guess the short answer is that almost nothing was lost. In fact, I guess what's made this transition so successful is that most of the critical knowledge was intentionally and carefully passed on. So one of the first things that I want to mention is, especially in my role, particularly in my role, I don't require a lot of... historical institutional knowledge in order to get the job done. There's a lot of overlapping medical knowledge. There's a lot of overlapping medical application. And so much of the work that we do, it involves core medical skills that are familiar to any well-trained clinician. So a lot of the procedures were easily transferable or very simply trainable, especially because There's such a clear step-by-step of protocols. We have very standardized equipment. And then overlapping competencies just added onto that. I guess it just wasn't very hard to train on the actual procedures and the actual protocol of it. Now, I also did get a hands-on mentorship with Dr. Wolvos. He's our chief medical advisor. He's been here for years. He has... expertise in the field that I don't think any other clinician has. And so I was directly trained by him. And when it came to perfusion, I was trained directly by, you know, Steve and Jacob, who they're the ones that helped develop the current perfusion systems that we use. And so, yes, we're an old, you know, a decades old institution, but most of the people that I mean, like you said, the person who started the organization is still with us. And then most of the people who have helped develop the processes that we use are still here as well. So it was easily accessible knowledge. And it kind of ensured that nothing got lost in translation when it came to the knowledge transfer, because it came straight from the source, right? You know, I sat down with Linda when I first started and we went over a 20 chapter SST training. booklet that had been developed and I reviewed it with Sarah. Sarah and I, we were kind of partners in crime when I first started here, because like I said, we, we kind of stood in when contractors weren't available or when they needed an extra hand. And so we deployed a lot together. Sarah is a wealth of institutional knowledge for Alcor and mentioned Steven Jacob. Again, they're both, you know, been with Alcor for a long time. They've been instrumental in the development of processes and systems. They helped with my training as well. Hugh and Mike, they're obviously, you know, they've been here from the beginning and obviously a wealth of knowledge. And I mean, both geniuses in their fields.

SPEAKER_00:

Mike is an encyclopedia, human encyclopedia of cryonics knowledge.

SPEAKER_01:

Yeah. I sat down with both of them on multiple occasions just to learn and obtain that knowledge. So like I said, it wasn't... And this... I mean, just me personally, I won't do a job that I don't know how to do. So I don't say lightly that I'm confident in being able to do my job because I can. And I wouldn't say it if it weren't true. So the oncoming... employees that we hire whether it's dart or otherwise they receive the same training and knowledge transfer and we very much ensure that our our team is equipped and fully prepared and confident to do the job that needs to get done

SPEAKER_00:

great thank you i hope that puts anybody who had those kinds of concerns mind mind at ease one other aspect of knowledge transfer a little bit a little bit of a pet project that you're want to work on long-term is also some type of mentorship program.

SPEAKER_01:

Yeah, I actually, I, when I was doing my master's, I did my project on this, on mentorship and the importance of it. So I've actually, I've started to kind of implement this with dart and it's one of the reasons why I bring active dart to new higher dart trainings is because I think it's important to not only form professional bonds between senior and newer team members, both formally and informally. I'm working on the formal aspect of it, but informally, it's kind of been implemented already throughout our programs. But as we grow, I want it to be a formal mentorship program to ensure that that knowledge is getting transferred appropriately but also um not not really the knowledge but the the processes the people the um being able to like i said people manage um situational knowledge that situational knowledge so um it it's really something to help develop confidence in high stress scenarios right It reinforces values, professionalism, all the things that are expected on a deployment and the high standards that we hold here at Alcor. I'd

SPEAKER_00:

like to move on to some more about how you build different Dart teams. So I guess for starters, how many Dart team members are there total?

SPEAKER_01:

So right now, based in the US for... For Alcor US, we have nine DART members. And they are either here local in the Phoenix metro area, Arizona, or stationed in strategic places around the continental US. We also have the three Alcor Canada DART team members and a few other contracted DART members. So in total, it's 15. We have a team of 15 and we're growing. We have an upcoming training this month. So we're hopefully adding at least two to three team members to the mix.

SPEAKER_00:

And I guess right now, where are you looking to add those new team members? Like what kind of geographical location are you recruiting from?

SPEAKER_01:

So our recruitment focused on finding team members in Florida area as well as near Texas. or around Northern California. We have SA kind of covering the Southern California area. And so we wanted to focus on finding someone kind of in the Bay Area, San Francisco, Silicon Valley area. So we focused on that area. And then, like I mentioned, Florida as well. So we want to focus on making sure that our largest member population areas are covered with drivable distance of a DART member.

SPEAKER_00:

And in terms of total numbers of cases, I guess collectively, I don't know if you have this number on hand or if you could quickly give a rough estimate, but how many cases would you estimate the kind of overall DART team has been a part of since inception?

SPEAKER_01:

I think the number's around 50. We have... had a very high caseload over the last few years compared to kind of historically what we've seen here at Alcor. And so, I mean, being in the 20s for caseload per year for the last two and a half, three years, I can't give you an exact number. No, but I would assume that it's in the 50s. I know that our most senior DART member has been on at least 30 plus cases. So... It's a pretty high caseload that they've been kind of thrown into for starting out on this. But I think it's been good because this is kind of the environment where these types of people thrive and the rapid fire critical situations. And so it's been great for them to get that experience kind of in their back pocket right off the bat.

SPEAKER_00:

So 24 cases a year. How does that compare to, I guess, an average 10 years ago or something along those lines, if you had to guess?

SPEAKER_01:

Yeah, I think for, you know, at least 10 years prior to me starting, which again was like 2022, the average was like five to seven cases a year. My first full year or I guess in 2022, we ended with a total of 15 cases for that year. And then my first full year, we had 23 cases. And so it was, it was a pretty significant jump. And, and then again, for 2024, we had 24 cases. So it's, it's been a jump and it doesn't seem like it's going to be slowing down anytime soon.

SPEAKER_00:

So I'm like extrapolating your, into the future with those caseloads very quickly due to the age range of Alcor's membership base. It seems like the experience level for the Dart team is going to kind of quickly surpass, you know, if it hasn't already, pretty much anybody out there. I guess something to keep in mind just as an organization, a strategic advantage that kind of can't be taken away easily. So you have these kind of 15 people, but for any given case, you have all these different smaller considerations on top of, you know, geography, and you have a choice of how you mix and match these teams. Could you talk a little bit about the considerations that you're evaluating when you're mixing and matching a specific team for a specific case?

SPEAKER_01:

Yeah. So, I mean, one of the first things I look at is geography, right? So where's the member that needs a standby and where's my team? But considerations definitely far exceed that. I am looking at their skill sets, you know, what their background is, whether they're nurse or military or medic. I'm also looking at experience levels. So, yeah. just because they're the closest to the member doesn't mean I'm going to automatically send them. It's the difference between sending three people just hired last month or a mix of maybe sending the person who's just trained with one of the more experienced start members as well as kind of like a middle experience level. That way we have a good mix while also considering that the newer hires need that experience as well. I look at, you know, it's not something I like to say I have to consider, but I have to consider it, but patient demographics. You know, if we're looking at a patient who far exceeds the capacity of two team members to be able to lift them, then I need to make sure that I'm sending enough team members to safely and efficiently lift do patient transfers, if that makes sense. I'm trying to diplomatically state this.

SPEAKER_00:

Are there other factors for weight that can make it harder to do, I guess, cannulation or affects blood vessels and potential perfusion? Because I think that's something that people need to know. I don't know if it'll be motivating, but as I understand it, you do want to try not to be too overweight just from a mechanical sense with perfusion.

SPEAKER_01:

Yeah, I wouldn't even necessarily say that it particularly makes it an issue. But you might be more, like you said, motivated or inclined to maybe just go get your carotids ultrasounded. Make sure that everything's patent. Make sure that you have or open. Make sure that there's no... you know, clots or anything like that. And that's a recommendation for all of our members. If I could have a prodded ultrasound on every single member we're about to cannulate, that would be absolutely fantastic. But I wouldn't say for the abilities of DART to perfuse. I mean, some of our cases that have dealt with, you know, a larger member have actually been the best cryopreservation, or even some of the largest vessels that I've seen. So it does affect those things. So it's definitely good to consider it, but it doesn't necessarily mean that you're going to have a poor cryopreservation or anything like that. So there are considerations when talking about long-term storage, though, however, for um, for the size, because the opening of the doer is, um, you know, we can't expect it, we can't expand it. So, um, but we have, we also have, uh, different techniques and tactics that we use to mitigate against that as well. So.

SPEAKER_00:

Okay. Well then, then, uh, I take it back. I may have overstated, uh, this problem, uh, from, from, from hearsay. which is why it's important to talk to people like you and actually get an understanding of this. Okay, so you have kind of all these different kind of bigger, smaller considerations that you're looking at when you're putting together teams, relatability to a case or ego, or you get really granular actually with how you're thinking about these things.

SPEAKER_01:

Oh, absolutely. Team dynamics is one of the things I look at and it includes... And I don't... This isn't a bad thing, but things like ego, communication style, relatability. It's... If we're going to a hospital that maybe I know we have had issues accessing a member in the past, I'm not... I'm probably not going to send... three Navy SEALs who are big, muscular, probably tattooed men. And that's not to say that they couldn't get the job done. Like I said, no-fail mission. And I think we all wear a different hat, right? I'm speaking to you now a lot differently than I'm going to speak to my kids or my husband or maybe some other professional. But... But team dynamics go a long way. So if I'm... And I have a specific case in mind, but if I'm going to a hospital where I know we've had issues in the past, like we've been barred and told not to come back or we would be trespassed, I'm probably more likely going to send one of my nurses. And that just... It goes to show the... kind of the strategic positives of having this very large demographic of Dart team members, right? We have the ability to customize our teams very precisely to meet every single situation that we have run into in the past or could run into in the future. So we have this diverse set of backgrounds and expertise and Right. Right. Now, all of these skills, all of the skills and knowledge is trainable, right? I could train anybody on the roles and structures of a hospital. But why do that when I can just have a nurse on the team who already knows it?

SPEAKER_00:

Yeah, I think that really reiterates the soft skill importance, because it doesn't matter if you have all the medical training in the world and you're the best at X, Y, Z. If for whatever reason you kind of rub one of the hospital administrators the wrong way, And they just put a roadblock in your way to getting the patient or, I mean, you're screwed.

SPEAKER_01:

Yeah, and they have every right to do so, right? Hospital employees are covered by many different legal frameworks that protect them from harassment, abuse. And if they deem that you are harassing them or abusing their time or their place of work, You're out. You're not coming back. It doesn't matter what contract you have. They'll call you when the patient passes. That's it.

SPEAKER_00:

Yeah. Us as chronicists, we understand what the goal is here. We understand that it's the patient's wishes. We understand what we're trying to do. We understand the mission. It's important to us. But to these people who are working at the hospital, they don't understand cryonics.

SPEAKER_01:

Yeah, absolutely. And I think this goes back to... I think I mentioned it earlier in this conversation. My training as a nurse included what's called patient-centered care. And what that does is it brings the focus of what you're doing back to the main goal, which in nursing and bedside nursing, it's obviously the care and the comfort of the patient and what the patient wants out of their care, right? So as clinicians, often we look as a... at a situation and we see a problem, we want to fix it, right? But there's so many more considerations that have to be taken because there's cultural backgrounds that differ from yours. There's financial backgrounds, social backgrounds, religious backgrounds that are going to differ from the way that maybe you want to solve this problem. And so when you look at it in a holistic kind of mindset rather than, hi, you know, I could walk into a hospital and say, you know, I'm the medical response director of Alcor and we have these contracts. You have to let me in. That's not going to go over as well as, you know, hey, you know, my name is Shelby. I'm here with this organization. We've been requested by this person to follow their care in order to give them the best cryopreservation possible, which happens at such and such time, and explain your processes. And they're going to be a lot more open to kind of letting you in, right? It's not just with the members themselves, but with their families, with the facility, with the funeral homes, with anyone that you interact with, right? I mean, also the members themselves, right? So when I'm speaking to a member, I ask them what they want from me as my role as the medical response director. What can I do in order to make your experience with Alcor better? Obviously, most people's answer is going to be, well, give me the best car preservation. But that's the starting point of building a rapport with the people you're around. And it's from everybody you interact with on the entire case from start to finish.

SPEAKER_00:

You know, I was originally thinking of it mostly from the perspective of hospitals and hospices and medical personnel. I can imagine it being maybe even more difficult in some circumstances with just family members I mean, especially if the family members don't fully understand the chronic procedures, especially if it's a neuro, I think some family members, I imagine that's hard to explain to them. I'm curious how, I guess, how you deal with those conversations.

SPEAKER_01:

Yeah, it's nice that you mentioned that. It is difficult, but it's something that comes inherent, I think, to at least nurses on our team. But also, we have... our paramedics, uh, paramedic firefighters who, you know, they deal with the same situations. Uh, someone who's died in a car accident, um, some, somebody who's been injured or hurt very badly in a fire. Um, you know, they deal with the very emergent aspect of those. And then, and then with nurses, you know, especially in the ICU, it's, it's that very fresh point of kind of the, the, injury or the emergency that has occurred and so you gain a lot of experience speaking with with family members and and loved ones um explaining what's happened um while also being empathetic and and considerate of how you're saying things right so um i'm not gonna speak in medical lingo and it It transfers directly to cryonics with I'm not going to come in and speak to a family member the same way I would maybe speak to Sarah about things when talking about the procedures or the processes. You have to be open to communication. You have to meet them where they are. You have to be good at finding out what they do know so that you can have a starting point of the conversation, right? And you have to be able to put it in terms that they understand. So while also considering the emotional state that they're going through. So it is complex. It's not something that you can just teach right off the bat. It is definitely something that's teachable, especially the more experienced you get with it. It just kind of becomes second nature.

SPEAKER_00:

Now, rounding off our... our discussion of building these Dart teams. You've mentioned both the non-field training, the field training. Obviously, both are valuable in their own ways and necessary in their own ways. My intuition tells me that the actual on-case training is really what distinguishes a team member. Does that ring true in your more practical experience?

SPEAKER_01:

Oh, absolutely. So, you know, definitely both matter. Obviously, you can't throw someone in the ring and expect them to do the protocol and the process as well, right? You have to be able to teach them. But field experience, it's irreplaceable. I can't, as much as I try and as pretty good at it as I am, you can't fully mimic what's going to happen in the field in a classroom setting, right? So I teach protocols, I run drills and simulations, but real cases teach you how to manage time when every second counts, how to navigate complex environments from hospice to ICU to it being the middle of the night, right? So how to adapt when things don't go according to plan. And so I really like the saying, Um, I, my, my father taught me this growing up and I come from a rodeo background and, um, he was teaching me how to rope and I, I wasn't swinging the rope, right. And he would come and correct me. And I remember looking up at him and saying, dad, why does it matter? I'm swinging it. And he said, practice doesn't make perfect, perfect practice makes perfect. Um, so. Experience tempers people. It builds confidence. It sharpens judgment. It teaches how to be calm under stressful situations. And that's something that can't be taught in the classroom. But what I teach them is a foundation to be able to perfectly practice in the field. I ingrain it and I work with different theories and models in my teaching structure that... It's very repetitive. It becomes muscle memory and kind of second nature to them. That way, when they get into the field and they're kind of being tested on time management, navigating these complex environments, right? Everything else is second nature to them. They don't have to go and look at a handbook to see what the protocol is. They know it. My team knows it. And I can confidently say that. So... Yeah, I think both are very important, but there's concepts of both, or I guess parts of both that are irreplaceable with the other. And

SPEAKER_00:

that is profound, but I can't, you just mentioned the background with Rodeo. And I can't not bring that up. It's too interesting. I promise I'll keep it brief and then we'll move on. There's still a lot more to talk about. I'm just very curious.

SPEAKER_01:

No worries. I don't mind. I'm very proud of my family's history. I come from a small town in Arizona and born and raised here. My father was born and raised here. My grandparents were born and raised here. And I promise this is going to be brief, but my great-grandparents were actually cattle ranchers up in northern Arizona. And just from there, those customs stayed in the family. My grandfather and father are both... you know, nationally recognized world champion, uh, rodeo Cowboys. Um, my uncle is a world champion professional bull rider. Um, both my uncle and my father were two of the founding members of the professional bull riders association. Um, so just a very strong family history in the rodeo world. And I, I attribute a lot of my skills and behavior and, um, capabilities and a lot of my confidence to that background i mean when you're three years old and you can hop on a horse bareback and go running through the desert you're pretty confident you can do anything in the world so yes i i can i don't much anymore but i do rope and ride horses and um and

SPEAKER_00:

so you're a real life cowgirl essentially

SPEAKER_01:

me Yes, not a professional one anymore, but yes, I shouldn't say anymore. I was never like a professional cowgirl, but I did compete in rodeo in middle school and high school.

SPEAKER_00:

Wow. Now I'm just one day somehow in some cryonics case, there'll be some weird confluence of events that will happen. We can't news about what they would be. but there will be some very strange, weird confluence events and somehow that skill will come in necessary. That would make an interesting short story. Okay, thank you for elaborating there. Moving on, the current operational procedures. So I remember thinking like a lot of people are hesitant to call emergency services in times of need. It's like because they've never done it or they don't do it often, like even when it's very much called for, they tend to like hesitate just because it's new and they don't know what to expect. So I thought it would be somewhat interesting just to give people, give Alcor members, you know, and I've seen this happen before amongst Alcor members. People have told me their stories, like this is not actually new. just theory, but people who, you know, should have called the chronic service provider in an emergency or didn't or just skipped their mind or their family members didn't. This does happen because in an emergency situation, you are not thinking clearly most of the time. Right. So I kind of want to give listeners just an understanding of what to expect when they call the Alcor emergency number. Sure. So I guess, who picks up the phone? When you call that number, who is picking up the phone? And let's just walk them through what happened from the time they call. Who's answering it? Who is it getting transferred to? How does that all work?

SPEAKER_01:

Sure. So when you call Alcor's emergency line, it is a third-party answering service. And so you... call, it gives you the option of deciding right then and there if it's an emergency call or just like a standard call. Because there is the option for both when you call the 800 number. And so if it's a standard call, it'll allow you to leave a message, a voicemail for Alcor and it sends an email to our admin staff. But if you... choose the emergency call, it immediately notifies. Usually before you're even off the phone with the answering service, I'm receiving what we call a telemed. And it's just a very loud, obnoxious alarm that goes off on my phone and gets your attention. And I receive a message with your information and I'm able to either call you back directly in that app or otherwise. So it's actually very handy because... which anybody is very much free to call me directly in case of an emergency. I'm not trying to put people off from doing this at all, but rather than receiving a call directly to me, and then I have to then take, you know, the 20, 30 seconds to a minute to send a message out to everyone else, that step is already skipped when you call the emergency line. And so just one thing off my plate. But

SPEAKER_00:

when you say that step is skipped, I mean, you're not there's multiple people being pinged when the emergency line is called.

SPEAKER_01:

Yes, correct. So our entire admin staff is added, people like Diane, who can confirm membership very rapidly, usually without even looking it up because she's so good. But very quickly, the entire team, the entire admin staff here at Alcor is on that notification. And so I can respond rapidly by calling and obtaining more medical information, Diane is confirming membership and then the rest of the team is just kind of at least informed in case they're needed at any point in the process.

SPEAKER_00:

And I guess what is considered an emergency and what's not considered an emergency and how careful should people be on airing on one of those or the other?

SPEAKER_01:

So My theory would be if you are thinking about it, just call. And so there's different situations. And I guess we can split it up into immediate or emergency notification and then a standard notification. So things that require you to call 911, that should automatically be a call to Alcor. If the member is hospitalized for any... Any serious medical condition, if the member is diagnosed with terminal illness or enters hospice care, member who's experiencing a sudden or severe decline in health, that would require a call to Alcor. And those things include... you know, emergency, like life-threatening medical events as well, especially, you know, cardiac arrest, sepsis, organ failure, stroke, respiratory failure, death. I mean, obviously, if death is imminent or expected, so if the member is in the hospital on life support, if the member is on hospice and has become maybe unresponsive, things like that. But here's the most important thing I want our members to take away. I don't need you to decide those things because I am highly trained and skilled in deciding when we need a standby. All I need you to do is call me and inform me of what's going on. And that is the most helpful thing that anybody in cryonics can do is just notify us and let us know. Even if it doesn't turn into a standby or deployment, I can at least know that something's happened and I can keep tabs. I can make a note of it. That way we have a little bit of a baseline or a history of the member and their health status. So like I said at the beginning of this, if you have to think about it, just call me. I hope people realize, especially after this podcast... I'm a pretty personable person, and I'm pretty responsive, especially to the membership here at Alcor. I'm not going to fault anyone for bothering me with something that's not an emergency. Every phone call, every notification, every health update, it's important to me. And I just, if there's one thing that our membership could take away from this entire podcast, it would be that. I would want it to be that. Call me, let me know. The worst thing a cryonicist can do is delay notification.

SPEAKER_00:

So yes, everybody, please take that advice. And I think we'll increase your odds of getting a good cryopreservation if you don't wait till the worst possible time. Because by the time it passes your threshold of like, oh, my God, this is definitely an emergency. You are now again, you are in the emergency and the odds that you will actually now be able to call and be able to give proper notice goes down. Right. So, yeah, don't wait until the last minute. I guess if we can. just expand a little bit on some other questions. I've gotten some questions from people about things like, should I reach out to Alcor if I'm getting anesthesia? Or recently someone asked about, should I reach out to Alcor if I'm taking a long international flight? What about situations like that? How do you parse those kinds of situations?

SPEAKER_01:

Short answer, absolutely yes. Notify us. You can email info at Alcor.org or medical at Alcor.org. Both of them notify me. If you are traveling, especially for any amount of time, I'd say longer than a few days, please let me know. If something happens, if you think about a situation where maybe you're walking down the street and you suddenly collapse and a bystander comes, sees your bracelet, your Alcor necklace, calls us, and this is the first I'm hearing that you're in Italy rather than Massachusetts. So it definitely just helps us be prepared. So if you're traveling, if you are having any sort of procedure done, I mean, I've had members reach out to me to say, they're having pretty standard or routine, even lab tests done. I'm okay with that. I would rather you notify me about something that's not necessarily an emergency or a risky situation than the opposite. General anesthesia in and of itself puts you at risk of of passing just because of the complications that can occur just by getting the medication, let alone if you're having a procedure done that's requiring anesthesia, that is probably a pretty invasive procedure. So yes, if you are undergoing any sort of procedure requiring general anesthesia or even something that's called twilight anesthesia, please just call us and let us know. You can also email those emails I mentioned. You know, we do have standard forms to fill out for a procedure. So if you're having surgery and you email us, we'll probably just send you that form back. But I know that many members have mentioned, well, it'd be nice if that was just on the website so I could fill it out and it just sends you the response. We are working on it. But general information that we would need to know is just the type of procedure being done, where the procedure is being done, when the procedure is being done, and the facility and doctor's information as well. Usually, the people that reach out to me who are having any sort of procedures, I have a form that introduces Alcor, what we do, who we are. and the necessary steps to take in case of an emergency. And it's a one-page sheet that you can just print off and hand to your doctor before going into your procedure. That way they know to call us immediately if anything happens.

SPEAKER_00:

So this is just, hey, Shelby, FYI, I'm going to be getting this procedure. Here's the information. And then if you need to follow up, I presume you're going to follow up with them if anything needs to happen. If you need to send anything or ask any follow-up questions.

SPEAKER_01:

Yes, absolutely. And what I usually do is if they tell me that the procedure starts at two and should take two hours, if, you know, they should be done by four, then by five, if I haven't heard from them or their loved one, um, I'll usually just send, uh, uh, you know, call them, make sure everything's okay. Um, or whatever form of communication they've, they've set up, we've set up beforehand. So, um, it's definitely, it's a good checks and balance. Um, it's, it's just very helpful. It's, it's, you know, if you're not sure, just call or email, let me know. And I can let you know, Hey, you know, procedures, not that risky, but I'll check in. I usually check in anyway, no matter what it is. So

SPEAKER_00:

someone had mentioned to me, which I brought it up, but I thought they were, I guess I thought it was a misconception on their part, but had mentioned about flying. So, I mean, people fly a lot that why, why is just knowing that someone is going, you know, I mean, I would imagine if they're going to a place that is a risky place to be, that would be important, but I'm curious why just knowing they're, you know, taking a vacation to Europe is, is useful to you.

SPEAKER_01:

Well, there's a lot that goes into that question, but, um, The main thing is ensuring that if I need to get to you quickly, I can. There's a lot of different, especially different countries. There's different travel guidelines for me to be able to bring kids to, which we're working on that. But there's just logistical, I guess not obstacles, but just considerations that... If I know in advance, I can mitigate those well ahead of time. If somebody... I mean, we have a member, just specifically one coming to mind, who lives in a different country half of their time, right? So they just let me know when they're in one place or the other. Because if I... Like I said, if I get a call and all they mention is your A number, my initial thought in starting my planning is... Of course, my first question is normally, where is this member located? But if I've already pre-planned at your home location, which we do a lot of pre-planning. So, and I guess I should provide context for this, but areas that have a high or dense member population, I have funeral homes set up. And for those who don't know, We use funeral homes to do some of our procedures there. They have what they call a prep room, which is essentially an operating room where they prepare their decedents. And so it's just kind of an easy, logistically efficient place for us to do our procedures. And so we partner with funeral homes a lot. But back to what I was saying, if If it's a high member population in one specific area, I have a cooperative funeral home. I have relationships with different hospitals or hospices in the area. Hopefully, we have a DART member nearby because we've tried to already strategically place those DART members in places. They've even gone and done what they would call recon, but just scoping out the area so they know everything that... could possibly go wrong, right? Because we all know that law, that what can go wrong will go wrong, right? So we try to mitigate those as much as possible. So letting me know when you're traveling, especially if you are at higher risk for any sort of imminent emergency happening, if you're higher in age, if you already have health problems, if you've already been diagnosed with specific maybe terminal illnesses or organ failure, things like that, let me know when you're traveling. That way I can pre-plan and I can be prepared for any sort of emergency situation.

SPEAKER_00:

Okay, so we've kind of discussed what's an emergency, what's not, what to expect when someone calls, but I kind of want to nerd out here a little bit more and really give people a sense of the behind the scenes. So say you get a call. It is an emergency. The team does need to be deployed. What happens when you get off that phone with the patient or the family member or the hospital or whomever is reporting the emergency?

SPEAKER_01:

So once a situation is verified as a probable deployment, the first thing I do is I post it onto our communications channel. And it's just an app that we use to handle all of our kind of case communication in one place. So through that system. But I post basically a summary of the phone call, the situation, the location, all of the logistics of the case for initial information to the entire team. And then probably the next step after that is getting on the phone with Dr. Robos. So we make up the deployment committee. And so there's a couple of different factors we consider. that would qualify a member for a standby. And so we would confer on those. And then if they meet that criteria, we officially deploy the team. So upon that official activation, Dart is automatically notified because I've already added the specific Dart members that I would want responding to this case onto that channel. for communication. And so they're immediately notified and they start their response. Depending on where they're at, whether they're local or regional, they would either head directly to the airport or head to Alcor to gather kits. Depending on situation, whether it's like we need to get there as soon as possible versus, you know, we expect we have a few days before the member passes then i'll allow them to just go to alcor pack the kits take them with them to the airport so it's a big coordination of of efforts of just getting people to the airport um but our processes are pretty streamlined now so we get them there upon landing there is a lot of coordination from there so Between myself and our DART lead, we already discussed chain of command. So I usually assign one of the DART members who are deploying to be the lead on the case. And so they would be my main point of contact for DART. That way I don't have to call three different people depending on the situation. So I coordinate with them, give them all the information they need on the member, on the facility information, who their point of contact is, and all of the things that the funeral home would need in order to get death certificates filed, which is a lot of information if you're not familiar with that process. So once they're boots on the ground, it's really a lot of hustle to set up. And then once we're set up and ready to go we're kind of just maintaining status of readiness and checking in on the member obtaining you know at least twice a day updates if not continuous if we're there on site and able to be at the bedside and then once they're declared uh legally deceased we start our processes immediately and and we're always ready to go so happens very quickly so there's know there's phases to it so it's a lot of hurry her up hurry up hurry up and then maybe a little bit of waiting and then a lot of hurry up hurry up um then same thing so

SPEAKER_00:

okay and what kind of in terms of like general equipment like what what are we talking about here

SPEAKER_01:

so our kits are comprised of medical and specialized equipment we need all of the gear in order to do SST. And I can quickly run through kind of a very general list, but we need to be able to one immediately start cooling, right? So we have our patient ice bath, which is, it's a buildable piece of equipment, meaning it can be broken down to fit into a suitcase and then built back up to be a full adult sized ice bath on scene. So that gets built and set up and ready to go along with uh the team or one team member depending on the situation goes out and gets at least the the patient's body weight worth of ice in pounds and so so that we can fill the ice bath and then we have the sccd which is the surface cooling conduction device and we we call it the squid because acronym but also it kind of looks like a squid which is our in-house built device that lays on top of the patient and it helps with the surface cooling while inside the ice bath and so that gets set up as well and then we have all of the equipment needed in order to perform cardiopulmonary support which includes the mechanical chest compression device, also called a thumper. It includes a ventilator and the airway that we have to place in order to use the ventilator. All of those pieces probably comprise at least 15 different components. And then we have all of our equipment that is required for medication administration. So we can either use a IV or central line that, if it already was placed by the hospital or facility that the member was at prior to passing, if it's clear, then we can use that. But I much prefer to always have our own access. So we use what's called an intraosseous line. And it is a cannula, very similar to an IV, but it goes into the bone. And this allows for direct circulation into the circulatory system. So we have all of the components for that, as well as all of our medication. And then after that, that's really only half of it. After the SST, we have to be able to do a full surgical procedure and perfusion. We have a all of the equipment required for creating a sterile environment and all of the sterile personal protective equipment, all of our sterilized medical equipment as far as surgical instruments and cannulas and all of the equipment needed for that. And so it's quite extensive. And all of our perfusion equipment, which is mostly comprised of in-house proprietary tools that we use to perfuse the CPAs. And then we also bring our own transport carrier to the scene. That way we can quickly pack up the patient and get them transported back to Alcor. So there's a lot of equipment. It's... It's a lot to go through and that's, I probably only named, you know, it's the main things and there's probably, you know, 150 other items that we include into that for contingencies as well.

SPEAKER_00:

No, that, that, that was impressive. I am, I am surprised you can list that all right off the top of your head at a moment's notice. Um, very impressive and coming full circle. folks, that is why you don't try this at home. That is why you need SST and serious professionals doing this. So if you're ever wondering, do I really need SST for Chronix? Yes. Yes, you do. Yes. So that's just on the equipment front. I don't want to freak people out, but But there are a lot of things aside from, you know, even just the, you know, some of the soft skill issues that can come up with dealing with people. There are things that can go wrong in, you know, in these situations. I think it's important people understand that to have a stronger appreciation for what you guys do and how you really are kind of pulling rabbits out of hats to make this happen. But if you could talk about some of the challenges, limitations, what could go wrong, or what you're planning for so that if it does go wrong, you have workarounds. I guess anywhere from equipment malfunctions to technological limitations to regulatory considerations. Could you kind of go over a handful of ones that pop to the top of the list in your mind? I'm sure there's a hundred things that could go wrong, but I guess what keeps you up at night in terms of the things that rise to the top?

SPEAKER_01:

Yeah, I think the very first thing, and I think anyone on my team would agree with this, is going to be the regulatory considerations. No two states are the same exactly when it comes to the different laws and regulations pertaining to the transport of human remains or tissues. And so we have to know those regulations. We have to be well-versed. or be able to very quickly understand the different laws and regulations surrounding that area. So I think that's going to be the top of the list because that differs so much from state to state. Whenever you're transporting, and this is only applicable to whole bodies, but whenever you're transporting human remains across state lines, you need a transit permit, which requires a death certificate, and all of those processes take time. And like I said, it's a different process. In every single state you go to, it's different, let alone when we're dealing with a whole other country. So that would definitely be kind of cream at the top of... of what's logistically challenging. But like I said, we're a no fail mission team and might delay things. It's never going to stop things. So other than that, as far as equipment goes, we have a saying in the medical and emergency response realm, and it's one is none, two is one. So if you have one IV, you really have none. Because if that fails, you're left with nothing. And so we always have backups for everything. Everything that is needed on a case, it's included in the kit twice. at least some things we have three or four of because they're more likely to fail on your first attempt. And so we also have different sizes of different things that we use because every person is going to be different, right? So you just... You have to have backups. You have to have contingencies. You have to pre-plan. And so when... When we get back from a case, we always debrief as a team, and we talk about what went well, what can be replicated, or what went wrong and what can be mitigated.

SPEAKER_00:

And you mentioned kind of these debriefs and breakdowns. Are these the same things as case reports, or is this something different?

SPEAKER_01:

No, this is something different. So we do gather... data when you know what we're doing is is for research purposes so we gather data we gather all of the information required to be able to qualify or quantify our work right and so um we do gather all of that data and it gets put into a case report but these debriefs are different so you know it's it's the difference of actually putting everything down on paper in a standardized format and having it all written down and it's all objective, right? A debrief is all encompassing the subjective and objective of the case, the challenges that we faced and what we can do to improve upon it. You know, emotional implications of a case. We, we talk about that. I mean, the job that we do is, We may have pediatric cases. So we talk about those things. We make sure that our team members are good and ready for the next case. And so it's kind of just an open communication meeting to fully debrief the case from start to finish and making sure that we're doing the best we can. And

SPEAKER_00:

you mentioned your... measuring what you can, what are some of the things that you're monitoring for the research and to improve? Like how many different variables are you bringing in and how are you measuring them?

SPEAKER_01:

Sure. So we, I mean, first of all, we document everything that happens on any case from start to finish. And that is communication that happens a year before an actual cryopreservation occurs. all the way to when the patient enters long-term storage and beyond because we monitor and document all of that. So when I start that channel for communication that I talked about when we're deploying, it can be open prior, right? So when we have a member on the watch list... I usually create that channel way ahead of time. And so there is a lot of history in those as far as member communication, health updates, something that I specifically look for and why me being a nurse, this goes back to why being a nurse in this role is actually a good thing. I obtain a lot of health history on our members, past medical events, past medical diagnosis, medications that the members on, all the things that could implicate or change techniques or processes of how we do the cryopreservation. And so that's important to get a full history and documents on all of our members. But during an actual case, what we are qualifying as far as the quality of the preservation, it's something called S-MIX, which is the standard measure of ischemic damage. And that's taking real-time ischemia that has occurred, kind of a estimate of ischemic damage that has occurred, applying the interventions that we administer, which is the cooling, the medication administration, and the perfusion, and turning that into kind of this standard of the amount of ischemic damage that has occurred post intervention. I

SPEAKER_00:

guess I can't stress enough that everything we're talking about here is just tip of the iceberg in terms of the amount of considerations you guys are all taking into account. So every time I hear you guys talk about it, I'm I'm very impressed. What would you consider areas that are working really well at the moment and areas that you think need a lot of improvement?

SPEAKER_01:

Sure. So, you know, there's definitely some things we can improve upon. I think that, you know, as membership grows, we're definitely going to need to grow our team. But I think we have a very strong foundation that we can build upon very easily. And we are also currently working on improving our international capabilities. And so there's a lot of things that I don't necessarily want to make public quite yet, but there's a lot of things coming down the pipeline for DART. And I think that the membership is going to be very pleased. I think it's going to raise a lot a lot of questions that we'll probably need to answer again for our membership in the future, but we're prepared for that. And I'm really happy with the way that dart is going and moving so far.

SPEAKER_00:

Yeah. And, and I consider this one conversation of many, one of my goals, you know, and I know what the goal you share is to really educate members on the dart team and, and, And I view this podcast and whatever comes of it as just a starting point. And even just to cover what's going on now, I think we're going to have to have a handful of conversations. Yes. I guess to wrap this up a little bit, we talked a lot about what you guys are doing on your end to make sure people have a good cryopreservation. But There's a lot people should be doing, a lot members should be doing on their end. I want people to understand, and this is something I've harped on for a long time, Kronix is not a set it and forget it kind of thing.

SPEAKER_01:

Yes.

SPEAKER_00:

You can pay your membership dues and you will be covered, but you do need to communicate with Alcor directly. you know, regularly and over time. And even just separate from communication with Alcor, you need to think about how you can put yourself into the best position. It doesn't matter if Dart does everything flawlessly. You know, there are way too many situations that can occur. Dart could not even be notified about your situation until six plus, 12 plus hours after you've passed. And that makes it super important. You think about how you're setting up your life. You think about who you're around. You think about what could happen in any given situation in an emergency. To increase your odds, you do need to position yourself in a good place to take advantage of Algor's deployment and recovery. as something that's coming down the pipeline, we do want to empower members to have the knowledge about the things that they can do themselves to put themselves in a better situation separate from Alcor. And we'll probably have a whole podcast on just those things at some

SPEAKER_01:

point.

SPEAKER_00:

But just to give people a taste of a couple of those things, could you, off the top of your head, what would you say are the one or two most important things individuals can do that only they can do that would help increase their chances of getting good preservation?

SPEAKER_01:

Well, first thing is you should probably know how your health is. If you haven't been to the doctor in a while, go see your doctor or whatever practitioner you prefer to see. And just get a kind of a health status on how you're doing. And don't ignore issues. The belief in cryonics, and if you're very serious about getting a good cryopreservation, then we're not at liberty to kind of brush things off. So get yourself a health. status update just even just for your own information to see how well your your body's holding up in this life and um if there's anything that you think is pertinent for me to know um i i do keep records uh if you're not quite i guess qualified to be on the member watch list I do just keep personal notes in a secure location that is private and confidential, just so I can keep tabs on our members who aren't officially needed to be watched, I guess. But just let me know. Shoot me some quick updates on how your health status is. Another big one is if you live alone, get yourself on the member check-in service, the Alcor check-in service, which is a... I believe we have 50 free spots for Alcor members to sign up. And so if you live alone, if you don't have a loved one or a friend near to you that can check in on you frequently, just get on the check-in service. You set the frequency of calls. You set the time of the call. You can check in on the app. without having to receive a call. And this just is peace of mind, right? So it lets us know that you're checking in and doing okay. You can set emergency contacts like a friend or a loved one who can get notified of when you've checked in or when you've missed a check-in. So that's one thing you can do. And then the other is the member readiness survey. And Daniel mentioned that he will put it in the podcast notes as a link. That way, you guys can access that easily. But the readiness survey is a very basic... I think it's only like 23 questions. And it just gives both the members and Alcor a basic understanding of am I ready to be cryopreserved? And it goes through questions on health status, living situation, emergency contacts, updating member contact information, such as email, phone number, and address. And then also some kind of more legal aspects of being prepared for cryopreservation like having a trust or will or things of that nature. So it's a little bit all encompassing, but it is pretty basic. But if you fill it out, it gives us a baseline, right? And we can kind of go from there on making sure that you're ready and prepared for a cryopreservation or an emergency situation.

SPEAKER_00:

Well, this has been a long podcast. Thank you for bearing with me, Shelby. Like I said, I think it should be one of many. Absolutely. If you're listening to this podcast, please tell other Alcor members, prospective members about it, or just anybody. Because while it's generally geared toward people who have some knowledge about cryonics, we try to explain concepts and not assume too much pre-knowledge. So yeah, share the word, subscribe. If you're listening to this just on the website, it is easier to subscribe on Apple Podcasts or Spotify. That way it'll notify you and there's some nicer podcast listening features for that. And that's it for now. Thank you, Shelby.

SPEAKER_01:

Absolutely, Daniel. Thank you so much. I really appreciate the opportunity to kind of dive deep and explain some of this stuff.