At the METI plant, a sprawling building off Cattlemen Road, bodies are piled on makeshift gurneys, and limbs, heads and torsos are scattered about on lab tables, benches, even chairs. The eyes are disconcerting-crystalline blue with big black pupils, they seem to follow you about the room. The place feels like a cross between a hospital morgue and a fashion designer's workshop, but the only fashions are cotton athletic shorts that cover private areas, in deference to modest visitors. Look right, and a technician is carefully tending to a tongue. Look left, and another is pulling a rubber face over a head.
These body parts belong to the lifelike computerized patient simulators produced by METI, Medical Educational Technologies, Inc. When computer programmers are finished, the patient simulators come to life-pupils dilate, chests heave as in a heart attack, and the dummies even speak. With a price tag of up to $200,000 each, the simulators are revolutionizing training in medical and nursing schools, community colleges and EMT programs around the world. With no real competitors, METI is the worldwide leader in this revolution, dominating an industry the Sarasota company created and continues to expand.
"Medicine is one of the toughest professions to get to change," says METI founder and CEO Lou Oberndorf. "The last time they changed the way they teach medical students was 110 years ago. For maybe 1,000 years, the medical profession has learned its trade by practicing on us. They don't have to anymore. Now they can practice safely and not endanger humans."
Established in 1996, METI has grown from five to 100 employees and occupies a 30,000-square-foot building with research, manufacturing and testing facilities. It recorded sales of $20 million last year. Oberndorf asserts his company's growth prospects have no ceiling, with neonatal simulators, military applications and entire simulated hospitals all on the way.
Oberndorf, who was based in New York, came across the idea of patient simulators when he headed commercial licensing for the now-defunct defense technology firm, Loral, in 1994. Angling to move out of the defense business, Loral unearthed research on a patient simulator at the University of Florida and licensed it. By 1996, Loral had sold just 13 simulators and was ready to dump the business. But Oberndorf, who says aerospace firms are better at engineering than marketing, still believed in the product. He and a partner bought the technology for $500,000 from Loral, and kept the company on as a partner to provide a building and other support. Their initial investment had to maintain the operation until sales and research grants materialized.
"If I knew then what I know today, I never would have done this from an investment standpoint," Oberndorf says. "We hit some cash bumps in the road but got through it. We turned profitable by 1999. Those first three or four years without a lot of capital forced us to be efficient."
The big challenge was persuading medical educators that there was a better way. There are 120 medical schools in the United States. It was evident early on that even if METI could convince every medical school to buy a patient simulator, it would need a larger customer base to succeed. Fortunately, former Florida Education Secretary Betty Castor championed the potential value of simulators within the community college system in the late 1990s, and with help from the state's 50-percent matching funds, community colleges soon began purchasing simulators for their nursing programs.
"We were blessed by the fact that the community colleges in Florida rank among the top of the nursing education institutions in the country," Oberndorf says. The schools were willing to try innovative technologies to keep their place among the nursing school elite.
Once Florida's community colleges were locked up, METI identified other potential customers, such as technical schools, paramedics and the military. Since 1999, the company's growth has averaged about 40 percent annually, according to Oberndorf. At the end of 2003, METI had 450 simulators in action in 360 places around the world, including at both the Sarasota and Manatee county technical institutes. In fact, the only place they don't have a presence in the medical education community is Russia.
One of METI's models is a portable used by Jacksonville RN and EMT-paramedic trainer Wayne Hodges, who travels to 17 Florida counties as part of a training outreach program connected with Shands Jacksonville Medical Center. "It's as close to a human being as you can get, without the flesh and blood," Hodges says. "I can teach skills that I had to learn while I was working on people, trying to save their lives."
The Trauma One Flight Program at Shands employs two helicopters to help save victims of auto accidents and other trauma. Hodges trains paramedics and EMTs to properly care for patients prior to the flight. His primary task with the simulator has been teaching intubation-inserting a tube through the nose, mouth or a surgically created hole to help victims with damaged airways to breathe. Students formerly practiced on static training dummies that were oversized and couldn't replicate the traumatic and often changing conditions of a real patient. The METI simulator poses a whole range of possibilities to students: The tongue puffs up, the vocal chords swell shut or the teeth pop out if handled too harshly.
"It can develop all the problems the human body would develop," Hodges says.
So far, Hodges has trained 300 people in the techniques, including medics in two counties where the process had never been done in the field. The sessions have been so popular that Shands Jacksonville Medical Center is applying for grants to expand its use of simulators. Hodges would like to get a pediatric and an infant model to enhance the program. "Nobody wants to give up a day for training to sit in a classroom when they could be out doing something else, but I'm getting course evaluations where people are asking to get the training repeated," he says.
One of the most unusual applications for METI simulators is at NASA, which is using them to train astronauts who need to practice emergency medical techniques in weightless conditions. For example, if an astronaut had a heart attack in space, the doctor on board would not know how hard to press to compress the chest. NASA flew the METI simulator thousands of feet up in an aircraft, which then plunged vertically, giving astronauts about 30 seconds of weightlessness in which to practice.
Joan McGill, existing business manager for the Sarasota County Committee for Economic Development until her move to MCC last summer, says METI is exactly the kind of high-tech company business leaders here are seeking.
"The company started here. It's the perfect fit: high tech employing highly skilled people and paying above the average wage," McGill says. "They have been a secret in the community for a long time, and they're just now starting to get recognized."
METI employs programmers from such far-flung places as China and Russia who create the software that make the simulators come to life. "We have a lot of engineers, a lot of professionals. We recruit all over the country and the world. My software group looks like the United Nations," Oberndorf says.
While salary ranges are competitive with those in the Southeast, finding reasonably priced housing for his 100 employees is difficult. "The cost of housing here is an issue," he says. "Our people live all the way from Brandon to Port Charlotte. They live along the I-75 corridor."
An even bigger challenge? Managing the company's explosive growth. "At times, we have outgrown our infrastructure," he says. "I was determined that our technology would continue to revolutionize. We're always looking out 12 to 18 months to what we need so we can get there even quicker. To this day, we still have no competition at the high end."
Growth is on two tracks right now: adding new customers and selling new products to existing customers. While the original simulators have changed little physically, METI is adding a line of pediatric and neo-natal simulators. It's also tapping into a brand-new market of simulated disasters. By networking simulators, METI can create a simulated hospital or a simulated disaster, with medical responders learning to make quick decisions on which patients need immediate medical attention and which can wait. Tragic events of the past three years, especially Sept. 11, have made such training critical.
"On 9/12, every leader of every community in America was looking at his emergency personnel and asking, 'What if?'" Oberndorf says.
With the help of local legislators, METI has received $20 million in federal grants over the last seven years, funding research for simulators with specific military applications. The latest was a $4-million grant last October to fund software and hardware upgrades, addressing a variety of new scenarios involving weapons of mass destruction, including biological and chemical attacks. The company sold 205 simulators last year, and officials project 225 for 2004. However, a large part of METI's revenue comes from new applications and software upgrades. The programmers continue to add variables to make the training more realistic.
"We're here to stay," Oberndorf says. "We're a Florida story. We're Florida people. I don't see us growing outside of Sarasota at all, absent acquisitions. We have the support of the community. In the last two years, the Sarasota representatives in Washington have helped this company immensely. Sarasota is a good place to be in business, and this is my home."