Hey guys, thank you for joining us today. I'm your host, Dr. Jeff Brown, with your co-host, Dr. Jeff Cole.
I am very excited for the two guests that we have with us today, Charlotte and Keith Bartosi, the CEO and co-founder of Intiscope. Intiscope is a company that's bringing a new airway device for first responders to the market. Keith and Charlotte, welcome. Thank you.
Welcome. I'd like to immediately go into your description of the product, Keith or Charlotte. So, Intiscope is an intuitive innovation device, is what I like to call it, but it is different than your standard Lorentzoscope that's been around since the 1940s in that, instead of using your strength, and it is a direct visualization device, instead of using your strength to pull up to visualize the vocal cords, you actually have a mechanical advantage. So, it's similar in the fact that it has a blade and a handle, but it also has two levers, and it has what I call a hard palate support piece that it basically uses leverage against the roof of the mouth or the hard palate to open the airway so you can visualize the trachea and do it or tracheal innovation.
Interesting. I think when you talk about need, I mean, a lot of intubations can be tricky, especially in the field. What further thoughts do you have on that? Yeah, a couple of things on that.
One thing is the anatomy of the patient plays a big role in how difficult an innovation is. There's other factors, especially in the pre-hospital setting, which obviously being, having my background as a fireman, the pre-hospital setting is where this was born. And that's where I saw a need because of the difficulty of an innovation when someone is on the ground versus an operating table. They're on a medical scene, maybe on the side of the road, but there's just a lot of factors that go into it.
Intubacope was actually born from a failed intubation attempt. It was one of those difficult in the field innovations, and it was a tough one, and he wasn't able to get it done, and he couldn't let it go. And he said there's got to be a better way. And he couldn't let it go.
And so that's how it just came to be. Yeah, and I can tell that story briefly if you want to hear it. So I actually started in the fire service a little bit later in life, and I found myself changing careers in my mid 30s and successfully ended up on a local fire department, local Memphis area fire department. I was the paramedic on the engine one day, and we made a call.
And it was one of those calls that you really want to be successful because it was a 55 year old male. The report was CPR was in progress, and he wasn't breathing. And so when you're on the way to the scene like that, you're thinking, I'm going to save this guy, right? And that's just, I mean, you know, not that we don't try to save everybody, but he's only 55.
And you know, we're going to go find out why this guy's not breathing. We're going to fix him. Well, I walked in, it was an office building, and they waved us in. We were the first ones on the scene.
I could see them doing CPR on this guy. And he was one of those big, you know, he looked like a football player, big guy, short neck, muscular. And so I knew it was going to be a difficult innovation. So I got down on the floor with him.
And you know, my lieutenant at the time handed me the standard laryngeoscope that I was talking about, the 1940s technology, I sweep the tongue like I've been doing, you know, I was very successful in innovation. So that's why I always did them. I was, I think I had not until that patient had not failed an innovation. So and had done a bunch of them.
So I at the time, I'm 63 early on in my career, 230 pounds, pretty strong worked out all the time, takes a lot of strength to take that blade and pull that tongue up out of the way to see that trachea. And I just couldn't do it. I tried three times and failed. We ended up losing that patient.
And so I went back to the fire station and I just, one thing, it was my first failure. And I didn't like that at all, especially with him being so young. And I was just like, I kept thinking there's got to be some better way than that. And that's when I came up with the idea of using the hard palate to basically use as a mechanical advantage point to push against and open the airway.
So now you just sweep the tongue and you squeeze a trigger, you squeeze a lever and these two operating arms spread that thing apart. And you can see the trachea right there. So are there some controls on how much pressure is this place? Is there a way to get into trouble with too much pressure?
You know, the hard palate is exactly what it is. It's a very hard structure. Obviously, it's a bone. It's, I mean, it's, it's not going anywhere.
When you think about what you're pressing against, with it being such a rigid structure in the roof of the mouth and everything in the area of your trachea and your lower jaw and everything is much more pliable than that, than that roof of your mouth. So that moves instead of the roof of the mouth. So you just control it basically with the squeeze of your hand. And it doesn't take near as much pressure as you would think.
You just squeeze it until you see it. And it actually has another advantage, which it, it actually protects the teeth because of the way the hard palate support is positioned. So once you activate it and squeeze the trigger, you can actually rock back a little bit and look around the, look around the area and locate that trachea and those vocal cords, which is something you can't do with the old technology because you're, you might damage the teeth of the gums. So what does being a technology do you have patents in place or what, what, what do you have a utility patent?
We, this is the first time we've done anything like this, don't start up or had a product like this. And so we applied for a patent very early on in the process. I mean, I basically had just drawings on a piece of paper that I took to the patent office. We started that process very early on.
We actually got our utility patent March of 2020. So and we have a European patent that's applied for that we are in Canadian and we're hoping that they see everything exactly like the US Patent Office did, which is, you know, I understand that's the case a lot of times. So we're hopeful that we're going to get those as well. So that's excellent.
With those, with those patents in place, do you have any sales projections for when you start producing this device and onward? Yes, we do. And of course, so when you look at innovations and there's 16.5 million innovations a year in the United States, three million of those are failed first attempts. So three million times a year in the United States, pre-hospital and hospital, they're failing that first attempt.
And so we feel like our low hanging fruit for our golden market strategy is going to be a unscheduled pre-hospital innovation, which in that field, you're looking at 88,000 ambulances, 150,000 fire trucks, 40,000 military vehicles. And that's going to be our target audience for this product when we go to market. That's going to be phase one. Of course, we're going after the hospitals and surgery centers and the, you know, you got minor meds that are required to have a crash cart with an innovation device on them.
I mean, we're going after all that market, but our projections are once we get to revenue stage, which we're hoping early 24 that we're going to be there, we're talking about a $25 to $30 million market in five years, revenue for industry open in the first five years. So that's kind of where we're at and what we're shooting for. And that's, like I said, that's not taking into account any hospitals or anything else. That's all pre-hospital market.
And that's US market. US only, correct. Exactly. Well, if you truly have a better widget, I can see how you may not have to sell the hospitals, right?
They're going to, right? And they're going to want to go on on board. Exactly. Yeah.
And you know how word of mouth is in the medical field. I mean, it just gets a word gets around. We've already experienced quite a bit of that. Yeah, we have.
We've got a lot of people that I run into in the fire service and just a lot of different places that are going. When can I get my hands on it? When can I get my hands on it? Which brings up a great next question.
What is what do you see as availability even in a test market situation? Well, we are in the final design phase right now. Of course, you know, anytime you've got a new product, you always have little tweaks to do on the design. And we're really close to the design freeze.
We hope to be finished with that and moving on through some testing. And we hope early 24, we're going to be in the phase of our company where we're doing marketing distribution and sales channels. So early 24 is what our goal is. So that brings up a good point.
Tell me more about how you plan on marketing this device and what your sales channels look like. Sure. So we're kind of going with we are a startup. So, you know, that plays a factor.
We've only got so much money for sales. But what we found is word of mouth has we've had like Charlie said, we've had success already. We've got I've got people from different fire departments around the Memphis area that like I said, they're asking me when drinking my hands on them. And we've got people all the way down to Texas that are just waiting to put this thing in service.
We are going to go with kind of a grassroots approach. We're going to start out with local here. And like I said, we've got a we've got a regional here and then regional in we've got we've already got that in place in Texas. We do have a couple of people that we're going to send out in the field that have had great success in that kind of approach.
And they are they are experienced in the approach that we're taking their experience in getting in the fire stations and getting in the you know, anywhere that you know, aimlessness, ambulance services and getting in there and showing products and getting people on board and selling products. So that's kind of going to be our approach. Excellent. And we feel really good about it.
Are you aware of any competitors or anybody else with something similar? Of course, you've got the 1940s technology, which you know, it's on one end of the spectrum. You've got video scopes on the total other end. And then we're in the middle somewhere with as far as you know, the video scopes are not a direct visualization.
The 1940s technology is. And so we really don't have any competition. Once once we hit the market, we feel like we're just going to take over the direct visualization market. There's just there's not going to be any need to purchase anything else.
And we've got a price point that we feel like is going to be very reasonable. And from from the feedback I'm getting from the people that do the purchasing on the local fire departments, they're like, absolutely. Because we're going to be somewhere we're going to be more expensive than that 1940s technology. But we're going to be way less than the video scopes.
Just a quick story. My EMS director at the fire department I worked for, he came in not too long ago. And he said he had one of the video scopes in his hand. And he said, give me one reason why I should keep buying these expensive video scopes that y'all don't use and you keep breaking.
And they are expensive to replace. And I was like, can you say that again? And let me get that on my phone and get that on recording. So we're going to be somewhere a price point in the middle.
I think we're going to be in a good spot where we've got just nobody, no competition. Who's helping you? What's your executive team look like? So we've got local investors.
We've got a gentleman by the name of Robert Longfield that's on our board of directors. We have a management team as well as Sage Medical, or I'm sorry, Sage business advisors. They have an investment side and a management side. They're also our management team, but they're investors.
And then we have the we've got a group down in Texas that's a retired fire. And some of them, I think are still active service, but we got a group down in Texas that are investors. And we have a large medical device studio. It was not, associated with you anyway, but they are doing our engineering and prototyping.
Yeah. And of course, Charlin and I are still active. I mean, we're the co-founders. She acts as the CEO.
I'm the technology person. And of course, we both are heavily involved. So that's kind of our team right there. So Keith, of course, a lot of the years with no, I'm an anesthesiologist.
I'm always interested in any kind of airway device. Describe for me, and this is the opportunity where we can go back through these questions and maybe give a little more deeper into the topics. What other than anatomy issues in a first responder environment do you encounter? And why does this device help you overcome those obstacles?
Yeah. Okay. So the pre-hospital setting versus the hospital setting. You know, you can put a patient at the perfect height.
You can have perfect lighting. You can tilt that patient up and down and position them exactly how you want them. You can't do that in the pre-hospital setting. I would say most of the time, our patients are on the floor because we're likely to be doing CPR or they've fallen or been injured and they're already on the ground.
They could be in a car. I've actually hung through a sunroof before to innovate somebody from the sunroof on the outside of the car because why was this course over? So that's a big factor. You also have weather factors.
If you're on a car, if you're on a scene and you're out in the elements and it's raining or even if it's really humid, you're going to have trouble with a device that is not direct visualization. If you're looking through a camera on a lens and you're in that environment, it can be very difficult. But I would say that and then you take into account that there's a lot of stressors that go in sometimes when you're a fireman versus being in a quiet setting like a hospital, you've got cars going by. There's always spectators and people watching you.
Nowadays everybody's filming you. There's always people standing around. You don't know who they are. They may be friends and family.
They may be just somebody that works with this person. And so it adds it's a lot of stressors that are added. And you talk about a car wreck or something and you've got cars going by. You've got police presence.
You've got other fire equipment, lights going off. It can be very chaotic is the way I would describe some scenes that we have to have to innovate somebody on. The great thing about Interscope though, the position of the patient is a lot less of a factor within the scope because you're sweeping that tongue and you don't have to get in that perfect position where you're tilting the head back and where you can get your strength and pull up with that arm. You don't have to do any of that.
You sweep the tongue and you squeeze the lever. And since a lot of our viewers will be anesthesiologists, CRI&A, and T their airway folks. And I just want to make the point that you and I had talked offline about the presence of blood or vomit secretions in the airway that we don't often see in the OR because like you said, it's a controlled setting. And I know in the times that I've had blood in an airway with the video scopes, they're almost useless because it obscures the lens of the device.
You don't have that with this device, right? That is correct. And that brings something else to mind. And that is the fact that even though there's 16.5 million innovations a year, you have to be the paramedic.
That's the first responder, the first one on the scene that gets the laryngeoscope in your hand. I mean, there's times when you go months without innovating somebody. So in the pre-hospital field, even though we do a lot of innovations, it's, you know, you may go a lot and skill decay is a real thing because just like they say about everything else, if you don't use it, you lose it. And so, I mean, we may go, like I said, months without innovating somebody.
This kind of takes that once you learn how to use the the scope, it's like it's not hard to train somebody to do it. Anybody with any experience innovating somebody, I can teach them how to use this thing in five minutes and they will never lose it. It's very intuitive and it's very easy to use. Hence the endoscope.
Right. Is that where that came from? Is that right? That, you know, it is that and it's a play on words.
Innovation. Innovation. Innovation. And the laryngeoscope.
That's clever. Yeah. Like that. So that's kind of how we came up with that.
But yeah, I mean, you're, we've tested this down at the Medical Research Institute Lab down in Memphis and had great success with it. That's where a lot of the test, that's where a lot of the training takes place for like video scopes and things. And that's one thing. It's very expensive to rent that place out and fire departments and pre-hospital.
They're just not going to spend thousands of dollars for somebody to go train on a video scope. So what they're going to do is they're going to take a mannequin and you're going to innovate a mannequin with your video scope. And of course, the mannequin has no fluids. It's dry.
There's no consultation. It's way easier than, you know, a real person. So that's a factor as well. It has a certain wow factor to it.
We keep us tested at, you know, these taken some people that have been a bit skeptical, you know, how is this better than a video scope? You know, you'll never get video scopes out of people's hands. And they walk down and people hand it to them. Like I said, the intuitive just hand it to them.
And they go, it works. I can see it. And they started calling people over from like the clinic. Come look at this.
You're a U-trogue truck. And you know, people, they're impressed. They're, I can't believe it. And then there's always the why did not think of that.
Yeah, right. Yeah, because it is. I mean, it's a simple concept. But there's actually what she's talking about.
There was an instance where our medical director was very impressed with it. And so he started calling people, anybody that was in the Mary lab that day, he was calling over there, Hey, come check this out. That was before we had a patent. And I was, I was, he was making me nervous because he was calling everybody over there to look at it.
And I imagine we've all looked at many things and said, wow, why didn't I think of that right? As most great inventions are that way, it seems. I've heard that multiple times. Well, the purpose of this podcast series that Jeff and I are doing is to find compelling and interesting companies.
And I think you guys fit the bill. When a lot of listeners are going to be thinking is, Hey, can I get a piece of this? What's your capital structure and what are you foresee in the future? Is Sage going to can hang on to all this?
Or are you going to have an opportunity for position investors to get involved? We do. We actually, we feel like we're really close to being funded to the revenue stage. But at the same time, we decided to leave our investment round open, the first round open.
So everybody can still get in at the same rate as everybody previous. So anybody watching this will be a potential investor. So we'll we'll put that in the notes. We'll we'll get that verified with JT or Andrew.
Yeah. And it's a spreadsheet guy. And it is a $5 million post money valuation. Yeah, I think one point to make also with our audience being physicians and health care providers, you know, those are people that work in surgery centers, working hospitals, those are decision makers at various levels, you know, whether it's in surgery center setting or whatever.
So, you know, I think to have investors who are physicians who are also decision makers on the BISIDE could be very helpful. Yeah. And we do have some some physicians that are investors as well. I want to go back and Keith let you talk a little bit more about your background and why you did this.
So I would like you to tell the audience, you know, a little bit more about you, who you are, where you came from and why this device is so important to you. Okay. So I grew up in the Memphis area. I left Memphis and went to college at Middle Tennessee State University, found myself back here after college, had a good job, married four kids.
All this, all this kid was 11 years old at the time. And Charlotte, we just, you know, we just thought, well, this is my life. I was a construction superintendent. I had a, you know, all the benefits and, you know, we were just just going along and Charlotte was on the PTA.
Well, she met a lady on the PTA that's husband was a fireman. And so I became friends with him through her. And then I met some more firemen. And then we all realized that we had common interests and started hanging out together.
And I would be around all those guys and I'd be like, hear them talking about their stories. And, you know, anytime you're around, you get a couple of firemen in the room, they're going to start telling stories. So I just really, it was attractive to me. And I just got to really take an inventory of what my life looked like and what I wanted my legacy to be.
And there was one instance that happened. Some of the firemen that I knew, young girl comes walking up to one of them and she goes, you probably don't remember me. And he said, I remember you, Amy. He said, I sure do.
And she said, I cannot tell you how what it meant to me that you crawled in my car that was upside down on popular avenue, held my hand and talked to me while while they were cutting me out of the car. And that's the moment that triggered it for me. I was like, I want to be that guy. That's awesome.
Somebody. And so I went home one day and I told Charlie, I said, Hey, I want to make a little career change. And I fully expected that she was going to tell me to put my big boy pants on and go to work the next day. When I told her I wanted to change careers at mid 30s and be a fireman.
Well, instead, she said, you know what, that is you. And I want you to do it. What do we have to do? And so I went to EMT school and I went to paramedic school and I joined the volunteer for I was pulling quadruple duty.
I was working full time. I was in EMT school or paramedic school. And I was also a volunteer fireman. And going through training there.
So that was a busy couple of years, but it really paid off and ended up a full time fireman. And I mean, here I am almost 14 years later. And every day I go to work, I love it. And I've had I've actually had the privilege of having that moment that triggered it, where somebody walked up to me and church one day and said, Hey, you don't remember our son.
And I said, yes, I did. I said, yes, I did. So it's just it's been I've been that passionate about it. And that's kind of what led me to the endoscope is I didn't want to just accept the status quo.
And I am, you know, I like I said before, I had never failed an innovation. And I really took it hard when I did. And we lost that guy that was 55 years old. And I was like, I said, when we were on the way to that scene, I was going, I'm gonna save this guy.
And when they handed me that the ringer scope, I was like, Oh, yes, I'm gonna do the innovation. Because that's what I'm good at. And I just really took that failure hard. And I would lay in the bed at the fire station and couldn't sleep for weeks.
And then it just hit me one day. I kept thinking, well, I didn't have enough strength. I just didn't have enough strength. What can I do?
What can I do? And then just hit me one night? He said, don't know him. He kept replaying the scene over and over and over in his mind, thinking, what could I have done different?
What could I have done different? And it hit him all of a sudden, I did everything I could. There was nothing I could have done different. What I need is a better tool.
Yeah. And that's exactly how it was born. Yeah. So I mean, that's what I mean, that's why I was so, you know, it does it, you when you make a call like that, you have to go back to the station and you have to put it behind you and you have to be ready because the next call comes in, it could come in two minutes.
It could come in anytime. So you got to put that behind you and be ready for the next one. But at the same time, you have quiet moments at the fire station too, when they're you're not training, you're not working out, you're not making calls. And every time I had a quiet moment at the fire station, after that happened, I was like, I got to come up with something, I got to come up with something.
And it got to be a better way. Yeah. And it just hit me one night. And I actually took that and I sketched out a patient, a side view of a patient with their airway and everything.
And I sketched out, I still got this drawing and I sketched out the first rendering of the endoscope. And I took that drawing. And the first place we went was the patent office. And the second place we went, I had run across a guy that made aircraft parts.
And I went to him and I said, I need you to make me a device. And he said, I've never done this before, but okay. So we spent hours at his cab table just designing this thing and going through. And he did a 3D print was the first one that we had.
And it just went from there and went from there to a machine shop. And I mean, it was a while before we ran across before we actually got anybody that made medical devices to make one. So it was a process. But I mean, I'm just, that's kind of the story about why I'm so passionate about it right there.
How did you how did you link up with the merge people in Nashville and Sage? What was the sequence of events there? Well, we actually, like I said, Charlie and I never have had done a startup before. This is the first product that I've ever invented.
And so we didn't really know what to do. And we actually ran it. I mean, we just had people that just fell in our lap there for a while. And one of them introduced us to this person to this person.
And we ended up at Startco, which is a it's like an incubator for startup companies. And Memphis starts here, right? Yeah, the zero to 510 K. Yeah, it's like it's like that, except for it can be any product.
And so we went through the Startco program and that's where we started meeting people. And that's where we met Sage. And at the end of it, you do a presentation on your device. And they help you make a pitch deck through the program and everything.
Well, when we did that pitch, we started getting phone calls. And Sage was one of our phone calls and merge was one of them. We were working with merge free that we met them through the Startco guys. But one of the guys at merge medical device studio had gone through the program, I think two years prior.
And one of the people at Startco said, hey, you know, he he works for a medical device company that that's what they do is make medical devices and he put us in touch. But it was Sage. They did see us on the present the pitch presentation and got in touch with us. Yeah.
And so that's all that came about. Yeah, that's great. So Keith, summarize, it sounds like a product invented by a fireman for fireman and other first responders. It's a device that's it sounds like to me is somewhat in between the oldest technology used to intubate and the newest technology which are the video scopes.
And in doing this, bringing this product to market, you've eliminated some of the disadvantages of the older technology such as positioning and eliminated some of the disadvantages of the newer technology such as foreign matter in airway blood secretions vomit. So it sounds like you've created a device that's got a really a perfect harmony in particular for first responders that might have a patient in a field or in a ditch or a trauma to a trauma to the airway. Am I saying this correctly? Absolutely.
Would you like to be a spokesperson? You know, I mean, the advantages go, I mean, that's true. And I actually, I actually, the only other failed innovation I've had in recent years is was somebody who had had a spinal fusion and I couldn't tilt their head back at all. So you wouldn't need to so with this into scope that would eliminate that problem.
That would eliminate the need. You could actually deploy it without tilting the head way back and I could have gotten that person innovated. I'm fairly certain as well. There's other benefits too.
It's so easy to use, hence the name and hence it being intuitive. So it's so easy to use that that skilled decay is less of a factor. You reduce those first time failure attempts in the field. The training time needed for it, like I said, is much less.
And you have cost associated with failed attempts, hospital stays, everything from hospital stays to litigation. And you're avoiding all that if you can get somebody you know, innovated quickly in the first time. And then it may seem obvious that those of us that are familiar with it, but I want to make sure the audience understands you're using traditional endotracheal tubes for this. There's no special tube or anything required, right?
Nothing special. Just the device is simply to open that airway so you can easily place that tube. And it's battery powered with a light source? It does have a light source, yes.
It actually has, essentially, that's what we've been finalizing is the light source on it. And we've actually gone with a lot instead of just one light, like the typical laryngoscope or the typical video scope. It has a series of lights in it, like a light strip. And it really puts a lot of light down there.
And you bring up a good point. With this using the traditional ET tube, it looks like, and you're probably better to speak to this than I have it. But from my understanding, a lot of pre-hospital fire departments and ambulance units, they're moving to that. And I don't really want to say that's the brand name that I know.
But yeah. People are going to a lesser effective airway, something that you place it and it doesn't protect the airway from aspiration. It's not directly in the trachea, but it's just a, it's what you go to when you fail an innovation. I think we can talk about LMA's.
Exactly. But we can talk about that. And LMA's don't protect the airway. I mean, you can ventilate through them, but these are patients that are potentially full stomach.
They're definitely not in the O. So any vomit or anything that comes up from the stomach can go down the airway. With your device, you're putting a traditional ET tube in the trachea tube and it would protect the airway. And it's my understanding and you would know better.
But it's my understanding that when those are placed pre-hospital, once the patient arrives at the hospital, that you're actually removing that and then actually innovating them with an ET tube. Right. That's a really good point. I haven't, I have yet to take somebody in the ER and the doctor not pull that thing out immediately because they're not going to have somebody sitting in the ER that's airway is not protected.
And those just don't do it. So that is a good point. Yeah, the doctor at the ER is going to take that thing out and he'll take them. Right.
So we eliminate all that step. And you hope he does it with into scope. I hope so. I'd like to be the weapon of choice.
Yeah, that'll be the easiest way to do it. I can promise you. Jeff, you have any other questions? I think this has been very educational.
Like, I like my approach. I didn't know anything about your company. You know, and so I feel like our listeners are going to have the same wow factor with what I've learned. So I really appreciate your time.
I wish you luck and thank you. We appreciate the opportunity. Yeah, thank you. Thank you both for putting this together and starting something like this.
And thanks for having us all. We're just, I mean, like I said, I'm really passionate about this. I'm excited, most of all, to get this thing in the hands of paramedics and doctors and people and it's... And it saves them a lot.
It's going to be my legacy. So that's fantastic. Thank you. That's what we bring up, you know, very pertinent points and some things we've thought about.
You know, as we grow a physician and healthcare provider community, particularly if we grow that to a large number, you know, there are there are people out there with ideas and you really like in your story, struggle with what I do. So what we want to do through our website, through our forum, is offer information to people, hopefully through, you know, formal sponsors and partners. And so we're going to be reaching out to company like merge medical device studio to, you know, to partner with us because we'd like to point innovators to them. There's another couple.
There's another couple companies I won't mention. In a similar capacity, you know, that we plan to partner with. So I think that's a helpful piece as we build out our community. This is a wonderful thing.
I mean, thanks again for you guys putting this all together and starting this. It's going to be great for people like us. Thanks, guys. And with that, I'm Dr.
Jeff Brown with Merged Medical Podcast, your co-host, Dr. Jeff Cole and Keith and Charlotte Bartosi of Interscope. Thanks for joining us.