By Ken Mammarella
Contributing Writer

The world’s only fully automated, wearable birthing simulator is one of the coolest things made in Delaware, according to a 2024 Delaware State Chamber of Commerce contest.

The fake blood and mucous are pretty cool, too. So are other simulated body parts – worn by people trained as standardized patients – made to teach nursing students, EMTs and others in healthcare.

They’re all from Avkin, a Newport company founded by Amy Cowperthwait and Amy Erol, with market demand and technology behind the products based upon their studies and work at the University of Delaware, and significantly incubated by UD’s Office of Economic Innovation and Partnerships – plus outsiders like the Delaware Manufacturing Extension Partnership.

“I’m kind of the visionary and the educator, and she’s more of the engineer. She’s the one that really helped us create the products,” Cowperthwait said of Erol, noting one huge issue is how “electronics and fluids don’t mix.” They now share ownership with investor John Martinson of Martinson Ventures.

Here’s an example of that challenge involving the Avtrach, for tracheostomy. The team wanted to place a sensor on a part of the trachea called the carina to cue the patient to respond appropriately. They also wanted to incorporate mucus to enhance realism. However, early on, engineering consultants suggested that it couldn’t be done.

The breakthrough involved using a small, condom-like covering for the sensor area. This blocked fluidics while still allowing enough pressure to be applied to activate the sensor. This innovation made ifor a realistic and functional airway training experience.

Avkin’s origin story

The modern use of lifelike mannikins, simulators and actors portraying patient encounters dates back to the 1960s, according to the Husson College of Health and Pharmacy.

So what simulations did Cowperthwait encounter when she started studying nurse at UD in the 1980s? “None,” she said, explaining that “the only thing that I ever remember learning not on a patient” was learning how to inject herself with a needle so that she could teach a diabetic to do so.

Avkin launched in 2016 and has averaged a 20% annual growth rate, now employing 32 full-time equivalents, including all four of Cowperthwait’s children, Adam as director of sales, Josiah as a solutions consultant, Megan Weldon as director of marketing and education and Bethany McGonigle as standardized patient coordinator. But not Amy’s husband, Kevin, who chose to stay retired.

On Avkin.com, Cowperthwait said she started to think about its products while teaching at UD and one day providing the manikin’s voice in a tracheostomy simulation. “The students walked in and said ‘Hi, Mr. Jones. What is your name and date of birth?’ Amy didn’t respond, as tracheostomy patients are typically nonverbal. The students looked at the lifeless manikin, said ‘Oh my goodness, he’s dead!’ and began chest compressions. While watching the students try to save the manikin, Amy sat in the control room wondering how they got to chest compressions when the patient just needed to be suctioned. Realizing that a human element was needed to properly educate her students, Amy started thinking of an overlay that someone could wear to give appropriate, real-life responses.”

The Avkin name is based on the words “akin” and “vera” (the Latin word for truth). The goal is to make product as real as possible, based on human physiology, with sensors inside for reactions.

It makes eight simulators: the Avbirth, its newest product, lauded in the chamber survey and also used on the Netflix show Jack Whitehall: Fatherhood With My Father; the Avtrach for tracheostomy; the Avthor for chest tubes; the Avtone, the world’s only wearable simulator for listening to the heart and lung; the Avstick, which vibrates the patient when the IV needle pierces its smart skin; the Avline for central venous care; the Avwound for pressure wounds; and the Avcath for urinary catheterization, with interchangeable genitalia. The Avband is like a smartwatch, enabling inconspicuous communication between control room, patient and simulators.

Standardized patients, simulation technicians

Avkin also make amniotic fluid, blood clots, exudate (a fluid that leaks out of blood vessels), placentas, umbilical cords, urine, veins and vernix (a waxy substance coating the skin of newborns).

With mannikins, “I felt as though the students were only getting a partial picture of what they were going to see in the hospital, and not so great and not so realistic,” Cowperthwait said, referring also to the concept of standardized patients, who are taught to act like patients with specific conditions.

McGonigle, in an Avkin blog, compares being a standardized patient with improv. “There are no specific lines given like there would be with a script because there is no way to anticipate exactly what the health professions students will do or say at any given time.”

Avkin products further increase the reality, and every few years, they upgrade their products, just like tech companies upgrade hardware and software. Similarly, users need to replace their simulators every few years, due to wear and tear. The increasing popularity of simulation products has created a new job of simulation technicians who maintain them.

“I’m the world’s most least likely CEO, because I didn’t have aspirations to start a company or be in business,” Cowperthwait said. “I just did it because I felt very passionate about getting these products out.”