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In Memoriam

Joel J. Nobel, MD

Our Tribute to Dr. Joel Nobel, Founder and President Emeritus of ECRI Institute
Joel J. Nobel, MD
December 8, 1934 – August 13, 2014
Joel J. Nobel, MD, December 8, 1934 – August 13, 2014
Man on a Mission
A Mentor, and A Valued Friend and Colleague

I had the pleasure to work with Joel Nobel for almost 30 years. Our most recent conversation was about a month ago related to an invitation he received to be a keynote speaker at an upcoming Saudi Food and Drug Authority (SFDA) conference on the reuse of single use medical devices. Joel had politely declined the invitation and asked me to find another ECRI colleague to fill in for him. During our conversation his voice sounded weak and I could understand how he may not have been up for a trip to Saudi Arabia. Little did I know that it would be the last time we would speak.

ECRI Institute has been receiving tributes from all over the world since we learned of Dr. Nobel's death. An e-mail from one of our SFDA colleagues I think says it best about how influential he was to so many. I quote, "this news falling like a rocket over my head!" As you can imagine, the ECRI Institute offices have been a somber place since we learned of Dr. Nobel's passing. Those of us who worked closely with him felt like we got hit by that rocket.

I've had a hard time picturing an ECRI Institute without Dr. Nobel. He was such a force of nature and had his strong hands on so much of our operations. It's sensible to ask how we can figure a way forward without him. But among Dr. Nobel's many gifts I think that the most important was how he was able to impart his knowledge and wisdom, entrepreneurial spirit, and sense of purpose to so many individuals. That definitely applies to ECRI Institute. Visitors to ECRI Institute are often amazed at how many staff have worked here for decades. We're also proud of our many colleagues who have come back to the fold after working elsewhere. We stayed or returned because we believe in the amazing mission he started nearly 50 years ago. And, although we are sad that Dr. Nobel has passed away, we are so confident in what he has taught us over the years that we feel well prepared to carry on.

As I am winding down my final days as ACCE President, I feel honored to have represented ECRI Institute and, in effect, Joel Nobel in this role. The Clinical Engineering profession owes Dr. Nobel a huge debt of gratitude. He literally got us off the ground and has been our guide for nearly 50 years through the services he ran and provided at ECRI Institute. Just like the legacy that he left with ECRI Institute, ACCE's membership is filled with those who were influenced by and learned from Joel.

I am also very confident that ACCE has a strong future. A big part of that comes from what many of us in ACCE were taught by Joel. It's that we should do it for the patients, do it well, and do it with honesty and integrity. If you would like to learn more about Joel Nobel and his legacy, click here for an ECRI Institute tribute. ECRI Institute will be organizing a formal memorial event in Dr. Nobel's honor sometime during the fall of 2014. I'll be sure to keep the ACCE community informed about this and any other memorial-related activities.

Thanks for all you have done Joel. And thank you for your support, mentorship, and trust. You were one of a kind and will always be Clinical Engineering's icon!

Jim Keller, ACCE President, August 21, 2014


Since I entered the profession, Dr. Joel Nobel was a person to be respected and a force to be reckoned with.

He was a pioneer, locally and globally, and encouraged many of us to take the profession to greater heights and deeper depths.

I am thankful for his friendship, his attention to meticulous science, and the organization that he created that has added great value to the US and the world.

Tom Judd, ACCE Advocacy Committee, August 18, 2014


When I met Dr. Joel Nobel at ECRI I was fresh out of college in 1975 and he was about 40 years old. He was clearly a "Man on a Mission" to save patients from pain and injury from defective medical devices, and to improve the efficiency and efficacy of healthcare. In retrospect, I now know that Joel was decades ahead of his time, and I learned that did not deter him one little bit!

The good Doctor handed each of ECRI's new engineering recruits in the 70's a loose-leaf binder chock full of rigorous Employee Handbook rules and a bright red Swiss Army knife, and threw each of us into an unknown sector of medical technology investigation with a mandate to learn the scientific, engineering, and medical principles, find the flaws in each product, identify constructive remedies where possible, write up our reports, submit to daunting internal scientific and peer review, publish our results, and then present our findings in public conferences. TALL order for 21-year olds on their first jobs, but Joel's faith in us, and his firm direction and discipline, allowed an awful lot of us to succeed beyond our wildest dreams!

I have to laugh to myself for the trust Joel placed in each of us as such young ages. In only a few years, many of us found ourselves presenting keynote speeches on his behalf at national and international scientific and medical sessions, and most of us had little more than a Bachelor's Degree and Dr. Nobel's say-so to back us up. As he sagely told me while calming my jitters before one of my first national debuts, "Just stick to what you know, Elliot, and don't let anyone draw you onto their turf. You know more about that product than anyone else in the nation, so stick to your guns."

I have to admit that Dr. Nobel was never easy to keep up with. He seemed to sleep but a couple of hours a night, and regardless of your medical, engineering, scientific, or legal specialty his habit of endless reading and his sharp, critical mind ensured that everyone needed to bring his or her "A-game" when you talked to him. Holidays and vacations seemed of little interest to him unless tied to a working mission or project, and the concept of retirement seemed unfathomable. Dr. Nobel never, ever sat still, and tracking him down around the globe was a challenge until the end! Not sure most of us would trade our own lives for his, but that was a choice that afforded him the constant cultural and scientific renewal and impact that made him tick.

I still hearken too many of the rules and explanations in that Employee Handbook, even though I've not been an employee at ECRI Institute for 25 years. Pearls like "a non-profit organization is not like most other corporations" as he tried to make it clear to everyone that ECRI's public mission and integrity took precedent over profit or rewards. Firm guidelines about spending funds as frugally as if they were your own personal money regardless of the situation, and incredibly restrictive conflict-of-interest and disclosure rules for each and every employee are today embedded in IRS and FDA guidelines and their peers around the world. I, and the non-profit organizations that I lead strive to live up to those requirements each and every day!

When I talked to Dr. Nobel as recently as last year, he had lost none of his missionary bravado, focus, or acuity, and his global treks were only limited by the wear and tear of travel. No country was too small, and no slice of society was unworthy of his time and attention. Unfortunately, though blessed with a brilliant mind and visionary perspective, his solid, stocky body turned out to be less robust than his intellect. Though I probably had close to a foot of height advantage over him, he was never less than a giant in my mind. I am sure that I won't be the only one to remember him that way, either!

You will certainly read of Dr. Nobel's accomplishments in the future, but I can tell you first hand that most of the accounts will be humble re-telling of a legacy that did -- and will continue to -- improve healthcare around the planet in remarkable and important ways. In the early days, half or more of the medical devices his engineers tested were at best mediocre, and many were a threat to life and/or limb. Today, though, most such testing reveals good-to-excellent products in the US market that are differentiated on features, price, and preference. That is quite an achievement, and it was won one year at a time relying on Dr. Nobel's commitment to "The Discipline of Science." and "The Integrity of Independence." That is the current marketing byline that the ECRI Institute that Joel founded, and it speaks volumes about the organizations ongoing mission.

Personally, few will know of Joel's wry humor and bent towards practical jokes, and few will know just how far he would go to help a younger engineer or physician develop a successful career. I owe him a huge debt of gratitude for his training, discipline, and visionary leadership, and can honestly help say that Dr. Nobel helped shape my career and life.

There are probably several other hundreds of my peers around the world -- younger and older -- who will have similar recollections and feelings, and I hope they all eventually say their piece. To me, early in my career Joel was like a second father, and leaving him and ECRI to expand my own career was not an easy decision for me to make in 1990, but he knew, too, that it was time for me to move on, and his friendship and support for me and many others proved to be unending. Farewell my dear friend. We will all miss you, but many of us will continue to do our best to honor you courage, vision, and insight. Honor and respect are due. Rest in peace, good Samurai, and soar joyously into the winds and in our memories for eternity.

Elliot Sloane, August 20, 2014


I do not know how many of you know who Dr. Joel Nobel was or had the pleasure to meet and speak with him. I had the opportunity of working with him for five years. Dr. Nobel was the Founder and President of what was then the Emergency Care Research Institute (ECRI).

Many things we take for granted today as biomeds, were not around thirty years ago when Dr. Noble asked questions regarding engineering principles and scientific investigation of medical devices. He did landmark work on resuscitation, crash cart design (yes 30 years ago the crash cart did not exist as we know it) and turned the industry on its head by simply testing a bunch of bag valve mask (BVM) units and finding half did not provide enough volume, oxygen and numerous other parameters to resuscitate patients. This was the first issue of what was to become Health Devices - keeping with his objective attitude of engineering principles and scientific investigation he developed a culture to question and validate. Many engineers, such as myself, worked for ECRI for years and took this methodology into the hospital. Dr. Nobel was always proud not only of the people working with him, but also those who had worked for him and maintained their passion for patient safety and basically "spread the word".

ECRI went on to validate ambulances and the equipment carried in the ambulance. Many of today's standards (called KKK) for EMS equipment and vehicles were developed by ECRI and Dr. Noble reaching out to assure appropriate technology and patient care everywhere a patient was treated. Electrical safety testing, defibrillator, laser and ESU output testing, receptacle testing, medical gas testing and many other functions we do today he helped develop and standardize for our profession. Equipment databases as well as standardized descriptions, testing protocols, etc. were all developed by ECRI during hospital biomedical early years. Projects many of us work on today to properly manage technology from pre-purchase through surplus - technology management of medical devices - was developed and proven domestically and internationally under his guidance at ECRI. Work we do today to assure compatibility between medical devices, systems and facilities was something ECRI started educating biomeds about in the 1980's. Laser safety, operating room fires, the list goes on and on of work he directed and mentored at ECRI that is now practiced daily to improve patient safety.

The biomedical profession has lost some of our foundation with Dr. Joel Nobel's passing.

Duane Mariotti, August 18, 2014


It was either shortly before graduating as a clinical engineer from Purdue in 1974 or very shortly thereafter, I came to appreciate the work of Joel Nobel and his ECRI team. I started the first clinical engineering program in a two hospital system in Cincinnati (totaling 650 beds) and ECRI's Health Devices became my "bible." I remember asking my incredulous boss for the "hundreds of dollars" to subscribe ... but my enthusiasm for the relatively new service must have won him over. If subscribing to ECRI's Health Devices and getting phone access to their talent had been the extent of my involvement with Joel's organization, I am sure that would have been sufficient for me to be praising the incubating role Joel and ECRI played in the early days of our industry.

But two years later I found myself in Plymouth Meeting working at ECRI. I only worked there (in what we referred to as "the lab") for 3 years but thanks to Joel and the talent he could attract, I believe they were the most formative of any time in my career.

Joel was probably the first real genius I met...though there were unquestionably others on his team (who remembers Guy Knickerbocker?). As it is with so many great geniuses, I soon learned Joel had idiosyncrasies that would forever make him an icon and a legend. Many of my past and current ECRI friends will remember some (or most) of the following:

  • always wearing OR "greens" and with his flak jacket serving as an overcoat...He didn't like to go out of the "lab" often and it was probably 2 years when he and I did a speaking engagement together and he was forced to wear a jacket and tie.
  • equipping the company Toyota Cressida wagons with survival gear and supplies...complete with machetes
  • conducting an interview from under his desk with a flummoxed job candidate (who didn't get the job)
  • having telephones installed in the bathroom stalls
  • driving around the office campus in his full sized farm tractor
  • dropping in on orientation for a new group of technicians to give classic career advice (which though humorous now, I can't repeat)
  • hiring a violinist during one holiday period to stroll up and down between our cubicles to play holiday music
  • on one holiday giving each member of the staff a smoke alarm and on another, a fire extinguisher (practical gifts which left no doubt as to his concerns for our safety)

 

I will miss Joel. I will miss the idiosyncrasies that endeared him to us and the genius that inspired us. I loved him for all of it and I will be always be grateful to him for giving us the extended ECRI family...a family whose talent was synergistic and that continues to grow to this day.

Joel...you left this world a much, much better place. Who can aspire to more? Thank you and God speed.

Stephen Grimes, August 20, 2014


Joel Nobel was certainly one-of-a-kind. What I particularly remember was how he took a genuine interest in every one of his employees - both personally and professionally. He wanted everyone to enjoy what they were doing and to grow in their position. This was an extension of what he felt about the mission of what was then the Emergency Care Research Institute (ECRI).

Joel and ECRI were committed to improving the safety and performance of medical devices, by evaluating their design and performance, and by explaining how to best use and maintain them. What is now ECRI Institute has been very, very successful because of Joel's leadership, and will be a testimony to Joel's vision for decades to come.

Robert Stiefel, August 19, 2014


"Been there, done that!" was essentially what he said about all the challenges and solutions that I presented at the World Health Organization's meeting in Madrid in the early eighties. I was reporting the first few years of experience in managing medical equipment for a university hospital in Brazil and obviously did not appreciate to hear those comments from that older gentleman who later I learned was Dr. Joel Nobel. So I made a point of visiting him and ECRI the next time I was in the US.

Joel was extremely kind to me during the visit and even offered me to stay at his "bunker" house but I noticed that he had a WWII tank parked in his garden in case I did not behave appropriately. From that point on, we started a long and fruitful relationship that lasted many years, not only in the US but also in several international projects. During all these years, I never ceased to be amazed to see how clear and far he presages into the future, well beyond the basics of technology management.

Binseng Wang, August 20, 2014


I was saddened to hear of the passing of Joel Nobel. He was a unique individual person. And what a visionary. To have the vision, passion and compassion to start the Emergency Care Research Institute (later ECRI) a not for profit organization dedicated to the safety of the 'patient' using tools like, Health Devices (journal), all I can say is 'wow'.

He brought together talented individuals to help him with his vision. I was not talented like that, I was just a newly graduated CE when I joined Dr. Nobel in 1976 in the field services group, ECRI Services.

Joel, thank you for your vision, leadership and toughness. You will be missed as a person and as an innovator.

Don Robida, August 20, 2014


Betsy and I were driving from Ocean Grove, NJ to our house in Setauket when Betsy mentioned that she thought pachysandras would make a good ground cover around our house.

I told her about the time Joel put all of us to work planting pachysandras around the newly constructed facility in Plymouth Meeting. Probably one of the most productive uses of the talented engineers and scientists Joel had amassed. Joel was quick to do what was right and expedient while crashing through the musty walls of convention.

I mused to Betsy about what life would have been like had I stayed at ECRI and how I would do competing against Joel in the "wheelchair races." We fellow workers in the 70's joked about an imagined Joel vision of a retirement community of loyal employees who, to pass their time, would participate in wheelchair races and other fun activities.

Ironic, coincidence? I prefer to think of this evening's musings as a brief whiff of the spirit of God that in some way made me aware of the respect I owe to the invaluable encouragement to excel in finding the truth inculcated in me by my boss, Joel Nobel.

Joel said, "If you don't know the answer to a question, say that you don't know but you'll find out the answer." This and many more guiding principles have enriched my life.

The morning I returned to work after the funeral of my father in 1974, Joel sat beside me at my desk, offered his condolences and shared his thoughts on memories of the death of his father and the importance of persistent memory of those we love. Whenever I see a schefflera plant I think of the kindness of Joel and the ECRI crew who sent one to my mother as a token of their sympathy.

Joe Dyro, August 19, 2014


In the mid 1970's at the beginning of my clinical engineering career, virtually everything I learned about how to evaluate, test, inspect, and maintain medical devices in the hospital environment came from ECRI and Health Devices under Joel's leadership. The engineering and scientific rigor they brought to their testing procedures along with the scrupulously unbiased nature of their reporting of results set the bar and became the model that continues to serve me still. The entire HTM and clinical engineering community owes Joel and his pioneering work with ECRI a tremendous debt of gratitude for the lasting contributions and gifts of insight he gave to us all.

Larry Fennigkoh, August 21, 2014


Joel J. Nobel, MD, was my colleague, mentor, and friend for 39 years at ECRI. It was with shock and deepest sorrow that I learned of his death when I came to work last Monday.

My colleagues at ECRI and those within the biomedical and clinical engineering fields have, over the past week, abundantly extolled the virtues of Dr. Nobel and his accomplishments: the MAX resuscitation cart, ECRI's benchmark Health Devices independent medical device evaluation program and publication, his vision for and dedication to improving medical device safety and efficacy, the close ties he always fostered with ECRI staff, his bawdy (and frequently questionable) sense of humor, and his fierce integrity, to mention just a few.

For me to give a comparable recitation of my almost four decades of experiences with Joel would take more out of me than I am capable of undertaking at this time. Rather, I offer an overarching perspective and two poignant anecdotes from others.

Joel was perceived by a few of us engineers at ECRI as a mentor. Over the years I have come to conclude, however, that mentors have a limited duration in that role. You take and apply the best of what a mentor has to offer. At some point down the road, however, you begin to question some of the perspectives, judgment, and guidance from the mentor. This is appropriate: you are learning. You further learn from observing the mentor's mistakes, as well as from your own mistakes. After about ten years though, if you are lucky enough to have had such an extended association, the mentor has largely run his or her course in that role and morphs into a peer sounding board and reviewer. Such was the case between Joel and me. I value tremendously my having known, worked, debated, played, and traveled with him.

I last spoke with Joel on July 1, 2014, to discuss a speaking invitation from Saudi Arabia. Since that time, just three weeks ago, I per chance encountered a first-hand historical anecdote about Joel's MAX Cart. While performing an accident investigation at a Delaware Valley area hospital I worked with the risk manager. She has been to ECRI many times for risk management society meetings. During my investigation she commented on the MAX Cart displayed in our lobby. She knew that Joel had invented it and asked about him. As a nurse in the late 1960s and early 1970s she stated that she had used it five times and successfully resuscitated all five patients. This is likely one of the few medical professionals who remember having used MAX. She commented that it functioned marvelously for resuscitation and quipped that she felt competent enough with MAX to give instructions on its use, if such training was still needed! I had meant to tell Joel about her experience and comments on the lives saved, but did not get the chance. I wish that I had.

In 2013, Joel received an extraordinary and touching email letter from the aging wife of physician who had been a medical resident at Pennsylvania Hospital with Joel in the mid 1960s. Joel shared the email with just a few of us. The woman had worked at the hospital at that time. She commented in her letter that of all the residents, Joel was "the only one that stuck with me because of your intentions to make it a better world for human beings." She went on saying "I remember your lunch time doodles of MAX and a rescue helicopter. You were so determined to use your life, heart, intellect, and talent to make a difference for humanity." Many other compliments and praises were in her email, including "So proud I am of you."

Joel indeed made a difference for humanity and he had much to be proud of. The world of healthcare is a demonstrably better and safer place because of him.

So, it has come to this. To Dr. Joel J. Nobel—I leave you with the opening of the First Aphorism of Hippocrates: "Life is short, and art long; the crisis fleeting; experience perilous, and decisions difficult." You experienced it all, sir.

Farewell, my friend.

Peace.

Mark Bruley, August 23, 2014


Joel Nobel was an exceptional individual and a profound, positive influence on the level of professionalism in today's Health Technology Management community. We all owe Joel a huge debt of gratitude for the many, many contributions he and his staff at ECRI have made over the years, but particularly during that critical time in the 1960s and 70s when the field of clinical engineering was just emerging.

I remember during those early years visiting with Joel and his young team at ECRI's first office - behind the red door on Chestnut Street in Philadelphia - and witnessing firsthand the extraordinary warmth that Joel, in his ever-present scrubs, projected as he presided over the family-like gathering around "his" lunch table. There was no doubt that he was the father figure.

Like Joel, I was privileged to be a recipient of grant funding in the 1970s from the W.K. Kellogg Foundation to develop one of the shared service programs that played a part in the early years of clinical engineering. It was an interesting time to be in the business and it was exciting to be a part of that small group of Kellogg beneficiaries that became known as "the founding fathers". Although I suppose we were all peers, Joel's statesman-like manner always moved him to the head of the line. He was a natural leader as well as an excellent and very articulate spokesperson. For me, his most memorable contribution was the testimony he gave to the Senate Subcommittee on the proposed Medical Device Amendments of 1973 in which he completely blew away the possibility that the "microshock" phenomenon "invented" by Dr. Carl Walter and famously publicized by Ralph Nader in The Ladies Home Journal was a significant threat. He did that by testifying (in part) that:

"Bogus statistics on electrocution in hospitals have been proclaimed and republished without end – or confirmation – for five years. Many millions of words have been written about microshock and many millions of dollars spent to avoid it. It is obvious, however, that we still know nothing of its real incidence…."

This dramatic declaration marked the beginning of the end of that very important first period of overblown concern about electrical safety.

Joel was an ardent student of classical military strategies and one of his favorite stories was about the workaround that was used in his day by the surgical residents in the downtown Emergency Rooms in Philadelphia where a fair number of street gang casualties were received. They were not allowed to carry any kind of side arm, so - he would explain - they used to keep one or two bottles of saline on the shelf above each of the gurneys to provide them with some means of self-protection. Then, with his impish smile, he would add that - to keep the record straight - if they ever had to use one, they would enter into the patient's notes that 500ccs of saline had been administered supra-cranially.

It was my privilege to know Joel Nobel. He was an inspirational mentor and I will miss him. Thank you Joel! You made this world a better place.

Malcolm Ridgway, August 24, 2014


The clinical engineering community in China is very sad to learn about the passing of Dr. Joel Nobel.

Some of Chinese clinical engineers (including ZHENG Kun and me) met him in person and listened to his remarkable speech on health care technology management during a Child Health Care conference held in Guangzhou, China, in 1993. Since that visit, we have pursued his vision of making "hospitals safer for everybody” and benefited from visits and trainings provided by people trained and inspired by Dr. Nobel.

We believe it is a great loss for all of us. We will never forget his leadership and contribution to safety and efficacy of healthcare technology.

ZHOU Dan and Chinese CE leadership, October 2, 2014

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