Arpana Shrestha and Sydney Gallo slipped into a break room at Adventist Health Sierra Vista, trading street clothes for scrubs before heading back onto the emergency department floor.
Late in the summer, the rhythm felt familiar: the board tracking patients who were waiting, ambulance radio traffic cutting through, routine tasks unfolding until, without warning, everything shifted. They had watched a patient airlifted to Stanford, seen clinicians set a broken bone in a 12-year-old girl and, once, witnessed a woman’s heart stop, then start again.
Between those flashes of urgency, the biomedical engineering students kept returning to a smaller problem: How do you catch danger before it announces itself?
In an ambulance, a paramedic can press a finger to a patient’s skin to check capillary refill, a quick read on blood flow. In the emergency department, that same signal can offer an early warning, long before a blood pressure number drops into crisis. Shrestha and Gallo began wondering why that check still depends on someone remembering to do it — and whether a device could automate it.
That kind of question sits at the center of the Biomedical Clinical Engineering Partnership, known as BiCEP. Over 10 weeks, a small cohort of second- and third-year biomedical engineering students rotates through hospital units, shadows clinicians and brings those observations back to campus, where they are developed into potential solutions.
“It’s part of a broader vision for driving innovation in medical technologies for San Luis Obispo and the larger community,” said biomedical engineering professor Chris Heylman who helps lead the program.
The summer marked BiCEP’s fourth year under a five-year grant from the National Institutes of Health, with a fifth year planned for this summer. Faculty organizers are working to secure additional funding to continue the program and sustain the clinical immersion experience. A bedside observation can become a prototype, then a senior project. Some students continue building after the summer ends.
Back on campus, the debrief began.
In an early session, small teams took turns describing what they had seen during rotations at Adventist Health Sierra Vista. The observations were specific, but still in motion. Students talked about pressure ulcers and the limitations of current cushions and mattresses. They sketched early ideas for arch correction, then paused as mentors pressed them to define success in real-world terms.
The cycle between clinic and campus is built into BiCEP. The cohort is small, made up of second- and third-year biomedical engineering students. During the first part of the program, they rotate through units that include the emergency department, intensive care, the operating room, neonatal intensive care and labor and delivery, before spending a longer stretch in one department.
On the university side, Heylman worked alongside biomedical engineering professors Michael Whitt and Ben Hawkins to guide BiCEP. In the room, they kept pulling students back to fundamentals.
“You have to pinpoint the population, the problem and how you would measure whether something actually works,” Heylman told them.
Clinician mentors pushed the same way. Neonatologist Steven Van Scoy, M.D., pressed students to think about what makes a solution viable inside a working hospital. “There’s a huge financial incentive to avoid these things,” he said, noting that hospitals can face denied reimbursement when preventable complications occur. But anything that adds steps for nurses or disrupts routine, he warned, is hard to sustain.
By the end of the summer, the focus narrows. Teams choose a single project, stay embedded longer and build a prototype to present. Many projects continue into senior design during the academic year, carrying clinical context with them.
As the summer moved on, Shrestha and Gallo had to decide whether their device could hold up beyond its first pass.
While shadowing clinicians in the emergency department, they moved between rooms, comparing notes in quieter moments and going silent when the pace shifted. An automated capillary refill device made sense in theory, but it had to survive conversations with the people who would actually use it.
“What stood out was how much the nurses rely on monitors,” Gallo said. “Once a patient is hooked up, they’re watching heart rate and blood pressure. They don’t always know something is wrong until the blood pressure drops.”
That reality sharpened the team’s attention, as capillary refill offered an earlier signal only if it could be measured consistently and without adding work. They began designing toward simplicity, aiming for something that could keep pace with the emergency department.
The ER environment also shaped how Shrestha approached the problem. “There’s so much going on,” she said, as nurses walked them through the equipment they rely on and explained what they watch for between checks. The experience pushed her to think about materials, durability and whether the device could be worn without getting in the way.
Gallo, who earned her EMT certification at Cuesta College, framed the work clinically. Watching patients arrive by ambulance and move through the department helped her connect early indicators to real outcomes. “It made me think about how you catch things before they turn into emergencies,” she said.
Makenna Ladyga and Isabella Gallegos followed a different path through labor and delivery.
They spoke on the floor not long after watching their first cesarean section, still sorting through what they had just witnessed. The procedure moved quickly, but details stayed sharp: a crowded room, a sudden rush of fluid, the father breathing along with the mother as he took photos. When the baby was held up, Gallegos said, the moment landed all at once.
“It was very intense,” she said.
Beyond the pace, the amount of force involved and the constraints clinicians work within raised new questions.
In labor and delivery, they learned more about retained placenta, a leading cause of postpartum hemorrhage, and the risks clinicians work to manage when it occurs. The force involved — and the limits clinicians work within — pushed them toward a design challenge. They set out to develop a safer way to remove retained placenta and other products of conception after childbirth, aiming to reduce infection risk and minimize trauma to the uterus.
“We wanted a less traumatic method,” Gallegos said.
With guidance from physician mentors, the team began developing a soft, spiral-tipped device designed to rotate rather than scrape, loosening placental tissue while staying below known damage thresholds. Gallegos compared the motion to a paint stirrer, a simple image for a problem that quickly became more complex.
As the project moved from early design to testing, Ladyga and Gallegos ran into a larger challenge: Very little research existed on how much force uterine tissue can safely withstand during placenta removal. “We couldn’t find data on the force being applied,” Ladyga said, “so we had to collect it ourselves.”
To fill that gap, the students conducted tensile testing on pregnant pig uterus tissue, collecting force data and comparing it to what physicians apply during manual removal. The results helped set design limits, turning a clinical observation into numbers the team could design around.
The process underscored how open-ended the work could be. “It would be cool to see this go farther,” Gallegos said. “It has the potential to keep evolving.”
In BiCEP, that impulse is often the point. It doesn’t stop at the final presentation. Many projects move into senior design, where new teams take them further. In some cases, a concept grows into a student-founded startup. Everest Medical grew out of BiCEP work focused on improving assisted childbirth and is developing an assisted-delivery device to modernize delivery tools and support safer care. The pathway is the same from the start: see the need, define it, test an answer and keep building.