Surgeons teach trauma interventions on computerised "smart" mannequins

New Orleans 10 October 2001Anyone who has completed a course on cardiopulmonary resuscitation (CPR) is familiar with the mannequin that is used as a teaching device for trainees to learn how to resuscitate a heart attack victim by compressing the chest and breathing into the airway of the simulated patient. Military surgeons at Ben Taub General Hospital, Houston, Texas, are using a new generation of "smart" mannequins as simulated accident and injury victims to teach and evaluate the performance of trauma teams.


At the 2001 Clinical Congress of the American College of Surgeons, Dr. Holcomb, MD, FACS, director of the US Army's Joint Trauma Training Center at Ben Taub General Hospital, reported on a unique study which used the patient simulator to evaluate the work of critical care professionals who work in teams. He pointed out that trauma surgeons, nurses, and paramedics participate in educational programmes teaching them how to work on trauma victims individually. "But when you work on a patient, the physicians, nurses, and medics work as a team", according to Dr. Holcomb.

Dr. Holcomb explained that mannequins in CPR training are "dumb". They are lumps of plastic that do not respond physiologically to resuscitation techniques. "We mimic working in an emergency room placing chest tubes, quickly recognising declines in blood pressure, and performing laparotomy, as well as communicating verbally and non-verbally among the team members", LtC. John Holcomb stated.

The Human Patient Simulator from Medical Education Technologies Inc. (METI), Sarasota, Florida, is essentially a computer which looks like a mannequin and reacts like a patient. "The mannequin can simulate a tension pneumothorax or collapsed lung. If the trauma team doesn't put a tube or a needle in the chest, then the mannequin dies. However, if the team recognises the physiology of the pneumothorax: decreased breath sounds, falling blood pressure, decreasing oxygen saturation, and intervenes appropriately, the oxygen saturation and blood pressure rise, and the mannequin lives."

Some trauma training programmes place video cameras in the emergency department and videotape trauma teams as they perform actual resuscitations on real patients. However, circumstances largely vary from patient to patient. "A pneumothorax in a young person is very different from a pneumothorax in an older one. So if a trauma team doesn't perform well, you cannot tell if it was because the patient was different or because team members didn't know what to do or were having a bad day. The mannequin provides the same physiological data from one time to the next, so you can tell how trauma teams handle specific clinical situations", Dr. Holcomb noted.

The study evaluated ten three-person resuscitation trauma teams before and after they underwent a 28-day trauma rotation. Teams were tested on their ability to resuscitate the Human Patient Simulator, which had been programmed to represent a severely injured multiple trauma patient. The mannequin simulated a trauma patient who had an Injury Severity Score of 39, which in an actual treatment situation carries a mortality of 50 percent. The teams' performance was measured by a unique assessment tool created by the military team to evaluate aspects of patient care which are universally accepted as being critical to the initial assessment and treatment of a trauma patient.

The tool includes five subjectively scored tasks, such as the restoration of breathing and circulation in the mannequin, and the effectiveness of communication among team members. The tool also tests eight time-sensitive activities, such as placing chest tubes and applying a tourniquet to a bleeding extremity. The study showed that all ten teams improved significantly in all of the subjectively scored tasks and in six of eight timed activities after the trauma rotation.

Dr. Holcomb and his associates are using the Human Patient Simulator regularly in the educational programme directed by Dr. Holcomb, which prepares surgeons, nurses, and medics for military field work. "Our job is to train military surgical teams who work at non-trauma centres but who may be called to take care of trauma patients in the worst possible environments, working out of tents in the field in foreign countries", he observed. More information on patient simulators is available in the VMW July 2001 article Advanced patient simulator lets students recognise any disease and perform emergency training.

Leslie Versweyveld

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