Real dummy teaches at Anaesthetics – UKZN

By Naren Bhimsan, chief technologist

Everybody's first encounter with Stan (short for Standard man) is the same, no matter if they are doctors, nurses, medical students, anesthesiologists or technologists. First chance they get, they try to kill him.

Stan's a dummy -- and one sophisticated dummy at that. From his resting place on an operating table at IALCH, Dept of Anaesthetics, the R 2,8 million (current replacement value)mass of plastic, metal, wire and circuit board spends his days crashing into all manner of medical trauma: heart attacks, asthma attacks, blocked airways, collapsed lungs.

Medical simulators like Stan, introduced ten years ago, are rapidly finding their way into hospitals around the world. They are part of a growing effort to train medical personal without risk to patients, to cut mistakes by professionals and, when errors happen, to find out why.

“The students want to see a “real” dummy”, says Naren Bhimsan, from the simulator lab whose computer makes Stan run. “They want to see the chest moving, feel for a pulse and a real CO2 coming out of his lungs. Stan actually breathes out CO2 ”

Flight simulators came about because airlines and the military figured it would be cheaper for a pilot to crash a virtual aircraft than a real one. The idea is similar in patient simulators: Better to kill a dummy than a patient.

"Just as people prepare with fire drills and disaster training, we want medical students to know what it's like before it happens," says Dr. Christian Kampik , a consultant in the Anaesthetic department who uses the simulator.

Stan has blinking eyelids, pupils that dilate, an airway that opens and closes, and a pulse. He breathes and exchanges gases like human lungs. One can inject drugs, drain fluid from his heart sac, intubate him and insert chest pumps. Stan's name comes from his default setting -- standard man -- but he can become "Truck Driver," a beer-swilling cardiac patient who smokes four packs a day. There is a program for "Soldier," who has a gunshot wound. We can also change his condition on the fly to keep students off-balance.

When doctor or nurse trainees give Stan a "drug," they scan the bar code on a syringe. Stan then reacts appropriately. Since Stan's heart and lung functions are the most advanced, he's become especially useful to anesthesiology students, who don't have much room for error when they put human patients to sleep. He can be programmed to suffer a heart attack during an operation, an allergic reaction to a drug or an unusual side effect.

We plan to use the dummy by the surgical, nursing and anesthesia departments for crisis training; by the registrars for trauma lessons; and by medical students for basic medical and health education.

"Let's say this guy has a heart attack, which means the heart is not pumping properly. I set the heart function to be low -- changing just one parameter -- and everything else changes. Blood pressure will go down, heart rate will go up, and oxygenation will go down as not enough blood reaches the body."

”Sometimes we program Stan to show signs of an extremely uncommon condition called malignant hyperthermia, in which anesthesia causes a dangerous rise in body temperature. It's very rare,” said Naren. "An anesthesiologist would only see it twice in their career. But if you don't treat it appropriately, the patient is guaranteed to die. We can train someone to handle the hyperthermia so when they come across the one patient in 15 years, they'll have experienced it before and be more likely to do the right thing."

The procedure is videotaped, and the group uses it to discuss what they could have done better. They can practice all the uncommon events, the crises. In the same way, medical students and registrars can come into the lab and work through scenarios a dozen times. The other way to learn? "On real live patients - on you, your wife or your children."

"It's not all reality, because it's still a simulation," he says. "But it's close."

The biggest challenge is to get the medical community to accept simulation and pay for these things. At the moment, people say R 2 million, that's too much, we can't afford it. But if your child has an asthmatic attack or has a severe allergic drug reaction, would you want your doctor to work on your child having never seen the problem before, or having practiced 10 to 20 times on a simulator?"

Adapted from report by Dr WB Murray - USA

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