Advanced mannequins help train Tenn. medical professionals
Mannequins are helpful for reviewing CPR, ventilation, arrhythmias
By Steve Hardy
The Chattanooga Times Free Press
ERLANGER, Tenn. — "I can't breathe!"
Erlanger nurses scramble to perform CPR and defibrillation on Mr. Bill, the medical mannequin. As the nurses open his throat and insert a breathing tube, the mannequin keeps meticulous track of their every treatment. Simulation director Rodney Westmoreland consults Mr. Bill's readings and corrects a nurse on her too-shallow chest compressions.
A few minutes later, Westmoreland presents a new scenario to the nurses: A pregnant woman was in a car accident and gave birth on the side of the road. Now that newborn needs treatment.
He steps aside, and the nurses rush tableside where a robotic infant lies, face turning blue. Westmoreland tells them to note that the child's chest is not rising as it should.
Amid a flurry of treatment, they discover that the baby will need medication, and emergency educator Nancy Stevens helps the nurses realize that the baby doesn't have enough time to receive the drugs by vein.
A nurse produces a drill, boring into the mannequin's shin to deliver the medication. The emergency technique is called intraosseous infusion, and it would have saved the newborn's life if the nurses were faced with a real deadly scenario.
Westmoreland, the medical simulations director at the Chattanooga branch of UT's medical school, performs simulated emergencies for hospital staffs, medical students and community groups like boy scouts. The Erlanger nurses who saved the infant were completing a scheduled review of emergency protocol.
He says that Erlanger's emergency room workers ask for incredibly difficult scenarios, recalling a recent case in which ER staff had to consult with X-rays of Mr. Bill that Westmoreland made, only to discover that they would have to perform a tracheotomy on the mannequin while inserting a needle into a deep chest artery.
Though they were initially puzzled, Mr. Bill made it through.
"It's hard to stump them," Westmoreland said. He added later, "[The mannequins] are all easy to kill."
"Every time I saw [Mr. Bill], I wanted to crumble, but I loved it at the same time," said Erlanger trauma coordinator Kelly Phillips, "You've got to step up and make decisions quickly. Time is precious in a code situation."
Besides Mr. Bill and the infant, Westmoreland works with Noelle, a difficult-birth simulator. He challenges students and professionals with breach births, tangled umbilical chords and occasional C-sections.
Meanwhile, Mr. Bill can perform about 50 medical scripts, Westmoreland said, and he can always tweak programs to add new symptoms.
"That's the cool thing, you can make this guy do all kinds of nasty things," Westmoreland said, "And they're all really believable."
Mr. Bill, the most advanced mannequin, has several lifelike features. Westmoreland can fill it with mock sweat, blood, tears, urine, nasal mucous and saliva, which he frequently makes frothy with soap. Mr. Bill's chest rises and falls as if breathing; his pupils dilate and contract in light; and his pulse is measurable by his femoral, brachial and carotid arteries.
Mr. Bill can even vocalize, and Westmoreland makes him yell when students shock him without giving him the warning they should give a real patient.
When the simulations director isn't on the road, he can train medical students from his mini-hospital at the Erlanger campus, which is set up with a mock intensive care unit, trauma room and delivery room. He orchestrates the simulations from his laptop, and cameras record the med students so they can review their tape after the training session.
The school began the medical simulation program in 2009. The price for Mr. Bill was $60,000, the two other mannequins were $20,000 each.
Phillips said that the mannequins are helpful to other nurses, noting, "They're not going to get into trouble if they make a mistake."
Nurses Lindsay Case and Joy Holland, who were among the group that recently trained with Mr. Bill and the infant said that the mannequins are helpful for reviewing CPR, ventillation and arrhythmias.
Westmoreland added that it gives staff an opportunity to work with the crash carts they use in actual emergencies.
"It's one of the few times they get to practice, but it's safe," he said.
Key features of the SimMan 3G:
- Pores and glands bleed, sweat, cry and drool.
- Pupils dilate according to light and health.
- Receptors can take and measure defibrillator shocks.
- Students can measure pulse at over a dozen sites on the body.
- Mannequin can groan, shout, and speak stored phrases or transmit speech from a trainer in another room.
- Chest rises and falls to simulate breathing.
- Students can inject mannequin with medicine, blood and other fluids, which mannequin measures.