Associated Press
DOTHAN, Ala. — Karen Clenney spends her days preparing patients for an assortment of medical scenarios - from giving birth to a collapsed lung or a heart murmur. She can even do a severed arm or a gunshot wound to the leg.
If someone needs a head wound, chances are Clenney has one in the freezer.
Clenney’s job is to program the 15 healthcare mannequins in Wallace Community College’s Health Sciences Simulation Center. The newer mannequins can be programmed to sweat, urinate and bleed. They have breath sounds, bowel sounds and pulses. An obstetric mannequin not only gives birth but can have a post-partum hemorrhage if necessary.
“They don’t get up and walk yet,” Clenney said. “We know that’s coming. They’re actually talking about that in the community - the hand movements, the grips ? because you want neurological checks.”
The simulation center is utilized by the college’s students in programs like nursing, respiratory, physical therapy assistant and emergency medical services.
With a dual job title of faculty support technician and simulation center coordinator, Clenney’s job is a marriage of healthcare, technology and little experimenting.
Through her job, Clenney has learned a little bit about moulage, which is a French word meaning casting or molding. Moulage is the art of creating mock wounds or injuries for training. It’s also used in Hollywood for special effects. It adds a hint of realism to the simulations.
Corn run through a blender, Cream of Wheat or oatmeal all make good vomit. She’ll even put a little on a mannequin’s gown to dry before students arrive. Cat food and chocolate pudding work well in a colostomy bag. Candy bars, of course, make good poop. Distilled water and a powder mix are used for blood. Ground up dried cranberries stand in for blood clots in a urine collection bag.
Watercolors can help create bruises. The goo inside fish oil softgels can be used to recreate infections, and Liquid Smoke can replicate the smell of a patient who has been in a house fire. While limburger cheese can recreate the smell of a dead body, it’s not something Clenney uses a lot because . well, it stinks.
If Clenney can’t find a recipe in her go-to moulage book, she’ll turn to the internet.
“With Google I am unstoppable,” she said.
She hopes the simulation center will be able to get some pre-made burn wounds or even create a drug den for EMS students complete with needles and other hazards paramedics might encounter in such a situation.
“It’s all-encompassing the senses - the smells, the sounds, the sights,” Clenney said. “We’re kinesthetic learners if we put our hands on, but how do you handle a smell of rotting flesh? Burning flesh - I don’t think anything can prepare you for that. Maybe we can, but we haven’t gotten there yet.”
Clenney has worked at Wallace Community College since 2007, originally hired under a Department of Labor grant. At the time, Wallace had just bought three mannequins for medical simulations. It was suggested to Clenney that she could learn about the mannequins for some added job security.
Instructional technology, as Clenney’s field is called, is an emerging job field. At conferences, Clenney is typically one of only a few people who have worked in healthcare simulation for 10 years or longer. There’s no set standard, Clenney said. Some employers will seek people who have more of a healthcare background who can learn the technology while some advertise for someone with a technology background.
Others want a healthcare practitioner who can program and network - a combo that is a bit unrealistic, Clenney said.
“You can’t expect a nurse or a paramedic or any of those instructors to walk in and run it,” Clenney said of the high-tech simulators. “You go to so many facilities and it’s just the nursing instructors trying to run these mannequins and they don’t know how to set up a network and they don’t know how to set up the cameras and when he malfunctions, hopefully they can get online with tech support. That’s where I feel like I fill that gap.”
Clenney works closely with instructors to program the scenarios they want to see students work through and the different medical paths a patient can take depending on the decisions made by students. Instructors provide all the vitals Clenney needs to program - heart rate, respiratory rates, and blood pressure.
There are pre-written scenarios that are used, and Clenney and instructors can tweak those to suit their needs. While the students run through the scenarios, Clenney and the instructors observe from behind a two-way mirror. From their observation room, instructors can give voice to the mannequin, watch patient vitals and observe students from different camera angles.
Even with all the technology, the goal for students is pretty basic.
“The thing is communication,” Clenney said. “The thing is teamwork and them working together and how they’re working with the patient.”
Rebecca Burke, program director of Wallace Community College’s Emergency Medical Services program, said mannequins have been used decades. Today’s mannequins are just more high-tech.
“Having the equipment we have now has made it much more lifelike without putting any live patients in any particularly harmful situation,” she said. “So, our equipment now can have bad stuff happen to them over and over and over again to build up the reflexes and build up the response of a variety of students from nursing to respiratory to EMS.”
It’s a different world from when students used chicken bones to practice drilling into bone, Halloween makeup for wounds, and plastic tubing wrapped in foam and latex to practice surgical airways, Burke said.
Today, medical simulations are much more efficient and realistic. Still, one of the main goals of instructors, Burke said, is to get the students to adapt to any situation. Instructors even go as far as taking away equipment students think they might need.
“The more I can create a stressful situation for them in a very safe setting, the more that teaches them to adapt in real life,” she said. “There’s no way we can ever train these students for every possible contingency for what they’re going to see, so, we want to teach them to be adaptable. Be trainable, be adaptable, always be mindful of your surroundings and the how . to overcome these obstacles. That is our goal. I’m not sure we always hit it, but our goal is to always get better at it.”
For her part, Clenney feels she’s contributing to better healthcare workers. It’s something she takes more personally since she lost her father a few months ago following an illness.
“Even though I am not a healthcare person, I feel like the things they do in here are going to make a difference,” Clenney said. ". For them to have a gut-check moment, I’d rather them have it in here. You don’t have the lawsuit; you don’t have the family screaming at you or falling out. This is the place that if you’re going to make errors, we want you to do it here.”
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