Mannequins receive emergency care

Richard Rosengarten | March 1, 2010
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Medical students surrounded Mr. Smith. His vital signs blinked and changed on the monitor. He… Medical students surrounded Mr. Smith. His vital signs blinked and changed on the monitor. He stopped breathing.

The students’ teacher, Dr. Paul Rogers, sat nearby, evaluating their performance. Smith’s pulse dropped.

“Now what do you want to do?” Rogers asked his students.

The defibrillator — one of the students applied it to Smith’s chest. She bit her lip, looking at the monitor. It didn’t work. The students rejoined their classmates, who watched them try to save Smith. He didn’t make it.

Fortunately for Smith, he isn’t a real person. Smith is a mannequin — an expensive, realistic one, and a most valuable tool for Pitt’s medical students.

“They have mere months before they become real doctors, and they are scared to death,” Rogers said of the students, who are all in their fourth year of study.

The students work in simulation rooms in Pitt’s Peter M. Winter Institute for Simulation Education and Research on McKee Place. There they face medical situations designed to be as realistic as possible.

The key is the mannequins, some of which come with a $45,000 or more price tag. They talk, bleed, give birth and die, just like people.

Jamie McKinney, who had intubated Smith — the standard mannequin moniker — pointed at him.

“That thing blinks and sweats, and its throat closes up,” she said. “It’s freaky.”

Thomas Dongilli, director of operations and administration for the institute, said the realism, although occasionally unsettling, is best for doctors and patients.

“You don’t want them doing stuff the first time on you,” he said.

Besides procedural experience, the idea is nervousness — getting rid of it, that is.

Dongilli walked through some of the institute’s 16 simulation rooms, all of which can be manipulated as necessary.

One features wall-sized curtains that picture a Downtown Pittsburgh cityscape. Street noises play from speakers as students simulate emergency medicine.

There are simulations for dental sedation emergencies. A “wet room” simulates biohazard situations, with trauma limbs that squirt fake (edible) blood.

Noelle, the obstetrical mannequin, gives birth to a mannequin baby from her motorized uterus. In one room, full of mannequin pieces, Dongilli drew fake blood from a torso’s subclavian artery.

The simulation rooms are as close to the real environment as you can get, Dongilli said, and students get caught in the illusion of reality.

Often, physicians will call an end to the simulation, and the students will insist on continuing, intent on saving their Smith.

“They’re not ready to give up,” Dongilli said.

The importance of advanced training have become more acute since the turn of the century, when an Institute of Medicine report revealed statistics on medical errors.

The term “medical errors” generally defines those that are preventable. Medical errors can refer to implementing the wrong procedure or incorrectly implementing the right one.

The institute’s report said between 45,000 and 98,000 Americans die each year because of medical errors.

A 2009 report by the Pennsylvania Department of Health found that Pennsylvania hospitals reported 13,771 health care-associated infections from July 1 to Dec. 31 of the previous year.

The subclavian artery from which Dongilli removed fake blood is located next to the vocal cords, the carotid artery and the lungs. In the event a physician needs to find that artery, precision is necessary.

This is why Rogers’ students spend two hours per day, five days per week at the institute.

The class is not mandatory, but Rogers said most of the students sign up. He said it’s a kind of experience that doesn’t exist in a textbook.

“I never saw a patient who had multiple choice answers on their chest,” he said.

His students take turns “running the code” — or managing a patient’s treatment.

Adam Fang ran the code Friday when the students couldn’t restart Smith’s heart. On the other side of a one-way mirror, operators watched and controlled Smith’s vitals. Someone spoke through a microphone as Smith’s voice and manipulated controls that can stop Smith’s heart.

Fang said he sees the positive in the experience.

“It’s trial by error here so we don’t mess up on the floor,” he said.

Amanda Stephenson, the student who applied the defibrillator, said it can be scary, especially when Rogers tells them how he’s seen their simulation situation really happen.

Rogers stopped the simulation to review what went wrong.

The procedures are all recorded so that later, even at home, the students can go online and review their procedures and mistakes.

Simulation services coordinator Melissa Wanker cited one area of the program in need of improvement: Laerdal Medical, a Norwegian company, manufactured most of the mannequins, and they are mostly pale, blond and 5 feet tall, with flat stomachs and blue eyes.

Wanker suggested different kinds of mannequins — obese ones, for instance — to achieve a greater realism.

Still, Dongilli said the Wiser program is as close to the real deal as it can be.

The program prepares Pitt medical students in various disciplines, and it involves doctors from varied backgrounds who work part time with the institute.

The Institute also offers a program for Basic Life Support training that any member of the public can take.

Dongilli said the results of their work already show.

Children’s Hospital of Pittsburgh of UPMC has now been named a Leapfrog Top Hospital two years in a row. The Leapfrog Hospital Survey is a national public comparison of hospitals on issues like infections rates and safety practices.

A Tribune-Review report found a 43 percent decrease in a kind of intensive care unit bloodstream infection since 2001.

The realism of the experience is key to reducing mistakes in the field.

When a student makes a mistake in the institute, Dongilli said, and Smith goes down, that student will never make the same mistake again in his career.

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