February 18, 2019
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The Sims

How tech-heavy, high-fidelity mannequins became a favored medical learning tool
Sim Man, a high-tech teaching tool, being used by Keith Miller, lead flight paramedic, and Pat Rauscher, chief LifeFlight nurse

The man is having trouble breathing in a St. Mary’s hospital room. He is choking on blood, and that blocked air passage means Pat Rauscher can’t perform an intubation. You remember intubation, right? George Clooney did one nearly every episode of ER by placing a tube in a patient’s mouth and down the trachea, thus saving another life. But now, Rauscher, St. Mary’s chief LifeFlight nurse, has to be the hero, and he has help: Keith Miller, lead flight paramedic.

Rauscher pours iodine on the man’s throat to prevent infection and takes a needle through the cricothyroid membrane (about one centimeter long) on the throat. With the hole in place, Rauscher guides a tube into the incision. The man, attached to a patient monitor that flashes brightly colored numbers signifying his heart rate and pulse, lies still while the nurses listen to his breathing. If it starts to return to normal, they’ve successfully surpassed the obstruction in the airway. The room — filled with nurses, a reporter, and a photographer — is so quiet. “You know, if this were a real emergency situation,” quips Miller, “the room would be this calm.”

Everyone erupts in laughter because the man with a rubber face isn’t a real patient. He isn’t a real person. He’s a mannequin — sort of. He’s a high-fidelity simulation man, a tech-heavy teaching tool for St. Mary’s employees. This mannequin, known as Sim Man around the hospital, is bilingual in English and Spanish. His fake lungs expand. His fake heart beats. His fake insides are a mix of plastic and metal. He’s one of three high-fidelity mannequins at St. Mary’s. “They are great for high-risk, low-volume procedures,” says Rauscher. The cricothyrotomy is one such procedure. “It’s a last-ditch effort where there is no air getting into their lungs,” says Miller, “and there’s not going to be any air unless you cut a hole.”

That advantage gives practitioners the most realistic experience possible without having to risk the life of a patient for the sake of practice. But to work with without life-threatening risk, the employees need Bev Farmer.

Farmer sits in a tiny room slightly bigger than a walk-in closet. In front of her are four monitors showing different angles of the adjacent room where the nurses are prepping the super mannequin for the cricothyrotomy. Her computer screen is filled with graphs of vital signs from respiratory rates to heartbeats. Another wave of the mouse, Sim Man wheezes, and St. Mary’s LifeFlight nurses work to fix it.

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