"If it_s a boy, we will call him Terry. If it_s a girl, we will call her Terrie."
No, this conversation doesn_t refer to a new baby, but a METI Emergency Care Simulator (ECS). Terry(ie) is the newest member of the Maryland Fire and Rescue Institute's (MFRI) faculty. He/she is a vital part of its mobile teaching lab fleet.
During 2005, MFRI used the ECS system to train advanced life support (ALS) personnel. The time it took to transport, set up and dismantle the system for each class and the wear and tear on the units were such that MFRI's ALS staff knew there had to be a better way. A mobile teaching lab for ALS training was the better way.
The mobile lab includes a trailer (24 feet long, 8 feet wide, and 6 feet 1 inch tall), the simulation mannequin, seven computers (three in Terry(ie), three laptops, and one fluid computer), four video cameras, three LCD monitors, and a heater/air conditioning unit (that must stay between 62 and 90 degrees year round).
The computers are loaded with 12 pre-packaged programs with scenarios that include as COPD, congestive heart failure, pneumonia with septic shock, and others. The mannequin includes such airway features as a lifelike intubation head, flexible tongue, and simulated lungs. Blinking eyes and variable pupil sizes, as well as various pulses, cardiac functions, blood pressure and sounds (including voice) help support the realistic training. All physiological, pharmacological, and event data is logged and time stamped.
The mobile unit resembles an ambulance with a cot and emergency medical supplies. A partitioned area at the front of the trailer houses the computers. The instructor has three options ƒ in the separate area, with the student in the back, or out of the unit. This varies depending upon the scenarios and level of training and testing. MFRI also has an instructor-driven portable simulator. "Hal" can be placed in a motor vehicle to allow students to practice working in that type of environment.
Terry(ie) is physiologically driven, which means it can interact with students. He/she is presently being used for the cardiac arrest portion of ACLS testing. Terry(ie) thrills students with its realistic "human like" ability and sounds. "It is excellent training, very realistic," commented a student in a recent class.
The best part of the class is the "changing patient condition that could be seen and felt." The lifelike breathing and bleeding, as well as pulse, urinary functions, and fluids in the belly all allow the student to assess based on real-life signs. A self-driven, closed loop simulator means that the student_s actions trigger responses in the "patient." Giving a wrong IV solution will cause the patient to react as he or she would in a real-life situation. The student must then react to this occurrence.
As part of this learning process, evolutions are videotaped and reviewed in a debriefing session. If needed, teaching points are restated and the student can retest. Future uses will include jurisdictions utilizing the lab for team teaching. The unit will move to different county fire/rescue stations and allow the on-duty personnel to work as a team on a simulation exercise.
The unit was unveiled in February 2006 at the METI Human Patient Simulation Conference. Terry(ie) and crew were very well received. The unit has been all over Maryland since then, on the road at least twice a week, touching hundreds of students. Three drivers and six operators have been kept busy keeping Terry(ie) "mobile" and in operating fitness. Amar Patel, the lead operator and "man behind the curtain" with Terry(ie), and staff from MFRI_s Logistical Support Section, worked for 13 months to ensure that the lab was the best and most effective teaching environment. The system cost approximately $150,000 total, with $60,000 for the simulator, and $20,000 for the trailer.
As always, good things can always be made better, and future upgrades may include a larger unit. In this unit, tall students must lean over during the exercises and the number of students that can work in the unit is limited. A larger and taller unit will make it easier for students to work individually and as a team. Another possible enhancement could be a recreational vehicle which will enable multiple stations for training and testing.
The unit traveling in March 2007 to the EMS Today Conference sponsored by JEMS. Amar and fellow faculty member Les Becker were the presenters at the well-received preconference workshop entitled ˙Simulation in Prehospital EMS Training and Education."
Amar is proud of what MFRI has accomplished with this unique type of training. "Simulation-based training is beneficial to the student. It_s great to watch the student when he or she transforms from thinking of the 'patient' as a mannequin to thinking of it as a 'real person.'" As one of the students put it on an evaluation sheet, "Terry was just cool." Or as another one said, ˙Almost as good as cadavers.Ó You can_t get any better than that.
S. R. Spicer Himes is a manager within the Administrative Services Section at the Maryland Fire and Rescue Institute, University of Maryland.