Every time the forceful, pitiless voice said, "Next!," it triggered an automatic Epi rush (squirt). This was despite the fact we knew we would hear it every 45 minutes until each of us had passed down the dark, sinister hallway that led to a training room equipped with no exits. It was time for our annual practical evaluation by our EMS service’s medical director (MD).
The stage was set as in years past. We had purchased his favorite pastries and brand of coffee to cultivate a climate of mercy for a man who held our licenses—and other organs—in his hands.
Nothing much changes for those of us being tested year after year. Every 365 days or so, we collectively huddle in a pathetic upright fetal position with our protocol books buried between our knees, heads flexed and eyes focused on pages flipping in rapid succession.
As usual, an occasional voice would loudly whisper, "What are the contraindications for CPAP again?" or "What’s Beck’s triad for pericardial tamponade?"
Each year, at least one medic can be found sucking his thumb and rhythmically rocking himself, succumbing to the fear rather than reviewing a modus operandi he had failed to reacquaint himself with throughout the year. It’s over for him, and we all know it … poor bastard. But we have no time for pity or empathy. We just put a black triage tag on his thumb and focus on our own clinical insecurities.
In fact, eyes only raise from our patient policy books when "Next!" echoed its way into our holding cell. Dilated pupils then scan the remaining quarry to see who is stupid enough to be "next." A heavy sigh by anyone is an acknowledgment of willingness to walk the green mile.
Now don’t get me wrong. Our MD is a warm, gracious, progressive, supportive, intelligent, kind, forgiving and compassionate man (who just so happens to read this column). Indeed, he holds us to state-of-the-art, evidence-based medicine, and for that we love him. But, let’s face it. Most of us would rather treat a bus load of hemophiliacs who accidently crashed into an osteoporosis tour bus than be assessed and judged by our peers, much less our medical director.
Add to that the new human patient simulators (HPS) they’ve come up with. These soulless, highly mechanized monsters can conjure up any medical or trauma scenario your sick and twisted little EMS mind can come up with.
But despite all the techno-wizardry, these dummies still look and feel like dummies. So, for me, it’s hard to take them as seriously as I should—especially considering what one pays for them. Oh, sure. Now I can actually hear wheezes and rales in all fields and assess shocky vital signs while viewing an ECG with a third-degree heart block. But even with all that going for them, their skin still feels rubbery and is the same color and texture as the original inflatable Resusci-Annie peering out of the corner closet. They still hold that same uncompromising, frozen facial expression—similar to the look you see on a nurse’s face when you are giving her your report.
So in a way, you’re still getting a half-truth from the patient, which forces you to continue to rely on the information given to you by the evaluator. The most unnecessary adjunct to these patient simulators is the programmed voice. They usually end up saying either just "no" or "yes" to your questions, because the programmer can’t anticipate your every question. Once, a programmer told me to ask only yes or no questions. I responded by asking the HPS, "So by answering only ‘yes’ or ‘no’ questions, are you thereby saying ‘yes’ to the negative implications of my disagreement with your positive intention?" The programmer had the patient throw up on me.
Operators of these devices are very protective of their toys, especially ones that cost more to purchase than an ambulance, helicopter and year’s supply of spit socks combined.
What kind of training does it take to operate one these babies? I don’t know, since no one who operates them will tell me. It’s too suspicious. I bet you only need be proficient in the video games Super Mario Bros. to make most of them rock.
I do find it ironic that despite all the emphasis on technological realism for training, the newer protocols for mega-code resuscitation now emphasize the basic importance of doing uninterrupted, continuous CPR and relying less on pauses for ventilations and pharmacological tools. Hmm … I guess good old Rescusci-Annie was trying to tell us something.
I have no doubt someday we’ll have a robot patient with life-like skin that can sweat, realistically change color and temperature, talk about your mother, massively creep you out with distorted facial expressions, and even kick your butt on a Saturday night. But please spare us the olfactory input chip. That just ain’t right.
Until next time, seeing (and smelling) is believing. JEMS