Healthcare Simulation News - Winter 2012 by CAE Healthcare

HEALTHCARE SIMULATION NEWS CONTENTS

Faulkner State Community College in Fairhope, Alabama, USA begins its patient simulations at the point of care, whether it is in a campus restroom or outside on the grounds. Here, a team of students transports the METI iStan.

“We get visitors from all around the world,” says Dr. Feroze Mahmood, of the Beth Israel Deaconess Medical Center TEE imaging simulation center. Feroze, director of Vascular Anesthesia and Echocardiography, is also conducting research on simulation training.

USF ATHLETICS MEDICAL TEAM TRAINS WITH PATIENT SIMULATION The University of South Florida’s Bulls gain a new player for one afternoon as iStan simulates a football injury in the field.

THE METI CUP COMPETITION AT THE AIR MEDICAL TRANSPORT CONFERENCE (AMTC) Top Air Medical Transport teams from Canada and the U.S. competed in three intense critical care simulations in St. Louis, Missouri this fall. HSN speaks to judges about what’s behind the METI Cup, and why they return year after year.

MILITARY SIMULATION TRAINING IN BUDAPEST, HUNGARY AND FORT POLK, USA Medical first responders incorporated advanced patient simulation into training at the NATO Military Medicine Centre of Excellence (MILMED COE) in Budapest and at the U.S. Army Base in Fort Polk, Louisiana.

BETH ISRAEL DEACONESS MEDICAL CENTER OPENS AN IMAGING SIMULATION CENTER Dr. Feroze Mahmood trains residents, anesthesiologists and cardiologists from around the world in a high-tech ultrasound simulation center.

On the Cover: An interdisciplinary medical response team treats a METI iStan patient simulator with a football injury at the University of South Florida. Photo provided courtesy of USF Health. Healthcare Simulation News is published quarterly by CAE Healthcare, with U.S. offices at 6300 Edgelake Drive, Sarasota, FL 34240. Telephone: (941) 377-5562. Send your feedback or article ideas to Kim Cartlidge at kim.cartlidge@cae.com. Copyright 2012 by CAE Healthcare. All rights reserved.

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The upcoming HSPN 2012 conference will feature more than 100 sessions on healthcare simulation learning as well as events, keynotes, a product showcase and training courses for healthcare educators and professionals.

HPSN 2012 CONFERENCE PREVIEW See who is presenting this February at HPSN 2012, an international gathering of top innovators in healthcare simulation.

ASIA PACIFIC SIMULATION IN NURSING EDUCATION CONFERENCE WRAP Malaysia’s Nilai University College and CAE Healthcare host their first simulation in nursing education conference for educators and students.

HPSN EUROPE CONFERENCE WRAP-UP The seventh annual conference covers obstetrics, nursing, debriefing, virtual reality and center operations through a lens of the theme, “Assessment through Simulation.”

USF’s Dr. Micki Cuppett, associate professor and director of the Athletic Training Education Program.

SIMULATION BRIEFS HEALTHCARE SIMULATION NEWS

At left, Dr. David Leffers, chair of Orthopaedics & Sports Medicine at USF, works with athletic trainers and paramedics to move the injured player. Below, USF Health Orthopaedic Surgeon Dr. Charles Nofsinger listens for breath sounds. Photos courtesy of USF Health.

METI iStan Trains Sports Medicine Team on the Football Field

s college football season was gearing up in the fall, one University of South Florida player attracted a horde of reporters and cameras during an afternoon practice. The iStan patient simulator, dressed in a full football uniform, suffered a rare but life-threatening spinal injury on the field. The entire sports medicine team responded. USF conducts sports injury simulations with its athletic training majors, but this was the first multi-disciplinary effort, with faculty and staff from the Sports Medicine and Orthopaedic Department, USF Athletics, the Sports Medicine and Athletic Related Trauma Institute (SMART), Tampa Fire Rescue and additional staff from the

University of Tampa, St. Leo University and the Tampa Bay Buccaneers. “They talked to each other for the first time about a scenario,” said Dr. Micki Cuppett, director of the Athletic Training Education Program at USF Health. “That was impactful. They continued the conversation after the debriefing.” Local media covered the scenario, even recording iStan’s vocal responses to physician’s questions. Since that day, Cuppett has received a number of requests from college and professional sports programs that want to create similar training exercises. Serious football injuries are rare, but Cuppett’s team at USF now has a script and a response plan that could save a player’s life.

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HEALTHCARE SIMULATION NEWS THE METI CUP

The METI Cup: Competition With a Learning Edge

Joshua Granada and Carlos Tavarez of the Orlando Medical Institute crew compete in the final round.

two-member air medical crew (AMC) prepares in the back of a helicopter en route to a sending facility, getting ready to treat a young woman who is 26 weeks pregnant and in active labor--or so they think! The pilot radios back that he is experiencing chest pain and can no longer pilot the aircraft, and the helicopter makes a hard landing. The crew members are injured, one with a broken arm and one with hearing loss due to the crash. The pilot has an impalement injury, a closed head injury, and a broken pelvis, and is also suffering from an acute heart attack. They must work through their own injuries to save his life. This was the final, 2011 METI Cup competition scenario at the Air Medical Transport Conference in St. Louis, Missouri. Three teams were given half an hour each to assess and treat the pilot, who was played by a METIman速 high fidelity patient simulator. The scenario was made to feel as realistic as possible, with one competitor wearing an immobilizing arm sling and the other wearing a sound-blocking headset as they raced to save the pilot.

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THE METI CUP HEALTHCARE SIMULATION NEWS Sherry Gauthier, STARS, 2011 METI Cup Winner For us, it involved endless hours studying, knowing our protocols and being critiqued and evaluated. I definitely gained confidence in my knowledge and my performance as a flight nurse.” Dave Allison, STARS, 2011 METI Cup Winner “Preparing for this has certainly helped me as a practitioner. Personally, the whole experience has been amazing and grueling. Having the opportunity to represent our organization, meet some great people, and do some traveling more than made up for the hard work involved.”

Dave Allison and Sherry Gauthier and of the STARS team won the 2011 METI Cup.

At top left, STARS team Sherry Gauthier and Dave Allison compete in the final round. Top right, transporting the gunshot wound patient in round two. Above, University of Michigan Survival Flight finalists Mike Chesney and Joetta Vamos.

Chief Judge Peter Gant, who is an emergency physician and Canadian-based Shock Trauma Air Rescue Society (STARS) flight physician, helped to create the METI Cup scenario based on his field experience. “There’s a little bit of theatrics, because so many people are watching, but in reality, having a hard landing is very possible, and it happens not infrequently in the North American air medical transport industry. You may be injured and have to take care of an injured person,” says Gant. Air medical crews are often called to treat critically ill or injured patients who need rapid transport, and they may travel by more than one mode with a patient: fixed wing, rotary wing and ground. “Typically the level of acuity is higher,” says METI Cup Judge Kelly Cox, senior director of Air Evac EMS, the largest privately held air medical transport organization in the United States, “and the requesting hospital or ground service has identified that air can provide a higher level of care.” The annual METI Cup competition is the largest and most challenging skills contest for AMCs, drawing top competitors from throughout North America. The competitive scenarios are based on real cases and played out on METI adult and pediatric patient simulators, which emulate physiological responses automatically.

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“We are unique in that we force the competitors to use the simulator as found,” says Cox. “We try to use the mannequins to the fullest, so we don’t give them information that the mannequins can give them.” Both STARS and Air Evac incorporate simulation into their ongoing team training. “Simulation has been an absolute building block in our organization for the past ten years,” Gant says. “When a team comes back from a mission, if they had trouble with something, we can go down to the sim room and go through it and practice. Our crews have to do a certain number of sim sessions each quarter.” At the 2011 METI Cup, the eleven competing teams started off with a pediatric simulation in which an eight-year-old presented with diabetic ketoacidosis (DKA) and persistent vomiting which had caused significant hypokalemia. Each team had 20 minutes to assess and treat the child. “The ringer was that he had three days of vomiting and his potassium was very low. Every therapy we administer for DKA lowers potassium further, so the AMC had to manage a sick, hypotensive child who was in need of airway management, and they had to treat the potassium before the other therapies for DKA,” says Gant. The second scenario took place in a remote site where a man had intentionally shot himself. There was alcohol on the scene, and while the gunshot wound was superficial, the man was hypotensive but also inappropriately bradycardic. A thorough check of the scene and the patient would reveal the prescription bottle (in his pocket), which confirmed the drug Propranolol. The team had to deduce that he had a non-life threatening gunshot wound, had likely overdosed and had a toxic bradycardia. “An overdose on beta blockers is difficult to deal with, these patients are very sick,” says Gant. “There are a series of usual therapies to try, and some new effective therapies including the administration of high dose insulin.” Each scenario attempts to incorporate current treatments and new practices to see whether or not the teams are keeping up with literature and mastering new skills. The scenarios also require deductive reasoning. “Each case is designed to force the AMC out of the envelope of normal thinking,” says Gant. Eleven, two-person air medical crews from Metro Life Flight, University of Michigan Survival Flight, STARS, Native Air — Omniflight, University of Mississippi Medical Center Aircare, Life Force Air Medical, Air Care and Mobile Care — University of Cincinnati, Carilion Clinic, Orlando Medical Institute, Lifeflight of Maine and Medflight competed in the 2011 METI Cup at AMTC.

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The 2012 METI Cup will take place at the Air Medical Transport Conference in Seattle, Washington October 22-24, 2012.

n the adult case, competitors were judged in part on how quickly they could conclude that the gunshot wound was superficial and move on to treating the overdose. “What we do is try to build cases that are broader than the best people that come to this competition, that are going to take the best team the full time to solve what needs to be solved. It’s tough because these teams are good!” Gant says. The METI Cup final rounds always draw crowds to watch the best of the best compete. The challenging scenarios generate talk and excitement at AMTC. But the long-term benefit, say Gant and Cox, is the learning that the teams put into practice every day. Top teams often spend hours of their own time honing their skills in preparation for the METI Cup. “While they are training, they are using their colleagues at their base and discussing trauma cases,” says Cox. “I think the value of the crew’s training grows exponentially at the base, through the number of people who will become better clinicians because of that one crew competing.” Gant would like to see 20 teams compete next year. The more teams who are studying, practicing and competing locally and regionally to win a spot in the METI Cup competitions, the higher the level of care they are providing their patients. “It warms my heart to watch these crews compete at their peak performance. You know they are taking that level of care out into the field every day,” says Gant. “That is where the real difference is made.”

MILITARY MEDICAL SIMULATION HEALTHCARE SIMULATION NEWS

Military Medical Simulation

CAE CAESAR SIMULATES BATTLEFIELD TRAUMA IN NATO TRAINING COURSE In October, CAE Healthcare helped NATO introduce human patient simulation into the First Responders Trainer Training (FRTT) course in Budapest, Hungary. The pilot course was hosted by the NATO Military Medicine Centre of Excellence (MILMED COE) in Budapest, which provides medical courses and training to NATO participating countries. Twelve experienced NATO medical instructors from Germany, Holland, Hungary and Bulgaria worked in small syndicates using a Caesar™ trauma patient simulator to perform advanced first aid, including practical usage of tourniquets, bandages and chest needle decompression.

MEDICAL TRAUMA SIMULATION TRAINING AT FORT POLK ARMY BASE In August, the U.S. Army’s Fort Polk, Louisiana Army Base was the site of two days of medical trauma simulation training for soldiers prior to rotation into “the box” at the Joint Readiness Training Center (JRTC). Soldiers from the Medical Exercise Support Battalion (MESB) and Combat Support Hospital (CSH) ran METI iStan and METIman patient simulators in the CSH’s emergency room, operating room, and throughout other sections of the hospital. The simulators were on loan from the 162nd Infantry Brigade stationed at Fort Polk, and their Tiger Medical Training Facility instructors provided the realistic training. The purpose of the exercise was to prepare the CSH for their JRTC rotation and possible future deployment. The Army’s Joint Readiness Training Center is focused on improving unit readiness by providing highly realistic, stressful, joint and combined arms training across the full spectrum of conflict. The JRTC training scenario is based on each participating organization’s mission essential tasks list, and many of the exercises are mission rehearsals for actual operations the organization is scheduled to conduct. These exercises replicate both combat scenarios and unique challenges the integrated military services may face in combat, including interaction with insurgents, nongovernmental organizations, the media and civilians.

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HEALTHCARE SIMULATION NEWS Beth Israel Deaconess

Imaging Simulation at Beth Israel Deaconess Medical Center

Dr. Feroze Mahmood, director of Vascular Anesthesia and Echocardiography at Beth Israel Deaconess Medical Center, trains a resident with the CAE VIMEDIX ultrasound simulator.

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hile the current wave in healthcare simulation is to create complex, multidisciplinary scenarios for team training, one department at Harvard University’s teaching hospital is taking an alternate, highly specialized approach. Beth Israel Deaconess Medical Center may have the only simulation center that is devoted solely to echocardiography training for cardiologists and anesthesiologists. Dr. Feroze Mahmood, Director of Vascular Anesthesia and Echocardiography at Beth Israel Deaconess, trains residents on

how to conduct and interpret the transthoracic (TTE) and transesophageal (TEE) ultrasound examinations in the offices of the anesthesiology department, adjacent to the OR. “This is a one-of-its-kind TEE simulation center,” Feroze says. “We get visitors from all around the world.” The imaging simulation center is separate from the Carl J. Shapiro Simulation and Skills Center, which serves the entire medical center and opened in 2006. Beth Israel Deaconess has invested about $1 million in simulators and state-of-the-art computers for its imaging simulation center, which opened in 2008.

Beth Israel Deaconess HEALTHCARE SIMULATION NEWS

Dr. Feroze Mahmood Delivers Specialized Training to Residents, Anesthesiologists and Cardiologists Anesthesiologists began using (TEE) imaging during surgeries in the mid-1990s, when the American Society of Anesthesiologists first established guidelines for the practice. “It has gradually become an incredible monitoring modality in the operating room, particularly for congenital heart surgery, valve replacement and life threatening situations,” says Mahmood. “The TEE has become a standard of care in cardiac surgery,” Mahmood says. “Cardiologists call it a road map to valve repair.” During surgery, anesthesiologists use the TEE to provide information about heart valve structure and function, about when to wean the patient off the cardiopulmonary bypass machine, and even about the success or failure of the procedure. “We have become the eyes and ears of cardiac surgeons, and incisions have become smaller and smaller. Our role has evolved from bystanders to

being involved in the decisionmaking process,” says Mahmood. At Beth Israel Deaconess, resident cardiologists and anesthesiologists train twice weekly in sessions that last 2-3 hours each. The center also offers oneweek intensives to outside physicians, and those sessions are booked a year out. “With simulators, we can also train them in what normal and abnormal looks like,” says Mahmood. As they teach, Mahmood and his associates are studying the effectiveness of the training, and how many hours of simulation are required to gain TEE proficiency. Each learner takes a baseline test and subsequent tests after each session. Dr. Mahmood conducts the tests on the two CAE VIMEDIX™ ultrasound simulators, which store learner data and enable instructors to tailor their approach to each resident. Mahmood says, “The metrics enable our researchers to see how a student got to an answer. We know which images the

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trainees are taking a long time to acquire. Some images are universally challenging, and some are specific to the trainer.” With practice, a learner’s hand movements become smoother and more meaningful as his or her speed increases, Mahmood says. In the future, he would like to take the TEE exam training a step further by developing complete patient scenarios. “We want to build scenarios, such as severe mitral regurgitation, a valve problem,” says Mahmood. “We would expect the trainee to go through a sequential evaluation, to perform linear measurements and Doppler calculation and come up with a diagnosis.” Dr. Feroze Mahmood will present a session on TEE imaging for anesthesiologists at the HSPN 2012 conference in Tampa, Florida this coming February 28-March 1. Find more information about the conference and presenters beginning on page 10.

“This is a one-of-its-kind TEE simulation center,” Dr. Feroze Mahmood says. “We get visitors from all around the world. The TEE has become a standard of care in cardiac surgery, Cardiologists call it a road map to valve repair.”

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HEALTHCARE SIMULATION NEWS HPSN 2012 CONFERENCE

Coming Up: HPSN 2012 Conference This February, top simulation experts, educators, practitioners and students will gather in Tampa, Florida for one of the largest annual healthcare simulation conferences in the world. HPSN features three days of training courses, educational sessions, keynote speakers and networking. We spoke to a few of the educators about their upcoming presentations.

PHYSICIANS’ USE OF THE STETHOSCOPE OF THE FUTURE GROWING EXPONENTIALLY “Point-of-care ultrasound, also known as bedside ultrasound, is being described as the stethoscope of the future,” says Dr. Robert Amyot, cardiologist with Hôpital du Sacré-Coeur de Montréal and director of ultrasound simulation products for CAE Healthcare. “For some organs and some situations, it’s better than a manual physical exam.” While cardiologists, radiologists and ob-gyns have relied on ultrasound for decades, the use of imaging technology is now exploding

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BUILDING A SIMULATION CENTER: AN ARCHITECT’S PERSPECTIVE When architect Malvin Whang of Harley Ellis Devereaux began planning the new simulation center for the University of California in San Francisco, he faced a few challenges. The simulation center was to be carved into existing space on the second floor of Kalmanovitz library, which had to remain fully operational during construction. The center had to function as a multidisciplinary training hub for medicine, nursing, dentistry and pharmacy students in one setting. Whang and the project man-

agers will present a case study of the project at HPSN 2012. “How do you get a simulation center from an idea to completion? We divide it into three phases—planning, design and building,” says Whang. “People tend to think about the design issues too early and start designing before they start planning,” Whang adds. “You have to understand what your curriculum and operational needs are and what your vision is first. You need that as a road map.”

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among non-traditional users, including paramedics, anesthesiologists, surgeons, intensivists and even pediatricians, who can scan bones for fractures. For example, the traditional FAST (Focused Assessment with Sonography for Trauma) exam, which scans for abdominal fluid in trauma patients, is a key triage tool in emergency rooms today. “The TEE (transesophageal) exam is being used more and more in the operating room,” says Amyot. “Anesthesiolgists are embracing ultrasound to monitor high-risk patients.” Medical schools in the United States are beginning to teach their first-year students to read and interpret ultrasound, which indicates that tomorrow’s physicians will be proficient well before they become residents, Amyot says. This explosive growth in ultrasound imaging products and their applications has resulted in a demand for education and training. “The accuracy of ultrasound imaging is very operator-dependent, so training is key,” Amyot says. Amyot will present "Point of Care Ultrasound: Technology Spreading Faster Than Expertise?” and the VIMEDIX ultrasound simulator, at the HPSN 2012 conference. The sessions will be hands-on, offering attendees the opportunity simulate transesophageal, transthoracic, abdominal and pelvic exams on the VIMEDIX mannequin.

CAE HEALTHCARE TO SHOWCASE NEW PRODUCTS, EXPANDED SIMULATION SOLUTIONS

✱ HPSN 2012 attendees will get the first look at CAE Healthcare’s expanded line of simulation solutions and be able to preview products that are coming soon, including the first high-fidelity birthing simulator. Here are a few highlights: CAE Caesar™, the wireless, rugged patient simulator that was created for point-of-care field training, will be operating and on display in the product showcase. Caesar is waterproof and has fully articulated joints as well as advanced responses to treatments. VIMEDIX™ is the ultrasound simulator for the thoracic and abdominal regions, and the only simulator offering the TEE, TTE, FAST and FOCUS exams on one platform. With a realistic mannequin, a split screen with the ultrasound view on one side and a 3D view of the anatomy on the other, and more than 50 pathologies, VIMEDIX offers rapid mastery of ultrasound assessment. The METI HPS, the gold standard patient simulator with true oxygen and CO2 exchange, is now easier to operate with the Müse touchscreen interface. The Müse interface allows more flexibility in programming the HPS physiology without sacrificing the advanced, realistic modeling.

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HPSN 2012 CONFERENCE HEALTHCARE SIMULATION NEWS Excerpt from Why Hospitals Should Fly by Author John Nance

“So what does it take to dramatically improve patient safety and service quality? It takes a host of new and different (and sometimes radical) methods centered on supporting the people on the front lines – those who actually take care of the patient.”

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DON’T MISS THE FREE HPSN 2012 CONFERENCE FEBRUARY 28-MARCH 1 IN TAMPA, FLORIDA. REGISTER TODAY AT HPSN.COM

The 2012 METI Awards for Best Healthcare Simulation Video

Why Hospitals Should Fly Author John Nance to Keynote HPSN 2012 Air Force veteran and patient safety advocate John Nance, author of Why Hospitals Should Fly, will deliver a keynote address at the HPSN 2012 conference in Tampa, Florida February 28-March 1. A founding member of the National Patient Safety Foundation, Nance is an internationally recognized broadcast analyst and advocate for both medical safety and aviation safety. He is also a decorated Air Force pilot and veteran of Vietnam, Operation Desert Storm and Operation Desert Shield.

Nance is known as a civilian pioneer in crew resource management, which incorporates communications, situational awareness, problem solving, decision-making, and teamwork in order to promote safety and efficiency. In Why Hospitals Should Fly — The Ultimate Flight Plan to Patient Safety and Quality Care, Nance offers a new paradigm of patient-centered care. The book won the American College of Healthcare Executives 2009 Book of the Year Award.

The winning videos will be shown at the HPSN2012 conference Submission deadline is January 31, 2012 Learn more at hpsn.

HPSN2012 Take the Challenge!

USF HEALTH: TEACHING MEDICAL STUDENTS TO SPOT PATIENT SAFETY ERRORS

At the University of South Florida in Tampa, medical students enter a simulated hospital room where an elderly patient with a urinary tract infection has rung for assistance to get to the bathroom. His anxious spouse stands at his bedside. The man is confused, and the room is rigged with more than two dozen safety violations. For example, the patient’s bed was raised earlier in the day to draw blood, and it hasn’t been lowered back down. His breath-

Share your video and showcase your institution online! Winners will be selected by a popular vote of our YouTube audience.

ing tube is connected to air instead of oxygen, and he has been given the wrong medication, which has caused his confusion. Dawn Schocken, Director Center for Advanced Clinical Learning at USF Health, created this patient safety simulation to encourage more thorough and hands-on training in hospital safety. “In the past, we haven’t explicitly taught this to medical students. We teach it implicitly, but it’s not in a format that can

predict student’s response on the hospital floor,” Schocken says. The simulation is based on protocols put out by the Institute for Healthcare Improvement (www.ihi.org). The aim is to begin teaching the culture of patient safety early, instead of once a student becomes a resident or after a negative event. Schocken is following a group of third-year students to find out if the early exposure to safety protocols translates to

We are still accepting EMS nursing teams. Learn more at hpsn.com

increased awareness and advocacy when they become residents. At the HPSN 2012 conference, Schocken will invite educators and clinicians to spot safety violations in a simulated patient room, and then help the participants build their own teaching scenarios to take back to their institutions.

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HEALTHCARE SIMULATION NEWS HSPN 2012 CONFERENCE

DARTMOUTH-HITCHCOCK MEDICAL CENTER: MASS CASUALTY DISASTER DRILL INVOLVES ENTIRE NEW HAMPSHIRE COMMUNITY

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In September of 2011, the community of Lebanon, New Hampshire simulated a high school chemistry lab explosion that involved four hospitals, the City of Lebanon police and fire departments, Golden Cross Ambulance Service and the entire student and faculty of Lebanon High School. “We wanted to test the emergency and disaster drill plans and the decontamination equipment,” says Gene Streck, simulation tech for DartmouthHitchcock Medical Center. “The school principal wanted to test the school’s emergency evacuation plan.” The students, who were unaware the drill was coming, had to be evacuated across a five-lane state road to a National Guard Armory, while local hos-

COLLIN COLLEGE TEACHES INTERDISCIPLINARY TEAMS HOW TO SURVIVE THE GOLDEN HOUR “The ‘Golden Hour’ is something all EMS students are taught,” says Jackie Langford, Director of Healthcare Simulation for Collin College in

pitals triaged the mock casualties amid the bustle of their fully operating emergency rooms. Both human patient actors and three patient simulators, including two METI iStans and a METI Pediatric ECS, suffered burns and blast injuries, including blast lung caused by the shock of the explosion. Streck will present a case study of the chemistry lab disaster drill with a focus on the yearlong planning process and logistics at the HPSN 2012 conference.

McKinney, Texas. “It starts from the time the emergency incident begins. For the best chance to survive, the patient needs to be rolling into the operating room within an hour.” Collin College has created an interdisciplinary Golden Hour simulation that incorporates EMS, nursing, respiratory and surgical students. “When they come in, they hit the floor running,” Langford says. “The students can practice what they do and get to know what the other disciplines do.” Langford plans to demonstrate the scenario at the HPSN 2012 conference with eight students from Collin College. and a METIman simulator.

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ST. JOSEPH HOSPITAL SYSTEM CREATES MALIGNANT HYPERTHERMIA SCENARIO FOR OPERATING ROOM Malignant hyperthermia is a rare but potentially deadly scenario that can occur when a patient is anesthetized. Due to a genetic predisposition or medical condition, a patient may react to anesthesia with a rapid rise in heart rate (tachycardia) and body temperature along with muscle rigidity. Complications can include cardiac arrest, brain or organ damage and death. John Davanzo, director of emergency and critical care services for St. Joseph Mercy Livingston Hospital in Michigan, created a simulated malignant hyperthermia scenario with a METI iStan patient simulator at the request of the operating room staff. He and his team, which includes Critical Care Educator Amy Heeg and Emergency Medicine Educator Teresa Rutt, have run the scenario in several of the St. Joseph’s hospital system operating rooms. “The scenario begins with the team doing an induction, and the malignant hyperthermia quickly follows,” Davanzo says. “There are specialized medications you give and protocols you follow. Catching the early

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signs and symptoms, the rising CO2 and rising body temperature, is really critical to having the protocols work.” The protocols include administering dantrolene, cooling the patient down, and bringing the patient out of anesthesia. “Dantrolene does not exist in the iStan medication library, so we have created states that simulate what will happen if they give dantrolene,” Davanzo says. “The first time we ran it, my two educators called me and said ‘it’s not working.’ I went over iStan top to bottom, and as we ran through it, we discovered that nobody had actually turned on the ventilator because we had never had a training mannequin that could accept a ventilator,” says Davanzo. “It was such a perfect confirmation of what we use simulation for.” Davanzo will present the scenario with iStan at the HPSN conference for OR, emergency and anesthesia practitioners. “ I t is one of those high-risk, low-incidence kind of events which makes it even more important to practice,” Davanzo says.

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DON’T MISS THE FREE HPSN2012 CONFERENCE FEBRUARY 28-MARCH 1 IN TAMPA, FLORIDA. REGISTER TODAY AT HPSN.COM

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HSPN 2012 CONFERENCE HEALTHCARE SIMULATION NEWS

MEDICAL MOULAGE: ADDING SENSORY CUES TO SIMULATION “Healthcare is a very sensory profession: it’s what you see, smell, feel and hear,” says Bobbie Merica, founder of Moulage Concepts in Chico, California. “Medical mou-lage bridges the gap between reality and simulation.” Medical Moulage, the art of creating and applying simulated wounds for learning purposes, is a vital part of simulation in a variety of healthcare fields. The realistic-appearing wounds, fluids and smells help learners assess and diagnose a practice patient. “Your moulage tells a story,” Merica says. “It’s important that it tells the correct story, or it may send learners down a path that leads them away from scenario objectives.” Merica creates moulage wounds from moulage gels, waxes, latex, and common products you might find on a kitchen shelf. She has published a book, “Medical Moulage: How to Make Your Simulations Come Alive,” which includes step-by-step instructions. For example, when moulaging human patient simulators, cream-based cosmetics should not be used without proper barriers. “Simulator skin is permeable, so I tell my classes it’s only groundbreaking if it comes back off,” Merica says. Merica will teach beginner, intermediate, advanced and

MEDICAL RESIDENTS GAIN PROFICIENCY IN ULTRASOUND-GUIDED CENTRAL LINE INSERTION THROUGH SIMULATION Research has demonstrated that the use of ultrasound to guide central line insertion in patients reduces odds of infection and prevents complications. Central line placement is an essential technique in hospitals, most often used to administer medications, fluids, IV therapies, dialysis and for blood pressure monitoring. As hospitals strive to reduce infection rates, the practice of ultrasoundguided central line placement is growing. Dr. Yanick Beaulieu, a cardiologist at Hôpital Sacré-Coeur de Montréal and an assistant professor at University of Montreal, is an advocate of ultrasound guided central line insertion for improved patient safety. He is also the original developer of the web-

trauma moulage courses at HPSN 2012. For a fee of $175, learners will be able to sign up for two courses and take home their created wounds, moulage board and matching apron. The beginner course will cover bruise staging, sputum, swollen lymph nodes, coffee ground emesis, wound strikethrough, jugular vein distention, rashes and an introduction to moulage gels. In the intermediate and advanced courses, moulage designers will work with gels,

based CAE ICCU imaging training solution and director of ultrasound education at CAE Healthcare. Beaulieu is currently conducting research at the University of Montreal on the use of a blended curriculum of e-learning and hands-on simulation to teach medical residents ultrasound-guided central line insertion and thoracentesis. Beaulieu will present the blended curriculum and its benefits in relation to traditional apprenticeship training at HPSN 2012. “There is a big clinical need for goal-directed, high-quality training,” says Beaulieu. “Simulation has a major impact on improving patient care and improves outcomes.”

waxes and latex to create a hematoma, infiltrated IVs, a sutured, post-op incision with an odorous infection discharge, and a JP drain. The trauma course will cover burns, deep lacerations, knife wounds and impaled objects. “We won’t actually put the smells together because they are fairly lingering, but we will offer that in the accessory moulage piece of it,” Merica says. Bobbie Merica will teach medical moulage courses at HPSN 2012 on February 28 and 29.

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HEALTHCARE SIMULATION NEWS ASIA PACIFIC CONFERENCE WRAP-UP

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Conference Wrap-Up Report: FIRST ANNUAL ASIA PACIFIC SIMULATION IN NURSING EDUCATION CONFERENCE In October, 300 nurses from Asia and the United Kingdom came together to participate in the First Annual Asia Pacific Simulation in Nursing Education Conference hosted by Nilai University College (NUC) in Malaysia with support by Kinetik Edar and CAE Healthcare. The conference theme was “Engaging Learners to be Great Learners.” The conference was opened in dramatic fashion with the NUC Chinese Drummers who ensured that the delegates were wide awake to enjoy and actively participate in the conference! Mike Bernstein, president of CAE Healthcare began the day talking about simulation education and the history of METI and CAE Healthcare before Madam Subramaniam (NUC) roused the whole audience with her keynote suggesting that students could undertake some of their clinical hours in a simulated practice environment. Following lunch, Professor Yamuchi (Nagoya University) focused on the quality aspect of simulation education before Amanda Wilford (CAE Healthcare) and Peevee Lacandola (St Judes’ College) led an interactive session focusing on using this technology for educating large numbers of students, which included an ethical dilemma. The first day concluded with a conference dinner and entertainment provided by NUC students who performed a selection of traditional and modern Malay singing and dancing. Professor Donna Mead OBE (University of Glamorgan) opened the second day by

exploring how you can use simulation as an effective educational approach. Following this, the delegates attended concurrent sessions that focused on many differing aspects of simulation ranging from pregnancy in cardiac arrest, mental health, calculating medications and teaching learners to recognize a pulmonary embolus for example. A Nursing METI Cup concluded the conference with four teams competing. The team from SEGI College, Malaysia triumphed although all the teams gave excellent care to the patient! Thank-you to Nilai University College for hosting this event with support from Kinetik Edar. By Amanda Wilford, manager of international services, nursing and allied health for CAE Healthcare.

Above at left, Professor Donna Mead OBE and Madam Gnaneswari Subramaniam, head of the Nilai University College Nursing Department, presented keynotes at the conference. Above, Marco Grit, Gary Eves, Madam Gnaneswari Subramaniam, Mike Bernstein, Dr. Chia Chee Fen (NUC Deputy President), Aminudin Jali (MD, Kinetik Edar), and Amanda Wilford.

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CONFERENCE HEALTHCARE SIMULATION NEWS EVENTS CALENDAR HEALTHCARE

✱HPSN Europe Conference

Jan-Joost Rethans from Maastrict University delivers a keynote lecture.

CAE Healthcare Europe, Middle East, Africa and India team with distributors from Portugal, Hungary, France, Turkey, Spain, Poland, Romania, Russia, India, Austria and Saudi Arabia.

ASSESSMENT THROUGH SIMULATION

In November, CAE Healthcare hosted its seventh HPSN Europe medical simulation and education conference in Mainz, Germany. Bengt Littke, senior advisor with Gripen Marketing, Saab Aeronautics in Sweden, delivered a keynote address on the use of simulators in military aviation. Jan-Joost Rethans, an associate professor with the Maastricht University faculty of Health Medicine and Life Sciences, presented a keynote lecture on standardized patients. The third keynote speaker, Dr. Andrew McIndoe, consultant anesthetist at University Hospitals Bristol NHS Foundation Trust, spoke on using simulators to perform high stakes assessments. The workshop presenters covered a range of themes, including obstetrics, modeling, debriefing, virtual reality, center operations, and nursing.

Above top, CAE Healthcare's Dr. Stefan Mönk demonstrates the physiological model in Müse software. Above, middle, conference attendees and the METIman patient simulator. At left, the CAE Healthcare organization team from Germany pictured from left to right: Petra Trinker, Maxim Werle, Marco Luff, Kiriakos Samiotakis, Christoph Sossna, Markus Zimmermann and Sylvia Franz.

SAVE THE DATE! The HSPN Europe 2012 conference will take place November 8-10, 2012. Visit hpsn.com for information.

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PRSRT STD US POSTAGE PAID PERMIT #1 MANASOTA, FL

Last HPSN Conference in Tampa, Florida!

Healthcare simulation in the sunshine. What could be more inspiring? Join us for the last HPSN (Human Patient Simulation Network) conference on Florida's west coast. The conference is free!

Expect the unexpected at an all-new, CAE Healthcare HPSN conference. ■ NEW LEARNING TRACKS—choose from more than 100 hands-on sessions and training courses with new tracks for imaging and EMS.

■ New Products—see trauma patient CAE Caesar™, the METI HPS® with Müse, the CAE VIMEDIX™ ultrasound simulator, the surgical simulation line and more.

■ Exciting Events—enjoy The METI Cup Competition, The METI Video Awards, a welcome reception and networking opportunities.

■ Live Action—witness live, simulated scenarios as instructors train and debrief real students. HPSN 2012 February 28-March 1, 2012 Tampa Marriott Waterside Hotel