Introduction To Simulation
A high level human patient simulator is a whole body mannequin with driving mechanical and computer software (Figure 1). This type of simulator has sophisticated modelling of the cardiovascular and respiratory systems of a human. Fluid status, acid-base and temperature are also modelled along with the pharmacodynamic effects of a number of intravenous drugs. Such systems improve upon desktop simulators by presenting information in a realistic form rather than at a computer screen interface.
The whole body mannequin can be instrumented and has a full monitoring interface. The simulator can be programmed to represent different types of patient, the young and fit or the old and frail. When a drug is administered to the mannequin it is recognised by the system and the appropriate pharmacodynamic response seen for the chosen physiological patient. Thus a small dose of adrenaline in a young and fit patient may simply cause tachycardia and hypertension. In the frail patient, modelled to have ischaemic heart disease, such changes may be exaggerated and accompanied by dysrhythmias or ischaemic changes. The mannequin can talk, by virtue of an actor speaking into a microphone from the control room. Thus communication skills can be brought into training if required. During the simulator session they learn to put theory into practice as they go through the structured educational goals.
Anyone working in the acute specialities will have concern about their ability to perform well in a difficult or life threatening situation. Teams responding to cardiac arrest or trauma calls can function efficiently or poorly together depending on a number of factors: knowledge, experience, team interaction and leadership to name but a few. These issues can be explored safely in a realistic environment in the Centre such as on a ward, in A&E, or in an operating theatre.
Crisis Avoidance and Crisis Management:
The Simulator allows us to rehearse events that are rarely seen in everyday practice. Incidents such as anaphylaxis can occur with alarming rapidity anywhere and at any time. Well-constructed protocols offer 'escape routes' in these difficult situations, be it in a hospital or a community setting. There is the potential for fixation errors as a result of diagnostic mistakes through confirmation bias. Thus courses will focus on mechanisms that help recognise and verify the provisional diagnosis as well as teaching the elements within the treatment protocol itself. Obviously, with recent publicity, medical error is an important problem within the health service. Through simulation different clinical personnel are taught about awareness and avoidance of error prone situations.
As in any high risk team based industry, good communication plays a key part of team working and avoiding errors. Simple components such as clear verbal communication, not raising ones voice and avoiding making statements into thin air can make a big difference to team communication. Fostering an atmosphere of open exchange including concentrating on what is right, not who is right, can help avoid many crisis. Such simple advice is surprisingly rarely practised. Through simulated scenarios and debriefing afterwards, the participants can evaluate their own and the teams communication.
Integration of physiology, pharmacology and pathology:
The simulator can be used to clarify difficult concepts and help bring principles learned in the classroom to life. This is particularly true with the management of sick and septic patients and the complex issues around cardiovascular and respiratory physiology. This can help trainee and junior nurses, physiotherapists and doctors in their management of sick patients.
The Simulation Centre at Montagu provides a powerful realistic environment for multi-professional team training, Crisis management as well as other educational goals. It provides this for Yorkshire and the Humber, through the funding of the Yorkshire and Humber Strategic Health Authority.
Dr Alasdair Strachan, Co-Director