A simulator for training in the use of medical equipment in anaesthesia and intensive care

Simulators are often used in training personnel when the consequences of inappropriate action could be dangerous or expensive. In the medical field, however, simulators are not very common. Mishaps and accidents related to the use of biomedical instrumentation are frequently a result of technical malfunction and improper use of the equipment.

Picture from a scenario training anaesthesiology (Click for a 4x enlargement)We have developed a "hands-on" simulator (PatSim) for training anaesthesia and intensive care operatives. The simulator consists of a mannequin, either placed on an operating table, or in a typical critical care unit bed. The mannequin is controlled from a PC. It may be ventilated by an anaesthesia machine or a ventilator.

Several parameters may be controlled from the PC. They can all be varied during the simulated treatment. Parameters are:

bulletLung compliance
bulletAirway resistance
bulletCuff leakage
bulletBlocking of the breathing sounds from one lung
bulletSounds in the airways
bulletGastric regurgitation
bulletSpontaneous breathing
bulletBlood pressure (invasive and non-invasive)
bulletForehead perspiration
bulletCyanosis (bluish lip)
bulletBleeding in the operation field
bulletClotting of the venous infusion line
bulletBody temperature
bulletBody movement under defibrillation
bulletArm movement

It is also possible during simulation to:
bulletuse surgical diathermia
bulletdefibrillate (both manual and semi-automatic)
bulletadminister medication (IV)
bulletwithdraw blood samples
bulletsuck (oral and in wound)
bulletperform CPR

The parameters such as ECG, bloodpressure, CO2, and airway pressure can be monitored by any ordinary electrodes/transducers and displayed on any appropriate monitor or workstation; there is no need for modification or special adaptation of the medical equipment used in the simulation scenario.

Because the resident should be exposed to a life-like situation, we either place the simulator mannequin in a room which resembles an intensive care unit or an operating theatre. The simulator is controlled from a separate control room with one-way windows to the operating theatre/intensive unit. Wireless communication with an instructor taking part in the scenario is facilitated, and the whole scenario is taped by a remote controlled video recorder for later debriefing.

So far, the project has only involved a limited number of trainees. Consequently, statistical evaluation of the performance is impossible, but the subjective evaluation so far provides a clear indication for future developement. It may be reasonable to suggest that the simulator will be of importance for training anaesthesia and intensive care personnel in handling different types of advanced medical equipment, procedures and CRM (Crew resource management).

Some of the few groups in Europe working with this kind of simulators have formed a group called The Society for European Simulators in Anaesthesiology Management (SESAM).

More information?

If you need more information, have comments or questions, please do not hesitate to contact us:

Arne Rettedal, associtate professor, direct line +47 51 83 20 41
Svein Landsvik, assistant professor, direct line +47 51 83 20 40
Ståle Freyer, senior engineer, direct line +47 51 83 20 19
Postal address: 
Medisinsk teknisk linje, 
Postboks 2557 Ullandhaug, 
N-4091 Stavanger
Telefax: +47 51 83 17 50

Links to related activities

bulletThe Society for European Simulators in Anaesthesiology Management
bulletThe Sophus project: Anaesthesia Simulators
bulletUniversity of Washington Patient Simulation Center
bulletTOMS Project

Last updated 31 jan 05.