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Thursday, February 2, 2023

The Sims

The man is having trouble breathing in a St. Mary’s hospital room. He is choking on blood, and that blocked air passage means Pat Rauscher can’t perform an intubation. You remember intubation, right? George Clooney did one nearly every episode of ER by placing a tube in a patient’s mouth and down the trachea, thus saving another life. But now, Rauscher, St. Mary’s chief LifeFlight nurse, has to be the hero, and he has help: Keith Miller, lead flight paramedic.

Rauscher pours iodine on the man’s throat to prevent infection and takes a needle through the cricothyroid membrane (about one centimeter long) on the throat. With the hole in place, Rauscher guides a tube into the incision. The man, attached to a patient monitor that flashes brightly colored numbers signifying his heart rate and pulse, lies still while the nurses listen to his breathing. If it starts to return to normal, they’ve successfully surpassed the obstruction in the airway. The room — filled with nurses, a reporter, and a photographer — is so quiet. “You know, if this were a real emergency situation,” quips Miller, “the room would be this calm.”

Everyone erupts in laughter because the man with a rubber face isn’t a real patient. He isn’t a real person. He’s a mannequin — sort of. He’s a high-fidelity simulation man, a tech-heavy teaching tool for St. Mary’s employees. This mannequin, known as Sim Man around the hospital, is bilingual in English and Spanish. His fake lungs expand. His fake heart beats. His fake insides are a mix of plastic and metal. He’s one of three high-fidelity mannequins at St. Mary’s. “They are great for high-risk, low-volume procedures,” says Rauscher. The cricothyrotomy is one such procedure. “It’s a last-ditch effort where there is no air getting into their lungs,” says Miller, “and there’s not going to be any air unless you cut a hole.”

That advantage gives practitioners the most realistic experience possible without having to risk the life of a patient for the sake of practice. But to work with without life-threatening risk, the employees need Bev Farmer.

Farmer sits in a tiny room slightly bigger than a walk-in closet. In front of her are four monitors showing different angles of the adjacent room where the nurses are prepping the super mannequin for the cricothyrotomy. Her computer screen is filled with graphs of vital signs from respiratory rates to heartbeats. Another wave of the mouse, Sim Man wheezes, and St. Mary’s LifeFlight nurses work to fix it.[pagebreak]

The nurses wouldn’t work so hard if Farmer, the staff development specialist and sim lab coordinator, wasn’t controlling Sim Man. She watches and clicks. Her movements are reactions that mirror real-life responses patients experience from the procedure. For example, if Rauscher, unlike Clooney’s character, sticks the tube through the trachea, censors in Sim Man notify Farmer of the problem, and she has Sim Man’s left lung collapse. The nurses then react to a new complication when they see only one side of his chest rise. Sim Man does what Farmer tells him to do. “He does everything but move,” Farmer says.

Upstairs in the labor and delivery ward is Noelle, another high-fidelity machine that “delivers” the hospital’s third high-fidelity practice mannequin, Sim Baby. Caring for an infant is different than adults, but each high-fidelity simulation device can receive numerous treatments and procedures: defibrillation, chest tubes, needle decompression, and a long list of invasive undertakings.

The need for continued education is the reason fueling the required simulations for St. Mary’s employees from paramedics to nurses. Like pilots using flight simulators, the employees review their skills annually, and that’s enough to fill the sim lab four days a week. The technology is fairly new, popping up in only the last decade, and patient safety advocates find the labs to be good news. Pulse, a national patient safety group, estimates deaths in the United States caused by medical errors to be more than 100,000 a year. Machines like Sim Man have one function, Pulse leaders say: reducing errors and improving patient safety. Farmer leads the team of nine educators tasked to reduce that number.

Miller and Rauscher practice cricothyrotomy every three months on Sim Man. This kind of practice on Sim Man generally produces more stress, Miller admits, because in real-life situations, more people are in the room and more procedures are done simultaneously. The fast-paced stress is what increases the chances for err, but practice becomes application. “We have to deal with those stresses,” Rauscher says, “and organize our thought process. It’s nice to practice a procedure like this, but the biggest thing about (Sim Man) is improving our thought process.”

For more information on St. Mary’s, visit www.stmarys.org.

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