Page 91 - Journal of Special Operations Medicine - Summer 2017

Manikin Human-Patient Simulator Training

Gregory T. Horn, MD; F. Young Bowling, ATP, BHS; David E. Lowe, ATP;
James G. Pairmore, PA-C; David R. Stagliano, MD; Nicholas M. Studer, MD, NRP

ABSTRACT

Background: Human-patient simulators (HPSs) may point-of-injury military field medical care requires de-
help enhance medical education. Manikin HPS devices velopment of the skills to recognize critical injury and
respond to common field medical interventions, such as execute invasive procedures while also placing providers
cricothyroidotomy, and have realistic feedback features, with limited experience in often extreme circumstances.
such as respirations and pulses. This study surveys Spe- Human-patient simulators (HPSs) offer one possible
cial Operations Medics for evaluations of HPS features. element that may help reduce critical medical errors
Methods: Of 518 subjects, 376 completed testing and through improved education. Refining the features of
1,2
surveys with valid responses. A total of 102 variables these HPS devices and manikins will allow for continued
were divided into three categories—general character- improvement of traditional and field medical education.
istics, procedures, and injuries—and assessed on a five-
point Likert scale. The Student t test was used to analyze Didactic lectures fall far short in providing the level of
data together and as separate groups against each other adult learning needed to master skills for use in live sce-
and against an aggregated mean. Results: Features narios. Deliberate practice on task training devices and
3
that received high scores (i.e., higher than 4.5/5) cor- tissue, manikin simulators, animal models, and healthy
responded closely with pillars of the Tactical Combat volunteers enhances learning and reduces risks to pa-
Casualty Care (TCCC) curriculum, basic life support, tients. Although simulation methods are still developing
and realism. Discussion: US Army Special Operations within medical fields, high-fidelity simulators, which are
Command and US Special Operations Command Med- capable of replicating almost exactly many dangerous
ics have overall high confidence in manikin HPS devices circumstances, have been considered essential to the field
and specifically in those that align with TCCC train- of aviation for decades. Parallels between the fields of
4,5
ing and lifesaving procedures. The skills most valued medicine and aviation are common because both fields
coincide with difficult-to-practice measures, such as require advanced training and proficiency with com-
cricothyroidotomy and wound packing. Features such plex, high-risk tasks. Additionally, the acceptable failure
as prerecorded sounds, sex, automated movements, rate in both fields is necessarily low. From these com-
skin color, defibrillation, bowel sounds, and electrocar- parisons, many lessons learned have been adopted to
diogram are rated lower. These evaluations may guide medicine. As with the development of improved flight
future development or procurement of manikin HPS simulators, higher-fidelity manikins, termed human-pa-
devices. tient simulators (HPSs) in the literature, have emerged
that allow medical personnel to attain more meaningful
Keywords: human-patient simulator; manikin; Tactical Com- experience by using the principles of feedback, deliber-
bat Casualty Care; training ate practice, outcome measurement, and multiple active
learning strategies. 6–8

Manikin HPSs were originally designed to train anes-
Introduction
thesiologists for operating-room crises and were devel-
Medical education struggles to reconcile the need to oped into complex full-body mannequins suitable for
train new healthcare providers to perform in real sce- replicating a variety of complicated scenarios. 5,9–11 In
narios with the potentially disastrous complications of that role, manikin HPSs were demonstrated to improve
inexpertly performed procedures by trainees. Errors are anesthesiologist responses to accidents and reduce er-
inherent to the learning process, but, at some point, nov- rors made at several levels of education. 12–16 Although
ice practitioners are expected to provide medical care no simulator can truly reproduce live experience, mani-
when lives hang in the balance. In particular, successful kin HPS devices may respond physiologically to medical

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