Page 76 - JSOM Summer 2019

FIGURE 1 Initial simulator using a box to represent the torso of a FIGURE 3 Initial simulator being used to train 18Ds on temporary
patient. vascular shunt placement.

FIGURE 2 Initial lower-fidelity simulator using Penrose drains to
represent an injured vessel (arrows). A temporary vascular shunt
in place spans across the injury and is secured in place with a silk
suture. Bags of saline were used to replicate small bowel.

FIGURE 4 Higher-fidelity simulator using a mannequin upper torso
and self-made lower torso.

aortobifemoral bypass graft (Figure 6). The graft was tied
down to rubber tubing proximally and distally. This allowed
for infusion of “blood” proximally and collection distally (for
reuse as needed). A surgical glove filled with saline was placed
in the right upper quadrant to simulate the liver (Figure 4). A
series of red balloons were filled with saline and tied together
to simulate small intestine overlying the vascular structures.
The trainer was successfully used for several iterations and al-
lowed for individual and team training on placement of intra-
vascular shunts and vascular repairs.

Experience
Both trainers were highly successful at achieving their education
goals. The medics and entire team reported increased comfort
with shunt placement after the training iterations. Likewise,
the surgeons found it helpful to practice vascular repairs on
the simulator. Most importantly, it provided an opportunity to this training was of direct benefit to the patient. Specifically,
work on team dynamics and communication skills when faced team members reported increased confidence and comfort with
with life- and/or limb-threatening injury where time is of the placement of the shunt into the injured patient. In addition, the
essence. Shortly after the initial iterations of the training, the surgeons reported quicker placement of the shunt, resulting in
team was confronted with an injury requiring shunting and decreased blood loss and less ischemia time for the distal limb.

74 | JSOM Volume 19, Edition 2 / Summer 2019