"Annie, Annie, wake up! Are you OK, Annie?" If you ever took CPR training (and you should), you probably met "Resusci Anne", the life-sized plastic doll that helps you learn chin thrusts and proper breathing techniques. Multiply Annie's capabilities by about a zillion and you have SimMan, the life-sized patient simulator.

The device is helping health-care and emergency folks learn what to do, and what not to do. And, as they say in the movies, "no humans are killed or injured in this training."

I first saw a patient simulator in the hospital of Camp Julien, the Canadian Forces base in Kabul, Afghanistan. The medical staff there actually don't see very many patients, since the base's population is primarily young, healthy and fit. But the camp medics have to be ready for anything, including mass casualties, so they need to keep their skills in top form. One way to do this is by practising scenarios on their SimMan mannequin, manufactured by Norway-based Laerdal Medical.

This $38,000 wonder can be programmed for a huge number of medical emergencies and other situations. Heart attack in a diabetic? Severe asthmatic who's going south? No problem. SimMan has a variable pulse that can be taken at various key points on the "body.”

Photo courtesy of Laerdal Medical Canada
Medical staff practise their techniques on a patient simulator developed by the Norwegian company Laerdal Medical.

Its chest rises and falls. You can take its blood pressure with a regular sphygmomanometer.

It can be intubated, defibrillated and even tolerates the fumbling insertion of a urinary catheter without complaint. In theory, it could complain because the mannequin is able to speak, according to Laerdal's Edmonton-based district sales manager John Dervin. It mouths pre-programmed phrases such as "Doc, I'm in so much pain!" Then there's the one that really annoys the nurses, says Dervin. "Nurse, I need my sponge bath now."

Since SimMan has a built-in microphone and speaker, the person operating it from another room could even have a real-time conversation with the attending doctor, nurse or emergency medical technician. The mannequin is so lifelike that Marilyn Ringness of Grande Prairie Regional EMS refers to it as a person. "He's available to all of our on-duty staff," she says, "and he's used for formal and informal training, especially when we have practicum students."

Laerdal's Dervin says the device has been a godsend to students in the health professions and to those charged with mentoring them. "With human resources so scarce, it's getting harder and harder to find practicum placements."

Having SimMan allows students to get real-world experiences that they might not see in hours of riding an ambulance or working in the ER, he notes. Laerdal also has a product called Virtual I that provides practice and feedback on the fine art of needle jabbing. After all, not many students want to volunteer their own arms for venipuncture practice by their peers. "I know how little that kid next to me studies," Dervin jokes, "and I'm going to let him stab me? Not likely."

Dervin says that SimMan can actually be male or female, since those, er, parts are interchangeable. He says the company provides regular upgrades, many of which are software changes that are given free of charge to customers. There are also websites where users can exchange programming scenarios.

The U.S. military, which has about 335 Laerdal simulators, was interested in smallpox, so the company added an optional smallpox training module complete with mock pustules.

What's next? "Reactive pupils are coming down the tube," says Dervin.

Alberta's STARS (Shock Trauma Air Rescue Society) air ambulance team was in on the ground floor of patient simulator technology. Dr. Greg Powell, professor of family medicine at the University of Calgary and CEO of STARS, came up with the idea of a mobile patient simulator based partly on his experience as a pilot.

The device, mounted in a motorhome, now travels around Alberta and eastern B.C., training rural health professionals.

Florida-based METI, Inc. makes a human patient simulator called Stan, which is based on some of Powell's innovations. Stan has even appeared on TV's ER program. And, yes, METI already has the reactive pupils feature working.

Powell proudly points to the full-featured, $180,000 US human patient simulator that STARS uses. "It does everything, including breathing in oxygen and breathing out carbon dioxide."

"Simulators are really the future of health professional education," adds Powell. "All the educational and training institutions are acquiring them."

Ringness agrees. She says they like their simulator so much that they're fund-raising for a child-sized version, which will cost about $8,500.

Simulator-based training can pay off in unexpected ways. Dervin tells of a major Western Canadian city that wound up in court after its paramedics attempted a procedure that ultimately did not save the patient. They were able to demonstrate that the medics were properly trained because they had done the procedure recently on a simulator. "So, there are risk management advantages to simulator training," Dervin says.

"Western Canada has been in the forefront of accepting patient simulators," he says. "Of the 50 or so SimMan units in Canada, 19 are in Western Canada."

The military makes good use of them, and educational institutions such as Grant MacEwan College, the Southern Alberta Institute of Technology and Medicine Hat College have all embraced these devices.

As for what the future holds for patient simulators, the sky really is the limit, because these devices could someday be used to simulate medical crises in space.

And, for the video-game generation, the possibilities for virtual reality training using head-mounted displays are intriguing.

New features are being added constantly and they'll work their way down into the lower ends of the product lines.

So, the next time you're recertifying your CPR and trying to get a good mouth seal on "Annie," don't be surprised if she burps or offers you some breath mints.

Web watch:
www.laerdal.ca
www.meti.com
www.gprems.com/friends/friends.asp