Use of Patient Simulation for Training Health Care Personnel outside Anesthesia

At different centers, simulators have been used to train diverse groups of personnel in a wide spectrum of health care domains. Many of the applications of simulation training in anesthesiology, particularly the CRM approach, can be translated to other highly dynamic, highly critical areas such as the ICU, PACU, emergency room, and obstetrics. The extension of CRM training to these areas has been under way at several centers. Such training applications can be geared primarily to physicians in these areas or, better yet, to entire teams of personnel, including physicians, nurses, orderlies, and clerks. The simulator can be particularly useful to nursing personnel for conducting in-service training on clinical skills or the use of clinical equipment.

ACRM-like training was performed and the results published in the following areas:

• The ICU^{[130] [131]}

• The emergency department or trauma center^{[9] [132] [133] [134] [135] [136] [137] [138] [139] [140] [141] [142] [143] [144] [145] [146] [147] [148] [149] [150] [151] [152] [153] [154] [155] [156] [157] [158] [159] [160] [161] [162] [163] [164] [165] [166] [167] [168] [169] [170] [171] 172 173 174 175 176 177}

• The delivery room^{[138] [139] [140]}

• Cardiac arrest response teams^{[36] [141] [142] [143]}

• Radiology^[144]

Other domains currently using simulation training that might find ACRM-like training appropriate include field response by ambulance staff and combat casualty care in the military.^[145] Figure 84-9 shows one room with 10 simulators in a training center for military medics that has more than 100 simulator mannequins altogether.

Another field in which simulation is used more frequently is training for the management of chemical, biologic, or nuclear threats from accidents, weapons of mass destruction, or terrorism. The group in Tübingen, Germany, used their simulator to test the constraints of

Figure 84-9 Simulation-based training center for military medics. The room is equipped with 10 SimMan training stations. During training sessions, one instructor team is sitting at each foot of each mannequin. Teaching is provided "on scene" during the sessions.

Use of the simulator environment provided very good insight into the problems of physicians in chemical protection suits caring for patients. Interestingly, the ability to perform lifesaving actions was better than expected. Kyle and coworkers performed a multidisciplinary study with combined simulation modalities (script based, model-based mannequin simulators, and simulated acted patients) to

Figure 84-10 Realistic patient simulation as a test bed for studying the performance of medical rescue teams in full chemical protection gear. Teams wore normal uniforms or full protection suits while performing basic resuscitation actions (e.g., placement of intravenous lines, drawing up drugs, intubation). (Picture taken at the Center for Patient Safety and Simulation, Tübingen, Germany.)

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Figure 84-11 In rescue situations with full protective gear, communication within the team and with the patient is difficult. (Picture taken from a video screen at the Center for Patient Safety and Simulation, Tübingen, Germany.)