Heritage Snapshot: Part 214 Medical Simulation Center

LOMA LINDA >> After growing in Risley Hall from a two-manikin facility to a program serving all schools, the 8,000-square-foot Medical Simulation Center (MSC) now resides in a unique, state-of-the-art, virtual hospital on the fourth floor of the Centennial Complex. It provides a safe learning environment with no patient risk. Except for the patients and drugs, all of the hospital equipment is real: resuscitation equipment, gurneys, surgical tables and instruments, cardiac monitors, ventilators, and defibrillators. Virtual reality and computer software allow surgery residents to perform virtual laparoscopic surgery. Within the MSC a manikin-patient simulator may be injured in an earthquake or car accident, be transported within a moving “ambulance” or noisy, vibrating “helicopter,” receive stabilizing care in an emergency department, undergo life-saving surgery in the operating room, recuperate in the post-anesthesia care unit, and then move into a med-surg room prior to discharge from the hospital. During that time, multiple care providers can perform their discipline-specific assessments and treatment, hand patient care over to subsequent teams, and then review all of the video footage in observation-debriefing rooms. Most of the manikins have names. The two most sophisticated ones are adult males named Bruno and Arnold. A nine-month-old female is named Katie. Some of the manikins are able to talk, breathe, have normal and abnormal heart, lung, and bowel sounds, respond to electrical shocks for defibrillation, have intravenous lines placed, be intubated and placed on respirators, and have chest tubes placed for decompression of air or blood outside of the lungs. According to T. Kent Denmark, MD (Class of 1994) director of the Medical Simulation Center, “The range of critical, physical findings and clinical conditions that can be reproduced is stunning.” With a variety of sophistication, manikins can talk, bleed, drool, sweat, experience heart attacks or seizures, and even attempt to “commit suicide.” Their pupils can dilate. Their tongues can swell. They can display chest rise, breast lumps, and stomach distension. One of the mannequins, named Harvey, has 29 heart sounds and 30 lung sounds. Harvey’s heart sounds can be monitored by up to 15 students, using wireless stethoscopes. The physiology of most of the manikins (respiration, heart rate, and blood pressure) are changed wirelessly in a central control room, from which educational activities are monitored through one-way mirrors and on huge, high-definition, flat-screen TV monitors. Students can check blood perfusion in the extremities and feel a manikin's carotid, brachial, and femoral pulse. If a manikin becomes cyanotic from lack of oxygen, his lips may turn blue. Two of the manikins can deliver babies, both naturally and by Caesarean Section. Some of the manikins are “babies” who are transferred after “delivery” to the mini-hospital’s Neonatal Intensive Care Unit. A pulse can be felt from the umbilical cord and fontanel. The Medical Simulation Center features a variety of specialized training areas to provide skill-building opportunities for nurses, physicians, allied health providers, and first responders. Areas of specialty include pediatrics, anesthesia, surgery, recovery, emergency medicine, and dentistry. The facility is available to public service agencies. For example, CalFire personnel arrived “on scene” to find a manikin “who had attempted to commit suicide by hanging.” Officers had to cut Bruno down and resuscitate him, while personnel in the control room manipulated his “physiology.” The Medical Simulation Center also provides a simulated ambulance and helicopter, complete with virtual environments; all the motion and sound effects of a real helicopter and real ambulance. A caregiver in the ambulance, for example, may have to learn how to attach an intravenous line or cardiac monitor leads while the “ambulance” is “bouncing over railroad tracks.” From humble beginnings, medical simulation continues to evolve into a high-tech field where students learn not only procedural skills and medical knowledge, but also about team building, communication, transfer of patient care, and ethics in a realistic health care setting. Currently students from the Schools of Medicine, Nursing, Allied Health Professions, and Dentistry participate in simulations. Multiple practitioners in the Medical Center also use these resources with scenarios focused on objectives ranging from completing simple procedures to laparoscopic surgery, and complex, interdisciplinary “code” emergencies, with difficult patient family dynamics (actors) as complicating factors. In the event of a disaster, requiring triage and treatment facilities to supplement Loma Linda University Medical Center, the Medical Simulation Center can quickly be converted into a fully functioning emergency center and mini-hospital.