SIMS Medical Academy™
Exploring simulation with the expectation of improved patient care.

Acute care patient in SIMS Medical Center

Environmental Control | Patient

Getting the patient to look and act as human as possible is important and also difficulty. Many patient simulators are designed with a wide open mouth to allow for intubation. While this is helpful for paramedics, respiratory therapists and some doctors, the open mouth detracts from a non-emergency patient event. There is really nothing that can be done for the mouth, but attention to skin features, hair, clothing and voice go a long way to make the patient look and act more "real." Here are some examples of how to enhance the learning experience.

Laerdal burn insert for patient simulation before enhancement

Shown is the standard burn "dry" insert for the Laerdal line of patient simulators. There are areas of third and second degree burns. The insert slips into a space located on the lateral aspect of the thigh.

Standard Laerdal burn insert for thigh area.

Rehab students needed to see how this type of burn is managed which meant adding tissue that could be debrided by either a nurse or a Physical Therapist. Note the difference between the image above and the "dry" insert. A significant amount of "dead" tissue has been added.

Burn enhancement kit

A small segment of a brown paper towel was torn into random size pieces no larger than half an inch. The pieces were placed in a paper cup and theatrical blood (thick) was added for color. Molasses was then added to darken the color and to increase the possibility that the "dead tissue" would stick to the burn site. We used a small paint brush to apply the paper. Water was added to the red dye and molasses left in the paper cup to form a watery "blood" which was then poured onto the burn side of gauze pads. When the pads were placed on the burn site, just the right amount of "blood" seeped through.

The faculty and students were very pleased with the experience. Instead of just talking about how to perform wound debridement, students were able to participate by watching the procedure and interacting with the patient. The female patient fell asleep in bed while smoking. The bed caught fire and she was burned on her right leg. As the students talked to the patient they discovered she has a drinking problem, a husband with a "bad" hip who cannot help her, and the possibility that she might lose part of her right leg from the accident.

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This patient is participating in a Trauma Room event at one of our member institutions. Common make-up was used to create bruising and abrasions. An inexpensive wig helped her look "different" from other patients.
The scenario is that she was standing on a ladder, changing the light bulb on her front porch lamp. She slipped resulting in her left leg getting caught in the ladder and breaking, then her face hitting the porch. She lay on the porch for almost four hours until her neighbor came home from work and called 911. The patient, Janet Wachowski, was taken on backboard with neck brace by ambulance to SIMS Medical Center Trauma. Paramedics placed her left lower leg in a pneumo-cast.

Upon arrival at SIMS Medical Center Trauma, she was evaluated and immediately sent to CT for spine clearance. The CT was negative and she was returned to Trauma without the neck brace. Her right eye is open while the left is "swollen" shut and the orbital area heavily bruised. There is also an abrasion on her chin. She now awaits a trip to Radiology to have her leg X-rayed. Ms. Wachowski has been given pain medication and is awake and talking.

Lateral view of lower leg, Trauma Patient at SIMS Medical Center In several of our member institutions, this patient can actually be taken to an X-ray lab and her lower leg radiographed. As you can see the leg is actually broken. There is little displacement now, but with some effort, this fracture could become serious enough to require surgery.

Having the patient react in realtime is very important. Some centers use the audio files available on the computer software. There are finite responses possible and the operator has to find and activate appropriate responses. Total Application Scenario requires that the patient actually speak, ask questions and interact with medical personnel. See Wireless Voice

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This is one of our favorites. Using a glove, we fill it with a variety of things like old bread, tomato paste, toothpaste (white or green is lovely), crackers, chocolate chips, anything that give the appearance and feel of the real thing. The glove is placed within an existing wound molded into the abdominal insert for the Vital-Sim line of patients. The topping is "fake" blood from a party store. Patient is bandaged. The students get to discover this after the post-surgical patient coughs and then complains about a pain and a funny feeling in the abdomen. Adding a very concerned relative makes the scenario more intense and covers "directive communication" competencies.

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Patient with bruise from steering wheel.

The bruise from the patient hitting the steering wheel of his car was created with common make-up. A base of medium green was applied first. Then a layer of dark gray, followed by red, and finished with dark gray to black powder-based make up. There are mixed reports on using grease or oil based make-up. Best to try either on a small area to make sure you can remove it later.