Instructor-driven simulators (IDS), also called intermediate fidelity simulators, use a partial or full body manikin as a physical presence on which to practice interventions. The simulators may interact with the user in limited ways, but the bulk of responses are created by the instructor. They often use real interventional equipment (probes, IV lines, ventilators, etc), and may or may not use real monitoring equipment. The output signals to their displays are consistent with the patient anatomy and condition being presented and are changed by the instructor to reflect real-time changes in patient condition.
The simulators are often set up to teach more than one topic or area. Since they are not programmed to be reactive to the user, an instructor / operator will adjust the relevant vital signs to accurately reflect patient responses. Unlike static part task trainers, however, these systems can give some performance feedback. The user is presented with a much closer approximation to an actual patient and environment than with static part task trainers. Because the instructor determines what response (if any) the patient should show, it may be easier in some cases to bring out a teaching point, especially if the point is regarding a patient whose parameters are out of the normal range.
There is significantly more realism and versatility of training topics than with part task trainers, but less than with model driven simulators. Commensurate with the realism and versatility, the start-up price is also somewhere between part task trainers and the high-end model driven systems. It is up to the trainer to determine how much realism is required for an application. It is also trainer-intensive, because the trainer must teach and, at the same time, create a patient response. An alternative is to have two trainers.
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Below is an alphabetical list of instructor-driven simulators with a brief description of the capabilities of each.
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Code Blue is an ACLS instruction package. A life-sized manikin represents the patient, which is connected to a computer program which the instructor uses to create a realistic patient response. There are also "virtual instruments," simulated instruments which are connected to the manikin and can be used to monitor or treat the patient. When certain interventions are performed on the manikin (intubation or peripheral IV catheter placement), sensors send signals to the instructor via the computer interface. The instructor can determine if the procedure was performed correctly and can cause the manikin to respond appropriately. Codes can be preprogrammed for testing situations to ensure uniformity. Responses can be programmed in ahead of time as well. Adult, pediatric and neonatal versions are available.
HAL is a wireless, PC-controlled manikin designed primarily for pre-hospital use, but can be used to teach ACLS and other skills for in-hospital providers as well. Initial care on-site can be practiced, followed by patient transport (ground or air) and in-hospital follow-up. The manikin has variable pulse strengths at multiple points, bilateral manually auscultated or automatic NIBP, multiple airway complications, and bilateral IV arms. Standard AEDs interface with the manikin. Trainee actions are automatically sensed and logged (such as endotracheal tube depth) as well as notes and logs from the instructor. The instructor interface is Gaumard's standard control software.
Newborn Hal is a wireless neonatal manikin that can be used independently or in conjunction with the Noelle birthing simulator. Invasive and noninvasive vital signs are adjusted in real time and are displayed on a simulated monitor. Cardiac rhythms and blood pressures can be detected by real monitors and defibrillators. Features such as cyanosis, decreased body movement, pulses, vocal sounds, and chest rise enable training of both perinatal and pediatric crises. Events or actions specific to any team member can be noted by the instructor in real time or bookmarked and annotated later. Newborn Hal is mainly instructor-driven, but does have a decompensation feature that can run automatically and adjust the vital signs and hypoxic color based on the effectiveness of ventilation. The manikin uses Gaumard's standard control software.
Noelle Obstetric Simulator (Gaumard)
Noelle is an obstetric and neonatal simulator package designed to demonstrate routine births as well as known and unexpected perinatal complications such as shoulder dystocia and breach position. Included in the system is an articulated infant with stress monitors in the neck to detect excessive force during delivery. Monitoring is available for the mother and baby (both before and after birth), including an ultrasound library. Possible interventions include airway and ventilation (mother and baby), fluid management, fetal positional changes (Leopold maneuvers, etc) and adjunct equipment usage (forceps, vacuum). The delivery is also simulated and programmable through a wide range of timeframes and patterns. Pause and fast forward are available during the delivery to enhance in-the-moment teaching points. The control software is Gaumard's standard interface.
This simulator was designed with Anesthesiology and Intensive Care in mind. It utilizes a full body manikin and real patient monitoring and equipment. It has pulmonary and cardiac signs, such as CO2 production and an EKG rhythm. Liquids are available to simulate tears, bleeding in the operating field, and perspiration. Skin changes (rash, cyanosis of the lips, etc) are demonstrated on the manikin as well. The manikin will demonstrate movement in the arm and general body movement during defibrillation.
Pediatric Hal comes as either a 1 year old or 5 year old full body manikin. The manikin is mainly instructor controlled, but does have a few automated features, such as a skin color change indicating hypoxia that resolves with appropriate ventilation (measured by the manikin). Vital signs are displayed on a simulated monitor except for EKG, which can also be displayed on any standard monitor, defibrillator or AED. Manikin signs include pulses, pupil reflex, chest rise on breathing / ventilation, and others. The manikin supports many treatment procedures, such as advanced airway management, intraosseous insertion and intramuscular injections. The control software is the standard Gaumard interface.
This wireless / tetherless manikin represents a premie baby weighing less than 1400g. For PALS training, ventilation and compressions are measured and recorded, and the vitals and patient color can be set up to respond automatically to effective ventilation. The program controls parameters such as pulse strength at multiple locations, left and right chest wall movement, heart / lung / crying sounds, and others. Scenarios can be programmed ahead. Vital signs are displayed on a simulated monitor, and the EKG trace can be displayed on any real monitor using real leads. Educational content includes x-rays, lab results, and more.
SimMan uses a full body simulator. In addition to many pulmonary features such as chest rise, lung sounds and difficult airway complications, the simulator demonstrates cardiac signs by utilizing a large ECG library, several palpable pulse points, and blood pressure and IV arms. Heart sounds are alterable to coincide with the disease being presented. Add-on modules include a trauma package and a portability kit, so that in-the-field scenarios can be run in the actual setting.
Susie is a wireless / tetherless full body manikin that allows training of basic crises in many hospital settings. The wireless system has a range of 300 meters, and can even be controlled between floors in a building. The manikin measures ventilations and compressions, senses the depth of intubation (with unilateral chest movement if appropriate), automatic pupillary response, and variable pulse strengths dependent on blood pressure. Real patient equipment can be used, including oxygen saturation probes, blood pressure cuffs and defibrillators. Preprogrammed scenarios can be used, as well as making changes on the fly. There are several separately purchased add-on modules available, including an Ob/Gyn package, bowel sounds, male / female catheterization, and others.
Truman is a partial torso manikin used to teach and test CPR and defibrillation skills. Real time feedback is provided on correct hand placement, depth of compression and rate of ventilation. Airway management including intubation can be taught on the Truman Multi as well. The simulated AED console measures pad placement, compares trainee treatment to the AHA / ERC algorithm, and restores carotid pulses on successful resuscitation.