Gunshot Wound Trainer Helps Trauma Team Rehearse Emergency Care
Posted on March 16, 2017
Gunshot wounds in children are a sad reality. “In 2009, an average of 20 U.S. children and adolescents were hospitalized each day due to firearm injuries.” When Boston Children’s Department of Surgery wanted to simulate a high-tempo, high-stakes gunshot wound case, they turned to SIMPeds.
Maria McMahon, MSN, RN, CPNP AC/PC, EMT-B, and David P. Mooney, MD, MPH, who lead the Trauma Crisis Resource Management simulations, needed a mannequin that would bleed enough to trigger a massive transfusion protocol and allow them to place a chest tube. They wanted all of the normal functions of a high-end mannequin (like heart/lung sounds, chest rise and fall and vitals info), but the trainer also had to look as realistic as possible to make the simulations credible.
Taking the clinicians’ design input into account, SIMPeds engineer Greg Loan decided to use the Laerdal SimJunior mannequin as the base for creating an ultra-realistic, high-end trainer. The next step was to design a chest to lay over SimJunior that would meet training needs.
The chest needed to have a section of ribs underneath the skin — something SimJunior doesn’t have — so participants could learn to find the correct intercostal space for chest-tube insertion. But with all of the added bulk, the engineering team worried that the chest would look oddly oversized for the rest of the mannequin. That is when the team decided to make the gunshot wound trainer look like an overweight child, hiding the added bulk and adding another dimension of realism. Through a combination of traditional sculpting techniques, special effects and computer-aided design, the SIMPeds Pediatric Gunshot Wound Trainer took form.
The trainer is custom-fit for the SimJunior mannequin and zips up the back like a reverse jacket. It features a realistic-looking gunshot entry and exit wound and allows trainees to perform a needle thoracostomy with blood/air blowback and place a chest tube causing frank bleeding. 3D-printed rib sections on the upper chest and underarm allow for palpation of intercostal spaces. The modules are waterproof and puncture-proof to prevent fluid from entering the mannequin and are easily replaceable.
The Pediatric Gunshot Wound trainer has been used several times since it was introduced in December 2016. As part of the Crisis Resource Management (CRM) training offered by SIMPeds, the trainer allows participants to practice the valuable principles of CRM in order to reduce errors and improve game-time performance. CRM, cutting-edge simulation technology and debriefing from SIMPeds make a powerful combination for enhancing the learning experience and improving patient outcomes.
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The pediatric gunshot wound trainer is one of 22 new trainers completed by SIMEngineering in Q1 of FY17. The majority of trainers were developed for Surgery, Orthopedic Surgery and Emergency Medicine. To see a trainer first hand or offer your own ideas for new trainers, please email Melissa.Burke@childrens.harvard.edu.