Simulation in the open

Four people stand in a circle, having a conversation with their backs to the camera. They are surrounded by concrete dividers and sandbags that separate them from a large bank of screens with imagery of a war-torn city and American Service members in full combat gear returning fire on insurgents. // Staff visiting from the Uniformed Services University of the Health Sciences (USU) experience the Wide Area Virtual Environment (WAVE). Students from USU and around the country are put in the WAVE to be tested in scenarios like helicopter evacuations, and surgery in a field hospital. Equipment hanging above the WAVE can be used to change the heat and even smell of the room, while motion trackers can detect when a student is returning fire in a combat-zone scenario. (Image credit: Air Force Staff Sgt. Joseph Pagan)
  By Christopher Austin

The Uniformed Services University’s Val G. Hemming Simulation Center (SimCen), located in the Forest Glen section of Silver Spring, Md., plays a key role in preparing military health care providers for their future.

On Sept. 14, the SimCen held an open house to showcase what makes the place so important to the University’s mission and to highlight National Healthcare Simulation week.
“Our goal is to maintain leadership in the world of medical and surgical simulation,” said Dr. Lou Clark, the director of Clinical Simulation at the SimCen. “We strive to create simulation events that foster patient safety, and to support trainees in working more effectively and compassionately with patients.”

Military health care providers are unique in that they not only have to be prepared to care for people in a hospitals, but also on the battlefield, in the air or in the wake of disasters or terrorist events. The SimCen does this through the use of a variety of training opportunities that combine 3-D or high fidelity simulators and patient actors.

For example: the Hybrid Simulation Lab is a mock surgical environment where students must appropriately respond to a patient – an advanced mannequin – while sometimes dealing with a human actor – referred to as a simulated patient – who plays the role of a concerned family member of the patient.

Medical students in tactical gear practice medical procedures on mannequins in a darkened room. The only light comes from red flash-lights attached to their helmets.
Students from USU practice medical procedures on simulated patients in a night scenario in the Hybrid Simulation Lab at the SimCen. (Image credit: Val G. Hemming Simulation Center)

The team of educators, clinicians, engineers and artists who make all this possible can watch the students from within a darkened control room lined with one-way mirrors to look into the operating rooms. By using a touch-pad, the SimCen staff can have the mannequin patients begin to hemorrhage fake blood, open their eyes, or begin to go into cardiac arrest, depending on the scenario they are testing the students on.  The lab also features traumatic injury, maternal-fetal, and child simulators.

The Clinical Skills lab, another tool of the SimCen, is full of simulated hospital rooms that are wired for observation by faculty and staff. Inside these rooms, the students interact with actors who play the role of standardized patients – patients displaying a predetermined set of symptoms and behaviors that are meant give students practice on learning medical interview and foundational physical exam skills. After their ‘office visit,’ the students can review their performance with instructors.

The most unique feature of the SimCen, though, is the Wide-Area Virtual Environment, or WAVE; a highly-controlled, interactive program that can put students in the middle of a variety of interactive virtual scenarios. The WAVE is under the direction of Dr. Al Liu, the director of virtual medical environments at the SimCen. The darkened 8,000 square foot room is surrounded by screens that can show a 3D landscape of a variety of environments, including a medical helicopter evacuation to a military operating room, a Critical Care Air Transport Team in a C-17 aircraft, a bombing in an urban subway system, or a foreign combat zone. Heating lamps in the room’s ceiling can create temperatures akin to deserts, and next to them sit canisters that can release scents into the room to increase the realism. During simulated firefights, air cannons can send foam ‘rubble’ onto students when an insurgent fires a rocket at them, and the students can even return fire thanks to a network of motion trackers around the room.  The sound of explosions, aircraft, gunfire and screams fill the air.

A table features a laptop open to a diagram of the anatomy of a human leg, a tablet, a shirt with a diagram of a human lung, and several sheets of temporary tattoos of wounds.
In the Hybrid Simulation Lab at the SimCen, Elizabeth Weissbrod, a medical illustrator, produces several moulage – or simulated wounds – that are used on simulated patients. Because of the high-volume of students that must be tested, and the time it takes to produce a full moulage out of silicon, Weissbrod is experimenting with using temporary tattoos and makeup to create efficient and realistic simulations. (Image credit: Christopher Austin)

“I think a lot of medical students are going to benefit from what’s happening here, and they’re going to be a lot more prepared for in-field scenarios because of it,” said Erin Sheffels, a researcher at USU who attended the open house.

According to Clark, the SimCen’s programs are only possible thanks to the collaboration of the actors and artists who create the authentic experiences that students take part in, which are supported by skilled technical and administrative teams that facilitate the systems allowing for truly interactive learning experiences.

“We’re a very diverse group here,” she said. “We have a wonderful medical illustrator, folks with theater arts background, animators, graphic artists… and we can’t do it without our administrative side of the house; IT experts and wonderful administrative support. It takes all the talents of all of these people to make the over 300 simulated events we run a year possible.”