- The Washington Times - Thursday, April 20, 2006

Over the years, I’ve read that 100,000 people, or 200,000, or some other high number, die annually because of mistakes by medical professionals.

I am never sure what the numbers mean. On the police beat, I saw many car accidents. Ambulance crews would find someone who had just come through a windshield with obvious head injuries, blood gurgling in lungs, unknown internal injuries, neck at a very bad angle, and convulsing.

The ambulance crews have just minutes to sort this out. Mistakes come easy.

How do you train for such disasters? The medical trade now is moving toward the use of semirobotic dummies whose only talent is being convincingly hurt. Many people have seen the mannequins used to teach such things as cardiopulmonary resuscitation. The new models are far more sophisticated.

One company that makes these programmable medical catastrophes is Gaumard Scientific. Hal is their accident victim. The company also has Noelle, a pregnant model, that gives birth.

Hal is too complex to describe in detail but to grab at random a few of the things that he can do or simulate: “Oral or nasal intubation. Programmable airway to control tongue edema, pharyngeal swelling and laryngospasm. Perform tracheosomy or needle cricothyrotomy.

“Sensors detect depth of intubation. Automatic unilateral chest rise with right mainstem intubation. Multiple upper airway sounds synchronized with breathing.”

This is getting to be enough things to worry about that it begins to be realistic. You can be sure they will be more so in the near future.

To me, the interesting thing is that Hal’s (or Noelle’s) problems can be controlled from a laptop over a wireless connection. I’ve done first-aid courses in which students are told that the victim, usually another student, has a broken leg and needs a splint. Fine, but there is no stress and no surprises. It’s very different when the victim actually has blood pressure, a pulse, sounds of breathing that change, and so on.

The mannequins are explicitly designed to stress the student. For example, of Noelle the pregnant woman Gaumard says, “Intuitive interface allows you to quickly create obstetrical and neonatal emergencies.”

Things are going to go wrong unexpectedly, as in the real world. The computer keeps a record of everything that was done, so that later the student and instructor can go over it.

With Hal you can “control rate and depth of respiration and observe chest rise. Ventilation is measured and logged. Gastric distention with excess bag-valve-mask ventilation. Select independent left, right, upper, and lower lung sounds. Multiple lung sounds are synchronized with selectable breathing patterns. Accommodates assisted ventilation, including bag-valve-mask and mechanical support. Four needle decompression sites. Left and right unilateral chest rise simulate pnemothoraces.”

Not Little League stuff. It is the direction medicine is taking. Various organizations, such as the University of Hawaii, are working on “virtual surgery,” in which the student operates on a nonexistent patient created by computer. The instruments — a scalpel for example — provide physical feedback: If the instrument encounters “bone” the instrument feels as though it had hit something solid.

The idea needs work, but is getting there. The principle is that it is much better to learn on something that isn’t going to die than to do on-the-job training with live patients. While neither HAL nor virtual surgical patients are quite like the real thing, they are close enough to improve performance in real emergencies.

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