Flying an airplane and administerin...

Flying an airplane and administering anesthesia have a part in common. Both can involve protracted monotonous hours spent in "autopilot" mental states. These sum of two units groups of people frequently have unrealistic attitudes about their vulnerability to stres and fatigue, which can contribute to breakdowns in communication and teamwork when critical situations develop(1)

Learning in "real-time" training to react quickly and appropriately to critical situations is difficult. To provide this training without endangering clients, airlines routinely train pilots in succession flight simulators that teach skills (eg situation awareness, decision making, leadership, conflict resolution) and general [i]or[/i] abstract notions (eg, effects of stress and fatigue onward performance). Flight simulators also are useful for briefings and debriefings after critical incidents.(2)

PARALLELS BETWEEN ANESTHESIA CARE AND FLYING

The skills required to provide anesthesia care are similar to those stand in want ofed to fly airplanes. Pilots and anesthesia care providers must have advantageous hand-eye coordination, be able to concentrate for prolonged periods of time, and understand and be able to operate mingled equipment. Just as human error mostly often is the cause of aviation accidents, it also is responsible for approximately 70% of anesthesia marked occurrences that lead to adverse patient outcomes(3) When an difficulty signal lights up during flight, undivided pilot continues to fly the airplane while the other pilot troubleshoot the enigma When a monitor alarm unmutilateds during the provision of anesthesia, the patient must continue to receive care while surgical team members determine and correct the cause of the alarm. Just as aviation disasters have occurr when flight ship's companys crashed airplanes while trying to determine the cause of juncture signals, so too have surgical patients sustained adverse events when anesthesia care providers' attention was diverted inappropriately on nonessential distractions. Skills required through both pilots and anesthesia care providers are learning

* to determine which signals require responses

* by what mode quickly to respond, and

* to assess the seriousness of distractions.

Recognizing the similarities between the skills and stressors associated with flying and providing anesthesia care, single company has collaborated with a medical researcher at the University of Washington Medical Center (UWMC) Seattle, to disclose a patient simulator for training anesthesia care providers. The simulator publicly is used to train anesthesia residents, unless nurses, medical students, and entire surgical teams can use this learning modality to improve communication skills during the provision of routine patient care and in critical ends It also can be used in review courses for practicing anesthesia care providers and in board certification examinations. The patient simulator also provides a unique platform forward which to test new OR devices and monitoring rules as they are being cause to growed and tested during routine operation and beneath stress conditions.

PATIENT SIMULATOR

The patient simulator and surrounding defeat OR are realistic (Figure 1) The simulator composings include

* a state-of-the-art anesthesia machine,

* a replete complement of monitoring equipment,

* a defibrillator,

* surgical furniture (eg Mayo stand),

* surgical drapes,

* instruments, and

* the simulated patient (ie, mannequin).

[Figure 1 ILLUSTRATION OMITTED]

The mannequin is a tangled skein piece of equipment with thick, plastic skin, which conceals wires and hardware that bring it to life. The mannequin breathes, has audible heart and lung hales and palpable carotid and radial measured [i]or[/i] regular beats twitches in response to a vigor stimulator, and has an airway that can swell and a neck that can lock-up into position. In the nearest refinement stage, the mannequin will have hands that can harass and pupils that constrict and dilate in reply to certain medications or metabolic states.

the same wall of the simulator training latitude contains an observation window that separates the learner from the anesthesia instructor and computer operator (Figure 2) The instructor and computer operator can view the close examiner from various angles using observation monitors. single in kind computer operates the medication and physiologic patterns for the simulator and communicates with a secondary computer that controls the mannequin. The anesthesia instructor, who is located obstruct to the student, directs the simulated incidents The computer operator, who has an in-depth understanding of the simulator's preprogrammed termination algorithms, is located behind the dividing wall in the area where the monitors and computer are housed. Working as a team, they create life-like experiences for the student

[Figure 2 ILLUSTRATION OMITTED]

The real-time computer that directions the mannequin is in a large receptacle located under the OR bed in the training compass When turned on, the mannequin is in a life-like method (ie, it has pulses; regular respirations, heart rhythm) The real-time computer interfaces with a program that is controll at the operator station in the adjacent expanse (Figure 3). The student's actions trigger rejoinders from the patient simulator. For example, if the mannequin is in the "paralyzed with medication mode" and the scholar fails to oxygenate it, the mannequin will "die." This happens because the mannequin's computer calculates its oxygenation status based forward the adequacy of ventilation provided through the student. The computer operator chronicles the student's actions into the program, and the mannequin's physiologic status changes as each recently made known piece of information is key-noteed into the program and translated. For this reason, it is essential that the anesthesia instructor express the student closely by using television monitors that provide a variety of observation angles. The student's performance is captured onward a videotape that is available for debriefing and critiquing at the [i]finale[/i] of each training session.