Heart-Stopping Drama in the ER

May 30, 2012

It’s one thing to study anatomy and take the time to practice perfect stitches that won’t leave much of a scar. But it’s a heart-pounding challenge when those skills are needed in the emergency room as you look at the broken bone sticking out of the patient’s leg and an artery spurts blood-red liquid with every heartbeat.

This is real-time medical training at the University of Arizona College of Medicine – where ultra-authentic artificial tissue and humanoid patients are the center of simulated emergencies that bring medicine to life – and death.

The UA Arizona Simulation Technology and Education Center, also known as ASTEC, is the national leader in creating artificial tissues and training modules for the next generation of medical professionals. 

Not for the Squeamish

No more cutting on cadavers or even live animals. Today’s UA med students practice their skills on biosynthetic tissues that look, feel, cut and bleed just like the real thing. 

These low-cost artificial tissues are biologically authentic, and for the squeamish, grossly realistic. Images of these tissues have not been included here due to their graphic nature, but they are available on the ASTEC website.

Such hands-on experiences can mean suturing a wound, removing plaque from a carotid artery, doing a laparoscopic hysterectomy in a plastic pelvis – or participating in a variety of real-time simulations where your grade may be determined by whether the mock patient – baby, student or adult sized – lives or dies.

Dr. Allan J. Hamilton is executive director of ASTEC, which brought together his dual passions for educating and for pushing scientific boundaries. He has won international awards for groundbreaking work in the area of minimally invasive stereotactic neurosurgery of the spine. He is a professor of surgery, a professor of psychology-surgery, a clinical professor of radiation/oncology and a professor of electrical and computer engineering. He also authored “The Scalpel and the Soul: Encounters with Surgery, the Supernatural and the Healing Power of Hope,” which won the 2009 Nautilus Silver Award.

Split-Second Response Training

Hamilton writes that "simulation allows us to put the practice back into medical practice." ASTEC was designed to provide training in a risk-free, supportive environment, where students are guided through scenarios often culled from Hamilton’s own experiences. He encourages them to think decisively and creatively.

"We try to make the experiences as real as possible. If we can make them sweat in here, they are less likely to sweat in the real ER someday."

Nothing can compare to the tactile experience when a student pierces and begins to cut through layers of oh-so-lifelike tissue for the first time. ASTEC’s artificial tissue and computerized training simulations have proved so beneficial they are now integrated into all four years of the UA medical school curriculum. 

These artificial tissues replicate human tissues in size, shape, color, texture and tensile properties. They produce realistic venous and arterial blood loss. But for all their high-end features, they are low cost; most biosynthetic tissues can be made from molds in one to three hours. ASTEC makes them in their lab located in the UA medical center; and once used, they can be re-melted and recycled into more artificial tissues.

ASTEC has provided more than 25,000 learner contact hours since opening in five years ago, training UA students, residents and faculty. ASTEC also provides simulation training to medical flight crews, fire departments, military and other rescue personnel, as well as health care professionals in outlying communities.

Mass Casualty Field Exercise

The center partnered with Tucson’s Northwest Fire Department and the Arizona Telemedicine Program to conduct an outdoor simulated mass casualty field exercise – a two-vehicle collision with seven patients. Seven computerized high-fidelity mannequins and three live video feeds transmitted information back to medical students on campus.

This ultra-realistic training exercise received the first place 2011 National Award for Innovation in Fire Safety Education and Training from the Congressional Institute for Fires Safety in Washington D.C.

Hamilton said most of these students had never before witnessed the famous “golden hour of trauma” – that short interval in which rescuers can stabilize severely injured victims and save their lives. That lesson was powerful enough.

However “less than two weeks later the very same NWFD unit from our training exercise would be the first responders on the scene after the tragic shooting of Congresswoman Gabrielle Gifford and 18 others,” Hamilton reported.

Meeting Growing Demand Here and Abroad

As their next challenge ASTEC, in collaboration with the fire department and the UA telemedicine program, is planning a series of simulations to address border-specific mass casualties to be held at several desert locations.

In January 2012 ASTEC moved into larger quarters at University Medical Center so it can meet growing demand and even expand internationally. ASTEC and the UA Department of Electrical and Computer Engineering are partnering with the Wroclaw Medical University and University of Technology in Poland to create a sister simulation center. The next step is to establish a telemedicine linkage between the UA and Poland.

More information on ASTEC including a simulation training video