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t m c » p u l s e | s e p t e m b e r 2 0 1 4 22 Pediatric Sim Training Delivers Results with monitors beeping and the sound of a baby crying, trainees work though high-risk scenarios with the help of the texas children's Simulation center B y A m a n d a S t e i n F or a family taking home an infant with a tracheostomy and ventilator, the reality of all that could go wrong can be "horrifying," says Amanda Spears, mom to fifteen-month-old Christian Zachary Spears, a patient of Texas Children's Hospital. But on the day when a complication with his tracheostomy tube caused her young son to stop breathing, Amanda knew exactly how to provide life-saving care—using a device known as an Ambu bag to provide manual breaths for respiratory support—while waiting for paramedics to arrive. "We immediately started chest com- pressions," Amanda Spears recalled. "Around the third cycle of us doing chest compressions and bagging him, he started breathing again. We bagged him until the paramedics showed up. They were just amazed with how well we handled the situation. Of course, emotions were high. But we were able to keep cool because we had actually been in this situation—not in real life, but in training. We had practice and prepara- tion for that moment." While all parents of infants on a ventilator with a tracheostomy go through standard training before the infant is released from the hospital, Amanda took part in a pilot program offered through the Texas Children's Hospital Simulation Center. She trained for four different airway emergencies using a high-fidelity mannequin fitted with a tracheostomy tube. "The high fidelity, or high tech mannequins that we use in simula- tions are very realistic. They do many things a real baby would do, providing an opportunity for traditionally health care providers, and now laypersons to practice management of life threatening situations. Our babies turn blue—signal- ing oxygen deficiency—breathe, cry, and have pulses," explained Jennifer Arnold, M.D., neonatologist at Texas Children's Hospital and medical director of the Texas Children's Simulation Center. "We always say that the technology is great, and that's what usually gets people excited about simulation, but it's not about the technology. These high tech mannequins are just a tool to allow a learner to really practice what they would do in a real situation and get immediate feedback from the 'patient.' It's really about the learning experience." Texas Children's releases as many as fifty patients a year on ventilators, and hospital educators hope that hands-on training for various airway emergencies could help decrease mor- tality and readmission rates. Nationally, tracheostomy-related airway emergen- cies after discharge from the hospital account for three percent of deaths in this patient population. In this simulation training program, trainees are given a series of tracheos- tomy-related airway scenarios—includ- ing a tracheostomy tube obstruction or a power failure—and are tasked with addressing the simulated emergen- cies with the skills they were taught in the classroom. As the trainees work Simulation training allows parents and physicians to practice life-saving techniques using high-fidelity mannequins. (credit: texas children's hospital) the immersion aspect of simulation training is just so powerful. you may forget what you heard in lecture, but you will never forget the mistake you made during a mock code. As we say, a mistake made in simulation is not a mistake that will be made in real-life. — mArtin lorin, m.d. Senior teaching faculty at texas children's Simulation center