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How fake blood and medical dummies could save billions
Drexel Simulation Lab technician Chris Eden during a medical simulation.
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Chris Eden has his silicone head wound removed by a co-worker.
Tess Vigeland: Today, Consumer Reports released new hospital ratings. Several teaching hospitals appeared at the bottom of the list, which was based on infection rates.
Perhaps what those doctors-in-training need is a little more practice on treating patients. That is, fake patients for real problems. From Philadelphia, Mara Zepeda looks at how the medical simulation industry could save the health care industry billions.
Mara Zepeda: In the 1980s, Dr. David Gaba noticed simulation training was standard for some professions. Pilots learned how to fly in fake cockpits. Soldiers practiced how to fight on replicated battlefields. So, why not doctors?
David Gaba: Well, I've sometimes been called the father, or the grandfather or the godfather of mannequin-based simulation.
Gaba is associate dean for simulation at Stanford's Medical School. Thirty years ago, the technology didn't exist, so Gaba took matters into his own hands. He was like the MacGyver of mannequins -- using screwdrivers, balloons and tape. He even wrote his own computer code. Doctors could practice monitoring oxygen levels, inserting breathing tubes or dealing with a collapsed lung on these makeshift mannequins.
Gaba: In the very early years, most people said, "Oh, that's an interesting toy. I hope you have some fun with that" or something.
But that toy eventually became a product. In 2000, a company called Laerdal introduced the SimMan. They had many of the features that Gaba was trying to create: a pulse, blood pressure and dilating eyes. Back then, a SimMan cost about a quarter million dollars. Now, SimMen are $70,000. As this technology became more affordable, more simulation labs cropped up.
Labs like this simulated emergency room at Drexel University's College of Nursing. It's 9 A.M. on a Monday when suddenly:
Man: Excuse me. Excuse me. We just had a bus explode down by the Liberty Bell. It's an official disaster in the city of Philadelphia. First of all, does anyone have experience with mass casualties?
It's a chaotic scene as more than a dozen victims of the blast are wheeled in on gurneys. Some are mannequins, like the ones you see in shop windows. Some are SimMen. And then there are pretend patients played by real people, like Chris Eden.
Participant: Can you tell me your name?
Chris Eden: My name is Chris.
Participant: Are you having any pain?
Eden: My head. My head hurts so much.
Medical Simulation from Marketplace on Vimeo.
Drills like these might translate into fewer malpractice suits and shorter hospital stays. That could save the health care system as much as $79 billion each year. That potential for huge savings has accelerated the industry's growth.
For makers of fake blood and SimMen, business has never been better. Rocky Rockstraw, the assistant dean of simulation at Drexel, is a regular customer.
Rocky Rockstraw: You know, it's expensive when people start talking about outfitting their schools and their colleges with simulation.
And taxpayers will be footing some of this bill. So how do we know if simulation even works? Robert Furberg analyzes health care technology at Research Triangle Institute.
Robert Furberg: It's really important to acknowledge that clinical simulation is still very young. There just isn't enough of an evidence base.
Furberg says it's a chicken-and-egg problem. He says we won't know if simulation works unless the government forks over the money to fund and study it, and build that evidence base.
Furberg: I think ultimately there's an indirect benefit to taxpayers, I mean, if reduction of medical error is associated with a reduction in overall health care costs.
The Department of Health and Human Services will soon announce $10.5 million in new medical simulation grants over the next three years, which will mean more funding for things like this:
Simulation lab technician: What I'm going to do now is I'm going to use much more liquid blood and let it run down the side of his face. And drip on to his clothes, which is actually natural. So we're OK with that.
In Philadelphia, I'm Mara Zepeda for Marketplace.
There is a hidden story in this interview. The headline says “how fake blood and medical dummies could save BILLIONS†. Yet, the comments from Rockstraw and Furberg only stress cost concerns and POLITICS, “expensive … taxpayers footing some of this bill… isn’t enough of an evidence base… won’t know if simulation works unless the government forks over the money to fund and study it â€. I purposely highlighted the word politics, because that’s the hidden issue here. Similar issues related to training were raised 50 years ago when simulation was first brought to aviation. Where are we now? Over 100,000 DEATHS a year estimated from medical ERRORS, while the airline industry can go multiple years with ZERO deaths.
Why do I call it a political issue? Because $79 million in well selected studies would answer any major evidence questions. But even with “$79 BILLION†at stake (using the value stated in the interview) the country doesn’t have the political “leadership†to find the money. Why? Because saving $79 billion for the taxpayers pockets means losing $79 billion from someone else’s pockets. Follow the money! There are people who will resist any change that threatens their wealth, even if others are dying.
And, contrary to what this article implies, there is ALREADY a LOT of evidence for the medical value of simulation - like a study of 20,000 childbirths in the U.K. showing major improvements in infant condition after simulation training. But what does Furberg say, “isn’t ENOUGH of an evidence base.†Actually, I don’t disagree with him. How can that be? Because, his statement is true if viewed as a POLITICAL observation. It’s just not true based on science or medicine.
I work in a college simulation lab where medical students are taught basic clinical skills using standardized patients (patient actors) and mechanical simulators. Some simulators are simple reproductions of one section of a body, such as a breast or a pelvis that allow for the teaching and the practice of specific exams. Some of the simulators are “androids†that simulate commonly measured vital signs – vital signs a health care practitioner might expect for a particular patient and combinations of vital signs that might indicate need for investigation/intervention. These simulators have roughly life-like skin, airways, body cavities and passages such as urethras and veins.
Mechanical simulators are great for students getting a first experience and practice with skills that are potentially dangerous or that are invasive to a patient – such as CPR, insertion of needles into blood vessels and insertion of tubes to relieve the bladder, to feed a patient or to help them breathe. Having practice with these skills on a realistic simulator may help student practitioners to be more competent and to focus more on the patient in their early clinical experiences.
Mechanical and computerized simulation in health care is gaining popularity as costs come down and as the simulators become more durable, better designed and easier to use. Improved miniaturization of electronics and mechanics, better materials and continued engineering and software refinement are being incorporated into the latest simulators.
At my college there's also development going on with virtual simulation (using environments such as “Second Life†and virtual reality games that simulate the patient's conditions subjectively) and with medical instruments such as stethoscopes, electronic thermometers, and blood pressure cuffs that give pre-programmed sounds or results when working with either standardized patients or mechanical simulators. These efforts are usually collaborations between various colleges of the university as well as with outside individuals and companies.
I do video and photo documentation of simulated emergencies for the federal government.
At one large simulation in Pueblo, Colorado several years ago, I was shooting pictures of the several hundred high school students recruited as "victims." They were being made up with moulage, as the fake injuries are called, early in the morning in the school gymnasium.
Suddenly one of the make-up artists shouted out across the chaotic gym: "Hey, I'm out of blood! I need blood! Anybody got some extra blood? I'll trade two bottles of snot for a bottle of blood!"
