1. Running, Recording and Debriefing Scenarios Using the SimMan® Interface and SimCapture® Frances Wickham Lee, DBA Director of Instructional Operations John A. Walker, BHS Senior Simulation Specialist John J. Schaefer, III, MD Director

2. Introduction CEPSC SimMan scenarios are designed to simplify the operation and documentation of participant performance. The following slides guide you through the sequence of loading, running, recording and saving the results of a training scenario. A brief discussion of the SimMan® User Interface is also included

3. Simulation Training with SimMan® 5 – 20 minute scenarios, video recorded, debriefed Participants perform all tasks on SimMan®--- Don’t just say they are ventilating him; they actually do it. Debriefing immediately following each scenario using SimCapture®

4. SIMMAN® FEATURES

5. Monitor SimMan® monitor is a touch screen replication of a patient monitor.

6. Head & Neck Allows head tilt and jaw thrust maneuvers Speakers allow SimMan to make vocal sounds—pre-recorded or through a microphone in the control room Bilateral carotid pulses

7. Torso Normal anatomical surface landmarks –Include Anatomical landmarks for chest compressions Chest compressions will produce carotid pulses and compression artifacts on monitor, if performed properly

8. ECG Connectors—provide 3-lead readings from four connectors ECG connectors are designed for ECG monitoring ONLY Do Not use for Defibrillation

9. Defibrillation Connectors— two connectors are the ONLY location for defibrillation Effective pacing results in pulse synchronized with heart rate and the display of paced rhythm on the patient and defibrillator monitor

10. Pulses Bilateral Carotid Bilateral Femoral Bilateral Pedal Left radial Left brachial Avoid excessive force, which may result in the inability to feel a pulse

11. Torso sounds Hidden speakers allow auscultation of Sounds –Lung –Heart –Bowel

12. Arms Left Arm is the Blood Pressure Arm Right Arm is the IV Arm

13. Blood Pressure Arm—Left Radial and Brachial pulses Korotkoff sounds Allows palpitation and auscultation of blood pressure that is measured and shown on the simulated monitor –Linked to ECG functions –Non-perfusing rhythm causes BP to go to zero Do Not introduce any fluids to the Left Arm

14. SpO 2 Probe Simulates the use of a pulse oximeter probe Values will appear on the monitor when the simulated probe is attached to manikin’s finger

15. SimMan® contains components made of LATEX

16. STEPS FOR RUNNING AND RECORDING A SCENARIO

17. Step 1– Opening a User/Scenario Open the appropriate “User” on the Log in screen. Follow the steps indicated in the dialog box. Each “User” can be considered as a scenario or group of scenarios that has been specifically designed around a series of learning objectives. Note: Sim Center staff will create all SimMan® Users

18. Step 2– Starting a Scenario When ready, select and click to start the scenario. Choose yes to clear the debrief log. The programmed scenario is now running in “Pause” mode

19. Step 3– Recording with SimCapture® At this point in the process OPEN Sim Capture® Left click on Start Session

20. Step 3– Recording with SimCapture®, continued Complete Sections 1 -5

21. Step 3– Recording with SimCapture®, continued 1.Near the top left corner of the screen select the simulator being used for example in Room SN 107 select SimMan 107 in Room SN 106 select SimMan 106 2.Select the course with the appropriate date, for example PA COPD 20090109 ; select the scenario that is running on SimMan i.e. PA COPD Scenario A 3.Session Notes are optional 4.There should be checks in front of Camera 1 and 2 and PC Monitor 5.Select the participating students from the list and select yourself from the list as Facilitator

22. Step 3– Recording with SimCapture®, continued The SUMMARY pane on the left should have only green and black text. ANY red text indicates an error and you will not be able to leave this screen until it is corrected

23. Step 3– Recording with SimCapture® When steps 1-5 are complete left click on start session. NOTE: This will NOT start recording the scenario

24. Step 3– Recording with SimCapture® After a few seconds a window similar to the one below should appear. When ready to record left click on Start Recording in the lower right corner of the window Not Recording is indicated in the upper left corner.

25. Step 4– Re-Open SimMan® Maximize SimMan® Click the right- facing arrow in the Control Center to start the scenario.

26. Step 5– Undocking the Event Menu The “Event Menus” are now the primary method of running the loaded scenario. For easier viewing, click on the top right corner of an event window to undock it. You can also make the list windows transparent by right-clicking it and selecting “Transparent”.

27. Step 6– Running the Scenario from the Event Menus Run the scenario from the Menus by clicking on the Event that has occurred or is about to occur. Clicking on an Event (such as “Pulse Ox”) will activate the appropriate manikin response and/or document the action in the debrief log. The action can also trigger a performance evaluation comment that will be reviewed during debriefing.

28. Step 6– Running the Scenario from the Event Menus, continued Most CEPSC Scenarios include a START SCENARIO event that must be checked to activate the scenario timer and begin the performance recording Many CEPSC Scenarios have events within folders. To open/close the folders to reveal all events, click on the “+” and “-” to the left of the folder

29. Step 7– Adding Performance Comments as Necessary Click on the “Comments “ button. Type in your comment and save it. These comments will be added to Debrief Log

30. Step 8– Monitoring the Scenario Events Selected Events have green check marks. The number of times an Event has been selected will appear to the right to the check mark. The last Event select appears in bold at the top of the menu.

31. Step 8– Monitoring the Scenario Events, continued Selected Events, comments, vital signs and automatic manikin responses show in the Event Log with a time in scenario stamp.

32. Step 8– Monitoring the Scenario Events, continued The Scenario Control Center provides information about –Time in Scenario –Name of and time in scenario frame (state within scenario) –Patient time, if this was set in the scenario. Note: Patient time decreases as the scenario progresses –Trends and Handlers (programmed routines) that are running

33. Click on the square button to “Halt” or stop the Scenario. Click on Yes when the dialog box appears. “Halted” will appear in the Scenario Control area. Step 9– Halting the Scenario

34. Step 8– Go to SimCapture® to Debrief Minimize SimMan® Software Maximize SimCapture® When the scenario is finished ALWAYS left click on Stop Session from within SimCapture® to end and go to debriefing Recording is indicated in the upper left corner.

35. Step 8– Go to SimCapture® to Debrief After SimCapture® stops SimMan and sends the scenario to debriefing the following window will appear. Left click on Debrief Session to start SimCapture debrief viewer.

36. Step 8– Go to SimCapture® to Debrief A window will appear showing all the scenarios contained on that SimCapture. The latest scenario recorded should be on top.

37. Step 8– Go to SimCapture® to Debrief The Recorded session will appear. Right click on the Event Log tab and then slide the Level Of Detail to the far left to show debriefing checklist. The video window can be resized

38. SIMMAN® USER INTERFACE

39. SimMan® 3.3 User Interface The SimMan User Interface allows for manual control and override of the SimMan Simulator®. The interface is divided into several distinct sections, which will be presented in the following slides.

40. Trends Trends are special features programmed to introduce realistic physiologic situations into scenarios. Active trend parameters are displayed in the Trend Area. The instructor can use the right/left mouse button to zoom in/out by placing the pointer over the vertical scale of numbers and clicking to zoom.

41. Respiration Use the mouse to slide the bar to adjust the Manikin’s respiratory rate. The respiratory rate will be numerically displayed to the right of the bar.

42. Airway and Circulatory The Available Point & Click Control Areas in Airway and Circulatory are: Trismus Decreased Cervical Range of Motion Tongue Edema Pharyngeal Obstruction Laryngospasm Left Pneumothorax Right Pneumothorax Right Lung Resistance Left Lung Resistance Radial/Brachial Pulse Stomach Distension Central Pulses Left Pedal Pulse Right Pedal Pulse

43. Airway and Circulatory Use the drop down menus to select the desired parameters for Vocal Sounds Auscultation Sounds

44. Running & Waiting Rhythms The Running Rhythm shows the ECG currently running on the Patient Monitor. The Waiting Rhythm section allows you to have a new rhythm waiting for activation to replace the “Running Rhythm.”

45. Instructor Monitor Control The Instructor Monitor Control Center is controlled by the mouse connected to the instructor’s computer. The actual Patient Monitor located at the simulated patient bedside is controlled by the student.

46. Instructor Monitor Control Different Scenarios may be programmed to have different monitor configurations. However, the basic interaction will be the same.

47. Patient Monitor Control The Patient Monitor is a touch screen monitor allowing the student or instructor easy access to the monitor control features. A scenario may be programmed to start with few or no parameters visible until activated by the student or the instructor. The Patient Monitor is an “extended desktop” that can be controlled by touch or the Instructor’s computer mouse.

48. Instructor Monitor Control The instructor can also control features of the Patient Monitor by pointing and clicking over the desired parameter icon located along the bottom of the Instructor Monitor Control Center. A checkmark will appear within the parameter box above the title. The selected parameters will be activated and displayed on the Patient Monitor located at the patient bedside.

49. Instructor Monitor Control Adjustments can be made to any of the physiologic values by pointing the mouse over the desired area and clicking. Windows will open allowing the instructor to select and apply the desired changes and functions.