Not Your Everyday Trauma Center

October 11, 2011 | CUNY Matters

In this CUNY-partnered training ground at a major local hospital, the patients are high-tech ‘human simulators.’

Emergency Medical Technicians rushed two patients on stretchers into the hospital trauma room and reported to a physician. The patients moaned and bled; outside a hurricane raged. Words and phrases proliferated: “Hit with flying debris,” “not responding,” “fracture,” “abdominal wound,” “morphine,” “surgery.” Suddenly a stretcher arrived with a third patient, a 7-year-old boy. He had slipped on water and was also unconscious. His distraught father tried to tell what he knew.

A frightening scene. But it wasn’t real.

It was a state-of-the-art training session for medical personnel at a new simulation center that marks an unprecedented collaboration between CUNY and the NYU Langone Medical Center.

The “stars” of the event — the patients — were mannequins, but a far cry from those in store windows. Although made from plastic, they can be programmed by computers to be injured or ill, to stop breathing and to mimic any number of other medical conditions.

In this simulation, Borough of Manhattan Community College Allied Sciences students Ra Jassir and Jonathan Ramos, numerous medical professionals and an actor who played the father worked with the mannequins.

Jassir and Ramos, who are studying to be EMTs at the BMCC campus, said they felt as if they were in a real-life situation — even though the patients were plastic, the hurricane was called “Irene” and the simulation occurred nine days after the real Tropical Storm hit the city.

Jassir said the simulation helped him to prepare for the frightening possibility that the worst could happen here. “You do kind of lose the perspective that it is not real,” he said when the “emergency” was over. “It’s the teamwork, the way everyone gets involved doing their job. It’s very believable. The mannequins simulate blood, they breathe. They shiver if they are in shock. It gives it a sort of reality.”

This practice session on Sept. 6 was one of several that marked the auspicious opening of the New York Simulation Center for the Health Sciences, said to be the most sophisticated facility of its kind in the United States. The center is the result of years of planning, championed by New York State Assembly Speaker Sheldon Silver. It was funded with almost $20.8 million, equally divided between the city and state. The 25,000-square-foot facility is spread out over the entire third floor of the C and D wing of Bellevue Hospital Center at 462 First Ave. in Manhattan.

“The City University of New York has always been deeply committed to educating and training those who serve New York as nurses, firefighters, emergency medical technicians, and through many other health-care and emergency-response capacities,” said CUNY Chancellor Matthew Goldstein. He commended Vice Chancellor for Facilities Planning, Construction and Management Iris Weinshall for her exemplary work in overseeing the construction of this largest-of-its-kind facility in any urban setting. He added that partnering with NYU is a “natural extension” of the University’s efforts to train those who can ensure the safety of all New Yorkers.

The crucial role simulation plays in an era where terrorism threats are commonplace and natural disasters seem to be increasing was also emphasized. The opening also occurred after tremors from a distant earthquake rumbled through New York the same week as the tropical storm — and days before the 10th commemoration of the anniversary of 9/11.

“You can never be too prepared for an emergency,” Assembly Speaker Silver noted.

And as always, accidents sometimes just happen.

In explaining the need for the center, its founding director Dr. Thomas Riles said he would like to remind the audience about the emergency landing of a plane in the Hudson River in January 2009 by the now legendary pilot Sully Sullenberger. “Would the outcome have been different had he not spent hours of training in flight simulations?” asked Riles, who is an expert in carotid artery disease and the Frank C. Spencer Professor of Surgery and Associate Dean for Medical Education and Technology at Langone.

Riles added that as the center was being designed he visited other prominent ones around the country. “None can compare in design, function, sophistication of technology, scope of program or expertise of staff,” he said. Later, he added, “We want to be the best in the world.”

Other speakers at the packed opening ceremony spoke about simulation as a new model for medical education because it enables professionals and students in various disciplines to get hands-on experience while working with one another. Typically, they are trained separately and often miss learning about the role collaboration plays.

Using the city and state allocations, CUNY provided the capital to construct and equip the center. NYU Langone will provide funding for the operation of the center until the university’s initial investment is amortized. After that, the two institutions will share operating expenses. Bellevue Hospital has given CUNY a 15-year lease for the space plus two five-year extensions. CUNY is subleasing the space to NYU Langone.

The center has multiple simulation rooms, including a disaster training room, a five-bed Intensive Care Unit, two operating rooms, trauma rooms, a labor and delivery room and 14 patient examination rooms, where the actors will be used. There are 17 mannequins, more formally known as human simulators, including three babies — one on loan until the center’s own arrives — and a newborn child. Among the other adults is a “birthing mom.” The gender on most of the mannequins is interchangeable — and there are also more than 50 mannequin body parts including arms and heads.

Funding for the center originally began with an allocation to CUNY’s Borough of Manhattan Community College, which has been providing simulation training on a smaller scale for 15 years. Participants in the simulation will include Langone Medical students and BMCC nursing students plus those in the Allied Health Science programs for paramedics and respiration therapy. There are also plans to include public and community based first responders throughout the city, including firefighters, emergency manage-ment workers from a variety of city agencies, Lower Manhattan community groups and business and volunteer ambulance services. New York Downtown Hospital will use the center for decontamination training and other emergency training exercises.

As Dr. Kathryn Brinsfield, Deputy Chief Medical Officer for the United States Depart-ment of Homeland Security, reminded those at the opening day ceremony: “Homeland security begins with Hometown security.”

Ballinger, the architectural firm, designed the center. Laerdal, an international company based in Norway — which specializes in the use of technology in medical training —manufactures the mannequins and their accompanying software, controlled by technicians using laptops. Mannequins can be programmed according to a particular script for an illness or an injury and the simulation rooms have computer screens and wireless monitors showing vital signs and other medical data. But if a student or professional makes an error, the technology will not correct it, enabling those involved to learn from their mistakes. The wrong decision or action could result in a mannequin’s decline or “death.”

Scott Arnold, a Laerdal regional manager in attendance at the opening ceremony, explained that the mannequin technology makes use of compressed air. “We use air to do a lot of what your body does for you,” he said, adding that if the correct medical procedures are used a mannequin’s condition will improve. The center also uses more than a hundred cameras to record training sessions, so that students can study them afterwards to view their successes as well.

On the day the center opened — along with treating the Tropical Storm Irene “patients,” a male mannequin was brought back from respiratory distress and a female mannequin had an emergency C-section, delivering a mannequin baby.

The baby not only survived. To provide reassurance that all was fine, it also cried.