A 5-year-old "patient" mannequin helps nursing students get it right. Photo courtesy of Children's Mercy Hospitals and Clinics.

Its real name is the Center for Excellence in Pediatric Resuscitation. Maybe they should nickname it the "anti-panic room."

For here, in this room at Children's Mercy Hospitals and Clinics, Kansas City, MO, caregivers learn to stay calm, think clearly and bring dying infants back from the brink. And if they fail, it's OK. They just run through the whole thing again, and again, until they get it right, because the patients in front of them are not flesh-and-blood but mannequins.

"Some people come into an emergency room (ER) and are exceptionally educated in their understanding of physiology and pharmacology," explained Gabriel Bailey, RN, one of the Center's facilitators. "But when it comes down to it, in the middle of a trauma, where time is essential, with blood all over, sometimes some of them can't do it. Here, we can mimic the anxiety of an ER. We can put on the pressure, the time constraints and simulate the whole chaotic, tense scene."   

The "patients" in this theater of emergency medicine are incredibly life-like mannequins: two the size of 40-week-old neonates, one the size of a year-old infant and a fourth the size of a 5-year-old, with the ability to speak English and Spanish. All four have realistic airway, pulmonary, cardiovascular, metabolic and neurological systems, allowing students to assess their vital functions, place IV lines in them, intubate them and perform CPR on them.  

"We provide students the opportunity to repeat a skill over and over until they can do it successfully on a patient that is not alive," said Amy Altergott, RN, coordinator of the center. "We can make the mannequins have seizures, stop breathing, cough and have vomiting motions."

They can also exhibit "unilateral or bilateral chest rise, and chest and lung sounds that correlate with whatever heart rate we program into the computer," said Bailey, who programs them. "Our 1- and 5-year-olds have eyes that open and close, and dilate in response to light. You can even see pulsations in the umbilicus of our newborn."

Medical mannequins have earned kudos as teaching tools from the Joint Commission and the Association of Medical Colleges, according to Robert Schremmer, MD, who co-created the center with another ER physician, Christopher Kennedy, MD. "Simulation is certainly a big part of the nursing school curriculum now," he said.

Communication Skills Stressed

At the center, simulated ER scenarios confront teams that usually include a physician, a nurse, a respiratory therapist and a pharmacist. Behind the scenes, Altergott, Bailey and other facilitators evaluate a team's effort.

Amy Altergott, RN, (left) inserts an IV in a pediatric mannequin at Children's Mercy, while Shirlee Rusk, RN, bags the "patient." Assessing their performance is Robert Schremmer, MD, director of the pediatric resuscitation center.

"We focus not only on their performance skills but their communication skills, whether everyone in the room was aware of what was going on, whether the team leader was aware of all their thoughts and not just barking orders," Bailey said.

Often team members "sit back and let the physicians run the ship," Altergott added. "But sometimes we've had nurses step up and take over the team leader role. We try to impress upon them that this is a team approach."

After each scenario, facilitators conduct a debriefing session and offer a verbal evaluation. "We've been struck by how accurately learners assess their own performances, although they are often hard on themselves," Dr. Schremmer said. "When they launch into their mistakes we say, 'OK hold on, here's what you did well.' We stress the positive."

Interactive education like this works best alongside good old-fashioned lecture hall learning, Dr. Schremmer continued. "I can't run a scenario where a patient needs to be intubated via rapid-sequence intubation without learners having had a didactic session on that," he said. "We will give medical students a mini-didactic on croup then have the mannequin present with stridor."

Some teams are quite dysfunctional at first. One recent scenario on ventricular fibrillation that required shocking the mannequin proved to be "a total disaster," Dr. Schremmer said. "They didn't know how to hook up the defibrillator so we made sure everybody touched and used the machine."

Good thing: the next day, one ER fellow on that very team faced a real child in ventricular fibrillation. "She was comfortable and able to direct her team of physicians, doctors and pharmacists and instruct everyone in the room on how to use the defibrillator," Bailey said.

Because their mannequins are wireless, tether-less and portable, Dr. Schremmer and his supporting cast now take their simulation scenarios on the road to other health care facilities-for a fee of $350 an hour. "Most groups want us to come to them," he said. "It's easier when they learn in their own environments." 

You can reach Michael Gibbons, a senior associate editor at ADVANCE, at 1-800-355-5627, ext. 1167.