Saturday, April 08, 2006

Patients - Simulated

We’ve seen many of the wonderful ways in which robots can be used in the medical arena; from patient rehabilitation to telesurgery, robots have truly been of aid to patients and doctors alike. While we rejoice over technological advances made in the field of medical robotics, let us not forget one more group of people in the medical world that robots can help – the doctors and surgeons-to-be! Yup, that’s right, even doctors and surgeons-in-training will find robots useful to them. How so? The Laerdal SimMan offers an answer: a robot for trainees to practise on. Gone are the days when trainees have to rely on lifeless mannequins to carry out Cardiopulmonary Resuscitation (CPR), or actual patients to carry out Advanced Cardiac Life Support (ACLS), Advanced Trauma Life Support (ATLS) or even anaesthesia administration; mannequins are certainly poor training tools as compared to actual patients, but there definitely aren’t any ‘spare’ patients that can be used for ‘redoing’ either! The SimMan, dubbed the ‘Universal Patient Simulator’ offers trainees the interactivity ordinary mannequins cannot provide. It is a medical robot specially designed with a plethora of features to simulate many behaviours of a patient. The SimMan looks, feels and acts very much like a patient. Its features are simply too numerous to count; some of these include realistic airway features with spontaneous respiration, variable respiratory rate and airway complications such as pharyngeal obstruction, tongue oedema, trismus, laryngospasm, decreased cervical range of motion, decreased lung compliance, stomach distension, pneumothorax decompression, cardiac functions with an ECG library of over 2,500 cardiac rhythm variants, CPR functions, pulse and blood pressure functions, circulatory and IV drug administration features, simulated patient sounds, as well as convenient interfacing with computers and software for control and logging. In short, SimMan provides trainees with an opportunity for extremely realistic, hands-on practice that could be carried out again and again. One of the best things is perhaps that of the simulated patient sounds; not only are the moans and groans a good indication of something being done wrongly, they are probably something the trainees will have to get themselves used to in the future. The SimMan is one of 2 robot patient simulators that Laerdal has to offer; the AirMan is the other. The AirMan serves as a simulator for the more specific field of difficult airway management, and includes airway features, CPR, pulse and blood pressure features, circulatory and IV drug administration features as well as simulated patient sounds. A little bit of history on the invention of robot patients here: In 1979, René Gonzalez, one of the inventors of SimMan witnessed a crew rushing to tend to an asphyxiating patient, albeit unsuccessfully, and wondered if things could be done better. He realised that there were too few avenues for real-life emergency handling practice, and the existing simulators available for medical trainees were expensive and not realistic enough. Hence, in 1995, he and a friend created ADAM (acronym for Advanced Difficult Airway Management), which was a life-sized, anatomically correct, 70-pound robot. ADAM breathed, talked, coughed, vomited, moaned, cried, had a pulse and measurable blood pressure, reacted to IV drugs and other treatments and could be remote controlled. It was from ADAM that SimMan and AirMan were evolved. All in all, both the robots SimMan and AirMan serve as a great alternative for medical trainees to practise their skills on. The not-too-forbidding price tag of US$10,000 to US$25,000 per unit helps as well.

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Exploration said...

u0206584- Vidhya Ganesan

I do agree that SimMan is a great invention for trainees to practise on. However, given the fact that medical surgeries are highly complex and crucial as they involve human lives, it may be a better idea any day for trainees to practise on cadavers as the closest model of a human body is a human body itself. There are many aspects and dynamics of the human body which doctors are still trying to explain and understand and hence cannot simulate to the last detail. Also, cadavers are inexpensive and never in sparse supply.

Security said...

u0204635 Tan Pei En

Not only that, the SimMan provides good practice for the future where surgeons may have to operate on real robots!

But seriously, it is such applications that make robots so useful. I mean, no human beings would want to be 'practised' on 10 times a day. And the variety of situations and medical conditions that the SimMan is designed to simulate allow for students to have a comprehensive experience of handling the patient. Real-life training seldom provides the student with every conceivable situation.

However, the real-life training must not be excluded. This is because we do not know what we may have overlooked in the SimMan which may be present in real human patients. Moreover, situations occur unexpectedly in real life and doctors simply have to respond the best that they can.

Finally, I just wonder - given the level of realism that the SimMan, or future versions, can attain - would students start to get emotionally attached to it? After all, it groans, cries, says 'ouch' and so on. Future versions may even complain verbally or talk about making a will in case they die. Given such realism, would the students (and the lab i/c) be sad when the SimMan really dies (i.e. it's circuits get fried or something to that effect)?

Industry said...

U0205239 Wang Weiwei

I agree with Pei En. Robot is very useful in such situation though real life training should be also carried out, maybe after the trainees get enough training on the robot.

About the point wheather people will be emotionally attached, I believe so. So many movies were produced that reflects the emotional links between we humans and the robots. I'm looking forward to see a world co-lived by both humans and their fellow robots.

Medical said...

U0204808 Li Junsheng

Thanks, everyone, for the great comments. SimMan is certainly a wonderful invention, but I agree robots will never be a good enough substitute for the real thing.

That being so, I would still find SimMan a good complement, perhaps not so much as a substitute, to cadavers or living patients. While I'm not sure if the current version of SimMan offers all the surgery practice needed, a trainee certainly can't say, "Er .. sorry, I think I cut something, can we do the whole thing over again?" when it comes to cadavers or living patients. :p

Emotional attachment? Yup, the level of realism SimMan provides might deeply affect a trainee. But let's look at it this way: if a trainee cannot transcend the 'emotions' exhibited by SimMan during his training, how can he or she seek to overcome the feelings for real life patients in future? A thousand times more the pain and sorrow, the piercing gazes, the helplessness in their eyes; perhaps SimMan would be able to give them a headstart in emotional and psychological training too. ;)

Edutainment said...

U0308283 Wu Chengyu

Well, I do agree with Junsheng. If a trainee or doctor-to-be cannot not even overcome the feeling when the robot passes away, then he/she will have a long way to go. I think it would be great to have them act as casualties for training for real life cases. On a side note though, do they supply different sizes for SimMan? As in, we all know how different size of people will require different treatment(location of arteries, amount of anesthetics...etc) so perhaps that would about different ages?