Team Infidel
Forum Spin Doctor
Boston Globe
December 26, 2007
Pg. 1
By Colin Nickerson, Globe Staff
CAMBRIDGE - Dr. Steve Dawson and his team are creating a dummy that will die if you don't treat it right.
Intended for training combat medics, the smart mannequin being built from scratch in his Massachusetts General Hospital lab mimics war wounds with horrifying realism, right down to blood spurting from torn arteries, sucking chest wounds, and appalling shrieks of agony.
Make a mistake treating this trauma - apply a tourniquet at the wrong spot or with the wrong pressure; fail to catch the fading pulse; waste seconds binding a gory but nonlethal wound, while missing a less-visible, deadlier injury (a common battlefield mistake) - and the dummy lapses into symptoms of shock.
Fail to arrest the shock, the dummy flatlines.
"This is a synthetic human for real training - training that simulates real wounds in real combat," said Dawson, an interventional radiologist and head of a $2.2 million Pentagon-funded project to design an all-new Combat Medic Training System, or Comets, to use its military moniker.
The military wants a simulator that will put medics in the field with a better sense of treating traumatic injury under battle conditions - experience that medics now get mostly on the job. Dawson and his team are supposed to deliver the first Comets prototypes by August 2009. Military medical officers say the pressures of war make the need for the device especially urgent.
"Right now, we've got 4,000 medics in training at any given time," said Colonel Robert H. Vandre, director of the Army Combat Casualty Care Research Program. Nearly all of these medics will serve in Iraq or Afghanistan. "Most casualties that are going to die, die before they get to the first doctor. Ninety percent of life-saving in combat is done by medics."
The dummy is a joint effort by MGH and the Center for Integration of Medicine and Innovative Technology, a consortium of Boston-area hospitals that focuses on areas, including military medicine, where advanced technology can improve treatment. Dawson is a pioneer of medical simulation, and a passionate advocate for the notion that dummies even more sophisticated than the Comets "medic model" should eventually be developed to train civilian doctors and nurses.
"Since ancient Egypt, doctors have been trained on live patients," he said. "Nowadays, that's almost barbarous. Medical students should learn to tie [surgical] knots or give neural injections on simulators that feel like real life - but aren't somebody's 84-year-old mother who happened to be wheeled into a teaching hospital."
Simulation is one of the fastest-growing fields in medical technology, and Dawson believes that within decades medical students, interns, and residents will do much of their training on highly realistic models, not putting hands on patients until they've mastered basic diagnostic and surgical techniques.
Since the start of the Iraq war, the Army has nearly doubled the training time for combat medics to 16 intensive weeks. Medics who complete the course have roughly the same level of skills as a civilian emergency medical technician, or ambulance medic. Training presently includes cruder or less mobile mannequins, as well as classroom and field instruction.
The Comets dummy has detachable limbs, so medics can train on, say, an arm ripped by shrapnel, then switch limbs to train on other wounds. Imitation blood moves in synthetic veins under the "skin" at such precise pressure that when a medic taps into a vein with an IV needle, a plume of red swirls up into the tube.
Drop an IV bag, so life-saving intravenous fluid is no longer flowing by gravity, and the dummy fades out of consciousness. A femur shattered without breaking skin can cause deadly internal bleeding whose only sign is swelling of the dummy's skin in the region of the fracture. A slow reaction by medics means a DOA for the combat hospital.
"There's a reset button," said Mark Ottensmeyer, in charge of engineering the Comets dummy, which has stainless steel for bone and a tiny air compressor to do the work of the heart. "But you've lost your patient. Better to make your mistakes on a mannequin than to be calling for a body bag."
American military medicine, from the level of the "68 Whiskey" - infantry medic - to nurses and surgeons at frontline hospitals, is arguably the best in the world. But replicating the confusion of combat, where even the coolest heads can lose their bearings, is difficult.
"Training with a high-fidelity patient simulator in a realistic environment is going to increase confidence and ability when [medics] go to work under fire," Major Aaron A. Saguil, a US Army doctor in Afghanistan responsible for primary care and medic training at the NATO hospital at Kandahar Air Field, said by e-mail.
Many present-day medical training dummies are either too cumbersome - $200,000-plus devices connected by coaxial cable to a computer requiring a technician to enter commands to generate each symptom - or too dumb. Others, notably "CPR Annie," are great for practicing rote techniques, such as cardiopulmonary resuscitation, but not especially versatile.
The MGH dummy is being designed tough so it can be used in stateside training under an array of field conditions, whether half-immersed in a swamp or in a blown-out Humvee in the dark of night. Medics working with flashlights and sense of touch will probe synthetic skin that responds like real skin and learn to bandage shrapnel or bullet wounds against the backdrop of training field explosions and weapons fire.
"It's rugged and simple," said Ryan Bardsley,a designer on the project. "It tries to show the basic indicators of injuries with realism, no red lights or buzzers. It's to teach medics to come on the scene, assess if someone is dead or alive, get them under cover, and deliver the immediate care they'll need to be still breathing when they reach the docs and nurses."
In the Cambridge "sim" lab, designer John Cho Moore last week was building a leg using silicon of varying textures to impart the feel of muscle and subcutaneous fat. "It's got to feel and respond exactly like an actual leg," he said. "When the medic ties a tourniquet, it's no good if the fake leg compresses to the bone, like foam rubber."
Computer work by Paul Neumann ensures that after medics are done, the dummy will download what the military calls an "after-action report" - telling what happened physiologically, how treatment went right, where treatment went wrong.
Fine computer tuning also ensures the dummy's screams and utterances will coordinate with actual symptoms. So, for instance, when it responds to proper treatment, and its eyes flutter back to consciousness, it will know to express the fervent wish of every wounded soldier: "I don't want to die," groans the prototype combat mannequin. "Get me the hell out of here."
December 26, 2007
Pg. 1
By Colin Nickerson, Globe Staff
CAMBRIDGE - Dr. Steve Dawson and his team are creating a dummy that will die if you don't treat it right.
Intended for training combat medics, the smart mannequin being built from scratch in his Massachusetts General Hospital lab mimics war wounds with horrifying realism, right down to blood spurting from torn arteries, sucking chest wounds, and appalling shrieks of agony.
Make a mistake treating this trauma - apply a tourniquet at the wrong spot or with the wrong pressure; fail to catch the fading pulse; waste seconds binding a gory but nonlethal wound, while missing a less-visible, deadlier injury (a common battlefield mistake) - and the dummy lapses into symptoms of shock.
Fail to arrest the shock, the dummy flatlines.
"This is a synthetic human for real training - training that simulates real wounds in real combat," said Dawson, an interventional radiologist and head of a $2.2 million Pentagon-funded project to design an all-new Combat Medic Training System, or Comets, to use its military moniker.
The military wants a simulator that will put medics in the field with a better sense of treating traumatic injury under battle conditions - experience that medics now get mostly on the job. Dawson and his team are supposed to deliver the first Comets prototypes by August 2009. Military medical officers say the pressures of war make the need for the device especially urgent.
"Right now, we've got 4,000 medics in training at any given time," said Colonel Robert H. Vandre, director of the Army Combat Casualty Care Research Program. Nearly all of these medics will serve in Iraq or Afghanistan. "Most casualties that are going to die, die before they get to the first doctor. Ninety percent of life-saving in combat is done by medics."
The dummy is a joint effort by MGH and the Center for Integration of Medicine and Innovative Technology, a consortium of Boston-area hospitals that focuses on areas, including military medicine, where advanced technology can improve treatment. Dawson is a pioneer of medical simulation, and a passionate advocate for the notion that dummies even more sophisticated than the Comets "medic model" should eventually be developed to train civilian doctors and nurses.
"Since ancient Egypt, doctors have been trained on live patients," he said. "Nowadays, that's almost barbarous. Medical students should learn to tie [surgical] knots or give neural injections on simulators that feel like real life - but aren't somebody's 84-year-old mother who happened to be wheeled into a teaching hospital."
Simulation is one of the fastest-growing fields in medical technology, and Dawson believes that within decades medical students, interns, and residents will do much of their training on highly realistic models, not putting hands on patients until they've mastered basic diagnostic and surgical techniques.
Since the start of the Iraq war, the Army has nearly doubled the training time for combat medics to 16 intensive weeks. Medics who complete the course have roughly the same level of skills as a civilian emergency medical technician, or ambulance medic. Training presently includes cruder or less mobile mannequins, as well as classroom and field instruction.
The Comets dummy has detachable limbs, so medics can train on, say, an arm ripped by shrapnel, then switch limbs to train on other wounds. Imitation blood moves in synthetic veins under the "skin" at such precise pressure that when a medic taps into a vein with an IV needle, a plume of red swirls up into the tube.
Drop an IV bag, so life-saving intravenous fluid is no longer flowing by gravity, and the dummy fades out of consciousness. A femur shattered without breaking skin can cause deadly internal bleeding whose only sign is swelling of the dummy's skin in the region of the fracture. A slow reaction by medics means a DOA for the combat hospital.
"There's a reset button," said Mark Ottensmeyer, in charge of engineering the Comets dummy, which has stainless steel for bone and a tiny air compressor to do the work of the heart. "But you've lost your patient. Better to make your mistakes on a mannequin than to be calling for a body bag."
American military medicine, from the level of the "68 Whiskey" - infantry medic - to nurses and surgeons at frontline hospitals, is arguably the best in the world. But replicating the confusion of combat, where even the coolest heads can lose their bearings, is difficult.
"Training with a high-fidelity patient simulator in a realistic environment is going to increase confidence and ability when [medics] go to work under fire," Major Aaron A. Saguil, a US Army doctor in Afghanistan responsible for primary care and medic training at the NATO hospital at Kandahar Air Field, said by e-mail.
Many present-day medical training dummies are either too cumbersome - $200,000-plus devices connected by coaxial cable to a computer requiring a technician to enter commands to generate each symptom - or too dumb. Others, notably "CPR Annie," are great for practicing rote techniques, such as cardiopulmonary resuscitation, but not especially versatile.
The MGH dummy is being designed tough so it can be used in stateside training under an array of field conditions, whether half-immersed in a swamp or in a blown-out Humvee in the dark of night. Medics working with flashlights and sense of touch will probe synthetic skin that responds like real skin and learn to bandage shrapnel or bullet wounds against the backdrop of training field explosions and weapons fire.
"It's rugged and simple," said Ryan Bardsley,a designer on the project. "It tries to show the basic indicators of injuries with realism, no red lights or buzzers. It's to teach medics to come on the scene, assess if someone is dead or alive, get them under cover, and deliver the immediate care they'll need to be still breathing when they reach the docs and nurses."
In the Cambridge "sim" lab, designer John Cho Moore last week was building a leg using silicon of varying textures to impart the feel of muscle and subcutaneous fat. "It's got to feel and respond exactly like an actual leg," he said. "When the medic ties a tourniquet, it's no good if the fake leg compresses to the bone, like foam rubber."
Computer work by Paul Neumann ensures that after medics are done, the dummy will download what the military calls an "after-action report" - telling what happened physiologically, how treatment went right, where treatment went wrong.
Fine computer tuning also ensures the dummy's screams and utterances will coordinate with actual symptoms. So, for instance, when it responds to proper treatment, and its eyes flutter back to consciousness, it will know to express the fervent wish of every wounded soldier: "I don't want to die," groans the prototype combat mannequin. "Get me the hell out of here."
