About two weeks ago, ECMO circuit I’ve made flew to US.

Last week, this DIY water circuit was used by critical care fellows in some hospitals in US.

I’m super happy to be able to contribute to the ECMO simulation in other country.

They also need this kind of training apparatus to guarantee practitioner’s ability.

This is the short movie that introduces how to make an imitated vascular circuit for ECMO simulation.

I made this circuit in order to help us perform ECMO training in much more practical way.

I’ve already shared some movies using this circuit for practical ECMO training.

DIY is a great way to break through the status quo and make simulation training efficient and exciting.

Feb 5 was a tough day for me because it was full of simulation.
I held three different kinds of seminars in one day.

No.1: ECLS/ECMO related simulation in the morning from 9:00-12:00am
No.2: Acute Heart Failure Syndrome simulation in the afternoon from 1:30-5:30pm
No.3: CVC hands-on training in the evening from 6:00-8:30pm

That day I had been dedicated to simulation for 8.5 hours in total.

Even though that day was a weekday, about 10 healthcare providers joined these simulation seminars.

In Japan, traditionally off-the-job training is supposed to be held on weekends, and then this tradition often causes huge loss of free time of educators, tiredness or exhaustion both mentally and physically, moreover disagreement of family members.

Despite of these disadvantages, Japanese disciplined educators devote themselves into some sort of simulation seminars and get fulfilled with the achievement of learners.

I hope these weekday seminars will be more common and simulation instructors will have more free time on weekends.

“SimNight” is one of my original simulation seminars.

As you notice, the name comes from “Simulation at Night”.

I have been doing this scenario-based simulation since 2012 in my simulation center.

Literally this seminar would be held from 7pm to 9pm mostly on Tuesday.

Participants who are healthcare providers like doctors and nurses come voluntarily from both my hospital and other institutions.

Surprisingly this seminar is free in charge, therefore it is very easy to apply and join.

Every time I provide 2 or 3 comprehensive scenarios related to the emergency medicine such as cardiovascular failure, respiratory failure, sepsis, trauma, poisoning and environmental disorder. Realism is the strongest point of my seminar.

Yesterday, I did “SimNight” seminar for the first time in about 2 months.
Participants who joined today’s seminar flew from Shizuoka that is far from my city.
I was surprised at the level of performance which they did as a team in these scenarios.
___

SimNight scenarios on 2015/2/3

53M
CC: pyrexia, rt leg swelling,pain & erythema
PH: DM not treated
by ambulance
Condition: NSTI of rt. leg with abnormal gas, septic shock/DIC→EGDT, ABx, CECT, debriedman to amputation

53M
CC: organophosphate poisoning
PH: HT, HL, depression
by ambulance
Condition: miosis, fasciculation, airway emergency by secretion → intubation, atropine + PAM

19M
CC: blunt trauma, rt. chest pain
PH: n.p.
by ambulance
Condition: rt tension pneumothorax, lung contusion, aortic injury, hepatic injury → needle decompression, chest tube, CECT, intubation, Angio

57M walk-in
CC: rigidity of muscles around mouth and neck, swallowing disorder
PH: alcoholics
Condition: tetanus,trismus, difficult airway→emergent cricothyrotomy

This is one of the most comprehensive ER simulation scenarios I’ve made.

Total required time for this scenario was more than one hour.

Interposed still pictures of patient information, data and images are taken from PPT slides made for this simulation. Of course these are real data from real patient.

I’ve made various kinds of these PPT slides for ER simulation based on our valuable treatment experiences. Cases are such as cardiovascular failure, respiratory failure, trauma, burn, septic shock, cardiac arrest, environmental disorder and poisoning.

As you notice, usually I use two large TV monitor (more than 50 inch), one is for displaying patient vital sings and the other is to share patient information each other.

This double monitor method is quite useful for sharing information and I love this simulation setting.

Participants can easily immerse themselves into the scenario due to real setting and true patient data derived from real patient.

This scenario has a lot of learning objectives, so that it might be too complicated to perform. For example, to perform rapid initial assessment and intervention for severe shock, to make differential diagnosis, to recognize the appropriate timing to start ECMO, to prepare and start ECMO precisely and safely and to transfer ECMO patient to another room.

However the real clinical setting is like this, so I want them to cope with the extremely difficult situation and overcome with mutual help and cooperation in simulated environment.

In order to mimic blood products, I’ve made these dummy blood products by laminating pictures with magnet in the back.

These pictures are able to stick to plastic bag which also has magnet on the surface.

This is a cheap and easy way to make simulated blood products or something like that.

This is a short movie clip from my special simulation seminar named “SimMarathon” on Dec 27, 2014.

I’ve developed this simulation seminar in order to try new innovative simulation.

This is the first scenario among 9 completed ones.

Diagnosis had not been informed to participants at first. The team in charge had to do all of assessment, collecting data, diagnosis, appropriate treatment, disposition and informed consent in this scenario.

The more real the scenario would be, the more excited the participants would become.

For me, this is the first attendance at IMSH.

This is a great opportunity to know the current world fashion in area of medical simulation education.

I applied “mentor/mentee program” as a mentee, and could make new connection with other simulation teachers through my mentor.

There are bunch of workshops, seminars and exhibits during this conference and bunch of simulation educators are coming from all over the world.

I could figure out both of my weak points and strong points  compared to the world standard.

Although I’ve participated several workshops, my lower English skill prevented me from being proactive in those courses.

I’ve strongly decided to develop my English communication ability to become a global standard educator.

SimMan3G in our simulation center puts on several different kinds of wigs according to scenarios. These are inevitable to get learners immersed into each scenario.

Japanese wigs with black hair or some gray hair look funny because the appearance of SimMan3G is basically western style!

This is the scenario training of starting VA-ECMO for persistent VF patient in our simulation center.

ECPR for out-of-hospital cardiac arrest, especially for persistent/recurrent VF, is not uncommon in Japanese high volume emergency centers.

This kind of training should be widely provided in order to reinforce emergency team members to perform ECMO procedures in a safe way.