Developing a clamshell thoracotomy model for multidisciplinary simulation training

Oral Presentation 8
Miroslav Voborsky, Dr Victoria Meighan, Prof Walter Eppich,  Dr Claire Condron, Adam Roche, Dr Ger O’Connor

Developing a clamshell thoracotomy model for multidisciplinary simulation training

Introduction
In Ireland's National Emergency Medicine Training Programme, high fidelity simulation is firmly entrenched. Trainees in emergency medicine frequently travel to RCSI SIM in Dublin to take part in high-fidelity simulation scenarios with a variety of on-site ED clinicians, nursing staff and advanced paramedics.

Teamwork, human factors, and patient and clinician safety are the main topics of these training days. The High Acuity Low Occurrence (HALO) procedures are part of the "Trauma Lead" module, which provided the possibility to develop an in-house clamshell thoracotomy model for these multidisciplinary simulation sessions.

Objectives
The aim was to develop a cost effective in house clamshell thoracotomy trainer, which is fixed to the chest of a high fidelity manikin, allowing ergonomically safe thoracotomy procedure for emergency medicine team as part of the complex management of the penetrating chest scenario. 

Methods
A healthcare simulation technician (MV) and a consultant emergency physician (VM) worked collaboratively to develop the model. VM has participated in numerous EDTs as the primary operator and an assistant and has hands on experience of the technical, ergonomic and critical thinking components the procedure requires. Spiral model to guide the evolutionary design and manufacture using the concepts of functional fidelity in developing this task trainer played key role in the model development. 

Outcomes
This novel model simulates a clamshell thoracotomy, which provides learners an anatomically correct and ergonomically safe approach when performing & practising the procedure. The chest wall comprises five main components to simulate the various anatomical structural layers; all made of synthetic materials and is re-usable for multiple training days.

Conclusion
In this innovation, we sought to develop high fidelity thoracotomy trainer to accompany non-technical skills practice for multidisciplinary simulation based education. This provides emergency clinicians with unique opportunity to practice HALO procedures in safe learning environment.