The IWK’s Sim Sam makes simulated emergency very real

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Surgical Sam, the world’s first breathing, bleeding, beating heart, high fidelity team trainer for pediatric surgery, is allowing IWK physicians and specialist teams to practice scenarios and emergencies that are very rarely encountered. Affectionately known as Sim Sam, the mannequin allows operating room and intensive care teams to immerse themselves in simulations that improve performance, safety and outcomes for children.
Photo by Gabrielle Gallant, IWK Health

“Sim Sam allows us to do the most realistic simulation of an extra-corporeal membrane oxygenation (ECMO) scenario where an ECMO machine provides life support by acting as the patient’s heart and lungs,” says Dr. David Horne, a pediatric cardiac surgeon at IWK Health. “It is a high acuity, low occurrence (HALO) event so it is highly stressful and demands extreme specialization and coordination of multiple disciplines.”

Sim Sam allows the whole multi-disciplinary team (cardiac surgery, pediatric intensive care unit (PICU), respiratory therapists, operating room nurses, perfusionists and ECMO specialists) to practice their roles during ECMO emergencies.

 “With Sim Sam, we are able to have vital signs change, with a change in a beating heart and pulse, do actual intubation and ventilation of the lungs and see them move, fibrillate or arrest the heart, distend it, make it bleed, and most importantly – place Sim Sam on ECMO with our actual equipment,” says Horne. “During our inaugural Sim Sam simulation, many clinicians said the simulation was so “real” that they felt the same stress they had encountered in real life ECMO scenarios.”

The realism is the product of the technical and contextual fidelity that Sim SAM brings to simulation. In addition to highly specialized clinical and technical skills, ECMO initiation requires robust leadership, teamwork and communication across and within multiple disciplines and teams. Simulation has become important grounding for health profession teams to hone what are often called “soft skills’ but in fact are crucial to providing excellence in patient care.

Surgical Sam was developed by the Boston Children’s Hospital and The Chamberlain Group, a company that got its start in the movie business. (They designed the iconic “bullet time” effect in the Matrix movies). The company now uses their special effects know-how to create medical training tools —hearts, blood vessels, internal organs, limbs, etc.—that mimic the touch, feel and resilience of actual tissues.

“As an ECMO specialist and respiratory therapist at the IWK, having Sim Sam to practice emergencies and routines is so important,” says Jennifer MacNeil. “We are a low volume ECMO center and do frequent simulations to improve our skills, Sim Sam takes this practice to a whole new level, by providing real time feedback in all situations.”

Photo by Gabrielle Gallant, IWK Health

The IWK averages two to six patients a year that need ECMO support. Those patients remain on ECMO anywhere from three days to three weeks. Certain ECMO emergencies may occur only once in a career for some ECMO-specialists. Not knowing how to manage those situations is dangerous.

Three to four ECMO simulations, with the entire ECMO team, are performed at IWK Health each year in collaboration with the IWK Simulation Program. The arrival of Sim Sam is a welcome addition to the Simulation Program and marks a milestone in the evolution of simulation-based learning at IWK Health.

Sim Sam was acquired with funding from the Maritime Provinces Higher Education Commission (MPHEC).

“The funding for Sim Sam was supported by Dr. Stephen Miller, Associate Dean, Continuing Professional Development and Medical Education; Director of Simulation, Faculty of Medicine, Dalhousie University” says Kathy Johnston, Coordinator of the IWK Simulation Program. “We’re grateful for this gift enabling IWK Health to provide state of the art simulation-based educational support for Pediatric Cardiovascular Surgery and the ECMO team.”