Less than 1 minute after takeoff, on January 15, 2009, US Airways flight 1549 struck a flock of geese and lost power to both engines. Captain Chesley “Sully” Sullenberger immediately reported to air traffic control, “This is Cactus 1539, hit birds. We lost thrust in both engines. We’re turning back toward LaGuardia.” Sully soon realized that they did not have the elevation or the time to make it back to the LaGuardia airfield, and he made the strategic decision to glide the commercial airliner onto the Hudson River. After landing the aircraft safely on the river with everyone aboard relatively unscathed, many labeled the incident “The Miracle on the Hudson.” In fact, it was no miracle that Sully and his flight crew had the experience and skills to perform the nearly impossible maneuver; it was partly due to countless hours logged behind the controls of a flight simulator and years of Crisis/Crew Resource Management (CRM) team training. When singled out for praise after the incident, Sully emphasized that all the members of the flight crew came together as a highly functioning team without which the situation might have turned out disastrously.

In the aviation industry, flight simulations replicate reality so closely that all commercial pilots, regardless of experience, are required to practice simulated flight training every year of their career. Much like the aviation industry, health care simulations aim to increase practitioners’ effectiveness and proficiency, gather data about how systems respond to various situations, and to increase the efficiency and safety of the services delivered. By simulating real patient interactions, imitating anatomic regions and clinical tasks, and mirroring real-life clinical situations, medical simulation can enhance the education of technical, behavioral, and teamwork skills. The modern-day health care simulation center shares the same fundamental purpose as yesterday’s skills laboratory, to practice and refine skills in an effort to improve proficiency and patient safety. A fully functional simulation center also adds the capacity to fully immerse teams for CRM team training. Modern simulation training tools are high-fidelity (allowing for an accurate lifelike reproduction of clinical situations) and high-technology tools, which are revolutionizing the way in which we learn and refine many of our skills in our rapidly advancing health care field.

In health care, the simulation training tool that is analogous to the flight simulator is the modern life-size human patient simulator. These human simulators are of such high fidelity that they have pulses at multiple anatomic locations, audible breath sounds and heart tones, pupils that dilate, arms for placement of vascular catheters, and an airway that can replicate varying degrees of difficult airway situations. Highly technical learning tools like human simulators have an established role in simulation education, but they may not be available at all facilities, nor are they fitted to all training tasks. Valuable simulation-based education does not have to be highly technical for it to be an effective training tool. Anesthesia technicians (ATs) already use simulation in their education. For example, practicing on equipment while it is not in use is a form of simulation, as is Basic Life Support (BLS) training on a Resusci Anne mannequin. There are many opportunities for the AT to use a variety of simulation tools to improve important technical and behavioral
skills, for example, a surgical towel (low fidelity) to practice suturing arterial line equipment, a simulated tibia model (moderate fidelity) to practice intraosseous cannulations, or a simulated patient interaction (high fidelity) that can assist with communication training. Although modern advances in technology have increased the fidelity and accessibility of simulators in health care, neither high technology nor high fidelity is necessary for real learning to occur.

There are many tasks that the AT performs that directly affect the quality and safety of patient care, whether it is diagnosing a problem with the anesthesia gas machine, assisting the anesthesia provider during a sterile procedure, or performing quality chest compressions during an intraoperative cardiac arrest. Many procedures in anesthesia require strict sterile technique and safe practices whenever sharps such as needles and scalpels are being used. In a controlled, learner-focused simulation environment, an AT can simulate important tasks such as proper sterile glove technique, maintenance of equipment tray sterility, and safe sharps disposal practices using blunt tip needles. Perfecting sterile technique and sharps safety is imperative before attempting these skills in reality. Breaking sterility and accidental needle injury put the patient and the provider at risk for infection. In the simulation setting, these skills can be refined without those risks.

As pointed out above, successful outcomes in a complex crisis depend less upon the actions of one individual, and more upon the coordinated actions of a team. ATs are critical members of most crises in the operating room (OR). Their assistance may be required for cardiopulmonary resuscitation, vascular access, or dealing with a difficult airway. The role of the AT during a crisis should not be underestimated. ATs should advocate for participation in all team training events or simulation that involve OR personnel (Fig. 58.1). When was the last time ATs in your department participated in a simulated emergency with OR personnel?

Simulation training can be conducted in many different environments. There are dedicated simulation centers with rooms outfitted to replicate an OR

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