A diehard patient

[Times photos: Fred Victorin] Pat Vitale, an engineer, checks on a Human Patient Simulator that has been completed to make sure everything is working before sending it out in the test lab.

By SUSAN ASCHOFF, Times Staff Writer
© St. Petersburg Times
published April 30, 2002

That's Stan, a Human Patient Simulator who helps students and emergency workers learn by simulating more than 70 very real medical crises.

SARASOTA -- The patient's head, cocked to one side and detached from its torso, does not move. But the eyelids blink, the pupils dilate.

Pat Vitale ignores the severed head. He puts his ear to the gaping neck, listening to the rhythmic breathing. Vitale thinks he hears a leak.

Poor Stan. It may be days before they get around to reattaching your head.

Stan, short for Standard Man, is a Human Patient Simulator, or HPS. His Ken doll-perfect hair and sculpted abs belie his proclivity to become the patient from hell. The full-size, computer-driven mannequin can bleed, suffocate or go into cardiac arrest. He is programmed to exhibit more than 70 medical crises. With the click of a computer mouse, he can morph into a 61-year-old trucker who smokes or a 30-year-old pregnant woman.

Vitale, a test engineer, is putting Stan through his paces.

When Stan is ready, he will teach medical students and emergency workers how to treat everything from a gushing wound to a blocked airway. His distress will be so lifelike some students will weep when they fail and Stan "dies."

Rose Brennan works on the leg of what will be a child-size Human Patient Simulator. She’s working on the foot, where a pulse point will be.

"It gives the students an opportunity to practice. In real life, if there's an emergency, the (medical) students are pushed to the side and become observers. With the simulators they can make a mistake, and no one's life is at risk," says Tess Mitchell, marketing director for Stan's maker, Medical Education Technologies Inc. in Sarasota.

Founded in 1996, the company is one of a handful in the world making medical simulators. METI's sophisticated technology -- Stan reacts in real time to even the most minute doses of medicine -- makes its product unique, Mitchell says. An HPS and supporting software can cost more than $200,000.

More than 200 teaching hospitals, universities, fire departments and military bases in the United States have one. St. Petersburg College has three: two adults and a child, called a PediaSim. Last November the college used the mannequins in a drill on terrorist attacks for emergency and hospital workers. The exercise also was a test run of one of METI's newest products, a software program that can create more than a dozen scenarios involving weapons of mass destruction -- chemical, biological and nuclear.

The University of South Florida gave its two Stans and one PediaSim their own operating room. They reside in the year-old Education Suite at Tampa General Hospital, guinea pigs for students in pharmacology, anesthesiology, surgery and critical care.

NASA wants the beleaguered patient to train astronauts for medical emergencies light-years distant from a hospital. The Army utilizes a smaller Model C, easier to tote and powered by a portable generator.

METI's challenge was to create a simulator to teach students not how to master a machine but how to respond to complex and unpredictable human beings.

Vitale and Eric Colonna, a test technician, roll over a Human Patient Simulator being tested at Medical Education Technologies Inc. in Sarasota. The company is one of a handful in the world making medical simulators.

"This is the closest thing to transitioning (from textbook) to human I've ever seen," says Nerina Stepanovsky, EMS program director at St. Petersburg College.

Stan's pulse can be felt through his skin, his swollen tongue palpated, his heartbeat tracked on a standard ECG monitor. A student can administer CPR or insert a ventilating tube. Bar-coded syringes identify the drug chosen, its concentration and amount, sending the information to the computer so the patient reacts according to dosage and his weight.

The newest Stan is a 6-foot, 250-pound hunk. Mitchell says the 28-year-old brunette was modeled on Mr. April in the Chippendale calendar. There is no female simulator. Stan does have interchangeable genitalia. Medical school students tend to dress him up and plop a wig on his zippered head if he's to play a female.

"Then he looks like a German swimmer," jokes one of the techs.

The mannequins are purchased from an outside supplier, then mercilessly deconstructed. Inside the nondescript Sarasota industrial park, a vision worthy of film director Tim Burton awaits. Heads rest on metal shelves, each skull drilled with about 30 holes for electronics and sensors. Glass eyes rest above a work bench. Boxes hold dismembered legs and arms. There are miles of electrical cables, to be bundled into "umbilical cords" connecting simulators to PCs.

Symptoms down to the flutter of an eyelid are controlled by computer mouse or handheld remote. An instructor can script new scenarios. Some use the microphone to give voice to Stan's suffering.

"Help me!" they plead to startled students.

Pinprick openings near Stan's mouth can ooze mucus or bleed colored water.

"I feel like I'm in the medical field," says Rose Brennan, an electronic mechanical assembler. She carefully shaves a depression in the toe of a child-size plastic leg. A pneumatic line will be threaded through holes and covered with "skin," one of 10 pulse points on a PediaSim.

The work is labor intensive. Technicians and assemblers and engineers handcraft each simulator. They produce about five a month.

"It's more challenging" than most jobs, says test engineer Vitale. "There's more to the electronics. You have pneumatics and controls and gas analyzers."

HPS software can morph Stan into a smoking, hypertensive 61-year-old truck driver. He is pictured in a photograph on the screen, a gimme cap on his head and an umbrella drink in his hand. Stan can be old or young, male or female, healthy or chronically ill or traumatized.

When students rotate through hospitals or clinics, the experience they gain will largely depend on who comes through the doors. "You can't order the kind of emergencies you need" to properly prepare them, says SPC's Stepanovsky.

Stan delivers on cue and tracks exactly what happened when. A printout is proof. "Sometimes you think you've done something quickly, but you haven't," says Stepanovsky. "It may have been five minutes before you put (oxygen) on. That's too long."

At METI, Stan continues to evolve. In the works is more lifelike skin that could be altered texturally to provide another diagnostic tool.

And on a desk upstairs sits the soft plastic head of a dog, a golden retriever, his eyes closed and mouth curved, as though he dreams of the day when he will be a vet's best friend.

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