Although our mannequin demonstrates chest movement with breathing a current limitation is the inability to simulate other patient movement. Consequently some narrative is required to describe movement during a scenario, diminishing realism.

Materials
Inflatable ‘test lung’ (Puritan Bennett 2 L?)
15mm (internal diameter) connector plus an endotracheal tube connector
Non-compressible suction tubing (Medi-Vac)
‘Y’ connector
Rotary switch valve (Bird)
E size oxygen tank with an adjustable pressure regulator Methods

Methods
Our mannequin lies on a stretcher atop of a thin mattress. Cut out a section of this mattress under the torso of the mannequin in the shape of a test lung (A). Cut a wooden block to the same shape to elevate the test lung so it’s flush with the surface of the mattress (B). The hard surface below the test lung expedites inflation.

Attach the 15mm and ETT connectors to the test lung and join it to the ‘Y’ connector with a piece of suction tubing. From the ‘Y’ add another piece of tubing long enough to run out from under the mattress to join a connection under the stretcher.






This connection runs discreetly for about 15’ to the control room and is hooked up to the pneumatic source: a size E Oxygen tank regulated to a working pressure of 50 psi with its output controlled by the rotary switch valve.


The disadvantage of using a gas tank is that gas consumption is high and the response to the manual maneuvers decreases when the tank empties to approximately 1100psi: at this point we change tanks and use the rest of the gas to run other features on the mannequin.

Results
Manually altering the frequency and amplitude of opening on the switch valve, will determine the force and speed of mannequin torso movement as a result of rapid inflation and deflation of the test lung embedded into the stretcher. Movement is readily coordinated with live or pre-programmed vocal sounds. We utilized this pneumatic system to create movement representing seizures, retching and coughing, combative patients, fasciculation, or simple benign movement.

Discussion
Learners readily appreciate the significance of these movements reducing the need for a concurrent description of events. The addition of another humanizing element to the mannequin helps us maintain an adequate level of realism while encouraging learner ‘buy in’. We are currently expanding this system to create arm and leg movements.

Originally presented at IMSH 2008 as the poster "Adding Mannequin Movement to Enhance Realism"
by Roger E Chow, Domenic DePinto, Dylan Bould, Howard Harris. WORK IN PROGRESS POSTER ABSTRACT # 54