On the set of U.Va.’s ER for medical students

Photo by Andrew Shurtleff

Dr. Marcus Martin (center), chief of emergency medicine, monitors the condition of the ‘patient’ while directing a team of rising fourth-year medical students in a life-saving exercise.

By Dan Heuchert

Blood was everywhere in Room 66 of the U.Va. Medical Center’s emergency department. The team worked feverishly to save Stan, a 35-year-old welder, blown some 30 feet off a scaffold in a workplace explosion.

Under the watchful eye and calm guidance of Dr. Marcus Martin, chief of emergency medicine, the team worked to assess the moaning patient, restore his airway, stem the bleeding, and stabilize him for delivery to the operating room.

When it was all over, the half-dozen medical students stood back as Martin praised them. “Good job, team. Outstanding.”

Neither the blood nor the patient were real. The exercise came on the last day of the third-year medical students’ surgical rotation, and focused on emergency diagnostic procedures and managing airways. It was made realistic by “Stan the Man” (short for “standard man”), a $60,000 computerized patient simulator obtained in December. (Plans are in the works to buy an even more expensive adult model, plus a pediatric model.) Stan bleeds fake blood, may be given a voice by a remote operator, can be hooked up to all manner of monitors, and offers realistic body structure for incisions, injections and other invasive procedures.

In short, he offers very realistic training in a consequence-free environment, enabling medical students to test their knowledge and skills in a crisis. “The [students’] pulse rate rises in there, even with the simulator,” Martin said. Students have the opportunity to perform a number of procedures that they are months, or maybe years, away from doing on a real patient, he added.

The students’ day started in Jordan Hall, where they were given a morning-long overview of disaster medicine and life-saving measures. The real fun — or simulated fun? — started later, in an ambulance bay outside the emergency department.

Martin briefed groups of six students on what was known about their “patient.” They donned yellow paper gowns and booties; as the accident scenario involved possible chemical exposures, the patient would have to be decontaminated before treatment began. The students were assigned roles, which were identified by stickers on their gowns — “team leader,” “airway,” “left side of patient.”

Soon, they were led into room 66, where they met Stan, bleeding from a couple of places, moaning with pain and complaining about his difficulty breathing.

A student ordered an IV and queried the patient on any medications he might be taking. They checked his pulse and put pressure on his wounds.

“Anything else?” Martin asked the students.

“His blood pressure is low,” one responded.

“Right,” Martin said. “How are his breath sounds?”

There was a brief confusion as the students realized that none of them had a stethoscope.

“Always have one,” Martin said. “I have one — here.”

Soon, Stan’s tongue was swelling, obstructing his airway. The student leader ordered a tracheotomy, an emergency incision into the windpipe to allow air into the lungs.

“You don’t worry about sterile technique?” asked one student standing near Stan’s feet.

“You’ve gotta get it done,” Martin said. “A little Betadine would be fine.”
The student mimed spraying some antiseptic toward Stan’s neck.
Later, a portable x-ray machine was wheeled in to take an image of Stan’s chest (although the images delivered came from a real patient).

At another point, a student wielding a rather large needle sought to place it in just the right spot in Stan’s abdomen — a procedure called a “diagnostic peritoneal lavage,” which seeks to determine if there is internal bleeding and where it is coming from.

“I’m depending on you, Mark,” Martin said encouragingly. “You’re the man.”

There indeed was blood in the abdomen, meaning a trip to the operating room was necessary. After Stan was pronounced ready for surgery, the students exchanged high-fives then retired to a conference room to view and discuss videotape of their response.

“The biggest fun for me is to take students who have no experience in this and push them along and make them make decisions,” Martin said. “They did well.”