To the Editor:
We hold an annual continuing medical education event that challenges providers to perform a number of simulated emergency procedures. 1 The event occurs in a wilderness setting with simultaneous supervision and monitoring of a relatively large number of learners. Typically, participants are required to demonstrate airway management including acquiring a surgical airway. The course participants have a large variation in experience and training and include non–medical personnel, EMT/ paramedics, nurses, medical students, residents, and attending physicians. In order to run this course we have created an airway model that allows learners to perform a surgical airway. This model is inexpensive and allows rapid turnover. It is easily constructed and offers reasonable anatomic verisimilitude. We offer it here as a suggestion to other instructors who have similar needs and a limited budget.
We used Styrofoam mannequin heads, corrugated polyethylene respiratory tubing, foam pipe insulation, foam tape, and ketchup packets (Figure 1) to create our model. The corrugated tubing approximates the adult trachea, with the corrugations simulating tracheal rings. Sections of the pipe insulation simulate the thyroid cartilage. Strips of foam tape serve to hold the tracheal portion of the model in place and to simulate the overlying skin and soft tissues. The ketchup packets provide additional soft tissue and simulated bleeding.
The necessary equipment.
To construct the model, a 3-inch section of the corrugated tubing is cut to create a trachea and is covered by a ketchup packet. A 1-inch section of pipe insulation is placed over the ketchup packet, holding it in place, creating the simulated airway (Figure 2). The airway is placed in a channel cut into the neck portion of the mannequin and covered with foam tape (Figure 3).
Construction of the tracheal portion of the model.
Mounting the tracheal portion.
Ideally a novice provider will practice a surgical airway before performing this procedure on an actual patient. Methods of practice include the use of high-fidelity simulators, cadaver labs, and live-animal models. Purchase of a simulator on which multiple procedures can be performed may cost from $5000 to 30 000 (Medical Education Technologies Inc; [888]462-7920, 6000 Fruitville Rd, Sarasota, FL 34232; Simulab Corp, [206]297-1260, 1144 NW 52nd St, Seattle, WA 98107). The same simulator may be rented for $600 to $800 for a several-day course. The cost of an animal or cadaver lab will vary between institutions. At our facility it costs between $800 and $1200 to run a single-afternoon pig lab. This method uses live tissue but is time intensive and only allows 1 cricothyroidotomy per animal. Special procedure courses may use cadavers at a cost of $275 to $325 per student (The Emergency Medicine Procedure Course, Premier Health Care Services Educational Division, [937]312-3627, 332 Congress Park Dr, Dayton, OH 45459), again with the limitation of 1 procedure per cadaver.
Our model offers several advantages in terms of cost and convenience. The heads can be purchased by mail order for $3.95 (Display Forms, [888]421-4241, PO Box 2288, Whittier, CA 90610-2288;
The ideal method to teach surgical airway skills is in real time with the direct supervision of experienced providers. An emergent cricothyroidotomy is a rare procedure, and prudence dictates that a novice should have practiced the procedure prior to actually performing it.
We offer our model as an inexpensive way to provide a large number of students with an opportunity to perform their initial cricothyroidotomy (Figure 4). In our situation, this model allowed us to test 60 participants nearly simultaneously using 15 preceptors, each supervising 4 airway stations (Figure 5). In this manner, every member of a typical first-year medical school class could perform a simulated surgical airway in an hour at a cost of less than $300 for a first-time set-up. Subsequent sessions could be run for less than $70.
The model in use.
The result of 3 hours work.
Our model is not intended for more experienced providers. It does not offer the challenge or accuracy of a cadaver or simulator. It does provide a relative approximation of the anatomic structures pertinent to the performance of the procedure. It allowed us to rapidly take a large group of learners through a procedure that is usually practiced at a much higher cost.