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High level simulator
  1. Gavin Lloyd
  1. South-west Regional Training Committee for Emergency Medicine (gavin.lloyd{at}

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    Editor,—We were delighted to read of the use of a high level simulator in emergency department training.1

    From January 2000, we in the south west have secured three years of funding for the use of the same METI-HPS simulator for specialist registrar training at the Bristol Simulation Centre ( Like the Wellington group, we face the challenge of creating realistic scenarios of critically ill and injured patients for the purpose of formative assessment. Clear advantages of the high level simulator over traditional advanced life support group scenario teaching include:

    • real time, accurate audio and visual monitoring responses to clinical and pharmacological interventions

    • the use of videotape assisted hot review

    • interactive physiology and pharmacology tuition, particularly in regards to the use of inotropes, anti-arrhythmics, sedatives, opioids and induction agents.

    The additional features available on the METI-HPS were perhaps a little understated in the Wellington paper. Voice simulation is standard, and has played a key part in thrombolysis study days run at the Bristol Medical Simulation Centre. The mannequin is also able to simulate needle decompression of a tension pneumothorax (with audible hiss) and successful pericardiocentesis of a cardiac tamponade (with “blood” aspiration). It is able to blink and reproduce unilateral pupillary signs. A child mannequin is available, and a neonatal one is being developed.

    On the other hand, at present the simulated wheezing is not convincing in asthma scenarios, and the mannequin cannot simulate grand mal fitting, colour change (pallor or cyanosis) or perspiration.

    Like the Wellington study day, the south west simulator programme for trainees is an innovative extension of traditional emergency department training. We see it as an evolving project that will be carefully evaluated from both the trainer and trainee perspective. A further use of this technology already allows online access to live training sessions broadcast from the centre via satellite ( to user terminals installed at nine hospital sites in the UK.

    We would welcome correspondence nationally and internationally.


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