Letter from the STORM Editorial Board

By: Amy Follmer, CHSOS-A

STORM Editorial Board Member
Zameirowski Institute for Experiential Learning
Simulation Technology Strategist
a357f308@kumc.edu

I recently found myself in a manikin failure scenario that tested my skills as a simulation operations specialist. I was disheartened by challenges and faced the difficult decision to declare the end of life for our pediatric manikin (nearly ten years past its manufacture date). Unhappy though I am, I see a benefit in sharing the struggles and lessons learned from this experience, providing a troubleshooting resource to the simulation operations community.

My simulation center does not run many pediatric simulation activities, and we don’t have many options when it comes to pediatric manikins. In fact, one such manikin was only being used once a year for an anesthesia residency pediatric laryngospasm simulation. Little did I know at the time, but during a refresh walkthrough for this event, I would make one mistake after another. Reflecting on that day, I am reminded of four key lessons that could benefit anyone in the simulation operations community.

Lesson #1: Trust Your Gut

Several times the week prior to the walkthrough, I had a feeling I should test the pediatric manikin in advance. The year before, we had issues with one feature on the manikin, but had found ways to work around it. However, when I felt the urge to test the manikin, I talked myself out of it. I reasoned that we had 2 hours blocked for setup the day of the walkthrough, which would be plenty of time. And, I asked myself, since we hadn’t used the manikin for a full year, what could possibly be wrong with it? If I had trusted my gut and tested the manikin a week earlier, I would have saved myself from stress later on. It would have seen that I needed more time to communicate with simulation instructors about the functionality needed to meet the learning objectives and I may have had enough time to locate a backup manikin option.

Lesson #2: Don’t Make Assumptions

When we began setup of the manikin, we heard a large internal air leak, which meant it would not function. I assumed, since the air leak came from a short, detached tube, it would be easy to identify where it needed to be reconnected. We tried our best, tracing all kinds of connections and searching the internet for pictures of various manikin pieces, but after two hours, we were no closer to having the manikin working than when we started. We lost that time. I then assumed, since this pediatric manikin was no longer on a warranty plan, we would be unable to get technical support for it. That was not the case either, and that lesson leads us into lesson #3.

Lesson #3: Ask for Help

Due to the assumption that our air leak would be an easy fix, and the assumption that we would not be able to get technical support for an out-of-warranty manikin, I took way too long to ask for help. I’m sure overconfidence in my problem-solving ability also came into play as well. Only when my team and I reached a dead end after two hours on our hunt for the air leak connection, did I decide to call technical support. Even then though, I figured it was pointless. Fortunately for us, technical support was able to help, and after 1.5 hours on the phone with them, we reconnected the air hose. Unfortunately, once the air hose was reconnected, all our issues were not resolved. In fact, we found additional problems that technical support declared would require sending an on-site technician.

Lesson #4: Test Critical Features First

After more than 5 hours of setup, and only 30 minutes away from the walkthrough start time, we had the manikin working. Sure, we had some hardware and software challenges, but the manikin was breathing, and we had some software control. However, we hadn’t yet tested the laryngospasm feature, and with ten minutes to spare, we activated it. Immediately we saw that the vocal cords didn’t close as they should for a laryngospasm. Instead, we heard more leaking air. A closer look at the airway revealed that the laryngospasm feature was irreparable. This was the final straw. We finally decided that this pediatric manikin had reached the end of its useful life. While we were still able to use a different manikin for the simulation event, we wasted time and effort by not focusing on the most critical features earlier in our testing.

Ultimately, these lessons were learned over the course of a very long day. I felt discouraged repeatedly as we fixed one problem with the manikin only to find another. This experience serves as a reminder of these key lessons for technology troubleshooting. Although I “know” the things I should have done, it’s so much harder to take the correct actions when in the actual situation. I’m thankful for this opportunity to practice and reflect on problem-solving.

When faced with a technology obstacle, I encourage everyone to remember to use the resources we have available, which can include our teams, our time, and our access to support. Take time to test equipment and consider alternative options in advance. Explore the pieces of the problem as unbiasedly as possible, and trust in your experiences and abilities. I’m sure I’ll make mistakes in the future, but the next time I approach a technology problem, I will start by taking a step back and leaning on these lessons learned.