Simulation helps keep doctors cool under fire

By PHILIP WALZER, The Virginian-Pilot

© August 2, 2004

Last updated: 11:41 PM

NORFOLK — A medical resident in green scrubs slithered across the floor toward the victim, dragging a medic pack.

Amid the sounds of gunshots and flashes of fire in the sky, he went to work inserting a chest tube.

A couple of minutes later, he screamed: “Tube in!”

The resident, Dr. Mayur Narayan, accomplished the procedure last week not in Iraq, but in the “Cave,” part of Old Dominion University’s simulation center.

Narayan was among two dozen residents and students from Eastern Virginia Medical School participating in a study assessing medical skills under combat conditions.

They worked on a TraumaMan torso, a latex-and-rubber replica with simulated organs and blood, in a dark 10-foot cube on the second floor of ODU’s Fieldhouse.

It seemed thousands of miles from the gym.

Projected on the walls surrounding them appeared images of white buildings perennially lighted by shelling. The pounding of gunfire regularly pierced the air.

The torso lay before a semi-circle of boxes, approximating a bunker. If the doctor raised his head above them once, he faced a sniper’s shot and the warning, “Get down.” The second time, he was “killed” with an Arnold Schwarzenegger-like farewell raining from the sky: “Hasta la vista, baby!”

Most residents last week shrugged off the challenges of the exercise, although they acknowledged it was harder to perform the procedures lying down.

“I wanted to see if I could do some skills outside the hospital environment,” said Dr. Charlie Cheng, 30, a fourth-year resident from Springfield. “I think I can, which is good to know.”

The results, though, show that several could have problems on the battlefield.

“There is a tremendous amount of variability,” said Mark W. Scerbo, an Old Dominion psychology professor who is the lead researcher on the project, which is co-run with EVMS.

“Some do what you’d expect and nail it. Some are struggling. And some are getting killed.”

More than a few completely missed the “pleural space,” the cavity between the lungs and the membranes that surround it, where the tube needs to go in.