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AMIA 2012

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Akshay Vankipuram

on 30 January 2013

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Transcript of AMIA 2012


Introduction

Advanced Cardiac Life Support

Development of the system
Distributed ACLS Trainer

Video

Database and Evaluation

Live Demonstration

Conclusion & Future Work Akshay Vankipuram, MS
Simulation Education and Training
Banner Good Samaritan Med Center

Prabal Khanal, ME
Arizona State University,
Phoenix AZ

Aaron Ashby, MS
Simulation Education and Training
Banner Good Samaritan Med Center
Arizona State University Development of Virtual Reality based Advanced Cardiac Life Support
Training Simulator in Unreal Development Kit® photo credit Nasa / Goddard Space Flight Center / Reto Stöckli MySQL integration using cSQL libraries

4 primary tables – Detail, Summary, Compressor, Medicator

Tasks sorted according to IDs in table

UserID and TeamID Database module Acknowledgements Refining and expanding the system
Include more causes of cardiac arrest
Explore ability to support user team matching
Tracking and scoring of each user’s training
Refine formative and summative feedback
Allow for error correction
Perturbation Training

Data
Analysis of team communication patterns
from a network perspective Future work Design and development of a virtual
reality simulator for ACLS training
Extensive real time data collection
Access provided from distributed locations
Objective measures of CPR performance
Validation study is ongoing CONCLUSIONS TeamSpeak 3 (TS3) SDK libraries

Voice activated communication

Separate server and client APIs

TS3 server started with UDK server

Each ACLS VR user initializes TS3 client Communication module Features
Real time feedback
Local and global messages
Two message types
Persuasive - time and event triggered
Affirmative - event triggered Messaging and feedback INTRODUCTION Advanced Cardiac Life Support Distributed ACLS Trainer Task ID
1
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
19
20
21
22
23
24
25
26 Task Description
Check Pulse
Get and place board
Compress Chest
Check airway
Head tilt chin lift
Place ambu bag
Ventilate
Switch to airway manager
Switch to CPR
Remove pillow
Place patches
Plug in defibrillator
Turn on defibrillator
Identify rhythm
Select 200 Joules
Charge the defibrillator
All clear
Remove ambu-bag
Deliver shock
Administer drug
Give post-drug fluid flush
Identify cause of PEA
Check patient history
Check Pupils Expected Role
Any
Any
Compressor
Airway
Airway
Respirator
Respirator
Compressor
Airway
Any
Defibrillator
Defibrillator
Defibrillator
Defibrillator
Defibrillator
Defibrillator
Any
Respirator
Defibrillator
Medicator
Medicator
Defibrillator
Leader
Airway Task instigation
check pulse icon
under the patient
chest of patient
mouth of the patient
Up and down arrows on the mouth of patient
place ambu bag icon
compress ambu bag (up-down arrow) icon
switch roles icon
switch roles icon
pillow
patch icon
plug icon
defibrillator switch
defibrillator HUD
energy select button on the defibrillator
charge button on the defibrillator
press and hold the control key
press and hold the control key
shock icon
drug icon in the medical tray on Medicator HUD
syringe icon
H's and T's table on the HUD
clipboard icon
patient's eyes CONCLUSIONS AND
FUTURE WORK Funding Source
Telemedicine & Advanced Technology Research Center Grant #

The Research Challenge
Training of non-collocated medical teams

Co-principle Investigators
2009 - 2012 Mark Smith, MD (Banner Health)
2009 - 2011 Kanav Kahol, PhD (Arizona State Univ)
2011 - 2012 Robert Greenes, MD, PhD, ACMI
(Arizona State Univ) Project Origin Purpose
Provide life saving intervention for cardiac and respiratory failure

Nature of environment
High stress
Time critical
Team-oriented Advanced cardiac life support (ACLS) Features
4 - 6 clinicians
Dynamically formed

Roles
Leader
Respirator
Medicator
Airway Manager
Compressor
Defibrillator ACLS Team Training Costs High
Staffing, Location Rental, High fidelity Mannikins

Accessibility
Teams must be assembled on location
Limited capacity
Lower repetitions of practice
Evaluation and Feedback
Instructors and evaluators required
Subjective assessment (high cognitive load)
Data Management and Performance Tracking
Limited Drawbacks of the current training Phases of ACLS training
Didactic training
Simulation based training (clinical simulation)

Features of Clinical Simulation
human analog (manikin) used
low or high fidelity mankins
expert raters evaluate performance of teams in real-time
Rotating roles
Certification every 2 years State of the art ACLS
training Compressor Airway Manager Environment
Avatars purchased and modified using Autodesk Maya 2011
Environmental assets and animations in Maya
Imported into UDK environment Defibrillator Leader Graphical user interface Medicator Respirator Role Specific GUI Video Simulates tactile feedback associated with CPR
Modified Novint Falcon® haptic joystick
Each client can use joystick but only two required per session
Designed by José Santiago Haptic module System Design Unreal Development Toolkit (UDK)
Features
Ability to create virtual environments
Single and multi-user
high fidelity

Creating the server in multi-user games and simulations

Allows integration of third party APIs

Creating and editing animations Platform Training Costs Lower
Development and maintenance of system relatively inexpensive
Accessibility
Provide training to numerous remote users
Capacity completely extendable
Higher repetitions of practice
Evaluation
Automated performance evaluation
Objective assessment
Data Management and Performance Tracking
Virtually limitless Complements of using VR training Former team members:
Mithra Vankipuram
José Santiago

Banner Staff
Denise Drumm-Gurnee
Karen Josey
Karen Zittergruen
Linda Tinker
Brian Wasem
Naomi Foote
Michael Kasperski
Patrick Farrer

Arizona State University
Department of Biomedical Informatics
Dr. Robert Greenes Questions? Karen Josey, MEd, BSN, RN, MSL
Simulation Education and Training
Banner Good Samaritan Med Center

Dr. Marshall (Mark) Smith, MD, PHD
Simulation and Innovation
Banner Good Samaritan Med Center Comparison of ACLS mock code training versus VR training Design Overview Aspects of the Virtual Environment
Digital representations of real environment
Accessible through a network connection
Automatic data capture from all user input
Real time formative feedback
Comprehensive summative feedback
Motivational features of Gaming Environments
Low cost to add or adjust features Why Virtual Reality? Features of team-based care delivery
Multiple roles
Different areas of expertise
Often without fixed membership
c
Critical needs of team training
Deliberate practice is required for expert performance
Opportunities for individual clinicians to practice their role with a team Applying VR in Medical Team Training
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