Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Learning Objectives: To design an anatomically accurate, reusable model of resuscitative hysterotomy providing learners realistic practice without utilizing biological tissue. Secondary objectives included minimizing utilization costs, while developing procedural proficiency for large groups of trainees.

Introduction/Background: High-acuity and low-frequency procedures are an important component of emergency medicine training that not all residents encounter before graduation. The pregnant patient in cardiac arrest requiring resuscitative hysterotomy exemplifies this phenomenon. High-fidelity commercial models are expensive, thus less suitable for repeated use by inexperienced learners. Conversely, many low cost models lack anatomic fidelity required to replicate the procedure. We present a low cost, high-fidelity option that is non-tissue based and conducive to repeated use. This allows learners to practice the technique prior to performing an invasive procedure on a patient.

Curricular Design: Gaumard S500 Original Childbirth Simulator, a childbirth skills trainer was repurposed as a rapidly reusable model for resuscitative hysterotomy. The empty pelvic base was fitted with a plastic sac containing a baby in simulated amniotic fluid and adjacent placenta. Pelvic organs including a bladder, uterus, subcutaneous tissue and skin were designed using soft pourable silicone rubber. Layers were colored to match soft tissue texture and appearance prior to assembly within the pelvic base. As learners successively perform the procedure, the abdominal covering and uterus layers can be easily resealed for repeated incisions.

Impact/Effectiveness: A cost-effective and reusable model allows residents to practice high-acuity, low-frequency procedures in realistic patient care scenarios. This model was implemented with 40 GME and UME learners performing the procedure during a simulated case during weekly didactics. Each participant described the experience as realistic and effective in improving confidence. The model will be integrated annually into simulation activities with plans to expand to other healthcare professionals via in-situ simulation scenarios in the ED.