As a pioneering medical charity, Magpas Air Ambulance is always striving to provide our clinicians with the best possible training in order to provide patients across the East of England and beyond with lifesaving medical care 24/7.
Understandably, state-of-the-art training mannequins and materials do not come cheap, so our training leads and consultants are regularly coming up with new, innovative ways for our medics to learn and practice skills that will save lives, without breaking the bank.
Magpas Air Ambulance Doctor Ali Hieatt—who has worked with the charity for almost 13 years, having joined as a volunteer in 2010—has recently developed a new way of practising and performing a procedure that is not easy to replicate in a training environment… By crafting a homemade pregnant uterus!
She recently talked us through the ambitious project:
What do you remember about the training when you joined Magpas Air Ambulance?
I remember the training being the most intense experience—unlike anything I had done before—and I had to fit it around my hospital rota, so I was training with Magpas Air Ambulance between shifts.
It was hard work but worth it. At the time there were very few opportunities to train in the specialty and following the course, I was lucky to be appointed to one of the pilot training schemes, which paved the way to what we now know as Pre-Hospital Emergency Medicine (PHEM) training.
Although the training has evolved as the medical specialty has, to this day the principles of the training remain the same; a combination of lectures, discussions and simulations, where trainees are introduced to the important concepts and considerations of PHEM.
Something we’ve also introduced is surgical skills training, using a range of models and materials.
Tell us about the project you’ve been working on to enhance training for a very specific procedure…
The surgical procedure is known as a resuscitative hysterotomy or perimortem caesarean section.
Evidence suggests that, should a pregnant patient suffer a cardiac arrest and not respond to initial treatment within the first four minutes, then their chances of survival improve if the baby is delivered by caesarean section. This is because the uterus and the baby take so much of the mother’s cardiac output in the later stages of pregnancy.
As you can imagine, real models to practice this procedure on are not available readily. So to ensure our clinicians are as prepared as they can be if they’re ever faced with this situation, I’ve designed a homemade pregnant uterus.
What this mocked-up pregnant uterus is aiming to do is provide practitioners with the ability to develop muscle memory for this procedure, so they can practice it over and over again—and then if they were ever faced with the awful situation of having to deliver a baby whilst its mother was in cardiac arrest, then their actions, the way they use their kit, where they put their kit and which kit they need, should all be second nature. This drilling improves performance and allows practitioners to concentrate on other parts of the resuscitation at that point, and means we won’t have a situation where a team may need to undertake this procedure but have not been exposed to the procedure itself.
How is it made?
It’s all made from materials from craft shops and haberdashers. We’ve been through lots of iterations of fabric, leatherette, plastic and giant balloons to fill with water. We’ve also tried multiple ways of making the umbilical cord (settling on a knitted one!) to ensure that the surgical steps undertaken when drilling would be as similar as possible to the real thing.
Although you can buy this as a mannequin, it’s extremely expensive and given that you will have to make incisions in the ‘skin’ and the ‘uterus’, there are multiple replacement parts that would mean you would not be able to practice repeatedly, like we can do now.
Have you made anything else for training purposes?
I think many of the surgical procedures that we undertake do need an introduction using tissue, whether that is cadaveric or animal, which forms a fundamental part of the training offered with Magpas Air Ambulance.
However, we have previously made other models to practice procedures such as a resuscitative thoracotomy—a procedure where the chest is opened to relieve the pressure of bleeding around the heart—again that is designed to aid learning, decision-making and making the process muscle memory for our medics.
You clearly have a passion for training and teaching the next generation of clinicians. What is it about the training that you enjoy so much?
I owe it to Magpas Air Ambulance to continue to support the charity’s massively strong ethos for training, as they have made me the doctor that I am today.
The passion for training that I was introduced to as a volunteer doctor all those years ago has really shaped the educationalist that I am now. So having the ability to provide doctors and paramedics in training with a way to practice techniques, to ensure that they have the right skills, thought processes and decision-making should they be faced with the most difficult of clinical situations, is a real privilege.