GB2628177A - Training manikin - Google Patents

Abstract

The invention provides a training manikin for defibrillation training. The manikin includes a manikin body having an outer skin and an inner cavity and an array of shock receiving nodes beneath the outer skin. Each shock receiving node includes a shock receiving electrode beneath the outer skin and an energy dissipator having an input electrically connected to the shock receiving electrode for dissipating the energy of a shock delivered by a live defibrillator through the outer skin of the manikin to the electrode. A signal receiver is electrically connected to an output of each of the dissipators at the plurality of shock receiving nodes for sensing delivery of shocks to the electrodes.

Description

TRAINING MANIKINS

Field of Invention

[0001] The present invention relates to training manikins, in particular, although not necessarily exclusively, to manikins to simulate patients in training scenarios for healthcare professionals, including nurses, paramedics and doctors for example. Manikins in accordance with embodiments of the present invention are particularly suited for use in emergency life support and resuscitation training.

Background

[0002] Training of healthcare professionals in emergency life support and resuscitation procedures is of critical importance, especially for those working as first responders or in emergency and critical care environments. The ability to correctly recognise life threatening conditions and correctly use a defibrillator where needed can literally mean the difference between life and death for a patient.

[0003] Emergency life support and resuscitation training generally relies on the use of training manikins (sometimes referred to as patient simulators) that seek to simulate certain physical attributes of a live patient, most commonly the patient's airways and the response of their chest to compressions that are administered during CPR. More advanced manikins seek to simulate other patient characteristics, including, for example, ECG signals and a patient's pulse. In practice, however, a user's perception of such conventional manikins is that they do not provide an especially realistic experience.

[0004] It is also known to provide systems that enable training in the use of defibrillators. Generally, these involve the use of a training defibrillator, which lacks a degree of realism because only a very low energy shock or no shock at all is delivered. It is also known to use a live unit on a specially adapted manikin that includes studs or marked areas on the manikin's 'skin' directing placement of the defibrillator electrodes and leaving no opportunity to get things wrong. Often the first time that a healthcare professional delivers a high energy shock with a live defibrillator is in a real emergency situation.

[0005] W02016177591A1 describes a defibrillation training system that enables the use of a live defibrillation unit by making use of an adapter connected to the live defibrillation unit by a resistance cable that dissipates the shock energy. No shock is delivered to the manikin itself, so whilst the described approach avoids the need to use dedicated training defibrillators, there is still a lack of realism.

[0006] One factor relevant to correctly recognising potentially life threatening conditions is understanding the significance of internal body sounds, for example sounds from the heart, lungs, bowel and other organs as heard through a stethoscope (referred to as auscultation). Attempts have been made to introduce simulated body sounds to training manikins, for example as described in WO 005078683A1, which describes the use of air-filled, flexible sound conductors to carry sound from a speaker to sound distributors distributed about the manikin.

Summary

[0007] In general, embodiments of the invention are concerned with addressing at least some of the shortcomings of known training manikins by providing manikins that more realistically simulate the characteristics and responses of a real patient in a variety of training scenarios.

[0008] In some embodiments, a training manikin provides an improved simulation of defibrillation by enabling use of a live defibrillator (as opposed to a training defibrillator), delivering an electrical shock to the manikin at the same energy levels as would be used in a real-life emergency situation.

Embodiments can also take account of the positioning of the defibrillator electrodes on the manikin body when determining the response of the manikin to defibrillation. This provides a more realistic training experience for the user.

[0009] In the same and/or some other embodiments, a training manikin provides an improved simulation of ECG measurements by generating ECG signals that are dependent on the placement of (conventional) ECG electrodes on the manikin body. Again, this provides an improved training experience for the user by giving realistic feedback for correct and incorrect placement of the electrodes.

[0010] In the same and/or some other embodiments, a training manikin provides an improved simulation of auscultation based on the generation of audio signals that are dependent on the placement of a (conventional) stethoscope on the manikin body. As with the other two approaches described above, this results in a more realistic training experience for the user, where the sounds they hear can be tailored based on the stethoscope positioning as well as the patient condition that is being simulated.

[0011] The above approaches can be used alone or in any combination to provide versatile training manikins suited for use in a variety of training scenarios whilst bringing realism to the training.

[0012] In a first aspect, the invention provides a training manikin for defibrillation training, the manikin comprising: a manikin body having an outer skin and an inner cavity; an array of shock receiving nodes beneath the outer skin, each shock receiving node comprising a shock receiving electrode beneath the outer skin and an energy dissipator having an input electrically connected to the shock receiving electrode for dissipating the energy of a shock delivered by a live defibrillator through the outer skin of the manikin to the electrode; and a signal receiver electrically connected to an output of each of the dissipators at the plurality of shock receiving nodes for sensing delivery of shocks to the electrodes.

[0013] In some embodiments, the nodes extend across a majority of the front of a torso of the manikin. The nodes may, for example, be arranged in a regular grid pattern. The density of the grid pattern may be determined based on the desired uses of the manikin. Typically, there will be at least 25 nodes, for example arranged in a 5 x 5 grid. In other examples there may be 100 nodes or more, for example in a 10 x 10 grid.

[0014] In some embodiments, the dissipator of each node is housed within the manikin body cavity. In some embodiments, the dissipator includes one or more resistors. The dissipator may be enclosed in a ventilated housing. In some embodiments one or more heat sinks for removing heat from the dissipators.

[0015] In some embodiments, the signal receiver is in communication with each shock receiving node via an addressable communications network. The signal receiver may, for example, be incorporated in a central control unit. In some embodiments, the central control unit is housed within the manikin body cavity.

[0016] In some embodiments of this first aspect, at least some of the shock receiving nodes of the manikin comprise an output electrode beneath the outer skin and a signal generator having an output electrically connected to the output electrode for applying an electrical waveform signal to the output electrode that is detectable through the outer skin of the manikin by an ECG electrode in contact with an outer surface of the outer skin; and a diode between the signal generator and the output electrode to protect the signal generator from a shock applied to the shock receiving node by a defibrillator; wherein the manikin comprises a controller electrically connected to an input of each of the signal generators at the plurality of signal generating nodes for controlling the signal generators.

[0017] In some embodiments, the output electrode and the shock receiving electrode of each node are the same component.

[0018] In some embodiments, the controller for the signal generators is incorporated in a central control unit along with the signal receiver.

[0019] In some embodiments of this first aspect, the manikin includes an array of speakers beneath the outer skin of the manikin for generating sounds that are audible through the outer skin of the manikin by a stethoscope in contact with an outer surface of the outer skin; and the manikin comprises a controller electrically connected to an input of each of the speakers at the plurality of sound generating nodes for controlling the speakers to generate sounds.

[0020] In some embodiments, at least some of the speakers are located at the shock receiving nodes.

[0021] In some embodiments, the controller for the speakers is incorporated in a central control unit along with the signal receiver.

[0022] In a second aspect, the invention provides a training manikin for simulating electrical activity of the heart, the manikin comprising a manikin body having an outer skin and an inner cavity; an array of signal generating nodes beneath the outer skin, each signal generating node comprising an output electrode beneath the outer skin and a signal generator having an output electrically connected to the output electrode for applying an electrical waveform signal to the output electrode that is detectable through the outer skin of the manikin by an ECG electrode in contact with an outer surface of the outer skin; and a controller electrically connected to an input of each of the signal generators at the plurality of signal generating nodes for controlling the signal generators.

[0023] In some embodiments, the nodes extend across a majority of the front of a torso of the manikin. As in the first aspect, the nodes in some embodiments will be arranged in a regular grid pattern and there may be at least 25 nodes (for example in a 5 x 5 grid).

[0024] In some embodiments, the the signal generator of each node is housed within the manikin body cavity.

[0025] In some embodiments, the controller is in communication with each signal generating node via an addressable communications network. The controller may be incorporated in a central control unit, which may be housed within the manikin body cavity.

[0026] In some embodiments, the controller controls the signal generators based on a scenario plan that is stored in a memory accessible to the controller.

[0027] In some embodiments of this second aspect, at least some of the signal generating nodes comprise a shock receiving electrode beneath the outer skin and an energy dissipator having an input electrically connected to the shock receiving electrode for dissipating the energy of a shock delivered by a live defibrillator through the outer skin of the manikin to the electrode; and a diode between the signal generator and the output electrode to protect the signal generator from a shock applied to the shock receiving node by a defibrillator; wherein the manikin comprises a signal receiver electrically connected to an output of each of the dissipators at the plurality of shock receiving nodes for sensing delivery of shocks to the electrodes.

[0028] The output electrode and the shock receiving electrode of each node may be the same component and the controller for the signal generators may be incorporated in a central control unit along with the signal receiver.

[0029] In some embodiments of this second aspect the manikin includes an array of speakers beneath the outer skin of the manikin for generating sounds that are audible through the outer skin of the manikin by a stethoscope in contact with an outer surface of the outer skin; and the manikin comprises a controller electrically connected to an input of each of the speakers at the plurality of sound generating nodes for controlling the speakers to generate sounds.

[0030] At least some of the speakers may be located at the signal generating nodes.

[0031] In some embodiments, the controller for the speakers is incorporated in a central control unit along with the controller for the signal generators.

[0032] In a third aspect, the invention provides a training manikin for simulating internal body sounds, the manikin comprising a manikin body having an outer skin and an inner cavity; an array of sound generating nodes beneath the outer skin, each sound generating node comprising a speaker beneath the outer skin for generating sounds that are audible through the outer skin of the manikin by a stethoscope in contact with an outer surface of the outer skin; and a controller electrically connected to an input of each of the speakers at the plurality of sound generating nodes for controlling the speakers to generate sounds.

[0033] As in the first and second aspects, the nodes may extend across a majority of the front of a torso of the manikin, for example in a regular grid pattern. Especially in the case of vibration speakers, for example, the speaker nodes need not be arranged as densely as nodes for the other functional components (signal generators and sensors). Generally, there will be at least four speaker nodes. Often there will be more.

[0034] In some embodiments of this third aspect, the controller comprises at least one multi-channel amplifier for driving the speakers. The amplifier may be housed within the manikin body cavity.

[0035] The controller in some embodiments of this third aspect comprises a body sound model that provides information about the internal body sounds that are associated with a given patient condition and a propagation calculator that determines how the sounds propagate from the sound source to each body location corresponding to a node at which a speaker is located, wherein the controller controls each speaker based on an output from the propagation calculator.

[0036] The controller may, for example, have access to a library of internal body sound samples and may control the speakers to generate sound outputs based at least partly on one or more of the sound samples.

[0037] In some embodiments, each sound generating node has an associated sensor capable of detecting the presence of a stethoscope in contact with the manikin skin in the proximity of the node.

In these embodiments, the controller may be configured to control the speakers based on the output from the sensor, whereby only speakers in proximity to the stethoscope are activated.

[0038] In some embodiments of this third aspect, at least some of the sound generating nodes comprise a shock receiving electrode beneath the outer skin and an energy dissipator having an input electrically connected to the shock receiving electrode for dissipating the energy of a shock delivered by a live defibrillator through the outer skin of the manikin to the electrode; wherein the manikin comprises a signal receiver electrically connected to an output of each of the dissipators at the plurality of shock receiving nodes for sensing delivery of shocks to the electrodes.

[0039] In some of the same or other embodiments of this third aspect, at least some of the sound generating nodes comprise an output electrode beneath the outer skin and a signal generator having an output electrically connected to the output electrode for applying an electrical waveform signal to the output electrode that is detectable through the outer skin of the manikin by an ECG electrode in contact with an outer surface of the outer skin; and a diode between the signal generator and the output electrode to protect the signal generator from a shock applied to the shock receiving node by a defibrillator; wherein the manikin comprises a controller electrically connected to an input of each of the signal generators at the plurality of signal generating nodes for controlling the signal generators.

[0040] In some embodiments the controller for the signal generators is incorporated in a central control unit along with the signal receiver and the controller for the speakers. As with the other aspects, the central control unit may be housed within the cavity of the manikin body.

[0041] The skilled person will appreciate that the features described and defined in connection with the aspects of the invention and the embodiments thereof may be combined in any combination, regardless of whether the specific combination is expressly mentioned herein. Thus, all such combinations are considered to be made available to the skilled person.

Brief Description of the Drawings

[0042] An embodiment of the invention will be described, by way of example only and with reference to the following drawings, in which: [0043] Figure 1 shows three partial views of a manikin in accordance with an embodiment of the invention, with ECG electrodes correctly positioned (left-hand image), ECG electrodes incorrectly positioned (middle image) and defibrillator pads located on the surface of the manikin's skin; [0044] Figure 2 shows a partial view of the manikin of fig. 1 being used for simulation of auscultation of heart sounds, with the user's stethoscope positioned in the pulmonic area on the manikin's chest and the other main areas for auscultation of the heart (aortic, tricuspid and mitral) being indicated by the letters A, T and M; [0045] Figure 3 schematically illustrates an example of a system incorporated in the manikin of fig. 1 for enabling simulated ECG signal measurement and defibrillation with a live defibrillator; and [0046] Figure 4 schematically illustrates an example of a system incorporated in the manikin of fig. 1 for enabling simulated auscultation with a conventional stethoscope.

Detailed Description

[0047] The exemplified embodiment provides a training manikin that can be used for defibrillation training with a live defibrillator delivering a standard (i.e. high energy shock) to the manikin in the same manner, from a user perspective, as it would be delivered to a real patient. The manikin also simulates ECG signals and intemal body sounds, as described further below.

[0048] The manikin (see figs. 1 and 2) includes a body, comprising at least a torso and head, with an outer skin that, as with known manikins, has the general appearance of human skin. In accordance with this embodiment of the invention the skin is semi-conductive. Semi-conductive in the present context refers to the ability for a shock to be delivered across the skin, analogous to shocking a live patient. In this example, the material properties are designed to closely represent the conductivity of hydrated human skin. In this way, the skin will conduct electrical signals locally, through the skin, from electrodes on the outer surface of the skin to electrodes under the skin, without conducting around the manikin body to any significant degree.

[0049] In accordance with embodiments of the invention, the manikin includes an array of functional nodes arranged in a grid pattern beneath the skin. In this example, the nodes extend over the front of the manikin torso from the top of the shoulders to the waist (in-line with the navel). In other examples the nodes may extend over the manikin to a greater or lesser extent. The number and density of the nodes may also differ between examples, in a sufficiently dense grip pattern to operate as desired. In the illustrated example, the nodes are arranged in a roughly 10 x 10 grid pattern at a spacing of about 50mm.

[0050] As explained in more detail below, in this example each node has the ability to: -emit a simulated ECG signal; -absorb (and sense/record) a shock from a defibrillator; and -emit a simulated internal body sound.

[0051] In other exemplary embodiments, different nodes can implement different ones of these features or different combinations of these features. That is, it is not necessary for all three functions to be present at each node.

[0052] The operation of the nodes is controlled by a central controller that is in communication with each of the nodes, for example through direct wired connections with each node or through an addressable communications network to which all of the nodes are connected. Each node can be controlled independently of the other nodes based on a predetermined training scenario plan. A training scenario plan may, for example, be create to simulate a specific patient condition by generating simulated ECG signals and internal body sounds associated with that condition, as well as including defined changes to these signals and sounds dependent on correct (or incorrect) defibrillation.

[0053] As seen in the left-hand and middle images in fig. 1, by arranging the nodes over the manikin torso it becomes possible, for example, to simulate conditions for incorrectly placed ECG electrodes, as well as correctly placed electrodes, giving realistic training outputs for both of these scenarios. Similarly, the array of nodes means that the location of the defibrillator pads when the shock is applied can be determined and feedback provided as to whether they are correctly placed or not, for example by way of training feedback and/or the reaction (or not) of the simulated ECG signals to the shock.

[0054] In a similar way, using an array of nodes to produce internal bodily sounds, allows the user to hear appropriate simulated sounds at different locations on the torso based on the expected propagation of sound from the heart, lungs and other organs to that location. In some embodiments, the nodes may include sensors for detecting the presence of a stethoscope (for example a regular stethoscope) in contact with the skin adjacent the particular node. In this way, the generation of the sound can be limited to nodes close to the stethoscope location.

[0055] Figure 3 illustrates an exemplary arrangement for enabling simulation of ECG signals at a node in combination with receiving a shock from a live defibrillator at the node. In this example the ECG electrodes are connected to the defibrillator, which also controls administering of a shock to the manikin through the defibrillator pads. The ECG electrodes and defibrillator pads are both applied to the outside surface of the manikin skin (in the same manner in which they would be applied to a live patient).

[0056] ECG signals are generated by a waveform generator, which is coupled to an output electrode on the underside of the manikin skin through a diode. These signals are conducted through the skin to its outside surface, where they can be detected in a conventional manner by the ECG electrodes. The diode blocks current passing from the skin to the waveform generator, protecting it from the defibrillator shock. A diode is used in this example but other functionally equivalent components can be used.

[0057] The waveform generator of the illustrated node is controlled by a central controller, in this example implemented as a single board computer (SBC), that also controls the waveform generators at all of the other nodes. The central controller communicates with the nodes through an addressable communications network, e.g. a network using a serial bus protocol. The nodes are controlled in accordance with a specific scenario plan, selected for example by a trainer, that is provided to the central controller. The scenario plan will, for example, dictate the ECG signals for each node (including potentially a null output for some or all of the nodes), based on the patient condition that is to be simulated and the location of each node on the manikin body.

[0058] In this example, each node also includes a dissipator capable of dissipating energy from a defibrillator shock. The dissipator may, for example, comprise one or more resistors, sized to dissipate the expected defibrillator shock (typically no more than about 360J). In some examples, the resistors may be housed in a ventilated casing. It is also possible to include a heat sink although generally this will not be required as the typical maximum shock energies will not generate a great deal of heat. In this example, the dissipator is coupled to a shock receiving electrode beneath the skin via a diode that passes current from the electrode to the dissipator but prevent current in the opposite direction -this can be beneficial to avoid feedback that might otherwise be caused by the generated ECG signals. When the defibrillator shock is administered through the defibrillator pads, the current passes through the skin to the shock receiving electrode, and through the diode to the dissipator where the energy of the shock is absorbed. The shock receiving electrode and the ECG signal output electrode may, in some examples, be the same component.

[0059] When the defibrillator shock is administered, the node signals the central controller to register the location of the shock on the manikin body. This data is collected and can be used to provide feedback to the user in real time and/or after the training session is complete. The data can also be used to modify the ECG signals that are being generated based on a simulated effect of the administered shock.

[0060] Figure 4 illustrates an exemplary arrangement for enabling the simulation of internal bodily sounds in the manikin. The sounds are generated by an array of speakers, which in this example are located at the nodes discussed above, along with the other functional components. In other examples, the speakers may be located at only a subset of the nodes (i.e., in a less dense arrangement than the other functional components) or at distinct nodes of their own. The speakers may, for example, be vibration speakers that make contact with an underside of the manikin skin. Each speaker is driven independently by a multi-channel amplifier, which is in turn controlled by a central controller (implemented, for example, as an SBC), which in this example is the same controller used to control the ECG signal generation and to register the defibrillator shocks. A dynamic mixer may be incorporated in the system to allow sounds to be equalised in a post-processing step (making realistic tuning easier). A dynamic mixer can also give the opportunity to compensate for phase interference when multiple, different sounds are being generated by speakers in close proximity to one another, without modifying the original sound generation.

[0061] It will be appreciated that when listening to internal body sounds through a stethoscope, the listener will hear a variation in sounds based on the condition of the patient and the location of the stethoscope. To realistically simulate internal body sounds, therefore, it is important to control the array of speakers to deliver the appropriate sound at each speaker location, based on the simulated patient condition. In order to do this, the illustrated embodiment uses a library of samples of real body sounds, with the specific sound emitted at each speaker being determined based on these samples in combination with the output from a body sound model and a propagation calculator. In other examples, synthesised internal body sounds can be used along with or in place of real samples, giving more control over the generated sounds. The body sound model provides information about the internal body sounds that are associated with a given patient condition and the propagation calculator determines how these sounds propagate from the sound source (e.g. the heart or lungs or bowel) to each body location corresponding to a node at which a speaker is located. The controller then takes the output from the propagation calculator and the relevant sample from the library to generate the desired output for each speaker.

[0062] In some cases, rather than drive all of the speakers all of the time, it may be desirable to drive only those speakers that, at a given point in time, can provide a useful audible input to the user's stethoscope. Thus, in some embodiments, each speaker node includes an associated sensor, for example a magnetic sensor, that is capable of sensing the presence of a stethoscope on the surface of the manikin skin in the vicinity of the sensor (and hence in the vicinity of the associated speaker). The sensor output can be provided to the controller, which can then control the amplifier to only drive the speaker or speakers that are in close proximity to the stethoscope.

[0063] In the embodiment described here, all of the components are housed within the manikin body, keeping the manikin compact and easy to transport. The manikin can also interface with external devices (e.g., desktop computers, laptop computers, tablets and smartphones) to enable a trainer to setup and run training scenarios and to provide feedback to the trainer and other users.

[0064] Adopting the approach described above, it is possible to provide a much more realistic simulation of a patient, for example during emergency life support and resuscitation training, including the ECG outputs when ECG electrodes are incorrectly placed and the response of the patient to wrongly administered defibrillation, as well as simulating the expected outputs and response when procedures are carried out correctly.

[0065] It will be understood that the above description of preferred features is given by way of example only and that various modifications may be made by those skilled in the art. It is, of course, not possible to describe every conceivable modification and alteration of the above devices or methods for purposes of describing the aforementioned aspects, but one of ordinary skill in the art can recognize that many further modifications and permutations of various aspects are possible. Accordingly, the described aspects are intended to embrace all such alterations, modifications, and variations that fall within the spirit and scope of the invention set forth in the appended claims.

Claims (15)

1. CLAIMS1. A training manikin for defibrillation training, the manikin comprising: a manikin body having an outer skin and an inner cavity; an array of shock receiving nodes beneath the outer skin, each shock receiving node comprising a shock receiving electrode beneath the outer skin and an energy dissipator having an input electrically connected to the shock receiving electrode for dissipating the energy of a shock delivered by a live defibrillator through the outer skin of the manikin to the electrode; and a signal receiver electrically connected to an output of each of the dissipators at the plurality of shock receiving nodes for sensing delivery of shocks to the electrodes.
2. 2. The manikin of claim 1, wherein the nodes extend across a majority of the front of a torso of the manikin.
3. 3. The manikin of claim 1 or claim 2, wherein the nodes are arranged in a regular grid pattern.
4. 4. The manikin of any one of the preceding claims, wherein there are at least 25 nodes.
5. 5. The mannikin of any one of the preceding claims, wherein the dissipator of each node is housed within the manikin body cavity.
6. 6. The manikin of any one of the preceding claims, comprising one or more heat sinks for removing heat from the dissipators 7.
7. The manikin of any one of the preceding claims, wherein the signal receiver is in communication with each shock receiving node via an addressable communications network.
8. The manikin of claim 7, wherein the signal receiver is incorporated in a central control unit.
9. 9. The manikin of claim 8, wherein the central control unit is housed within the manikin body cavity.
10. 10. The manikin of any one of the preceding claims, wherein at least some of the shock receiving nodes comprise an output electrode beneath the outer skin and a signal generator having an output electrically connected to the output electrode for applying an electrical waveform signal to the output electrode that is detectable through the outer skin of the manikin by an ECG electrode in contact with an outer surface of the outer skin; and a diode between the signal generator and the output electrode to protect the signal generator from a shock applied to the shock receiving node by a defibrillator; wherein the manikin comprises a controller electrically connected to an input of each of the signal generators at the plurality of signal generating nodes for controlling the signal generators.
11. 11. The manikin of claim 10, wherein the output electrode and the shock receiving electrode of each node are the same component.
12. 12. The manikin of claim 10 or claim 11, wherein the controller for the signal generators is incorporated in a central control unit along with the signal receiver.
13. 13. The manikin of any one of the preceding claims, comprising: an array of speakers beneath the outer skin of the manikin for generating sounds that are audible through the outer skin of the manikin by a stethoscope in contact with an outer surface of the outer skin; and the manikin comprises a controller electrically connected to an input of each of the speakers at the plurality of sound generating nodes for controlling the speakers to generate sounds.
14. 14. The manikin of claim 13, wherein at least some of the speakers are located at the shock receiving nodes.
15. 15. The manikin of claim 13 or claim 14, wherein the controller for the speakers is incorporated in a central control unit along with the signal receiver.