Technical Reports Simulated Emergency Department Procedures with Minimal Monetary Investment Cricothyrotomy Simulator Christopher M. Pettineo, BA; John A. Vozenilek, MD, FACEP; Ernest Wang, MD, FACEP; John Flaherty, MD, MPH, FACEP; Morris Kharasch, MD, FACEP; Pam Aitchison, RN Introduction: Existing patient simulators require the imagination, suspension of disbelief, and often verbal cuing to mitigate their lack of fidelity for some procedures. This limitation can reduce their utility as a mode for evaluation of students’ procedural skill and procedural competence. This article outlines the materials and methods for making a simulated sheep trachea holder, which enhances existing simulation modal- ities and augments the interface between device and learner. This simple addition increases the fidelity of low fidelity procedural trainers. Methods: A sheep trachea holder was created and presented to attending Emer- gency Medicine physician-educators at Evanston Northwestern Healthcare as an adjunct for procedural training. The materials and methods for making the simulated sheep trachea holder are outlined in this article. Results: The limiting factor of production is access to the foam and silicone used to make the simulator. The sheep trachea holder has been reproduced twice, features a washable exterior, and is used biweekly as a teaching tool for the cricothyrotomy skill. Conclusions: The homemade simulated sheep trachea holder is a safer and better- received alternative to our previous educational modality. (Sim Healthcare 4:60 – 64, 2009) Key Words: simulation, cricothyrotomy, skin, bleeding, education, skills, procedure, emer- gency medicine Emergency Medicine physician-educators at Evanston Northwestern Healthcare have long searched for and evalu- ated different models to increase the fidelity of high-risk life saving procedures. In a prior study, a biologic model was presented for cricothyrotomy training. 1 Though advanta- geous for its anatomic accuracy, the use of cadaveric sheep tracheae is limited by availability, the absence of a “skin layer” or bleeding, and the need for specialized clean up. Previously, trainees had demonstrated the cricothyrotomy technique on sheep tracheas covered with vinyl neck skins purchased as replacement parts for patient simulators. The purchased neck skins were used several times in an effort to save money, resulting in several openings per skin. Also, the material is slippery on the fresh sheep trachea, which increased the chances students could slip and cut themselves during the demonstration. In an effort to enhance the simulation experience of Emer- gency Medicine residents, an innovative addition was created for the existing cricothyrotomy skill station. The creation of the reusable sheep trachea holder and accompanying bleed- ing skin has proved to be a better received educational expe- rience for the students. Using a few purchases from a craft store, one is able to create thin bleeding skin for a fraction of the price compared with commercially produced nonbleed- ing neck skins (Table 1). A prototype was tested by attending Emergency Medicine physician-educators and reproduced for use in future cricothyrotomy simulations using sheep tracheas. The provided recipe offers detailed instruction for recreating a sheep trachea holder and simulated bleeding skin on a limited budget. METHODS Step 1: Blood The simulated blood is created using commercially available mixes; however, the amount of water is altered from that recommended by the manufacturer. Begin by procuring an empty 1000 mL bottle; any 1000 mL con- tainer with a cap will work. Empty the contents of the container and fill the bottle with 200 mL of hot water. Next add 200 mL of It’Snot. Finally, using 75% of the recom- mended water, add the premixed simulated blood to the bottle. The 425 mL of simulated blood is available from simulation catalogs as a replacement part for most low fidelity simulators. Cap the bottle and shake vigorously for 30 seconds. Let the bottle’s contents settle until all the bubbles disappear, which takes about 45 minutes. Division of Emergency Medicine, Evanston Northwestern Healthcare, Center for Simulation Technology and Academic Research (CSTAR), Evanston, IL. Reprints: Christopher M. Pettineo, BA, 2650 Ridge Avenue, Evanston, IL 60201 (e-mail: cpettineo@yahoo.com). The authors have indicated they have no conflict of interest to disclose. Copyright © 2009 Society for Simulation in Healthcare DOI: 10.1097/SIH.0b013e31817b9572 60 Simulated Emergency Department Procedures Simulation in Healthcare