Abstract
Intraosseous infusion remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients and those presenting to the emergency department. There is a scarcity of cost-effective, anatomically correct trainers to improve physician confidence and competency in this skill. The purpose of this report is to describe the development and evaluation of a three-dimensional (3D) printed Adult Proximal Intraosseous (IO) Tibia task trainer for simulation-based medical education. The proposed trainer was designed by combining open-source models of a human skeleton and a lower leg surface scan in Blender (Blender Foundation - www.blender.org) and manipulating them further using a JavaScript program. Polylactic acid was used to simulate bone while cured silicone moulds were used to replicate skin and soft tissue. Two trainers were produced and tested by 15 rural family medicine residents, six rural emergency medicine physicians, and six registered nurses. Participants evaluated the realism of the trainer and its efficacy as a training tool through a structured survey.The trainer received overall positive feedback from all participants, and most participants felt that no improvements were required to use the trainer for medical education. Notable suggestions for improvement included adding an infusion component, increasing the size of the tibial tubercle for better landmarking, and creating a variety of sizes for different patient body types. Residents and emergency medicine physicians practising in rural Newfoundland and Labrador found the 3D-printed trainer to be a practical tool for practising intraosseous technique. The outcome of this report supports the use of this cost-effective trainer for simulation-based medical education.
Highlights
Simulation-based medical education (SBME) is a rapidly growing field that employs realistic simulators to allow physicians and medical students to practice clinical procedures without causing unnecessary patient harm [1]
IO is primarily used in the Emergency Department (ED), where rapid vascular access is of critical importance for patients presenting with shock, major trauma, cardiac arrest, and other conditions requiring emergent fluid or drug administration
IO access is superior in both success rate and access time than other alternative routes, such as central venous catheterization (CVC) [4,5]
Summary
Simulation-based medical education (SBME) is a rapidly growing field that employs realistic simulators to allow physicians and medical students to practice clinical procedures without causing unnecessary patient harm [1]. Correct models can be created from 3D reconstructions of MRI and CT scans or open-source resources online [2], allowing for accurate landmarking and positioning using real anatomical features Specialities such as Emergency Medicine, especially in rural communities, can benefit from SBME by allowing learners and professionals to learn and practice rare but potentially life-saving skills in a controlled and safe environment. IO access is superior in both success rate and access time than other alternative routes, such as central venous catheterization (CVC) [4,5] As such, both the 2010 American Heart Association Guidelines for Advanced Cardiovascular Life Support (ACLS) and European Resuscitation Council Guidelines recommend using IO access for drug administration when IV access is difficult or impossible [5,6]. When Danish researchers investigated reasons for lack of IO use in situations where it was medically necessary, in a cohort of 761 physicians, nurses, and emergency responders, they found that lack of training was the second most common response after lack of equipment [8]
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