Low-cost Simulator Research Articles

The Creation of a Novel Low-Cost Bench-Top Kidney Transplant Surgery Simulator and a Survey on Its Fidelity and Educational Utility

IntroductionResident inexperience during time-sensitive vascular anastomoses of a kidney transplant can negatively impact outcomes. In light of this, we created a low-cost bench-top kidney transplant surgery simulator to help residents practice vascular anastomoses.MethodsWe searched for inexpensive materials to design an iliac fossa and kidney allograft. Eighteen residents with real-life kidney transplant experience trialed the simulator and scored its fidelity and educational utility on a 0-100 visual analog scale (VAS) survey.ResultsA 35.9 x 19.4 x 12.4 cm plastic box mimicked the iliac fossa. Hooks attached to the box’s sidewall held under tension 1.27 and 0.64 cm diameter Penrose drains to replicate the external iliac vein and artery. A modified kidney-shaped stress ball with 1.27 x 4, 0.64 x 4, and 0.64 x 15 cm Penrose drains replicated a kidney allograft with its vein, artery, and ureter, respectively. Residents performed and assisted in vascular anastomoses on the simulator. The iliac fossa and allograft cost $20.20 and each practice run cost $7.20. Residents thought that the simulator was less difficult than real-life procedure, had acceptable fidelity levels, and they highly rated its educational utility.ConclusionOur novel low-cost bench-top kidney transplant surgery simulator focusing on vascular anastomoses received positive educational feedback from residents.

Simulator-based ultrasound training for identification of endotracheal tube placement in a neonatal intensive care unit using point of care ultrasound

BackgroundSimulators are an extensively utilized teaching tool in clinical settings. Simulation enables learners to practice and improve their skills in a safe and controlled environment before using these skills on patients. We evaluated the effect of a training session utilizing a novel intubation ultrasound simulator on the accuracy of provider detection of tracheal versus esophageal neonatal endotracheal tube (ETT) placement using point-of-care ultrasound (POCUS). We also investigated whether the time to POCUS image interpretation decreased with repeated simulator attempts.MethodsSixty neonatal health care providers participated in a three-hour simulator-based training session in the neonatal intensive care unit (NICU) of Aga Khan University Hospital (AKUH), Karachi, Pakistan. Participants included neonatologists, neonatal fellows, pediatric residents and senior nursing staff. The training utilized a novel low-cost simulator made with gelatin, water and psyllium fiber. Training consisted of a didactic session, practice with the simulator, and practice with intubated NICU patients. At the end of training, participants underwent an objective structured assessment of technical skills (OSATS) and ten rounds of simulator-based testing of their ability to use POCUS to differentiate between simulated tracheal and esophageal intubations.ResultsThe majority of the participants in the training had an average of 7.0 years (SD 4.9) of clinical experience. After controlling for gender, profession, years of practice and POCUS knowledge, linear mixed model and mixed effects logistic regression demonstrated marginal improvement in POCUS interpretation over repeated simulator testing. The mean time-to-interpretation decreased from 24.7 (SD 20.3) seconds for test 1 to 10.1 (SD 4.5) seconds for Test 10, p < 0.001. There was an average reduction of 1.3 s (β = − 1.3; 95% CI: − 1.66 to − 1.0) in time-to-interpretation with repeated simulator testing after adjusting for the covariates listed above.ConclusionWe found a three-hour simulator-based training session had a significant impact on technical skills and performance of neonatal health care providers in identification of ETT position using POCUS. Further research is needed to examine whether these skills are transferable to intubated newborns in various health settings.Trial registrationClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

Amniocentesis learning curve using a low-cost simulation model to teach maternal-fetal medicine fellows.

To describe the learning curve for amniocentesis among Maternal-Fetal Medicine (MFM) fellows using a low-cost simulation model in Mexico. Fourteen first- and second-year MFM fellows with no previous experience in amniocentesis participated in this single-center prospective study from March to June of 2019. The study was approved by the Institutional Review Board at the Instituto Nacional de Perinatologia and written informed consent was obtained from all participants. After an introductory course based on a standardized technique for amniocentesis, each fellow performed this procedure using a low-cost simulation model; experienced operators supervised the procedures. Learning curves were then created using cumulative sum analysis. Thresholds for acceptable and unacceptable failure rates were defined as 10% and 25%, respectively. Experienced MFM specialists evaluated 3675 procedures. On average, MFM fellows performed 263±53 procedures. The mean number to achieve competence was 255±53. The overall failure rate among the trainees was 16%. We describe individual learning curves for amniocentesis among MFM fellows using a low-cost simulation model. This approach allows direct assessment of proficiency in amniocentesis before clinical practice.

Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity.

BackgroundThe high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery.ObjectiveThe aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality).MethodsIn this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability.ResultsEvidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures.ConclusionsThe results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery.

Behavioral and workload measures in real and simulated driving: Do they tell us the same thing about the validity of driving simulation?

Only few studies have compared the level of mental workload induced by driving a real vehicle and driving a simulator, and they have found conflicting results. The goal of the present study was to examine whether driving behavior and mental workload level differed between driving a (low-cost) simulator and driving on roads. With this purpose, we developed the virtual equivalent of a route where participants could drive freely. In both driving conditions, we examined whether behavioral and mental workload measures differed or not. Results confirmed that driving speed in simulated condition closely matches that in real driving. Workload level, however, as measured by blink frequency, response time to a subsidiary task and subjective ratings, was consistently higher in the simulator. While behavioral validity of low-cost driving simulators is relatively robust for speed measures, no similar conclusion can be drawn regarding attentional resources allocated to vehicle handling. Some of the results supported the relative validity of driving simulators in terms of mental workload. The combined evaluation of behavioral and workload measures confirmed discrepancy between these two dimensions of driving simulators validity and suggests that the validity of driving simulators is also to be investigated at the level of the underlying processes for in-depth evaluation to better approach the real conditions of driving.

Head Posture Recognition Method Based on POSIT Algorithm

Helmet Mounted Sight (HMS) is an optical aiming and display device installed on the fighter, which plays an important role in modern air combat, but it cost a lot to install a real HMS on ground fighter simulator, so it is a wise choice to design a low-cost simulation HMS instead. In this process, the head posture recognition method is the key point in simulation HMS design. In this paper, a head posture recognition method is proposed for Flight Training Simulation. Firstly, the development process and working principle of Helmet Mounted Sight (HMS) are deeply studied, then the principle of POSIT algorithm is introduced, after that the head posture recognition method based on POSIT is proposed. Finally, the hardware design and software workflow of head posture recognition system are given.

Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept.

BackgroundEmergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public–private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.MethodsFrom 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).Lessons LearnedDuring the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.ConclusionThese key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

Technical description of a low-cost ankle arthroscopy simulator

Objective: To describe a low-cost, accessible, reproducible ankle arthroscopy simulator model which, after validation, will allow the development and improvement of technical skills required in arthroscopic surgical practice. Methods: This study describes the production of an ankle arthroscopy model that simulates camera, arthroscope, and ankle joint. Results: The simulator works properly when connected to a monitor, television, computer, or cell phone. Conclusion: A reproducible, accessible, low-cost ankle arthroscopy simulator can be developed using components available from local and online stores, with an approximate cost of R$232.00. Level Evidence V; Economic and Decision Analyses – Development of an Economic or Decision Model; Expert Opinion.

Developing Cricothyroidotomy Skills Using a Biomaterial-Covered Model

Cricothyroidotomy is an advanced and life-saving technique, but it is also a rare and a difficult procedure. The purpose of the present study was to produce a low-cost simulation model with realistic anatomic features to investigate its effectiveness in developing cricothyroidotomy skills. This study was performed at a university simulation center with 57 second-year student paramedics and a cricothyroidotomy simulation model. Total scores were assessed using a checklist. This consisted of 13 steps and was scored as misapplication/omission=0, correct performance and timing with hesitation=1, and correct performance and timing without hesitation=2. One of these steps, local anesthesia of the area if time is available, was not performed owing to time limitations. The highest possible score was 24. Data are presented as mean±SD with range, as appropriate. Normal distribution was evaluated using the Kolmogorov-Smirnov test, Student t test, and Mann-Whitney U test, and correlation analysis was used for statistical analysis. Students completed the cricothyroidotomy procedure steps in 116±46 (55-238) s. At performance assessment, the score achieved was 12±5 (2-24). The highest total score of 24 was achieved by 3 students (5%). Total scores exhibited negative and significant correlation with procedure time (r=-0.403, P=0.002). The model developed in this study is an inexpensive and effective method that can be used in cricothyroidotomy training for student paramedics. We think that repeating the cricothyroidotomy procedure on the model will increase success levels.

Development of a Low-cost, High-fidelity Skin Model for Suturing

BackgroundIn a survey of students at our institution, suturing was the most desired workshop for simulation; however, cost, quality, and availability of skin pads is often prohibitive for suturing workshops. In-hospital fabrication may be utilized to manufacture noncommercial, high-fidelity, and low-cost simulation models. We describe the production, value, and face validation of our simulated skin model. Materials and methodsUsing an in-hospital fabrication laboratory, we have developed a model for skin and subcutaneous tissue. Our model uses a variety of commercially available materials to simulate the epidermis, dermis, subcutaneous fat, fascia, and muscle. A cost analysis was performed by comparing it with other commonly used commercial skin models. Expert surgeons assessed the material characteristics, durability, and overall quality of our model in comparison with other commercial models. ResultsThe materials cost of our novel skin pad model was 30.9% of the mean cost of five different commonly used foam and silicone-based commercial skin models. This low-cost model is more durable than the commercial models, does not require skin pad holders, and is of higher fidelity than the commercial products. In addition to skin closure, our model may be used to simulate fascial closure or fasciotomy. ConclusionsModel creation using in-hospital workspaces is an effective strategy to decrease cost while improving quality of surgical simulation. Our methods for creation of an inexpensive and high-fidelity skin pad may be purposed for several soft tissue models.

An Open‐Source Three‐Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training

A limited number of three-dimensionally (3D)-printed laryngeal simulators have been described in the literature, only one of which is specifically designed for percutaneous injection laryngoplasty (PIL) training and is currently of limited availability. This study describes the development and evaluation of a high-fidelity, open-source, low-cost 3D-printed simulator for PIL training, improving on existing models. Simulator design and survey evaluation. Computed tomography scans of the upper airways were processed with 3D Slicer to generate a computer model of the endolarynx. Blender and Fusion 360 were used to refine the mucosal model and develop casts for silicone injection molding. The casted endolaryngeal structures were inserted into a modified version of a publicly available laryngeal cartilage model. The final models were evaluated by 10 expert laryngologists using a customized version of the Michigan Standard Simulation Experience Scale. Internal consistency and interrater reliability of the survey were evaluated using Cronbach's α and intraclass correlation, respectively. Expert laryngologists highly rated the model for measures of fidelity, educational value, and overall quality (mean = 4.8, standard deviation = 0.5; 1 = strongly disagree, 5 = strongly agree). All reviewers rated the model as ready for use as is or with slight modifications. The filament needed for one cartilage model costs $0.96, whereas the silicone needed for one soft-tissue model costs $1.89. Using 3D-printing technology, we successfully created the first open-source, low-cost, and anatomically accurate laryngeal model for injection laryngoplasty training. Our simulator is made freely available for download on Wikifactory with step-by-step tutorials for 3D printing, silicone molding, assembly, and use. NA Laryngoscope, 131:E890-E895, 2021.

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Simulation-Based Mastery Learning With Virtual Coaching: Experience in Training Standardized Upper Endoscopy to Novice Endoscopists

Highlighting Simulation Practices in the Neonatal Environment.

Simulation is an effective teaching methodology to enhance clinical thinking and reasoning skills among nursing students and practicing nurses. The opportunity to practice in a safe environment maintains a structure that promotes learning at all levels. There are various levels of fidelity as well as cost to facilitate simulation in the neonatal setting. This at times hinders the ability to incorporate simulation into educational practices. The purpose of this article is to provide a discussion on simulation practices in the neonatal setting, an overview of low-cost neonatal simulation exemplars, and implications for practice.

Computer-Aided Surgical Simulation for Correcting Complex Limb Deformities in Children

This work aims to present an in-house low-cost computer-aided simulation (CASS) process that was recently implemented in the preoperative planning of complex osteotomies for limb deformities in children. Five patients admitted to the Unit of Paediatric Orthopaedics and Traumatology from April 2018 to December 2019, for correcting congenital or post-traumatic limb deformities were included in the study. Three-dimensional (3D) digital models were generated from Computed Tomography (CT) scans, using free open-source software, and the surgery was planned and simulated starting from the 3D digital model. 3D printed sterilizable models were fabricated using a low-cost 3D printer, and animations of the operation were generated with the aim to accurately explain the operation to parents. All procedures were successfully planned using our CASS method and the 3D printed models were used during the operation, improving the understanding of the severely abnormal bony anatomy. The surgery was precisely reproduced according to CASS and the deformities were successfully corrected in four cases, while in one case, the intraoperative intentional undersizing of the bone osteotomy produced an incomplete correction of a congenital forearm deformity. Our study describes the application of a safe, effective, user-friendly, and low-cost CASS process in paediatric orthopaedics (PO) surgery. We are convinced that our study will stimulate the widespread adoption of this technological innovation in routine clinical practice for the treatment of rare congenital and post-traumatic limb deformities during childhood.

Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study.

BackgroundSimulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access.ObjectiveThis study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence.MethodsFor the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed.ResultsA good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study’s simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67).ConclusionsThe development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained.

CREATION OF A LOW-COST ENDOSCOPIC FLAVECTOMY TRAINING MODEL

ABSTRACT Objective The objective of the study was the development of a low cost simulator of the endoscopic lumbar spine flavectomy technique for use as a teaching method in order to make endoscopic training more accessible. Methods The study was a descriptive research project conducted at the Orthopedic Skills Laboratory of the Health Sciences Department of the Federal University of Paraná. Easily accessible, low cost materials, such as a commercial-use mannequin, EVA plastic, PVC and copper tubing were used to develop the simulator.. Results At the end of the project, it was possible to build a simulator of the endoscopic lumbar spine flavectomy technique with a budget of approximately 464 BRL, or approximately 140 USD. Conclusions We concluded that it was possible to build an endoscopic lumbar spine flavectomy technique simulator on a budget of less than half a Brazilian minimum monthly wage, which makes training more accessible to academics, residents and surgeons. Level of Evidence V; Expert opinion.

Regional measurements to analyze large-area luminescent solar concentrators

Abstract Experimentally analyzing the photovoltaic (PV) performance and the photon transport mechanism of large-area luminescent solar concentrators (LSCs) (>200 cm2) has proven difficult because common solar simulators and integrating spheres have limited measuring capacity. This report introduces an approach of regional measurements to address these issues using common laboratory instruments. In this approach, the LSC is configured to have different surface and edge regions. The surface regions are sequentially illuminated by a low-cost solar simulator, and the edge regions sequentially measured by a small-area solar cell or a general photoluminescence (PL) spectrometer. The methodology is validated through the comparison with the conventional method and Monte Carlo ray-tracing simulation in the study of the PV performance of a series of R305-based LSCs. Experimental results from the regional measurements reveal important the photon transport mechanism of the LSCs. The results show that severe photon transport loss exists within a surface distance (dsurf) of 5 inches (12.7 cm), and photons with the longest average transport distance ( max) experience number of absorption events (Nabs) for an average of 11.3 times. The approach of regional measurements can effectively measure the PV performance and investigate the photon transport mechanism of large-area LSCs.

Construct Validity and Experience of Using a Low-cost Arthroscopic Knee Surgery Simulator

To validate an affordable and easily reproducible arthroscopic knee surgery simulator made from simple, low-cost materials by demonstrating its ability to distinguish experienced from novice arthroscopists (i.e., construct validity). Additionally, acceptance and usefulness of the simulator in medical training and education were assessed. The simulator was used to perform a partial meniscectomy in both menisci. External and intra-articular images obtained during the procedures were used to assess objective visual parameters. The Arthroscopic Surgical Skill Evaluation Tool and a Likert scale addressing individual perceptions about the simulator and its applicability in medical education were also used. The study was conducted at Hospital de Clínicas da Universidade Federal do Paraná, a teaching hospital in southern Brazil. Thirty sixth-year medical students were recruited, as well as 10 orthopedic surgeons who had knee arthroscopy expertise and were members of a sports traumatology and knee arthroscopy group. There were statistically significant differences between the groups in all objective parameters. The mean time to perform the procedure was 60% higher among students compared to surgeons. Students needed 72.5% more time on average to perform triangulations and obtained an error rate approximately twice higher in the assessment of the area removed from the menisci. Regarding Arthroscopic Surgical Skill Evaluation Tool scores, statistically significant differences were found between surgeons and students in all 8 domains and in the total score. The simulator was well accepted, as over 90% of participants found it useful for education and training, believed it contributed to teaching and assessing specific surgical steps and procedures, and reported that the task was enjoyable. The arthroscopic knee surgery simulator was largely accepted and had good applicability in objective measurement of surgical skills, distinguishing medical students from orthopedic surgeons and thus demonstrating construct validity.

Uso de Simulador de Baixo Custo na Autoaplicação de Insulina: Estudo Quase-experimental

Objetivo: Avaliar o efeito de uma intervenção educativa com uso de simulador de baixo custo na prática de autoaplicação de insulina entre indivíduos com DM2. Método: Estudo quase-experimental (before and after), com 136 indivíduos que convivem com Diabetes Mellitus tipo II e fazem uso de insulina convencional. O estudo será divido em duas etapas, a primeira etapa será a pré-intervenção e intervenção e a segunda etapa, pós-intervenção. Os dados serão analisados pelo teste estatístico Qui-quadrado e por medidas de tendência central, considerando nível de confiança de 95%. Resultados esperados: A intervenção educativa com uso de simulador de baixo custo voltada aos indivíduos que fazem uso de insulina poderá favorecer o desenvolvimento de habilidades para uma autoaplicação correta e segura de insulina, tal como a remissão de sinais e sintomas cutâneos nos locais de injeção.

Validation of a low-cost simulation strategy for burn escharotomy training

BackgroundEscharotomy is the primary effective intervention to relieve constriction and impending vascular compromise in deep, circumferential or near-circumferential burns of the extremities and trunk. Training on escharotomy indications, technique and pitfalls is essential, as escharotomy is both an infrequent and high-risk procedure in civilian and military medical environments, including low-resource settings. Therefore, we aimed to validate an educational strategy that combines video-based instruction with a low-cost, low-fidelity simulation model for teaching burn escharotomy. MethodsPre-hospital and hospital-based medical personnel, with varying degrees of burn care-related experience, participated in a one-hour training session. The first part of the training consisted of video-based instruction that described the indications, preparation, steps, pitfalls and complications associated with escharotomy. The second part of the training consisted of a supervised, hands-on simulation with a previously described low-cost, low-fidelity escharotomy model. Participants were then offered two psychometrically validated instruments to assess their learning experience. Results40 participants were grouped according to prior burn care and surgical experience: attending surgeons (6), surgery and emergency medicine residents and fellows (26), medical students (5), and pre-hospital personnel (3). On two psychometrically validated questionnaires, participants at both the attending and trainee levels overwhelmingly confirmed that our educational strategy met best educational practices on the criteria of active learning, collaboration, diverse ways of learning, and high expectations; they also highly rated their satisfaction with and self-confidence under this learning strategy. DiscussionAn educational strategy that combines video-based instruction and a low-cost, low-fidelity escharotomy simulation model was successfully demonstrated with participants across a broad range of prior burn care experience levels. This strategy is easily reproducible and broadly applicable to increase the knowledge and confidence of medical personnel before they are called to perform escharotomy. Important applications include resource-limited environments and deployed military settings.