Future Combat Medics to Train on Next-gen Manikin That Bleeds

With Army contract, UW Medicine simulation lab helps create lifelike robot that responds to external stimuli

manikin
Clinicians observe a simulated combat rescue of a soldier who has lost part of a leg. The soldier is a manikin with hardware and software components that enhance its human likeness. Clare McLean

Troy Reihsen was doing his best to save the injured soldier in front of him.

“You’re going to be OK, buddy, just stay with me,” Reihsen said as he tied a tourniquet on the hemorrhaging right leg, blown off below the knee.

After ensuring that the bleeding had stopped and other wounds had been addressed, Reihsen declared the soldier ready for transport.

manikin
The manikin’s software also communicates its vital signs in real time on a video monitor that students and trainees can watch.
Then the sound of whizzing bullets stopped, audience lights went up, and an actor emerged to applause from under a rubberized manikin suit. The triage scenario had ended at the WWAMI Institute for Simulation in Healthcare (WISH) lab at UW Medical Center in Seattle.

Reihsen was demoing an early iteration of a research project aimed at saving lives on the battlefield. It is being funded by an $8 million Department of Defense contract awarded to the University of Minnesota, part of which came to WISH researchers.

By 2019, researchers expect to have a more lifelike manikin that looks, feels and bleeds like a wounded soldier.

“It will help our future medics experience what it’s like to deal with wounded soldiers, and how a limb or torso may actually look and feel,” said Col. Robert Rush, deputy commander for surgical services at Madigan Army Medical Center. “And because of the simulator’s modularity, we can train many different medical specialties without having to purchase a different simulator for each.”

Combat medics will use the simulator to practice skills such as applying tourniquets, treating burns and inserting breathing tubes, said Dr. Robert Sweet, WISH executive director and a professor of urology at the University of Washington School of Medicine.

manikin
Troy Reihsen directs the artificial tissue lab in UW Medicine‘s WWAMI Institute for Simulation in Healthcare. Clare McLean

The manikin’s realism comes from painstaking design from head to toe. Its anatomically correct body is based on 3D models of MRI scans. Its synthetic skin has pores and feels real to touch. Its tongue is slick with moisture. Its arms can move—and break—just like our own. Its animatronic legs twist and turn.

It also involves software that gives rise to hemorrhaging wounds, blocked airways and other conditions, and elicits a video game-like experience designed to give real-time feedback. Students can see a pixellated version of the manikin on a computer screen along with its vital signs, which respond to treatment; they receive confirmation upon properly performing procedures like inserting a tracheal tube.

The team of doctors, engineers, software developers, industry partners and special-effects artists hopes their project demonstrates that soldiers can practice on plastic yet still gain experience with realistic physiology and anatomy.

“The science of simulation is just getting started,” said Reihsen, who runs a WISH lab focused on synthetic tissues. “We hope this project produces data that shows how valuable these simulators can be.”

The current manikin advances earlier work that ran from 2012-2015, when Sweet’s lab was based in Minnesota. That yielded a proof-of-concept simulator dubbed “Frank,” for Frankenstein. It was a hodgepodge of parts taken from existing simulation systems.

While Frank showed that a lifelike manikin could train soldiers, it also had major drawbacks: Cobbling together parts from three manufacturers required the team to create custom electronic connections and software. That was expensive and time-consuming.

manikin
The combat manikin’s synthetic skin has pores; its tongue is slick with moisture.

Sweet and his team are now creating an open platform that will let any manufacturer or software developer contribute. One device manufacturer might focus on, say, arms that appear to have first-degree burns, while another might build internal organs. Software companies could write code for a wide range of medical scenarios.

That open platform will have broad application to the civilian healthcare sector, as well.

“Today the state of simulators is a bit like the early days of video games,” Sweet said. “You had to use a different machine at the arcade to play a different game. We’re trying to build the first Atari console.”

True head-to-toe, back-to-belly realism in a manikin is still far down the road, he acknowledged, but  “crowdsourcing manikin development will get us there faster.”

This work is supported by the U.S. Army Medical Research and Materiel Command under Research Contract W81XWH-14-C-0101.  The views, opinions and/or findings contained in this article are those of the author(s) and should not be construed as an official Department of the Army position, policy or decision unless so designated by other documentation.