Now that the American Heart Association is requiring the use of instrumented directive feedback devices in all adult CPR training, what do we do with our old Little Anne manikins?
Rather than wasting thousands of dollars, the EMS Training Section of the Fairfax County (Va.) Fire and Rescue Department has come up with a way to repurpose its Little Annes into trauma manikins that allow trainees to perform chest decompressions, place occlusive dressings over gunshot or stab wounds, and drop in nasopharyngeal airways.
Here is the procedure we developed.
Decommissioned “Anne” CPR simulator
Drill with bits of ½” and ¼” (for ribs) and 3/8” (for nostrils)
Jigsaw or Dremel saw
Picture of wound/red paper for wound simulation
ESS Eye Pro goggles
Disassemble the Anne CPR simulator and remove the plastic bag that simulates the airway and lungs (Photo 2).
To create the slits on the second intercostal space, use the heat gun to soften the plastic for 10–20 seconds and drill 5–6 holes using the ½” bit. If you do not have a heat gun, you may use the smaller drill bit, ¼”, to start the hole and then follow up with the ½” drill bit to expand it.
After the drill holes are made, take the scissors/shears or Dremel or jigsaw and cut along the outline of the second intercostal space, completely removing all the plastic in that space. If you have a powerful enough saw and blade, you may be able to bypass the drilling portion and go straight to cutting the outline of the space.
The heat gun is very useful in softening the hard plastic to make cutting and drilling a lot easier. Be mindful of how long you heat the area (Photo 3).
On the inside of the rib cage, remove 4–5 inches of the plastic running vertically along the ribs. This creates a pocket for the plastic air sacs to fit in without the pressure of the hard plastic pressing down and possibly damaging or popping the sacs.
To remove the plastic use the heat gun to soften it. Use the Dremel or jigsaw to cut from the first rib to the fourth (or as needed depending the plastic air sac size) and remove the plastic.
Depending how good your saw is, you may use the heat gun to melt/round any jagged edges from the rib cuts to provide a smoother texture (Photo 4).
To create the wound simply take the CPR simulator skin and cut about a centimeter-size slit. From there make several cuts from the slit mimicking the rays off an amateur drawing of a sun.
After making the cuts use a nonflammable object (I used the widest and longest drill bit) to stick through the slit and simultaneously use the heat gun to heat the opening, rotating carefully around, slightly widening the opening to its desired diameter. Once you’ve made your desired wound size, you can tape on the opposite side a picture of a wound or use moulage to simulate different kinds of wounds that would need an occlusive dressing (Photo 5).
To simulate a tension pneumothorax, we used air sacs you can easily retrieve from packaging products, such as the packaging from Amazon deliveries. Covering the side up with medical tape isn’t required, but I found it helped with protecting the plastic from damage from the modified changes from the rib cage.
To hold the air sacs up we used hard foam cut into 5x5 cubes. Anything firm can be used if foam isn’t available, but the size should still be as close to 5x5 as possible to create the appropriate prop to support the plastic air sac.
Maillim Empie is a firefighter-EMT at the Fairfax County (Va.) Fire and Rescue Department.