Vomiting dummy hurls reality at Royal Flying Doctor Service emergency training

Updated March 22, 2017 16:34:17

A dummy that violently regurgitates sickly green fluid is the latest recruit of the Royal Flying Doctor Service (RFDS) in Broken Hill.

The brainchild of RFDS doctor Andy Caldin, the dummy's purpose is to expose paramedics and nurses to the harsh realities of artificial respiration in the outback.

"This is our vomiting mannequin," Dr Caldin said as he courteously introduced the dummy.

"It's a SALAD simulator — Suction Assisted Laryngoscopy Airway Decontamination.

"It allows us to train for the uncommon, but very difficult, scenario of a patient who vomits while we're taking over their breathing for them."

The dummy is similar to the world-famous Resusci Anne mannequin developed by Norwegian toymaker Asmund Laerdal and based on the death mask of a young woman found drowned in Paris' River Seine in the 19th century.

But the RFDS dummy harbours a surprise.

"We use a 50-litre reservoir that's connected to a pump — actually, a caravan shower pump — that can pump at four litres per minute," Dr Caldin said.

Audio: Listen to Dr Andy Calpin of the RFDS talk about the role of the 'vomit doll' (ABC News)

"We've adapted an existing airway-simulating mannequin so that the pipes connect and the vomit comes out of the right places.

"So, we've developed our own model that we use for in-house training.

"We've only had it for the last two or three months and we share this between our bases in the RFDS south-eastern section."

Carpentry to medicine and now mannequin-making

Like Asmund Laerdal before him, Dr Caldin relied on skills he learned in a previous trade to put the dummy together.

"I used to be a carpenter in a former life, when I lived in England," he said.

"After I trained for two years as a carpenter, I did a manual job fixing big signs, so I had the skills required that I think my senior medical officer, Dr Peter Brendt, identified.

"He said 'Andy, I want you to build me one of these', so I took it on."

The dummy is so realistic it also regurgitates 'sputum', not just from its mouth, but its nose too.

"That happens all the time. As your nose is connected to the back of your throat, it comes out in lots of funny places and it can be quite overwhelming, as you can see," Dr Caldin said.

"I can also adjust the rate of the flow... You can hear the pump in the background there."

Dr Caldin said there was more to resuscitation than just mouth-to-mouth blowing, especially in an emergency situation when the patient may not have an empty stomach.

A laryngoscope is used view the patient's airway while a suction catheter may need to be employed to remove regurgitated material.

Finally, to assist with patient breathing, an endotracheal tube is inserted into the airway, all adding up to a complex series of actions to keep the person oxygenated.

"The more you do it, the luckier you get and we train hard for this sort of [emergency] situation — in fact, every day, between 10 and 11am," Dr Caldin said.

Daily training for artificial respiration emergencies

"The on-call doctor and on-call flight nurse run through these simulations everyday across our bases."

Dr Caldin said the training was necessary, as the need for artificial respiration could be as common in the outback as it is on the coast.

"There are many situations where we would need to take over somebody's breathing," he said.

"For example, if you fell off the back of a ute and bumped your head and had a bleed inside the skull, you wouldn't be looking after your airway reflexes like you would when you're awake.

"There aren't the muscles that are normally in place keeping your vomit and stomach contents where they should be.

"So, if somebody's unconscious, those muscles relax and you can get passive regurgitation of stomach contents into the lungs and that's a really bad thing.

"You don't want vomit in your lungs. It can be life threatening and it can happen very quickly, and that's why we train for this."

But 50 litres, at four litres per minute? Is that realistic?

"You could be surprised at what some people are capable of after a Saturday night with a belly full of beer," Dr Caldin exclaimed.

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First posted March 22, 2017 14:49:16