Noelle, who is in labor at Conemaugh Memorial Medical Center in Johnstown, tells a nurse that she isn't feeling right. Then her water breaks. The nurse checks the monitors and realizes that the umbilical cord has prolapsed. This is an obstetrical emergency.
Noelle has had this emergency — and others — thousands of times in the past three years that she has been in the simulation lab at Conemaugh. Noelle Birthing Simulator, made by Gaumard Scientific Co., Florida, is a full-size mannequin used to help nurses, residents and physicians practice real-life emergencies.
"You have to suspend reality when you come in here," said Leah Patton, manager of the medical skills learning center at Conemaugh. "Noelle is a real-life woman with a real-life fetus. She simulates high-risk, low-volume emergencies so staff can practice until they get it right."
Noelle helps the staff to think beyond the medical emergency to consider the broader picture, such as missing batteries for a necessary piece of equipment or a unit that is on lockdown.
Carol McIlhenny, woman-child clinical nurse educator, said these emergencies are rare in real life.
"We prefer to practice, to simulate, a variety of scenarios that it is critical to be prepared to handle, even if we only see them in reality once every one to three months," she said.
Adults learn from experience, she said, which is why it is better to practice the emergency procedures instead of just learning about them from textbooks.
A few months ago, a nurse came up to McIlhenny and was really excited. The nurse told her that she took care of a patient with an umbilical cord prolapse, which is when the cord comes through the birth canal before the baby. McIlhenny asked her why she was excited.
"She said that she knew exactly what to do because of the simulation," she said.
Jodie Babich, clinical nurse educator, said it is a really good feeling when staff know how to handle emergencies because of the simulations.
"To know that we had a hand in that role is such a good feeling," she said. "Nurses are sometimes starved for educational experiences. We are grateful that Conemaugh supports us with training opportunities."
In addition to the child birth emergencies, Noelle can have a related emergency, such as going into cardiac arrest before giving birth. That then results in an emergency for the infant, which can also be practiced. Conemaugh also has a male mannequin that simulates having a heart attack, stroke or seizure. The male simulates bleeding and sweating. The hospital also has a child, an infant and a newborn, for a total of five mannequins. The adult male is most expensive at $135,000. The adult female was $53,000. Technician Mike Mincek operates the computer scenarios.
Dr. David Mullins, emergency room resident, said he practices weekly.
"It helps a lot to prepare for stressful situations," he said. "You get immediate feedback and can improve."
What is even more important than the simulation is the debriefing that occurs afterward.
"We stress teamwork," McIlhenny said. "We are in this together; we point fingers at no one. We put criticism aside; this is a learning opportunity. We are quick to pat each other on the back. The administration wants the staff to be competent. Quality care and patient safety are paramount."
About 4,980 learners go through training each year, with half being nurses and many practicing multiple scenarios. Conemaugh Memorial Medical Center had about 1,600 births last year.
