Choosing the Right Manikin for the Job
Some basic life support models aren't so "basic" any more. Here's what you need to know if you're in the manikin market.
Way back in the day, we used to pack up our cleaned CPR manikins, legs and all, into giant hard cases and drag those behemoths back to the storage room. The best you could hope for was to avoid getting a hernia trying to heave “Anne” up onto the rolling cart.
Believe it or not, Anne still exists. But since her inception, basic life support (BLS) manikins have been getting smaller, lighter, and smarter. The following information reviews the features available in CPR manikins today and how you can save money or add value by selecting the right manikins for your target audience.
CPR manikins come in all shapes, sizes, and colors, and even in diff erent ethnicities. They have cool names like “Brad,” “Helal,” and “Fat Old Fred.” Features can include very lifelike anatomy, audio and visual compression feedback systems, and even computer-aided student assessment in real time.
Below are some common features of CPR manikins that will help you determine which features are important to you and your audience, and which features you can do without. I’ve excluded any “advanced” manikins that are designed for advanced airway management or drug/fl uid administration. So if you need a manikin to practice taking rectal temperatures, this is not the article for you, as it’s focused on manikin features important primarily to BLS instruction.
Some manikins look more real than others. One thing I’ve learned is that reality costs more than portability.
Typically manikins that are lifelike have different “skin” colors to choose from. They have realistic- looking torsos and faces and are usually closer in size to a real adult, child, or infant. These manikins are typically heavier and more expensive than lesslifelike manikins. Brands that provide manikins with lifelike features include Simulaids, Laerdal, and Life/ form.
If you’re using AED trainers, AED pad placement is more realistic on lifelike manikins, which usually have more chest surface area and better anatomical features. Lifelike manikins usually have “chest skin” that covers a hard molded body. The stickiness of AED trainer pads is a problem no matter what manikins you have. Manikins with foam body construction, such as the CPR Prompt and Basic Buddy models, are a bit easier to clean but can wear out faster than those with a replaceable chest skin.
More advanced manikins can be used for training with a live AED or defibrillator/monitor where rescuers can actually discharge electricity into the manikin. The manikins described in this article are to be used with AED training devices that do not delivery electricity.
Good chest compressions are the one part of CPR that is directly linked to the survival of sudden cardiac arrest. Manikins that provide compression feedback help the instructor and the students keep on pace and in the right location. Good compression training equals more lives saved, and compression feedback systems help reinforce good compression technique.
Audio Feedback: “Real people usually won’t click.” That is something I find myself saying when I’m training because some of the manikins I use have a distinct click that can be heard when the student compresses in the right location and at the right depth. The click also helps me assess the student’s rate and location. When students say, “My manikin won’t click,” it tells me the students are getting great feedback from the manikins because they want to do it right to get that satisfying “click.” Some manikins with audio compression feedback include CPR Prompt, Little Anne, and the Prestan manikins.
Visual Feedback: The Prestan manikin has a unique light-up system under the chest skin near the shoulder. A series of small indicator lights will let you know if the student is pumping at the correct rate. When the student has two green lights, he or she is right on target at 100 beats per minute. When testing the Prestan, we found the lights to be very helpful, accurate, and easy to see.
The CPARLENE® manikins by Life/ form also provide you and your students with indicator lights, but the system is connected externally to the manikin. It provides additional feedback on correct lung infl ation volume, hand placement, and compression depth. Similarly, Simulaids makes the “Adam” and “David” CPR training manikins that can be purchased with an exterior console box that will give feedback on hand position, as well as check compressions and adequate chest rise.
Computer Feedback: Some basic life support manikins aren’t so “basic” any more. The “CPR Recording Manikin” by Simulaids and the Resusci®Anne series by Laerdal can both be linked to a laptop computer and provide real-time visual and statistical feedback on the students’ compressions and ventilations. You may have guessed already, these manikins are expensive. If you must transport them frequently, consider the wear and tear on your manikins, and look into the extended warranty options when choosing one with a lot of electronics. For a static environment like a hospital or teaching facility, though, BLS training doesn’t get much better.
It’s important to remember that feedback systems are additional tools to be used in conjunction with the instructor’s knowledge of CPR. Sometimes the problem with feedback systems is that the instructor can rely too much on the feedback from the manikin and forget to watch the student! While feedback systems can have a “wow” factor, they are not meant to be a substitute for an experienced instructor’s keen eye for good CPR technique.
A very cost-eff ective feature is the adult manikin that can convert to a child. The CPR Prompt and Basic Buddy manikin lines both convert from adult to child. In the case of the CPR Prompt model, the force and depth required to hear the “click” can be adjusted between adult and child settings. To convert the Basic Buddy, a foam block from the back of the manikin is removed, reducing the amount of force required to achieve the proper compression depth for a child. The adult/child conversion basically doubles your manikin count without having to carry extra manikins.
Lung systems are about as variable as the manikins themselves, as each brand and model has its own system. It’s good to compare costs, because instructors buy a lot of lungs. Some manikins feature reusable lungs with washable mouth-/nosepieces, but most lungs for BLS manikins are disposable. One useful feature is a face-shield/ lung that extends from the lungs and folds out over the lips. Face-shield/lungs reduce the bacteria and grime that can get on and inside a manikin.
Cleaning and Assembly
You can’t talk about lung systems without bringing up manikin assembly and breakdown. It’s always best to “try before you buy,” and certain manikins are assembled and broken down a lot easier than others. If you have a chance to rent a set first, I would recommend it. Some manikins take several minutes to set up, and others take about 30 seconds. Multiply that by 10 manikins and that can be quite a time saver.
Some manikins that use face-shield/ lungs are advertised as “non-cleaning.” The lung bag is pulled out, a new one is inserted, and the manikin is ready to go for the next class. Other manikins require more extensive cleaning. I always wipe down any type of manikin, because many diff erent people can come in contact with it. I guess I’m a bit old school and I like the smell of bleach.
When you’re schlepping 10 manikins up to the fift h fl oor of an office building or even into someone’s living room, portability is a major factor. The schlepping of manikins is a daily duty in this business, so in my eyes the portability factor cannot be underestimated. Most of the lifelike manikins are heavier, and some are sold as individuals as opposed to a set in a carry bag. Some of the more portable manikin sets (lightweight and sold with carry bags that hold four to five manikins) include the CPR Prompt, Basic Buddy, Prestan, and Laerdal’s Little Anne®.
Manikins are now available to use for choking rescue training. There are specialized manikins that allow rescuers to actually use abdominal thrusts to dislodge a foreign object. The foreign object comes with the manikin — you don’t need to bring a steak to class. It may not be cost eff ective to have one for each student, but having one or two in the class can seriously improve retention for students who get to simulate choking care and really understand how hard they have to thrust to remove a foreign object. A newer choking trainer, the Act Fast Anti- Choking Trainer, is actually worn by the student, so students can try abdominal thrusts on each other. A successful thrust will eject a foam dart from the top of the trainer.
Picking the right manikin is an important decision, since you’ll be working with it for years to come. Be sure to pick the features that you really need to help your target audience retain their skills. Think about the environment you train in, how portable you need them to be, what type of lung and feedback systems you need, and your budget. Try to rent a few diff erent sets to see what works for you and your students. I’ve put together a “Manikin Features” spreadsheet, available at http://ohsonline.com/research/2010/03/manikin-featuresproduct- comparo.aspx, which you can use as a quick-reference guide so you don’t feel like a dummy when you’re shopping for one!
This article originally appeared in the June 2010 issue of Occupational Health & Safety.
Rob Pryce, a former paramedic, has been teaching emergency response programs since 1996. He is the Operations Director for EMS Safety Services, Inc. EMS Safety specializes in CPR, AED, First Aid, and Bloodborne Pathogens training programs and is an authorized distributor of training manikins, AEDs, and other equipment for rescuers and instructors. For more information, call 800-215-9555 or visit www.emssafety.com.