He currently sees “three main audiences” for medical simulation at the Richmond Center: residents and students from Virginia Commonwealth University who rotate through the VA; VA personnel; and the community at large.

With the look, feel, and smell of live tissue, the “cut suit” was developed to be worn by “role players” to provide medics and combat lifesavers with simulated effects of severe traumatic events on a live human. Design features allow dozens of realistic medical procedures, from extremity hemorrhage control to thoracotomy and intra-thoracic exploration.

With those constituencies in mind, Czekajlo is crafting the local simulation center “from the ground up,” with approximately 3,000 square feet of dedicated space in the hospital and initial funding arriving in fall 2014. That funding allowed the acquisition of several medical simulators, including SonoSim® ultrasound simulators, a Simbionix vascular surgery simulator, and a “surgical cut suit” from Strategic Operations.

With the look, feel, and smell of live tissue, the “cut suit” was developed to be worn by “role players” to provide medics and combat lifesavers with simulated effects of severe traumatic events on a live human. Design features allow dozens of realistic medical procedures, from extremity hemorrhage control to thoracotomy and intra-thoracic exploration.

According to Executive Vice President of Strategic Operations Kit Lavell, the VA heard about the suit through the work the company had been doing with the medical school at Rocky Vista University. Instructors there had seen an early prototype a few years prior at a Special Operations Medical Association (SOMA) conference.

“We were using the original cut suit for Tactical Combat Casualty Care,” Lavell explained. “But they asked us if we could build a surgical version.”

“So we are now introducing what we call advanced surgical skills packages designed for advanced training of specific procedures,” he added. “It will be offered as a package that can be used and then sent back to us for refurbishment. We’ll be making specific packages for different pathologies and trauma surgeries.”

“The cut suit allows you to do a lot more than some of the manikins,” Czekajlo observed. “You can train skills like a cricothyrotomy or chest tubes on a manikin, and stuff like that. But it’s a little different if you have somebody who is awake, scared and swinging at you while you are trying to put a tube into their throat.”

Czekajlo himself wore a cut suit during a recent unannounced disaster drill. Although the facility is not a designated “trauma center,” the scenario brought him into the emergency department presenting symptoms of a potential pneumothorax.

“They picked up on that pretty quickly and they wanted to get a chest tube into me,” he offered. “But then they couldn’t find a scalpel for nine minutes.”

In addition to the dedicated simulation space, Czekajlo emphasized the ability to use many of the capabilities on the wards themselves, where he targets issues related to “knowledge, skills, and logistics.”

“Knowledge is important, but doesn’t always translate into performance,” he said. “So we can use task trainers and simulators to improve performance of skills.”

He offered the example of the Advanced Cardiovascular Life Support (ACLS) course, where “the best data is that retention of skills at six months is about 30 percent. But the certification is valid for two years … So my thought is that we have to do the training on the wards.”

One recent representative simulation activity involved a “mock drill” in the MRI suite, in which a simulated patient went into cardiac arrest during an MRI. The event highlighted a range of challenging issues: from removing the patient from the scanner to the way the oxygen was positioned outside the machine.