HUMAn, a Real-Time Evolutive Patient Model for Major Incident Simulation: Development and Validation Study.

Background: Major incidents correspond to any situation where the location, number, severity, or type of casualties requires extraordinary resources. Major incident management must be efficient to save as many lives as possible. As any paramedic or emergency medical technician may unexpectedly have to respond to major incidents, regular training is mandatory. Those trainings usually include simulations. The vast majority of major incident simulations are limited by the fact that simulated patients do not evolve during the simulation, regardless of the time elapsed and treatment decisions. Therefore, most simulations fail to incorporate the critical temporal effect of decision-making.

Objective: This study aimed to develop and validate a simplified mathematical model of physiology, capable of plausibly simulating the real-time evolution of several injuries.

Methods: A modified version of the user-centered design framework, including a relevance, development, and validation phase, was used to define the development process of the physiological model. A 12-member design and development team was established, including prehospital physicians, paramedics, and computer scientists. To determine whether the developed model was clinically realistic, 15 experienced professionals working in the prehospital field participated in the validation phase. They were asked to rate clinical and physiological parameters according to a 5-point Likert scale ranging from 1 (impossible) to 5 (absolutely realistic).

Results: The design and development team led to the development of the HUMAn model (Human is an Uncomplicated Model of Anatomy). During the relevance phase, the team defined the needed features of the model: clinically realistic, able to compute the evolution of prehospital vital signs, yet simple enough to allow real-time computation for several simulated patients on regular computers or tablets. During the development phase, iterations led to the development of a heart-lung-brain interaction model coupled to functional blocks representing the main anatomical body parts. During the validation phase, the evolution of nine simulated patients presenting pathologies devised to test the different systems and their interactions was assessed. Overall, clinical parameters of all patients had a median rating of 5 (absolutely realistic; IQR 4-5). Most (n=52, 96%) individual clinical parameters had a median rating of 5, the remainder (n=2, 4%) being rated 4. Overall physiological parameters of all patients had a median rating of 5 (absolutely realistic; IQR 3-5). The majority of individual physiological parameters (n=43, 79%) had a median rating of 5, with (n=9, 17%) rated 4, and only (n=2 ,4%) rated 3.

Conclusions: A simplified model of trauma patient evolution was successfully created and deemed clinically realistic by experienced clinicians. This model should now be included in computer-based simulations and its impact on the teaching of major incident management assessed through randomized trials.