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METIman User Guide License/Copyright CAE Healthcare METIman Simulator Software and Users Guide THIS IS A LEGAL AGREEMENT. PLEASE READ THIS DOCUMENT CAREFULLY. The software you are about to access is provided to you pursuant to the purchase of the Product by the legal entity which employs you, or which you represent (the Licensee or You), from CAE Healthcare. This purchase of the Product is subject to CAE Healthcares Healthcare Education Products General Terms and Conditions (the HEPGTC) and this End-User License agreement (License). This License governs the grant of licenses for the software, in object code only, embedded in or bundled with the Product or required to operate the Product, as the case may be (Software), as well as all related Product documentation and information (Data) supplied by CAE Healthcare either with or separately from the Product, which items as indicated in the HEPGTC are not sold but licensed. Acceptance of these terms and conditions must be without modification of any of the terms, conditions and notices contained herein. Consequently, please be sure to read the terms of this License carefully. If You agree to these terms, conditions and other provisions in their entirety, then click the ACCEPT button below. If You do not accept these terms, conditions and other provisions in their entirety, without modification of any sort, then click the DECLINE button below and your access to the Software and Data is prohibited. 1. 1.1 DEFINITIONS AND INTERPRETATION The preamble forms an integral part of this License. 1.2 in this License, the following terms have the meaning set out below:

Terms with a capital letter defined in the Preamble have the meaning indicated in the Preamble. Whenever used Confidential Information means any and all scientific and technical information which is in the possession of,

(a) or belonging to, CAE Healthcare and relating to the Product, including without limitation, all Data, Software, trade secrets, know-how, processes, methodologies, samples, components, analyses, compilations, guides and other information or documents prepared by CAE Healthcare, its subsidiaries and affiliates and/or their officers, servants, agents, representatives, employees or advisers which contain or are otherwise generated from or reflect any CAE Healthcare proprietary information, whether or not covered by intellectual property rights or explicitly designated as confidential or proprietary, which is disclosed by any means in written, oral, electronic, or any other form.

(b) and the use of the Product solely as an educational tool. Purpose means the use of the Software and the Data solely for the operation and maintenance of the Product, 2. LICENSE In consideration of Licensees agreement and compliance with the terms and conditions contained in the HEPGTC 2.1 and in this License, CAE Healthcare grants to Licensee, and Licensee accepts, a personal, non-exclusive, non-transferable license to use the Software and Data exclusively with the Product, and with the computer on which this License appears. Except for the License granted herein, CAE Healthcare grants no express or implied right under any patent, 2.2 copyright, mask work right, trademark, know how or other intellectual property rights. Without limiting the foregoing, the Licensee shall not obtain any rights to CAE Healthcares property, or any part thereof, by implication, estoppel or otherwise. Title to and full ownership of any trade secrets and other intellectual property rights related to the Product and components thereof shall remain with CAE Healthcare and, if applicable, its suppliers. For clarification, Licensee agrees that the source code for the Software is a trade secret of CAE Healthcare and only CAE Healthcare shall have the right to alter, maintain, enhance or otherwise modify the Software. i License/Copyright Without limiting the foregoing or any other terms in this License, Licensee shall, and shall ensure that any 2.3 person authorized to access the Product, which are limited to Licensees employees, agents, representatives, medical staff and students (Authorized Users):

not copy (save and except for normal back up and disaster recovery purposes provided such copy shall include

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(b) or Data;

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(g) a third party, on a commercial basis or not. not incorporate the Product, in whole or in part, to any product or service that Licensee would make available to Notwithstanding anything else contained in this License, in no event shall Licensee use the Product and/or 2.4 Confidential Information to enable, support, or otherwise aid Licensee or a third party to develop any product, software or service competitive with any of CAE Healthcares products. Licensee agrees to grant CAE Healthcare, its agents and representatives, at any time during Licensees normal 2.5 business hours and upon reasonable prior notice, the right to access to Licensees premises, to ensure that the use of the Product is done at all times in compliance with the terms and conditions of this License. 2.6 CAE Healthcare reserves the right to embed a software security mechanism within the Product to monitor usage of the Product to verify Licensees compliance with this Agreement, as well as to control access to the Software through use of: a) a hardware lock device and/or b) a license administration software and/or c) a license authorization key

(collectively, the Key). 2.7 Some Products may provide Licensee with the option of saving and reproducing the images created by such Products (Work) during their use. In this regard, Licensee hereby recognizes that the entire rights, title and interests in and to such Work remain the exclusive property of CAE Healthcare. Licensee shall not modify such Work in any way whatsoever and shall not remove or alter any CAE Healthcare notices. However, Licensee is permitted to produce and reproduce such Work only for non-commercial educational purposes. 3. FEEDBACK Licensee agrees to provide CAE Healthcare, from time to time, with comments, suggestions, data, information or feedback (Feedback) on the Product. Licensee acknowledges and agrees that such Feedback may be freely used by CAE Healthcare, at its sole discretion, for the design, development, improvement, marketing and commercialization of its products and services, without any restrictions based on confidentiality or intellectual property rights. ii License/Copyright 4. TERM AND TERMINATION 4.1 until terminated as provided hereafter. This License shall become effective as of the date of Your execution of this License and shall remain in effect 4.2 4.3

(a) This License terminates immediately upon termination of the HEPGTC. CAE Healthcare may terminate this License immediately, upon written notice, should Licensee:

fail to comply with any of the terms and conditions of this License;

terminate or suspend its business; make an assignment for the benefit of creditors, or any proceedings are

(b) instituted by any party or against it seeking to declare it bankrupt or insolvent, or seeking liquidation, winding-up, reorganization, arrangement, adjustment, protection, relief or composition of its debts under any law relating to bankruptcy, insolvency, reorganization or relief of debtors, or seeking the entry of an order for relief or the appointment of a receiver, trustee or other similar official for it or for any substantial part of its property;

Upon termination of this License, Licensee agrees to immediately discontinue use of the Confidential 4.4 Information and the Product, and to return same to CAE Healthcare as well as any copies, summaries or extracts thereof, with any associated CD ROM(s), DVD, keys, dongles or other devices as may be directed by CAE Healthcare. At CAE Healthcares request, Licensee shall promptly provide a written certificate signed by an officer of Licensee confirming that such items have been returned to CAE Healthcare or destroyed as so directed by CAE Healthcare. The following shall survive and continue in full force and effect notwithstanding any termination of this 4.5 License: the obligations of Licensee under Sections 2 (License), 5 (Non-Disclosure); as well as any other clauses which by their nature and context are intended to survive. 5. NON-DISCLOSURE Licensee agrees to keep this License and all Confidential Information obtained hereunder in strict confidence, 5.1 and shall only disclose same a) to Authorized Users solely for the Purpose and provided such access to the Product conforms, at all times, to the terms and conditions governing the use of the Product contained herein, or b) if required to be disclosed by law, and only to the extent of such disclosure and limited to the purpose requested, with prior notice to CAE Healthcare to permit it to seek an appropriate remedy to prevent the disclosure, or alternatively to agree to the terms of such disclosure. 5.2 The obligations of confidentiality, use and non-disclosure referred to in this Section 5 shall not apply to information which: (i) is or becomes publicly available through no fault of Licensee; (ii) was already in the rightful possession of Licensee prior to its receipt from CAE Healthcare; (iii) is independently developed by Licensee, provided it is not, in whole or in part, related to the Product; and (iv) is obtained by Licensee in good faith and on a non-confidential basis and without a use restriction from a third party who lawfully obtained and disclosed such information. However, Confidential Information does not come within the foregoing exceptions merely because features of it may be found separately or within a general disclosure in the public domain. 5.3 Licensee agrees to be responsible for enforcing the terms of this Section 5 and to take such action, legal or otherwise, to the extent necessary to cause anyone having access to the Confidential Information to comply with the terms and conditions set forth herein (including all actions that Licensee would take to protect its own trade secrets and confidential information but with not less than reasonable care). Licensee shall be responsible and indemnify, defend and hold harmless CAE Healthcare for any default caused by any such persons. iii License/Copyright 6. IRREPARABLE HARM 6.1 Licensee acknowledges that the Software and Data constitute a special, irreplaceable asset of great value to CAE Healthcare, and that a breach, in any way, of any of Licensees obligations under Sections 2 (License), and 5

(Non-Disclosure) hereof would cause serious and irreparable harm to CAE Healthcare which may not be adequately compensated for in damages. If the Licensee breaches any of such provisions, Licensee consents to an injunction being issued against it restraining it from any further breach of such provision, without derogation from any other remedy which CAE Healthcare may have in the event of such a breach. 7. WARRANTY, LIMITATION OF LIABILITY 7.1 THE HEPGTC. ANY WARRANTIES PROVIDED ARE PERSONAL AND NOT TRANSFERABLE. THE SOLE WARRANTIES PROVIDED BY CAE HEALTHCARE ARE LIMITED TO THE WARRANTIES PROVIDED IN 7.2 CAE HEALTHCARES LIABILITY SHALL IN NO CIRCUMSTANCES EXCEED THE LIMITATION OF LIABILITY INDICATED IN THE HEPGTC. LIABILITY, IF ANY, SHALL BE SOLELY FOR DIRECT DAMAGES, NOT TO EXCEED ON A CUMULATIVE BASIS THE AMOUNT PAID BY LICENSEE FOR THE PRODUCT. 8. GOVERNING LAW 8.1 This Agreement shall be governed by, subject to, and interpreted according to the laws of the State of Florida, U. S. A., without regard to its conflict of law rules. In all cases, the Parties expressly exclude and waive the application of the United Nations Convention on Commercial Agreements for the International Sale of Goods (1980)

(Vienna Sales Convention) as amended. 8.2 The exclusive forum for the resolution of any and all disputes arising out of or in connection with this Agreement shall be a court of appropriate jurisdiction located in the State of Florida, U.S.A. Each Party hereby waives any right that it might otherwise have to object to such venue or seek dismissal of the action on the basis of forum non-conveniens. EACH PARTY HERETO IRREVOCABLY WAIVES, TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW, ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO THIS AGREEMENT. Notwithstanding the foregoing, if a party seeks injunctive proceedings to preserve confidentiality 8.3 obligations or intellectual property rights, then it is entitled to seek relief before the competent court/body of any jurisdiction. 9. MISCELLANEOUS 9.1 United States Government Customer: If Licensee is the United States Government (U.S. Government) or a unit or agency of the U.S. Government, the Software and Data are deemed to be commercial computer software and commercial computer software documentation, respectively, pursuant to DFAR Section 227.7202 and FAR Section 12.212 b) as applicable. Any use, modification, reproduction, release, performance, display, or disclosure of the Software and/or Data by the U. S. Government, or any of its units or agencies shall be governed solely by the terms of this License and the HEPGTC. Any technical data provided by CAE Healthcare with the Product that is not covered by the above provisions is deemed to be technical data-commercial items pursuant to DFAR Section 252.227.7015(a). 9.2 Healthcare. Amendment. This License may only be amended by the duly authorized representatives of CAE No Waiver: The failure of CAE Healthcare to enforce at any time any of the provisions of this License, or 9.3 to require at any time the performance by Licensee of any of the provisions hereof, shall not be construed to be a waiver of such provisions, nor in any way affect the validity of this License or any part thereof, or the right of CAE Healthcare thereafter to enforce any such provision. 9.4 rights for any third parties or any persons other than the parties to this Agreement. No third-party beneficiaries. Nothing in this Agreement shall be construed as creating or giving rise to any 9.5 to the addressee as indicated in the HEPGTC. Notices: Notices or communications pertaining to this Agreement must be given in writing and delivered iv METIman Specifications 9.6 Preamble/Headings. The preamble forms an integral part of this Agreement. The division of this Agreement into Clauses, Articles, sections, subsections and other subdivisions and the insertion of headings are for convenience of reference only and will not affect the construction or interpretation of this Agreement. Severability. If any one or more of the provisions of this License shall be held to be invalid, illegal or 9.7 unenforceable, the validity, legality or enforceability of the remaining provisions of this Agreement shall not in any way be affected or impaired thereby. Assignment and Succession. Licensee may not assign or delegate this Agreement in whole or in part, 9.8 expressly or by operation of law, without CAE Healthcares prior written consent. CAE Healthcare may assign this Agreement, in whole or in part, and/or its rights and obligations, in CAE Healthcares sole discretion, to any party. This Agreement shall be binding upon and enure to the benefit of the parties hereto and their permitted successors and assigns. Any assignment of this Agreement, or any license granted herein, in violation of the provisions of this Section shall be void. 9.9 matter referred to herein, and supersede any other agreements, written or oral, concerning the subject matter hereof. Entire Agreement. This License constitutes the complete agreement of the parties with respect to the subject Language. The parties declare that they have requested and hereby confirm their express wish that this 9.10 License, and related agreements and documents be drawn up in the English language and that any notification, letter or any other communication from a party to the other pertaining thereto shall be solely in the English language. End of License v METIman Specifications Mannequin/Simulator METIman Specifications Size Weight Environmental Requirements Ambient Temperature Range Mannequin/Simulator Mannequin/Simulator 74 H x 26 W x 11 D (188cm x 66cm x 28cm) 100 lbs (45.36 kg) Operation:

Storage:

40F to 104F (4C to 40C) 40F to 122F (4C to 50C) Relative Humidity:

0% to 90% non-condensing Power Mannequin/Simulator AC Input:

Consumption:

AC 90 240VAC, 50/60Hz 70W nominal Internal Batteries:

18.5V lithium-ion, rechargeable 4 hours (Typical) Run Time:

Communications Simulator Network Wired:

Wireless:

10/100 Ethernet or IEEE 802.11g Wireless Voice 537 MHz to 819MHz (Country Specific) Electrotherapy Defibrillation:

20 to 360 joules (Monophasic, Biphasic) Pacing:

20mA to 180mA vi Cautions and Warnings Cautions/Warnings Please read and understand these cautions and warnings before you begin using the METIman system. USE OF THIS EQUIPMENT IN AN UNSPECIFIED MANNER MAY IMPAIR DESIGNED PROTECTION. Your safety is in your hands. Be sure to follow the instructions on the proper setup, breakdown and use of the METIman system. SHOCK HAZARD Electrical Safety This product must be connected to an electrical outlet that is properly grounded. Precautions should be taken so that grounding or polarization is not defeated. Do not place defibrillator paddles on or adjacent to the ECG patient electrodes. Contact between defibrillator paddles and the electrodes may cause injury to the user and damage to the equipment. Always use the supplied power cords. Do not substitute. Always use the supplied power adapter to run the simulator from AC. Operate the system from a power source with the following rating:

- 115VAC, 50/60 hertz (cycles per second) (e.g., North America, Japan)

- 230VAC, 50/60 hertz (cycles per second) (e.g., Europe) Do not allow excess fluids to flow on or into electronic parts. Do not attempt to disassemble the simulator or service any of the electrical components other than the resetting of circuit breakers. vii Cautions and Warnings General Use Warnings Electrical System Operate the system from a power source with the following rating: 115VAC, 50/60 hertz

(cycles per second) (e.g. North America, Japan), and 230VAC, 50/60 hertz (cycles per second) (e.g. Europe) Do not operate the METIman system in rain. Apply water to the mannequin only in accordance with the supported clinical procedures identified in this User Guide. Do not allow excess fluids to flow on or into electronic parts. CO2 Production System 2 canisters in dry location between 32 and 104 F. (0 to 40C). Do not expose CO2 Care must always be taken when using high-pressure equipment. Do not disassemble or alter regulator. Store CO canister to heat above 140 F as rupture may occur. Never point CO Use only CAE Healthcare specified CO Wear protective gloves and eye protection when removing canister from regulator assembly. 2 canister towards your face or someone nearby. 2 canisters. Bleeding and Secretion System DO NOT modify the tank or any assembly component. ALWAYS protect eyes, skin and clothing against accidental exposure. NEVER exceed 35 strokes while pressurizing the tank. ALWAYS read and follow instructions for creating trauma fluids (e.g. blood). NEVER fill the tank with more than 6 liters (1.6 gallons) of fluid. After use, ALWAYS release pressure and clean the tank. DO NOT store liquids in the tank. ALWAYS release tank pressure before servicing. NEVER transport or ship in a pressurized and/or full state or leave a pressurized tank unattended. viii Cautions and Warnings Mannequin Do not disassemble factory-assembled parts of the mannequin. Do not clean the mannequin with chemical solvents. Use water and a light soap solution only. Make sure that mannequin is set up on a stable, sturdy work surface to avoid collapsing and causing injury to users. METIman should be operated in ambient temperatures below 104 Do not introduce foreign substances into the airway - with the exception of small of approved lubricant. Only perform invasive procedures supported by the system as described in the applicable sections of the User Guide. Do not pick the mannequin up by the limbs support head and leverage weight with torso. It may be necessary to have the help of a second person to lift and move METIman. F (40 C). amounts Latex Warning CAE Healthcare simulators incorporate latex into their design. When performing certain maintenance procedures, the latex can become exposed. Users with latex sensitivity should take necessary precautions when handling the simulator while performing those procedures. ix Cautions and Warnings Battery General Warnings METIman uses Li-ion batteries. Li-ion batteries have special requirements during handling to avoid hazardous situations. The Polymer Li-ion Battery pack should be stored indoors and be kept far from fire and high temperatures. Do not store batteries with hairpins, coins, screws or other similar objects. Do not heat the battery. Do not throw the battery into a fire. Do not use or leave the battery close to heat or flame. Do not use the battery inside of a car where temperature may exceed 80C (176F). Also do not charge/discharge the battery in such conditions. Do not short-circuit the positive (+) and negative (-) terminals with other metals. Do not place the battery in a device with the positive (+) and negative (-) terminals in the incorrect positions. Do not strike the battery with force. Do not step on, throw or drop or drop the battery to cause strong shock. Do not disassemble or modify the battery. Do not solder a battery directly. Do not use a battery that has been damaged or deformed. x Cautions and Warnings Additional Warnings Stop charging the battery if the battery has not completed charging within the specified time. When leakage or foul odor is detected, do not use and keep away from heat or flame. Immediately wash thoroughly with fresh water if liquid leaks onto your skin or clothes. If liquid leaking from the battery gets into your eyes, do not rub your eyes. Immediately wash eyes completely with clean water and seek medical attention. If the amount of time the battery is able power the equipment diminishes significantly, the battery life is at an end. Replace the battery with a new battery of the exact same make and model. Immediately remove a battery whose life cycle has expired from the equipment. When the battery is thrown away, apply vinyl tape to the positive (+) and negative (-) terminals to avoid short circuits. When not using battery for an extended period, remove it from the equipment and store it in a place with low humidity and temperature. In all instances, keep the battery away from objects or materials with static electric charges. The battery can be used within the following temperature range. Do not exceed this range:

Charge temperature range: 0C (32F) to 45C (113F) xi Mse Software Specifications System Requirements If you are not using a TouchPro computer provided by CAE Healthcare, please be sure to utilize a computer with wireless capability. When operating the TouchPro software, a computer with a Macintosh or Microsoft Windows operating system may be used. To run the TouchPro software, the computer used must meet the following minimum requirements:

Macintosh Operating System Mac OS X 10.5.8 (minimum) Safari Adobe Flash Player Adobe Reader 9.x (or higher) 5.x.x or Firefox 10 ESR (minimum) 10.1.x.x (minimum) Windows Operating System 10 ESR, Internet Explorer 8 or Safari 5.x.x (minimum) XP Service Pack 2, Vista or Windows 7 Firefox Adobe Flash Player Adobe Reader 9.x (or higher) 10.1.x.x (minimum) Hardware (Windows and Macintosh) Intel Core Duo, 2.0 GHz (minimum) 2 GB DDR3 RAM (minimum) 8 GB Hard Drive space available 1024x768 screen resolution (minimum) USB 2.0 Wireless 802.11b/g/n Ethernet card 100BASE-T Ethernet Adapter Macintosh, Quicktime and Safari are registered trademarks of Apple Inc. Windows Media and Internet Explorer are registered trademarks of the Microsoft Corporation in the United States and/or other countries. Firefox is a registered trademark of the Mozilla Foundation. Adobe Flash Player is a trademark of Adobe Systems Inc. xii Table of Contents Table Table of Contents License/Copyright i METIman Specifications vi Cautions/Warnings vii System Requirements xii Introduction 1 METIman 1 Equipment Overview 2 Standard Components Inventory ............................................................................................................2 Optional Components Inventory .............................................................................................................3 METIman Standard Equipment 4 Full-Body Wireless Simulator ..................................................................................................................4 Battery Charger and External Power Supply ............................................................................................4 Instructor Workstation (Laptop or Tablet) ...............................................................................................4 CO2 Canisters (Prehospital Only)...... .......................................................................................................4 Inventory Kit ..........................................................................................................................................5 Wireless Microphone ..............................................................................................................................6 Wireless Voice Link ..................................................................................................................................6 Trauma Fill Tank ......................................................................................................................................7 xiii Table of Contents Optional Equipment for METIman 7 METIman Replacement Lithium Battery ........ .......................................................................................7 External Compressed Air Kit ........ ..........................................................................................................7 External CO2 Kit ........ .............................................................................................................................8 Air Compressor ........................................................................................................................................8 Hands-Free Training Cables ....................................................................................................................9 METIman Learning Applications and Training Courses ........ .................................................................10 METIman Learning Applications ......... ..........................................................................................................10 METIman Training Courses ......... ...................................................................................................................10 Tool Kit........ .........................................................................................................................................10 METIVision ............................................................................................................................................11 METI FX .................................................................................................................................................11 Moulage Kit ..........................................................................................................................................12 METIman Setup 13 Before Beginning Setup 14 Step 1: Place METIman in the Work Area 15 Step 2: Connect the Lower Legs to METIman 16 Step 3: Power On METIman 18 Step 4: Power On the Instructor Workstation 19 Step 5: Connect to the METIman Network Laptop Instructor Workstation (Macintosh) Option 20 Step 5: Connect to the METIman Network Tablet Instructor Workstation (Microsoft Windows) Option 22 Optional: Connect the SpO2 Probe 23 Optional: Connect External Air 24 xiv Table of Contents Optional: Insert the CO2 Canister (Prehospital Only) 25 Use of CO2 Canisters ...............................................................................................................................25 Assembly of the CO2 Regulator ..............................................................................................................25 Insertion of the CO2 Canister (Prehospital Only) ....................................................................................26 Optional: Detach the Arms 28 Optional: Prepare the Bleeding System 30 Using the Trauma Fill Tank .................................................................................................................................30 Attaching the Overflow Bottle to the Trauma Fill Tank Assembly .................................................................31 Operating the Trauma Fill Tank ..............................................................................................................31 Step 1: Pour the Fluid into the Trauma Fill Tank ...............................................................................................31 Step 2: Connect the Trauma Fill Tank Connector to the Simulator .....................................................................32 Step 3: Pressurize the Trauma Fill Tank and Fill the On-Board Blood Reservoir ........................................................................................................32 Step 4: Release Pressure from the Trauma Fill Tank .........................................................................................33 Step 5: Disconnect the Trauma Fill Tank Umbilical from the Simulator .............................................................33 Preparing for Storage ............................................................................................................................33 Step 1: Clean the Simulator and Fluid System .................................................................................................33 Step 2: Clean the Trauma Fill Tank...................................................................................................................33 Step 3: Store the Trauma Fill Tank ...................................................................................................................33 Optional: Connect a TouchPro Computer to the Wireless Network 34 Step 1: Set Up METIman ........................................................................................................................34 Step 2: Obtain METImans IP Address ....................................................................................................34 Step 3: Configure the TouchPro Computers Network Settings ...............................................................35 Step 4 - Option 1: Join the METIman Network Using a Macintosh Operating System ...................................36 Step 4 - Option 2: Join the METIman Network Using a Windows Operating System .....................................38 Step 5: Access the Software from the TouchPro Computer .....................................................................40 xv Table of Contents Using the Software 41 Starting the Application 41 The Home Page 44 The SCE Selection Panel 45 The SCE Library 46 Printing SCEs 47 The Run Screen 48 Using the Patient Status Display ...........................................................................................................49 The Event Logs ......................................................................................................................................50 Adding a Scenario to an SCE ..................................................................................................................51 Physiological Views ...............................................................................................................................51 Setting Parameters ...............................................................................................................................53 Using the Conditions Palette to Set Parameters ...............................................................................................53 Using the Physiological Views to Set Parameters .............................................................................................55 Performing Interventions......................................................................................................................56 Using the Medications Palette ........................................................................................................................56 Using the Interventions Palette .......................................................................................................................58 Changing Scenario States......................................................................................................................60 Changing Scenario States from the Scenario Screen ........................................................................................60 Changing Scenario States from the Run Screen ...............................................................................................62 SCE Time ...............................................................................................................................................63 Exiting the SCE ......................................................................................................................................63 Stopping the SCE ...................................................................................................................................63 Saving a Patient ....................................................................................................................................64 Resetting a Patient................................................................................................................................66 Medication Monitor ..............................................................................................................................67 xvi Table of Contents Creating and Editing SCEs 68 Creating an SCE .....................................................................................................................................68 Creating a Patients Profile and Baseline ...............................................................................................70 Content Management ...........................................................................................................................71 SCE Configuration .................................................................................................................................72 Condition Setup Screen and Creating Quick Links ............................................................................................72 TouchPro Setup ..............................................................................................................................................73 Patient Status Display ....................................................................................................................................74 The Scenario Designer 75 The Scenario Button ..............................................................................................................................76 Scenario Designer Views ......................................................................................................................77 Creating a New Scenario .......................................................................................................................79 Modifying Scenario States ..............................................................................................................................79 Adding Parameters and Interventions ............................................................................................................80 Adding Transitions .........................................................................................................................................82 ELSE Statements .............................................................................................................................................84 Deleting Scenario States .................................................................................................................................85 Deleting Parameters and Transitions ..............................................................................................................86 Emptying the Trash ........................................................................................................................................87 Saving the Scenario ........................................................................................................................................88 Saving States to the State Library ...................................................................................................................89 xvii Table of Contents Administrative Tools 90 History 90 System Administration 91 Content Management ...........................................................................................................................91 Learning Applications .....................................................................................................................................92 SCEs ...............................................................................................................................................................93 Base Patients .................................................................................................................................................94 Scenarios ........................................................................................................................................................95 User Accounts .......................................................................................................................................96 Creating a User ...............................................................................................................................................97 Editing a User .................................................................................................................................................98 Deleting a User ...............................................................................................................................................98 Groups ..................................................................................................................................................99 Privilege System .............................................................................................................................100 Creating a New Group ..................................................................................................................................101 Deleting a Group ..........................................................................................................................................101 Maintenance ....................................................................................................................................... 102 System Settings .................................................................................................................................. 103 System Configuration ...................................................................................................................................103 Data Management .......................................................................................................................................103 Product Licensing .........................................................................................................................................104 Error Log ......................................................................................................................................................104 Localization ..................................................................................................................................................104 xviii Table of Contents Account Profile 105 Profile Information ............................................................................................................................. 105 Favorite SCEs ....................................................................................................................................... 106 Medication Preferences ....................................................................................................................... 107 Profile Preferences .............................................................................................................................. 108 Using TouchPro 109 Accessing the TouchPro Software 109 Modifying the TouchPro Display 111 Changing the Layout ........................................................................................................................... 111 Selecting a Preconfigured Layout ....................................................................................................112 Changing a Waveform or Numeric Display ......................................................................................113 Adding a Waveform Display ...........................................................................................................114 Adding a Numeric Display ..............................................................................................................115 Moving a Waveform or Numeric Display .........................................................................................116 Saving a Layout .............................................................................................................................117 Sounds 118 12-Lead ECG 119 NIMB Cycling and Manual NIBP 120 Patients 122 Configuring the TouchPro Software 123 Changing the Language of the TouchPro Software 124 Exiting the TouchPro Software 124 xix Table of Contents Using METIman 125 Neurological 126 Eyes..................................................................................................................................................... 127 Convulsions ........................................................................................................................................ 127 Neuromuscular Blockade .................................................................................................................... 127 Body Temperature ............................................................................................................................... 127 Blood Temperature.............................................................................................................................. 127 Head Secretions (Prehospital Only) ..................................................................................................... 128 Respiratory 129 Airway ................................................................................................................................................ 130 Swollen Tongue ............................................................................................................................................132 Posterior Pharynx Swelling (Prehospital Only) ..............................................................................................132 Realistic Upper Airway (Prehospital Only) ....................................................................................................133 Laryngospasm (Prehosptial Only) .................................................................................................................134 Teeth with Breakaway Incisors (Prehosptial Only) ........................................................................................134 Airway Secretions (Nursing Only) .................................................................................................................135 Cricothyrotomy .............................................................................................................................................136 Replacing the Cricothyrotomy Tape ...............................................................................................................136 Resealing the Membrane After a Puncture ....................................................................................................137 Pulmonary .......................................................................................................................................... 138 Needle Decompression (Prehospital Only) .............................................................................................................139 Bronchial Occlusion (Prehospital Only) .........................................................................................................140 Respiratory Rate ...........................................................................................................................................140 Pulse Oximetry .............................................................................................................................................140 CO2 Exhalation (Prehospital Only) .................................................................................................................140 Positive Pressure Ventilation .........................................................................................................................141 Gastric Distention (Prehospital Only) ............................................................................................................141 xx Table of Contents Chest Tube: METIman Prehospital .................................................................................................................141 Chest Tube: METIman Nursing ......................................................................................................................143 Cardiovascular144 Pulses: METIman Prehospital .............................................................................................................. 146 Pulses: METIman Nursing ................................................................................................................... 147 Blood Pressure .................................................................................................................................... 148 Systolic and Diastolic Blood Pressure ............................................................................................................148 Non-Invasive Blood Pressure Measurement ..................................................................................................148 Heart Rate ........................................................................................................................................... 152 Five-Lead ECG ..................................................................................................................................... 152 Cardiovascular Interventions/Therapy ................................................................................................. 153 Chest Compressions ......................................................................................................................................154 Defibrillation and Cardioversion ...................................................................................................................154 Pacing ..........................................................................................................................................................155 Subclavian Catheter (Nursing Only) .................................................................................................... 156 Intramuscular Injection ....................................................................................................................... 156 IV Cannulation .................................................................................................................................... 156 Fluids .................................................................................................................................................. 158 Hemorrhage Setup .......................................................................................................................................159 Hemorrhage Control .....................................................................................................................................159 Tourniquet Application .................................................................................................................................160 Fluid Loss Blood ............................................................................................................................................160 Fluid Loss Plasma .........................................................................................................................................160 xxi Table of Contents Gastrointestinal 161 Gastrointestinal Gavage, Lavage and Suction (Nursing Only) .............................................................. 161 Gavage (Nursing Only) .................................................................................................................................161 Lavage (Nursing Only) ..................................................................................................................................161 Gastric Suction (Nursing Only) ......................................................................................................................162 Genitourinary System 163 Urinary Catheterization ....................................................................................................................... 163 Simulating Urine Output ..................................................................................................................... 164 Changing the Simulators Genitalia ..................................................................................................... 165 Sounds 166 Speech ................................................................................................................................................ 166 Vocal Sounds ................................................................................................................................................166 Speech Sounds .............................................................................................................................................168 Wireless Voice Capability ..............................................................................................................................170 Wireless Voice Link .......................................................................................................................................170 Throat Sounds ..................................................................................................................................... 171 Breath Sounds..................................................................................................................................... 172 Heart Sounds ...................................................................................................................................... 173 Bowel Sounds ..................................................................................................................................... 174 xxii Care and Maintenance 175 METIman Warranty Programs 176 General Information ........................................................................................................................... 176 Units Out of Agreement ...................................................................................................................... 176 How to Contact Customer Service. ..................................................................................................... 177 Contract Period ................................................................................................................................... 178 Limitations of Agreement ................................................................................................................... 178 Return Materials Authorization (RMA) ................................................................................................ 178 System Software Upgrade Support 179 Pricing Structure 179 Time and Materials ............................................................................................................................. 179 Breakdown 180 Step 1: Stop All Running SCEs ............................................................................................................. 180 Step 2: Clean the Simulator and the Fluid System ............................................................................... 180 Step 3: Shut Down the Software ......................................................................................................... 180 Step 4: Power off the Simulator .......................................................................................................... 181 Maintenance Advice 181 General Simulator Care ....................................................................................................................... 181 Storage ............................................................................................................................................... 181 Care of Electronic Equipment .............................................................................................................. 182 Airway Inspection ............................................................................................................................... 182 Replacing the Battery ......................................................................................................................... 182 Recharging the Battery ....................................................................................................................... 184 Draining Condensation from the Simulator ......................................................................................... 185 xxiii Cleaning the Simulator and the On-Board Bleeding System 186 Cleaning the Trauma Fill Tank 187 Cleaning the In-Line Filter................................................................................................................... 188 Troubleshooting the Trauma Fill Tank .................................................................................................. 189 Emptying and Flushing the Chest Tube Reservoir ................................................................................ 190 Flushing the IV Lines ........................................................................................................................... 190 Emptying the Genitourinary Reservoir ................................................................................................ 190 Emptying the Head Secretions Lines (Prehospital Only) ...................................................................... 190 Emptying the Airway Secretions Reservoir (Nursing Only) .................................................................. 190 Flushing the Subclavian Catheter (Nursing Only) ................................................................................ 190 Handling CO2 Canisters 191 Removing CO2 Canisters from the Regulator ........................................................................................ 191 Important Canister Information .......................................................................................................... 192 Related CAUTIONS/WARNINGS ............................................................................................................ 192 CO2 Canister ..................................................................................................................................................192 CO2 Regulator Assembly ...............................................................................................................................192 Use of Equipment .........................................................................................................................................192 Condition Guidelines for Programming METIman 193 Appendix A Mse Parameters Descriptions A-1 Appendix B - Wireless Voice Link B-1 xxiv Introduction Introduction METIman Nursing and Prehospital simulators give you all the power of CAE Healthcares cutting edge simulation technology with more of what you want. METIman Nursing was created by nurses to teach the fundamentals of nursing practice, and METIman Prehospital was built for medics by medics. Both simulators are less expensive than other simulators, are easy to use and have everything you need with nothing you dont. METIman METIman is fully wireless with on-board fluid, pneumatic and electrical systems and is built tough to withstand a wide variety of real-life, indoor and outdoor learning environments. METiman comes with extensive clinical features and capabilities designed specifically for emergency medical personnel and nurses. The simulator can be placed on standard operating room tables, on an ICU bed, on the ground or even in a vehicle (in the case of a simulated accident). METIman can also be seated in an upright position. In addition, METIman has the assessment, cardiovascular, genitourinary and trauma features familiar to CAE Healthcare customers plus an SpO2 finger probe, fluids on board, bilateral noninvasive blood pressure and IV access. Wireless and tetherless, METIman takes simulation education to a new and exciting level of realism. 1 Introduction Equipment Overview METIman has been designed to be used in any learning environment. METImans standard features are easily integrated into a laboratory setting or remote locations. Standard Components Inventory METIman comes with all the necessary equipment for establishing an educational simulation center. Standard Equipment METIman Simulator Battery Charger and External Power Supply Instructor Workstation (Laptop or Tablet) CO2 Canisters (Prehospital Only) Inventory Kit Wireless Microphone or Wireless Voice Link Trauma Fill Tank NOTE: As you would with any shipment, cross-check this inventory with your CAE Healthcare packing invoice to verify that all components have been received. 2 Introduction Optional Components Inventory Optional equipment is available to accommodate special customer requirements. For example, options like an air compressor, METIVision and METI FX enable instructors to create real-life scenarios at authentic locations. Optional Equipment METIman Replacement Lithium Battery External Compressed Air Kit External CO2 Kit Air Compressor Hands-Free Training Cables METIman Learning Applications and Training Courses Tool Kit METIVision METI FX METI FX Moulage Kit Contact CAE Healthcare Customer Service at 866-462-7920 if there are any questions or if optional equipment is needed. 3 Introduction METIman Standard Equipment METIman comes with standard equipment that allows students and instructors the ability to create an endless number of possible clinical situations. The following equipment is provided with your METIman simulator. Full-Body Wireless Simulator All patient assessments and clinical interventions are played out on the METIman mannequin, which represents a human patient. At six feet, two inches (188 cm) in height and weighing 100 pounds (45.36 kg), METIman is fully operational in the supine, lateral, prone and seated positions. The simulator offers features like arm pronation and supination; breath, heart and bowel sounds; palpable pulses; patient voice; and genitourinary features. Battery Charger and External Power Supply The simulator is rechargeable using the Battery Charger provided. Instructor Workstation (Laptop or Tablet) The Instructor Workstation is a computer that utilizes Mse Software to operate as the main simulation control center. Instructors control the simulation session from the Workstation by using SCEs that meet their learning objectives. The standard METIman configuration includes a choice of Laptop Instructor Workstation or a ruggedized Tablet Instructor Workstation. CO2 Canisters (Prehospital Only) Four CO2 canisters are included with METIman to supply the on-board CO2 exhalation feature. 4 Inventory Kit iStan comes with a number of accessories and replacement components. Included in the Inventory Kit are:

iStan Start-Up Kit (Quick Start Chart and Setup Map) iStan Logo Accessories Priming syringe Roll (4 ft) of VHB tape and roll of 2-inch-wide red tape (for cricothyrotomy) Cricothyrotomy skin BP adapter kit Silicone lubricant Chest tube priming tube ECG posts Pacing/Defibrillation disks Condensation drain Wound umbilicals SpO Female genitalia VGA mini adapter 2 probe Introduction 5 Introduction Wireless Microphone The wireless receiver enables the user to communicate through the simulator using a microphone. The clip-on microphone is attached to a transmitter that may be attached to a belt or waistband. Wireless Microphone The microphone is battery-operated and has a power switch on the top to turn it on and off. Wireless Voice Link The wireless voice link replaces the wireless microphone feature in some METIman simulators and comes packaged separately. For more information about this feature, see Appendix B

-Wireless Voice Link on page B-1. 6 Introduction Trauma Fill Tank Fluids are supplied to the simulator using a trauma fill tank. One tank is supplied and can be used for distilled water mixed with red food coloring to create simulated blood. Disassembled Trauma Fill Tank Trauma Fill Tank (Disassembled and Assembled) Assembled Trauma Fill Tank This tank should be cleaned after each use. Optional Equipment for METIman Additional components enable the METIman system to be customized to fit the specific needs of a wide variety of education environments. METIman Replacement Lithium Battery Under normal usage, a battery pack should last up to two years. External Compressed Air Kit The External Compressed Air Kit gives the user the ability to connect METIman to a CAE Healthcare compressor, tank or wall air using the kits hose and fittings. When connecting to wall air, the kit attaches to the customers wall adapter. 7 Introduction External Compressed Air Kit The internal pump turns off automatically when external compressed air is sensed. The External Compressed Air Kit includes a flexible 30 ft (9 m) hose attached to a preset air regulator, a fitting for air compressors and adapters for wall or tank air. External CO2 Kit The External CO2 Kit gives the user the ability to connect METIman to an external source of CO2

(30-120 psi). The External CO2 Kit includes a flexible 30 ft (9 m) hose attached to a preset air regulator and an adapter for wall or tank fittings. Air Compressor An air compressor (product #AIR-003) designed for quiet operation is available for same-room use, and an alternative air compressor (product #AIR-002) is available for situations where the compressor resides in a location, such as a storage room, set apart from the simulator. Both Air Compressors are AC powered and include a regulator and an air hose with the appropriate connector fitting. A 220VAC/50 Hz version of the Quiet In-Room Air Compressor (product #AIR-004) is also available. 8 Introduction Hands-Free Training Cables Hands-Free Training Cables connect to most popular defibrillators and cardiac pacing units and take the place of non-reusable electrode pads. Three different cable designs are available to support the most popular defibrillation and pacing equipment. Each cable kit includes posts that attach to the defibrillator or pace locations on METIman. Physio-Control (Medtronic, Inc.) Zoll (Zoll Medical Corporation)

(product #ACC-005)

(product #ACC-006) Philips (Koninklijke Philips Electronics, N.V.)

(product #ACC-007) 9 Introduction METIman Learning Applications and Training Courses METIman Learning Applications CAE Healthcare Learning Applications enhance the use of the simulator by providing preprogrammed scenarios and corresponding support documentation (i.e., course objectives, instructors notes) that can be readily integrated into a lesson plan, a specific curriculum or an educational program. EMS Learning Application 1 (EDU-047) Adult Nursing Learning Apllication (EDU-071) METIman Training Courses METIman Basic and Advanced courses offer learners at all levels in-depth instruction in the setup, operation, development of scenarios and maintenance related to the use of METIman. The METIman Basic course provides learners with an overview of the system and its components, as well as an introduction to patient creation and scenario design. METIman Basic - two days at CAE Healthcare facility (TRN-018) METIman Basic On-Site - two days at learner-defined facility (TRN-020) The METIman Advanced course builds upon the concepts introduced in the prerequisite Basic course. After a quick review of the Basic course, Advanced instruction spends the majority of the two days providing learners with the ability to design patients and scenarios that can be used immediately upon completion of the course. METIman Advanced - two days at CAE Healthcare facility (TRN-019) METIman Advanced On-Site - two days at learner-defined facility (TRN-021) Tool Kit To simplify common adjustments and periodic repairs, CAE Healthcare has put together a kit containing tools selected for use with the simulator (product #TOL-001). Tool Kit 10 Introduction METIVision METIVision is a fully integrated, digital audio-visual management system that is data-

synchronized in real-time for use with CAE Healthcare simulators. METIVision is the only solution available with the capability not only to capture and store simulation data, but to broadcast and review any medical simulation exercise using CAE Healthcare simulators. Complete with physiologic data logs, event logs, pharmacology logs and patient monitoring data, METIVision offers the capability to provide a complete record of your simulation exercise for debriefing, assessment and evaluation (product #MTV-001). METIVision Console METI FX CAE Healthcare takes realism to the next level with METI FX: a realistic set of advanced moulage wound simulation and special effects. METI FX includes incredibly lifelike wounds that accurately replicate muscle, tissue and subcutaneous fat and reflect the true physical nature of a wound and its treatment. And, METI FX comes complete with CAE Healthcares own educational learning tools a set of how-to treatment cards explaining procedures and learning objectives for both civilian and military patient scenarios (product #MFX-100). METI FX Simulation 11 Introduction Moulage Kit The kit provides the materials needed to create wounds on METIman (product #MODS-999). The Moulage Kit may also be ordered separately. Moulage Kit 12 METIman Setup The following pages will guide you through assembling and configuring METIman. Below is a list of steps required to prepare METIman for operation. 1 2 3 4 5 Place METIman in the Work Area Connect the Lower Legs to METIman Power On METIman Power On the Instructor Workstation Connect to the METIman Network Connect the SpO2 Probe (Optional) Connect the External Air (Optional) Insert the CO2 Canister (Optional, Prehospital Only) Detach the Arms (Optional) Prepare the Bleeding System (Optional) Connect the TouchPro (Optional) Setup 13 Before Beginning Setup Proper operation of the METIman simulation unit requires correct configuration. Before setting up the system, keep in mind these basic guidelines:

Understand the Cautions and Warnings information located in the Introduction section of this User Guide. Follow the sequence of steps carefully. Complete all steps in order. Do not power on any components until instructed in the text. KEEP all original shipping materials, including BOXES warranty and repair items must be return shipped to CAE Healthcare in their original packaging. When unpacking METIman for the first time, careful use of a box cutter protects both the packaging and the product. A Setup Map, included with the unit, covers these same steps in abbreviated fashion. Setup 14 Step 1: Place METIman in the Work Area Select a work area with enough room for all equipment, providing ample space for easy access to the simulator. At a least 10 x 12 (3 meter x 4 meter) work area is recommended for movement and positioning of components around the simulator. Positioning METIman METIman and the Laptop or Tablet Instructor Workstation can be operated from their batteries, allowing for wireless use. In a lab environment, make sure a multi-plug AC power outlet exists within the workspace to recharge the simulators battery and its powered components. Before placing the simulator on a surface, be certain the surface can easily support 200 pounds. NEVER lift the simulator by the LIMBS. When lifting, be sure to support the torso and head of the simulator while lifting. Setup 15 Step 2: Connect the Lower Legs to METIman NOTE: Use extreme care when handling the sensor cables and pulse tubes. NEVER let a leg hang off a surface without the locking pin securely in place. Doing so can seriously damage the sensor cables and pulse tubes. a. On each leg, at the knee, remove the locking pin from its position. Removing the Locking Pin b. c. Place lower limbs in their correct positions, leaving enough room to manipulate connectors. On each leg, match and connect the color-coded tubing to the three white tubing connectors. Connecting Tubing Setup 16 d. Match and connect the color-coded tubing to the three black electrical connectors. Connecting Electrical e. Carefully place tubes and cables in the hole on the lower leg. f. Align holes on the knees and insert the locking pin. g. Screw the nut on the locking pin, holding it in place. Affixing the Locking Pin Setup 17 Setup Step 3: Power On METIman a. Locate the ON/OFF button beneath the skin covering METImans left hip. The ON/OFF Button METImans ON/OFF Button b. ON/OFF button for one second. The power light blinks, Press and hold the indicating the system is busy. In approximately one minute, the light stops blinking and remains solid, indicating the simulator is now ready. NOTE: METIman can be operated continuously for approximately four hours without recharging the battery. 18 Step 4: Power On the Instructor Workstation a. b. Place the Laptop or Tablet Instructor Workstation near METIman in a convenient location. Ensure the Instructor Workstation battery is fully charged, or connect the AC adapter to the workstation and a surge-protected power outlet. c. Power on the Instructor Workstation. Setup 19 Step 5: Connect to the METIman Network Laptop Instructor Workstation (Macintosh) Option a. Click the AirPort icon located in the top-right-hand corner of the screen. Clicking the AirPort Icon b. If the AirPort is not on, select Turn AirPort On. Activating the AirPort Card c. Select the network (e.g., number). MMPXXX or MMNXXX, where XXX is the simulators unit Selecting the Network Setup 20 The AirPort dialog box appears. The AirPort Dialog Box d. Enter the password metiadmin into the Password field. e. Click OK. Connecting to the METIman Network The Mse software can now be launched. Setup 21 Step 5: Connect to the METIman Network Tablet Instructor Workstation (Microsoft Windows) Option Once METIman and the Instructor Workstation are both powered on, they automatically establish a wireless connection and, when the Internet Explorer browser is opened, the Mse software launches. If the auto-connect does not occur, perform the following steps:

1. 2. 3. Wireless Network icon in the task bar. Tap on the Select the METIman wireless network (e.g., MMPXXX or MMNXXX, where XXXX is the serial number for the unit). The network password is metiadmin and the password is case-sensitive. Connect button. Click the The wireless connection is established. The Mse software can now be launched using Internet Explorer. Setup 22 Optional: Connect the SpO2 Probe Connect and attach the SpO2 probe to METIman. a. Locate the SPO2 port on METImans left hip. 2 probe to the SPO2 port. Connect the SpO b. c. Place the SpO 2 probe on METIman. Attached SpO2 probe The probe must be connected to view pulse oximetry data on the TouchPro software. Attached SpO2 Probe Setup 23 Setup Optional: Connect External Air Using the External Air kit allows METIman to be run by an external air source rather than the internal compressor. The air hose can be connected to or disconnected from METIman at any time. When the external air pressure is sensed, the pump internal to METIman turns off automatically. When you want to make METIman mobile again, simply disconnect the hose. The optional External Compressed Air Kit consists of a flexible 30 ft (9 m) hose attached to a preset air regulator and a fitting for air compressors and adapters for wall or tank air. To connect the air hose:

1. 2. Connect the External Compressed Air Kit to a CAE Healthcare compressor using the Quick Coupler attached to the regulator. (Other compressed air sources have their own adapters. Locate the adapter for your compressed air source.) Connect the other end of the External Compressed Air Kit to the port on the left shoulder. EXTERNAL AIR The EXTERNAL AIR port The EXTERNAL AIR port METIman Prehospitals Left Shoulder METIman Nursings Left Shoulder 24 Optional: Insert the CO2 Canister (Prehospital Only) Some SCEs include the simulation of CO2 exhalation. The following instructions show how to safely connect the CO2 canister to the simulator. WARNING: Careful handling, including the use of eye protection, is required when using CO2 canisters. Please read and understand all the important cautions and warnings on removing canisters as well as safety steps that must be used when handling CO2 canisters. Use of CO2 Canisters 2 canisters in a dry location between 32 and 104 F. (0 to 40C) 2 canister to heat above 140 F, as rupture may occur. Store the CO Do not expose the CO Never point the CO Use only CAE Healthcare specified CO Do not remove the canister from the regulator base until empty. The canister end is punctured when screwed into the regulator base. Never ship the CO 2 canister toward your face or someone nearby. 2 canister attached to the regulator assembly. 2 canisters. Assembly of the CO2 Regulator Care must always be taken when using high-pressure equipment. Do not disassemble or alter the regulator. Dry completely if the regulator becomes wet. Discontinue use of this equipment if leakage or visible damage is evident. Setup 25 Setup Insertion of the CO2 Canister (Prehospital Only) To insert the CO2 canister:

a. Lift the chest skin at the waist and lift the abdominal insert. b. From the simulators right midsection, remove the pull pin and disconnect the blue CO2 hose. Remove the pull pin Remove the Pull Pin c. Remove the regulator from the simulator. d. While holding the regulator firmly, carefully twist the CO regulator as far as it will go. The final turns puncture the CO2 canister, which is necessary for correct operation. 2 canister into the Insert the CO2 canister into the regulator Connecting the CO2 Canister CAUTION: Do not loosen the canister once it has been inserted into the regulator assembly until the contents are exhausted and pressure relieved. CAUTION: Removing the canister before it is empty results in the sudden release of all high-

pressure gas with a possibility of liquid CO2 spray. Unprotected skin could receive freezing burns. 26 e. 2 canister, regulator and hoses inside the simulator. Use the pull pin Place the CO to secure this assembly to the tray. A properly installed assembly will have the CO2 canister pointed down toward the rear of the simulator. Place the canister, regulator and hoses inside the simulator Placing the Canister, Regulator and Hoses f. g. Attach the blue CO 2 hose to the connection on the regulator. Carefully reposition the abdominal insert and pull the skin back over the simulator to its original location. Once the canister and regulator assembly are in place, CO2 is measurable with a disposable ETCO2 detector during positive pressure ventilation. Based on the training environment, a CO2 canister may last from 10 minutes (rapid ventilation) to 25 minutes. See important Cautions and Instructions for removing, transporting and disposing of the CO2 canisters in the Care and Maintenance section. Setup 27 Setup Optional: Detach the Arms METImans arms may be removed for use with trauma scenarios. To detach METImans arms:

1. Unscrew and remove the locking pin at the elbow. Removing the Locking Pin 2. 3. Carefully separate the lower arm from the upper arm. Twist to disconnect the four tubing connectors (white). Disconnecting the Tubing 28 4. Squeeze to disconnect the three electrical connectors (black). Disconnecting the Electrical Connectors 5. Place the loose connectors carefully within the upper arm. NOTE: When replacing arms, ensure tubing and electrical connectors are matched using the color-coding. Setup 29 Optional: Prepare the Bleeding System ONLY distilled water or distilled water containing food coloring should be used with the secretion system. A mixture of no more than 29 mL (1 oz) red food coloring with 3.8 liters (1 gallon) of distilled water should be used to create simulated blood. The blood mixture should be created in advance in a separate distilled water container. NOTE: The higher the ratio of food coloring, the greater the possibility of staining. Using the Trauma Fill Tank The Trauma Fill Tank is used to fill the on-board blood reservoir. CAUTIONS and WARNINGS Carefully follow all instructions for using the Trauma Fill Tank. Pay particular attention to the following cautions and warnings:

ALWAYS read and follow instructions for creating trauma fluids (e.g. blood). ALWAYS protect eyes, skin and clothing against accidental exposure. After use, ALWAYS release pressure and clean the tank. ALWAYS release tank pressure before servicing. DO NOT modify the tank or any assembly component. DO NOT store liquids in the tank. NEVER transport or ship in a pressurized and/or full state. NEVER leave a pressurized tank unattended. NEVER fill the tank with more than 6 liters (1.6 gallons) of fluid. NEVER exceed 35 strokes while pressurizing the tank. Setup 30 Setup Attaching the Overflow Bottle to the Trauma Fill Tank Assembly The overflow bottle is used to collect overflow when the METIman on-board tank is filled. To attach the Overflow Bottle to the Trauma Fill Tank:

1. Connect the clear trauma fill tank hose to the bottle lid fitting. Connect the clear hose to the bottle lid fitting Connecting the Trauma Fill Tank Umbilical to the Overflow Bottle 2. Clip the bottle to the tank using the attached carabiner mechanism. The carabiner The Carabiner Operating the Trauma Fill Tank Be careful to complete the following steps correctly to ensure proper use and maintenance of the METIman and its peripherals. Step 1: Pour the Fluid into the Trauma Fill Tank Pour the desired amount of fluid into the Trauma Fill Tank, being careful to NOT to exceed 6 liters (1.6 gallons) of fluid. NOTE: The right thigh tank holds 1.5 liters and is used for blood. Three (3) liters of simulated blood provides enough fluid to fill the right thigh reservoir twice. The amount of blood used in a training session varies with the patient, the wounds simulated and the learners experience. 31 Step 2: Connect the Trauma Fill Tank Connector to the Simulator a. Locate the tan FILL port and white VENT port. b. Connect the Trauma Fill Tank to the corresponding ports on the simulator FILL (with the tan label) and VENT (with the white label) hoses of the Both connections must be made for correct operation. Step 3: Pressurize the Trauma Fill Tank and Fill the On-Board Blood Reservoir An integrated hand pump is used to create the pressure for the Trauma Fill Tank. WARNING: To prevent ejected pump assembly and/or solution from striking and injuring you, NEVER stand with your face or body directly over the top of the tank when pumping or loosening the pump. To operate the pump and fill the reservoir:

a. b. Unlock the pump handle by turning counter-clockwise. (Be careful not to loosen the pump from the tank.) Stroke the pump handle up and down from 25 to 35 times to transport 2 liters of simulated blood to the on-board blood reservoir. NEVER exceed 35 strokes while pressurizing the tank. c. Lock the pump handle back into the pump assembly by turning clockwise. d. Watch the Overflow Bottle located on the tank assembly. When liquid begins to appear in this bottle, the on-board blood reservoir is full. (Filling the on-board blood reservoir takes approximately 3 to 5 minutes.) Setup 32 Step 4: Release Pressure from the Trauma Fill Tank Immediately release pressure from the tank by turning and holding the yellow pressure relief knob clockwise until all air pressure is gone. If pressure will not release using the relief knob:

a. Place a rag over the top of the tank and pump handle. b. While firmly pushing down on the pump handle, slowly turn the handle counter-

clockwise. NEVER leave a pressurized tank unattended. Step 5: Disconnect the Trauma Fill Tank Umbilical from the Simulator Disconnect the Trauma Fill Tank Umbilical from the simulator and store the assembly out of the way for later use. After use, ALWAYS release pressure and clean the tank. Preparing for Storage After filling and using the Trauma Fill Tank and the simulators blood reservoir, both must be cleaned for storage. Step 1: Clean the Simulator and Fluid System When the simulation is completed and the Trauma Fill Tank has been disconnected, remove the fluids and clean the simulator (see Cleaning the Simulator and the On Board Bleeding System in the Care and Maintenance section of this User Guide). Step 2: Clean the Trauma Fill Tank Before storing the Trauma Fill Tank, make sure the equipment is clean (see Cleaning the Trauma Fill Tank in the Care and Maintenance section of this User Guide.) Step 3: Store the Trauma Fill Tank After cleaning, the Trauma Fill Tank assembly should be stored securely for future use. a. Allow the interior of the tank to dry by loosening the pump assembly. Do NOT leave the pump assembly out of bottle, however, because dust contaminates the system. b. Loosely wrap the Trauma Tank Umbilical around the neck of the tank to protect it. c. Store all components in a clean, dry area. Setup 33 Optional: Connecting a TouchPro Computer to the Wireless Network The CAE Healthcare TouchPro computer is pre-configured for use with METIman. If you wish to supply your own TouchPro computer, use the following instructions to connect the computer to the METIman network. Up to two additional computers may be used to run the TouchPro software. The additional computers must meet the TouchPro Software Specifications mapped out in the Muse and TouchPro Specifications section of this User Guide on page xii. Follow the steps below to use the TouchPro software on a TouchPro computer. Step 1: Set Up METIman The METIman simulator must be set up and powered on, and the Instructor Workstation must be powered on and connected to the METIman network. If you have followed the complete setup procedure, you may proceed to Step 2. Step 2: Obtain METImans IP Address METImans IP address is the same as the IP address used to access the Mse software on the Instructor Workstation. It can be found in the Address field of the web browser on the Mse Start screen. METImans IP address IMPORTANT: The IP address is different for each simulator. The Mse Start Screen NOTE: If the Address field does not appear, check the view settings of your browser. In Safari, access the View menu and select Show Toolbar. Setup 34 Step 3: Configure the TouchPro Computers Network Settings Access the Networking screens (the TCP/IP settings screens) for your operating system. If you are unfamiliar with these screens, contact your Network Administrator or CAE Healthcare Customer Service (1-866-462-7920) for help with this step. Setup TCP/IP Network Screen Macintosh Internet Protocol Version 4 (TCP/IPv4) Properties Screen Windows Enter a unique IP address in the IP address or IPv4 Address field and a subnet mask in the Subnet Mask field. The unique IP address must match the IP address obtained in Step 2 except for the number after the third and final period. This number can be any number between 2 and 254 BUT must be different from the final number of the IP address obtained in Step 2 (METImans IP address) and the IP address of the Instructor Workstation and any other computers on the network. No two IP addresses can be the same, including the Instructor Workstations IP address. Unique IP Address: 192.168.XXX.XXX Subnet Mask: 255.255.255.0 Router/Gateway: (Leave Blank) Example: If the IP address of your METIman is 192.168.206.5, and the IP address of your Instructor Workstation for your METIman is 192.168.206.10, you could assign the TouchPro computer the IP address 192.168.206.20. 35 Setup Step 4 Option 1: Join the METIman Network Using a Macintosh Operating System a. Click the AirPort icon located in the top-right-hand corner of the screen. Clicking the AirPort Icon b. If the AirPort is not on, select Turn AirPort On. Selecting Turn AirPort On 36 c. Select the network - e.g., for METIman Prehospital, simulators unit number). MMPXXX (where XXX is the Selecting METImans Network The AirPort dialog box appears. The AirPort Dialog Box d. Enter the password metiadmin into the Password field. e. Click OK. Select a network Click OK Connecting to METImans Network The computer has joined the METIman network. You can now proceed to Step 5. Setup 37 Step 4 Option 2: Join the METIman Network Using a Windows Operating System a. Click the screen. Wireless Network icon located in the bottom-right-hand corner of the Clicking the Wireless Network Icon b. Click Connect to a Network. Clicking Connect to a Network The Connect to a network dialog box appears. Setup 38 c. Select the network, i.e., METIman Prehospital number). MMPXXX (XXX is the simulators unit Select a network Selecting METImans Network d. If prompted for a password, enter metiadmin into the available field e. Click Connect. Click Connect Connecting to METImans Network The computer has joined the METIman network. You can now proceed to Step 5. Setup 39 Setup Step 5: Access the Software from the TouchPro Computer On the TouchPro computer, launch the web browser (e.g., Safari a.

). b. Enter the IP address obtained in Start screen appears. Step 2 into the browsers address field. The Mse The Mse Start Screen The TouchPro software can now be launched. OPTIONAL: From your web browser, a bookmark can be created on the TouchPro computer for ease of access to the Mse or TouchPro software. Please consult your web browsers help menu for aid in creating a bookmark. IMPORTANT: The Instructor Workstation MUST remain on and connected to the METIman network for the TouchPro computer to be able to operate. 40 Using the Software Using the Software The Mse software used with the METIman simulator is a web-based application that can communicate directly with the simulator. With the software, users can run SCEs, create scenarios and SCEs, import and export data and perform administrative functions. NOTE: For optimal Mse performance, no other software programs should be open while Mse is running. IMPORTANT: Only one Mse application window and/or tab can be used per Instructor Workstation, per simulator at a time. IMPORTANT: Do NOT use any of the browsers navigational tools while operating Mse. Starting the Application Once the METIman simulator is powered on and the Instructor Workstation is connected to the METIman network, the Mse software can now be launched. To launch the software:

1. Using the Laptop or Tablet Instructor Workstation, launch the web browser (e.g., Safari, Internet Explorer). NOTE: If using a computer other than the one supplied, the computer will have to be configured to the METIman network. (The directions for using a different computer are the same as the directions for Connecting a TouchPro Computer to the Wireless Network, found on page 34.) The Mse Start Screen appears. The Mse icon The Mse Start Screen 41 Using the Software 2. Select Mse. The Login Screen appears. The Login Screen NOTE: The METIman User Guide (English version) is available for download by clicking the User Guide link in the bottom, left-hand corner of the screen. To access the User Guide in other languages, please visit www.caehealthcare.com and click the Support link. Click the globe-shaped Language icon in the bottom left corner to change the language of the Mse software. 42 Using the Software 3. Enter the access the software. Username admin and the Password admin in the appropriate fields to Enter the admin and the admin in the appropriate fields Entering the Username and Password The software opens to the Home page by default. 43 Using the Software The Home Page From the Home page, users can run, create, search for and edit SCEs. The Home page can be accessed by clicking the Home button in the top, right-hand corner of any screen in the Mse software. The Home Button The Print SCE and Add to Favorites buttons The SCE Summary Panel A selected SCE The SCE Selection Panel Open Library and New SCE buttons Run button Review button The Home Page 44 Using the Software The SCE Selection Panel Simulated Clinical Experiences, or SCEs, are process tools that enable the faculty/educator to execute a learning strategy using simulation. Each process tool provides an extensive overview and outline of the learning exercise and requires minimal additional faculty development time for use. Each SCE is comprised of a patient and can include up to four (4) scenarios. Available SCEs appear in the SCE Selection panel. Click any SCE to select it. Search field Base SCEs Running Now SCE Locked SCEs The SCE Selection Panel The SCE Selection panel has four tabs that access SCEs: Running Now, Recent, Favorites and All. lists all the recently run or edited SCEs lists the SCEs that are currently running and is only available when at Running Now least one SCE is running Recent Favorites lists all SCEs that have been selected as favorites. To add a favorite SCE to your profile, click the Add to Favorites button at the top of any SCE on the Home screen. Managing favorites is achieved in the Account Profile portion of the software. All lists all available SCEs from all available Learning Applications Click the arrow buttons to view more installed SCEs. Once selected, the SCE appears in the SCE Summary panel. 45 Using the Software To search for an installed SCE, enter part of the name of an SCE in the Search field and click the Search button. Click Run to execute the SCE. The SCE Library Access more SCEs from your library by clicking the Open Library button at the bottom of the SCE Selection panel. The SCE Library appears, listing all available Learning Applications. Click the desired Learning Application name to access the SCEs for that Learning Application. The SCEs for that Learning Application appear. Click the name of the SCE you want to open. Click the SCEs icon to view all user-created SCEs. Click Close Library to exit the SCE Library. User-created SCEs The SCE Library 46 Using the Software Printing SCEs To print an SCE:

1. 2. 3. From the Home page, select the SCE to print. The SCE summary panel appears. From the SCE summary panel, click the A PDF of the selected SCE appears in a new browser window. Print SCE button. Save the PDF to a CD or flash drive for printing from another computer, OR To print from the Instructor Workstation, consult your network administrator for assistance connecting to a printer. If the Instructor Workstation is connected to a wireless printer, the Instructor Workstation will need to be disconnected from the simulator network and connected to the network on which the printer resides before printing. After printing, the Instructor Workstation will need to be disconnected from the printers network and reconnected to the simulator network. When finished saving or printing the PDF, close the browser window containing the PDF to return to Mse. 47 Using the Software The Run Screen The Run screen is available when users are running an SCE. From the Run screen, users can manage the SCE, view physiological status and events and perform overrides and interventions. From the Home screen, click Run to access the Run screen. The Run Screen appears. Clicking the Run Button SCE Name Patient Physiological Display widgets Scenario Events 48 Physiological View The Run Screen Conditions, Medications and Interventions palettes Using the Software Using the Patient Status Display On the Run screen, there are widgets that display the patients physiological status. The Patient Status Display widgets can be changed to reflect the users needs. There are six available display panels for the widgets. Waveform widgets utilize two display panels. The Patient Status Display Widgets 49 Using the Software To change a Patient Status Display widget, click the widget you would like to change. A list of available parameters appears. Click any widget to access a menu to change the display Changing a Patient Status Display Widget Choose the desired parameter from the list, and the widget changes to reflect the new selection. The Event Log During an SCE, all software operations sensed by the simulator or entered manually (e.g., virtual defibrillation), are recorded by an event entry that appears on the screen. The event entry notes what occurred and the time it happened. Events Logs can also be exported. The Event Logs 50 Using the Software Adding a Scenario to an SCE SCEs incorporate scenarios that contain preprogrammed physiology. Additional scenarios can be added to SCEs to enhance the current scenarios physiology. Click the Add Scenario button on the Run screen to add a scenario to an SCE that is running. The Add Scenario Button Click the Add Scenario button to add a scenario to an SCE The Select a Scenario Dialog Box Physiological Views From the Run screen, users can select from five different views representative of various body systems and features:

Neurological Respiratory Cardiovascular Fluids Sounds 51 Using the Software To access each view, click the appropriate organ, icon or button. For Speech Sounds, click the speech balloon For Neurological, click the brain. For Respiratory, click the lung For Cardiovascular, click the heart. For Fluids, click the blood droplet. For Sounds, click the Sounds button. Speech balloon Brain Heart Blood droplet Lung Sounds button From each view, various parameters can be determined and managed. Physiological Views 52 Using the Software Setting Parameters Parameter settings may be established or changed while an SCE is running in two ways: from the Conditions palette or by selecting a parameter from one of the physiological views on the Run screen. Using the Conditions Palette to Set Parameters There are two ways to apply conditions using the Conditions palette: using a Quick Link or using the complete Conditions menu. Quick Links are preconfigured conditions that are made accessible in the Conditions palette for quick application. Quick Links can also be created for the Medications and Interventions palettes. To set parameters using the Quick Links in the Conditions palette, click a Quick Link. The condition is applied and is reflected in the patients physiology. Conditions button Quick Links NOTE: Quick Links must be added while creating or editing the SCE. The Conditions Menu 53 Using the Software Or, to apply a condition that is not preconfigured in the Conditions palette, click the Conditions button. Conditions are organized by system, or all available conditions can be listed by choosing ALL CONDITIONS. Conditions Menu Navigate through the menus, and once the condition has been located, click the conditions name from the list. Selecting a Condition The condition is applied and appears in the patients physiology. NOTE: Not all conditions affect the patients physiology. 54 Using the Software Using the Physiological Views to Set Parameters From the appropriate physiological view, locate the desired parameter. Select the parameter and set the new value. The parameter is changed and is reflected in the patients physiology. Parameters have varying controls, such as sliders, switches and menus. In the image below, the Heart Rate parameter is shown. Within the Heart Rate parameter, there are switches that toggle between Modeled and Override and Seconds and Minutes, a slider that sets the beats per minute and a field where the beats per minute value can be keyed in. Toggle the switch from Override to Modeled to return to its original state Drag the slider to set the value Setting a Parameter from a Physiological View Once the parameter has been set, it is reflected in the patients physiology. 55 Using the Software Performing Interventions An intervention in the Mse software is the application of a medication or medical intervention occurring while an SCE is running. Interventions are applied using the Medications and Interventions palettes or by interacting with the simulator. Using the Medications Palette There are two ways to administer medications using the Medications palette: using a Quick Link or using the Medications menu. Quick Links are preconfigured medications that are made accessible in the Medications palette for quick application. Quick Links can also be created for the Conditions and Interventions palettes. To set parameters using the Quick Links in the Medications palette, click a Quick Link. The medication is applied and is reflected in the patients physiology, if applicable. NOTE: Not all medications affect the patients physiology, but all are logged. Medications button Quick Links NOTE: Quick Links must be added while creating or editing the SCE. The Medications Palette 56 Using the Software Or, to apply a medication that is not preconfigured in the Medications palette, click the Medications button. Medications are organized by type, or all available medications are listed under ALL MEDICATIONS. The Medications Menu Navigate through the menus, and once the medication has been located, click the medications name from the list. Selecting a Medication The medication is applied and is reflected in the patients physiology, if applicable. NOTE: Not all medications affect the patients physiology, but all are logged. 57 Using the Software Using the Interventions Palette There are two ways to perform and/or administer interventions using the Interventions palette:

using a Quick Link or using the complete Interventions menu. Quick Links are preconfigured interventions that are made accessible in the Interventions palette for quick application. Quick Links can also be created for the Conditions and Medications palettes. To apply an intervention using the Quick Links in the Intervention palette, click a Quick Link. The intervention is applied and is reflected in the patients physiology. Quick Links The Interventions button NOTE: Quick Links must be added while creating or editing the SCE. The Interventions Palette 58 Using the Software Or, to apply an intervention that is not preconfigured in the Interventions palette, click Interventions button. Interventions are organized by type, or all available interventions can be listed by choosing ALL INTERVENTIONS. Interventions Menu Navigate through the menus, and once the intervention has been located, click the interventions name from the list. The intervention is applied and is reflected in the patients physiology. Selecting an Intervention 59 Using the Software Changing Scenario States From the Run screen, users can advance scenario states as desired. A scenario state can be changed from the Scenario screen or from the Run screen. Changing Scenario States from the Scenario Screen To change a scenario state from the Scenario screen:

1. From the Run screen, click the desired loaded scenario. The Scenario Management pop-up menu appears. The Scenario Management Pop-Up Menu 2. Select Show Scenario from the Scenario pop-up menu. 60 Using the Software Jump to State button A selected state The Scenario screen appears displaying the scenario. Click a scenario and select Show Scenario to access the Scenario screen States The Scenario Screen At the top of this screen, the Scenario Time and State Time are visible. Additionally, users can also pause and continue playing the scenario by clicking the Pause and Play buttons on the Scenario Management pop-up menu, which can still be accessed from the left side of the screen. NOTE: Pausing a scenario does NOT pause the SCE. 3. Click the Jump to State button. Click the Jump to State button The Jump to State Button The Jump to State menu appears, displaying the available states. 4. Select the desired state. The scenario transitions to the selected state and the state is highlighted. NOTE: Double-click a state to expand to the full view. Click the Close Window button to return to the Run screen. The Close Window Button 61 Using the Software Changing Scenario States from the Run Screen The scenario state can also be changed from the Run screen. To change the scenario state from the Run screen:

1. Click the desired scenario. The Scenario Management pop-up menu appears, and all available states are listed. States in the scenario The Scenario Management Pop-Up Menu Pause or continue the scenario by selecting the Pause and Play options from the menu. 2. Select the desired state. The scenario proceeds to the selected state. 62 Using the Software SCE Time The Timeline bar along with the Play, Pause, Fast-Forward and Reset buttons are located at the top of the Run screen. Timeline Bar The Play button starts the SCE time if it has been paused. The Pause button pauses the SCE time. The Fast-Forward button accelerates the SCE time. The Timeline bar shows the amount of time that has elapsed and shows bookmarks that have been created. Bookmarks are used to create a point in the SCE timeline to which users may easily return. To create a bookmark, click Bookmark. The Bookmark button Bookmarks Bookmarks Exiting the SCE To exit the SCE and return to the Home page, click the Return button. The Return Button Stopping the SCE To stop the simulation, exit the SCE and return to the Home page, click Stop. IMPORTANT: Another SCE cannot be run until the current SCE has been stopped. The Stop Button 63 Using the Software Saving a Patient Save a Patient when an additional patient with different physiology is needed for repeated use. To save a Patient:

1. 2. 3. From the Home screen, run an SCE that has a Patient with the same gender as the Patient to be created. From the Run screen, apply the desired conditions and set the necessary parameters. Once complete, click Patient at the bottom of the Run screen. Clicking Patient The Patient pop-up menu appears. 4. Click Save. Clicking Save from the Patient Pop-Up Menu The Save a copy of the Patient dialog box appears. The Save a Copy of the Patient Dialog Box 64 Using the Software 5. Enter a name for the new Patient in the Enter the new patient name field of the Save a copy of the Patient dialog box. Entering a Name for the Patient 6. Click Save. The new Patient is now available in the Patients Palette. The Patient in the Patients Palette 65 Using the Software Resetting a Patient Resetting a Patient brings the Patient back to its original physiological state at the start of the SCE. However, the SCE time is unaffected. Additionally, the reset appears in the Events Log. NOTE: If patient baseline physiology settings have been selected, they are removed when the Patient is reset. To reset a Patient:

1. While running an SCE, click Patient at the bottom of the Run screen. Clicking Patient The Patient pop-up menu appears. 2. Click Reset. Clicking Reset from the Patient Pop-Up Menu The Reset the Patient warning box appears stating that the patients physiology will be reset to its state at the load time and all running scenarios will be paused. The Reset the Patient Dialog Box 3. Reset. The Patient returns to its original physiological state at the start of the Click SCE. 66 Using the Software Medication Monitor The Medication Monitor tracks the infusion of medication administered. To activate the Medication Monitor, from the Run screen, click Medication Monitor at the bottom, right-hand portion of the screen. The Medication Monitor appears as a movable box on the Run screen. Select Medication Monitor The Medication Monitor The number shown on the Medication Monitor next to each medication listing is the normalized effector site concentration. When a medication is reset from the Medication Monitor by clicking the Reset button, the reset clears the medication from the physiological model and from the Medication Monitor. With continuous infusions, the amount infused goes back to zero, but the infusion continues. If you want the infusion to completely stop, the infusion must be stopped via the Medications Library. 67 Using the Software Creating and Editing SCEs Creating and editing SCEs is a similar process. Once the SCE is created, the steps for editing are the same. Use the New SCE button to create a new SCE. Use the Review button to edit an existing SCE. New SCE Button Review Button The minimal requirements for creating a new SCE include selecting a Patient, naming the SCE and saving the SCE. Once the new SCE is created, you can continue with the SCE creation or use the Review button to edit later. To edit an existing SCE, click Review. Creating an SCE Creating an SCE begins with naming the SCE and determining the Patient Profile. To name a new SCE:

1. From the Home screen, click New SCE. New SCE Button The Patients Palette appears. 2. Select a Patient from the palette and click Create. Click the Create button to begin creating an SCE Selecting a Patient 68 Using the Software The SCE Editor appears, showing the Enter a name for the SCE dialog box. The Enter a name for the SCE dialog box The SCE Editor Screen 3. Enter the name for the SCE. IMPORTANT: When naming the SCE, the name of the SCE may NOT exceed 80 characters. Additionally, SCE file names CANNOT contain any special characters, such as / \ : * ? < > % | "

4. Save. Once the SCE is saved, it is stored and can be edited and reviewed Click at any time, including while creating a Patient Profile and content, determining settings and programming scenarios. 69 Using the Software Creating a Patients Profile and Baseline To create the Patient Profile:

1. 2. From the SCE Editor, in the Set the Patients name, age, gender and weight by filling in the appropriate fields. Profile field, click Edit. Setting the Patients Name, Gender and Weight and Changing the Patients Picture 3. 4. Save. Change Picture button if you wish to change the patients picture. Click the Click IMPORTANT: No aspect of the patients profile can contain any special characters, such as / \ : * ? < > % | "

To set the Patients Baseline:

1. From the SCE Editor, click Baseline. The Patient Baseline screen appears. The Patient Baseline Screen 2. 3. Set the Patients baseline by setting parameters. Click Save. When the SCE begins, the Patient presents with these settings. Once the SCE is named and the Patient Profile determined, the SCE content can be entered and set up using the SCE Editor. 70 Using the Software Content Management SCE Content is entered by clicking the Overview, Background, Preparation and Notes buttons under the Content Management heading in the SCE Editor. The Content Management Buttons Each screen allows users to enter different information. Click the Edit button of each section on the SCE Editor to access a rich-text editor that enables data entry. IMPORTANT: Text can be copied and pasted into the fields from TextEdit or Notepad programs only. Click Save when all data for the field has been entered. The Rich-Text Editor 71 Using the Software SCE Configuration Conditions, the TouchPro software and the Patient Status Display can be configured by clicking the buttons under the SCE Configuration heading in the SCE Editor. SCE Configuration Buttons Condition Setup Screen and Creating Quick Links Click Condition Setup to access the Condition Setup screen. From the Conditions Setup screen, conditions, medications and interventions can be preconfigured for the SCE creating Quick Links. On the Condition Setup screen, Conditions, Medications and Interventions buttons are available. Click the Conditions, Medications and Interventions buttons to navigate through the available conditions and interventions. Condition Setup Screen To create a Quick Link, drag and drop the desired choice(s) to the list of Quick Links to add them to the SCE. 72 Using the Software TouchPro Setup TouchPro software is an additional feature of the Mse software. To preconfigure the TouchPro for use with the Mse software, click TouchPro Setup under the SCE Configuration heading on the SCE Editor. The TouchPro Pre-selected Layout screen appears. The TouchPro Setup Screen From the TouchPro Pre-selected Layout screen, the following predefined layouts can be made available in the TouchPro software for a particular SCE:

Saturation-Pulse ICU-OR No CVP ICU-OR ICU-Arterial Line Only EMS-ED-Telemetry Switch On to activate a desired layout. Switch Off to deactivate a layout. Any number of the layouts may be selected. 73 Using the Software Patient Status Display To configure the Patient Status Display shown on the Run screen, click Patient Status Display under the SCE Configuration heading on the SCE Editor. The Patient Status Display screen appears. Patient Status Display Screen To preconfigure the Patient Status Display for an SCE, drag and drop the desired waveform, numeric or volume widgets on the Patient Status Display screen to an available display panel. Drag and drop the waveform into an available display panel Assigning a Waveform NOTE: Waveforms occupy two display panels. Once placed, click the widget to assign a particular physiologic parameter. 74 Using the Software Scenario Designer The Scenario Designer allows users to create or edit new scenarios. To access the Scenario Designer from the SCE Editor screen, click the Add Scenario button under the Preloaded Scenarios heading. Click the Add Scenario button The Choose Scenario dialog box appears. Clicking the Add Scenario Button The Choose Scenario Dialog Box To choose a saved scenario from the list, select the scenario and click Add. The scenario appears beneath the Preloaded Scenarios heading. Click the scenario to open it in the Scenario Designer. Enter a keyword in the Search field to search for a scenario. To create a scenario from scratch, click New. The Scenario Designer appears. IMPORTANT: When naming a new Scenario, the scenario name may NOT exceed 128 characters. Additionally, scenario file names CANNOT contain any special characters, such as / \

75 Using the Software Once the choice has been made, the Scenario Designer appears. Scenario button View buttons Canvas Conditions The Scenario Designer The Scenario Button Clicking the Scenario button accesses the Scenario drop-down menu, which allows users to save scenarios, add blank states and rename and delete selected states. The Scenario Drop-Down Menu IMPORTANT: When naming a new Scenario, the scenario name may NOT exceed 128 characters. When naming a Scenario State, the state name may NOT exceed 127 characters. Additionally, scenario file and state names CANNOT contain any special characters, such as such as / \ : * ? < > % | "

76 Using the Software Scenario Designer Views The Scenario Designer has two views: The Graphical View and the Line Item view. The Graphical View allows users to branch out scenario states. The Line Item view places the states into a linear format. Click the Graphical View button to utilize the Graphical View. Double-click on any state to expand and view it with all its components as shown in the example below. Graphical View button The Graphical View 77 Using the Software Click the Line Item View icon to utilize the Line Item view. Double-click on any state to expand and view all its components as shown in the example below. Line Item View button Line Item View 78 Using the Software Creating a New Scenario When beginning to create a new scenario, the canvas is blank. Scenario states can be created by dragging and dropping conditions, medications and interventions from their respective menus on the right side of the Scenario Designer to the canvas. Drag and drop a Condition to the canvas to create a State Dragging-and-Dropping a Condition to the Canvas Or, a new, empty state can be added by clicking the Scenario button. Once clicked, the Scenario drop-down menu appears. Click New State, and a new state appears on the canvas. NOTE: When naming a Scenario State, the state name may NOT exceed 127 characters. Additionally, scenario file and state names CANNOT contain any special characters, such as such as / \ : * ? < > % |

Modifying Scenario States Once a scenario state has been placed on the canvas, it can be modified. Additional parameters, transitions and notes can be added. Each state can contain multiple parameters and transitions. Click the state name to rename the state. Collapse State button A State Click the Collapse State button to minimize the state. Double-click the collapsed state to expand. 79 Using the Software Adding Parameters and Interventions Additional parameters and interventions can be set in two ways. Users can drag and drop additional parameters from the Conditions menu to the canvas or to states. Drag a Condition to a state Or, click the Parameters button within the state to be modified. Adding a Condition The Parameters button The Parameters Button 80 The Patient Control screen appears. Using the Software The Patient Control Screen Click the various organs to change the views, and select the desired parameter. Once a parameter has been selected, it appears in the Patient Control panel. Add as many parameters as needed. Added parameters appear consecutively within the state. Drag and drop to reorder as needed. Click Complete to save and exit the Patient Control screen, or click Cancel to exit without saving. NOTE: If the physiology of any of the parameters conflicts, the Mse software reflects the physiology of the last parameter entered. 81 Using the Software Adding Transitions To add a transition, you must have both an original state and a state that results from the transition. To add a transition:

1. Click the Create button in the original state. Creating a Transition A menu appears with all available transition variables. Transitions Menu 2. Select the desired variable from the menu. For example, if a medication is desired, select Medications, and select the desired medication from the list. Once the medication is selected a dialog box appears, asking for the proper dose and the variable. Setting a Medication Dosage and Variable 3. Once the dose and variable have been selected, click Accept. 82 Using the Software 4. Click the states appears. Select the resulting state from the menu. GOTO arrow to connect the transition. A menu listing all the available Select a State from the menu to transition to GOTO arrow Transition Menu An orange connector line appears linking the transition to the state. The orange connector line indicates a connected transition A Connected Transition 5. Follow the same steps to add multiple transitions to the state. 83 Using the Software ELSE Statements An ELSE statement is used to transition to a state automatically when none of the other programmed transitions occur. Before specifying an ELSE statement, at least one other state must be created first. To add an ELSE statement, click ELSE in the original state. A menu appears with all the available states listed. Select a State from the ELSE menu Click the desired state. A black connector line appears linking the ELSE statement to the state. ELSE Menu The black connector line indicates a connected ELSE statement A Connected ELSE Statement 84 Using the Software Deleting Scenario States To delete a state, in the Graphical view, drag and drop the state into the trash. Drag and drop the state in the trash Deleting a State in the Graphic View In the Line Item view, drag and drop the state into the trash. Drag and drop the state in the trash Deleting a State in the Line Item View Deleted states remain in the trash can until you log out of the software or the trash is cleared. 85 Using the Software Deleting Parameters and Transitions From an active state, drag and drop the desired parameter or transition into the trash. Drag and drop the parameter in the trash Deleting a Parameter 86 Using the Software Emptying the Trash From the Scenario Designer screen, click the Trash Can. All items placed in the trash are listed. Trash Can Contents Click Empty Trash to empty the trash. If you do not wish to delete the items listed, they can be dragged back into the scenario, at which time they are removed from the trash. Logging out of the software automatically empties the trash. NOTE: Items emptied from the trash cannot be retrieved. 87 Using the Software Saving the Scenario At any time during scenario creation or modification, the scenario can be saved. To save scenarios, click the Scenario button to access the Scenario drop-down menu. To save on the most recent version of a modified scenario, click Save. To save a new scenario, click Save As. Or, when Save is clicked when saving a new scenario, users receive the same prompts. To save a modified scenario as a new scenario, click Save As. When Save As is clicked, the Save Scenario dialog box appears. The Scenario Drop-Down Menu Enter a name for the scenario in the Enter scenario name field. The Save Scenario Dialog Box Enter the name for the scenario in the Enter scenario name field and click Save. IMPORTANT: When naming a new scenario, the scenario name may NOT exceed 128 characters. Additionally, scenario file names CANNOT contain any special characters, such as /

88 Using the Software Saving States to the State Library Users can save states in the State Library for later use. To save a state, drag and drop the state to the State Library button. Drag and drop states to the State Libary button to save them The state is stored in the library and appears in the State Library panel. A Saved State A saved state Click Conditions Library to Exit the State Library. A Saved State 89 Using the Software Administrative Tools The Mse software has administrative tools that allow users to manage logs, stored content, users and system settings. The administrative tools are accessed via the Administrative Tools buttons, located on the Home screen. System Administration button History button Administrative Tools Buttons Account Profile button Click the History button to view and manage Simulation Session Logs. Click the System Administration button to manage stored content, user accounts, groups and system settings. Click the Account Profile button to manage and determine preferences for the active account. History From the History screen, users can view and export the Simulation Session Logs of performed SCEs. Each Simulation Session lists the Start Time, the title of the SCE and the Patients name. In addition, the Physiological Data and Simulation Events Logs are available for review and download. The History Screen By clicking the Simulation Events link of a Simulation Session, users can view the entire log of the simulation and all the events that occurred during the SCE. When the Physiological Data link of a Simulation Session is clicked, users can view all the physiological data that occurred during the SCE. On both the Simulation Events and Physiological Data screens, there is an Export button that, when clicked, exports the data to a CSV file that can be stored on an external device. 90 Using the Software System Administration From the System Administration screen, users can control and access Content Management, User Accounts, Groups and System Settings. To access the System Administration screen, click the System Administration button from the Home screen. The System Administration Button Content Management From the Content Management screen, users can manage Learning Applications, SCEs, Patients, Scenarios and Conditions. To access the Content Management screen, from the System Administration screen, click Content Management. The Content Management Button 91 Using the Software Learning Applications From the Content Management screen, click Learning Modules to access the Learning Applications screen. Click Learning Modules to access the Learning Applications screen Install Learning Module button The Learning Applications Screen The Learning Applications screen appears, listing all available CAE Healthcare Learning Applications and their accompanying SCEs. Additionally, Learning Applications can be installed from this screen. To install a Learning Application:

Install Learning Module. The Select file to upload dialog box appears. Click Locate the correct Learning Application file on the Learning Application CD. The file extension is sce. Select the file and click Refresh the screen by clicking the follow the steps above for accessing the Learning Applications screen. The Learning Application appears on the Learning Applications screen and is available for use. Home button in the Mse software and then Select. 1. 2. 3. 4. 92 Using the Software SCEs From the Content Management screen, click SCEs to access the SCEs screen. All user-created SCEs appear in the SCEs panel. Click SCEs to access the SCEs screen Import SCE button The SCEs Screen On the SCEs screen, users can import and export the SCEs they have created. NOTE: SCEs purchased from CAE Healthcare CANNOT be exported. Click Import SCE to import an SCE from an external device as an sce file. Click Export to export an SCE to an external device. 93 Using the Software Base Patients From the Content Management screen, click Base Patients to access the Base Patients screen. All Patients appear in the Patients panel. Click Base Patients to access the Base Patients screen Import Patient button The Base Patients Screen On the Base Patients screen, users can rename, review, delete, import and export Patients they have created by clicking the respective buttons within each Patient. Locked Patients can only be reviewed from this screen. Click Import Patient to import a Patient file from an external device. Click Export to export a Patient file to an external device, such as the Instructor Workstations hard drive or a USB portable device. 94 Using the Software Scenarios From the Content Management screen, click Scenarios to access the Scenarios screen. All Scenarios appear in the Scenarios panel. Click Scenarios to access the Scenarios screen Import Scenario button Create New Scenario button The Scenarios Screen On the Scenarios screen, users can rename, review, delete, import and export Scenarios they have created. Locked Scenarios can only be reviewed from this screen. Users can also create new scenarios from the Scenarios screen by clicking the Create New Scenario button. User-created scenarios can be renamed, reviewed and deleted from the Scenarios screen by clicking the respective buttons within each scenario. Click Import to import a scenario file from an external device. Click Export to export a scenario file to an external device. 95 Using the Software User Accounts From the User Accounts screen, users can create, edit and delete users. To access the User Accounts features, on the System Administration screen, click User Accounts. Click User Accounts to access the User Accounts screen The User Accounts Screen 96 Using the Software Creating a User To create a new user:

1. Click the screen and requests information about the user. New button in the Users panel. The User Data panel appears on the Creating a New User 2. Enter the users personal data. First Name Last Name Email Password The password should be one that is not easily guessed Confirm Password NOTE: A suggested User ID is generated automatically when the users first and last names are entered; however, an alternate User ID can be entered. 3. 4. Assign the user to a Group by clicking on the group name in the Groups panel. New groups can be created as well. Users may be assigned to only one group. Click Create. 97 Using the Software Editing a User Edit a user when changes are needed to the user account. To edit a users information or privileges:

1. 2. 3. From the Users panel, select the user to edit. Click Make the desired changes and click Save. Edit. The users details appear in the User Data panel. Deleting a User Delete a user when the user is no longer needed. To permanently delete a user:

1. 2. 3. Delete. From the Users panel, select the user to be deleted. Click The User Deletion Warning box appears stating any content created by this user will be reassigned to your account and asks if you are sure you want to delete the user. The User Deletion Warning Box 4. Yes. Click The user and his corresponding data are deleted. However, any SCEs, scenarios or Patients created default to the user who deleted him. 98 Using the Software Groups Users are assigned to groups to define access privileges. To access the Groups screen, from the System Administration screen, click Groups. Click Groups to access the Groups screen The Groups Screen From the Groups screen, users can create new groups, delete groups and assign privileges to groups. In the Groups panel, three groups appear by default. Administrators Educators Deactivated Users Each default group has privileges assigned. 99 Using the Software Privilege System The Mse software has three different privileges:

System Management User Management Content Management User Management and Content Management can be assigned independently or combined. The System Management privilege contains all privileges. System Management Users with the System Management privilege have access to all features of the Mse software, including the benefits of the User Management and Content Management privileges, listed below. Users with the System Management privilege can also view system settings, back up and restore data and apply software updates. User Management Users with the User Management privilege can manage all users and groups. Content Management Users with the Content Management privilege can create and manage all SCEs. IMPORTANT: Users with the System Management or User Management privilege can DELETE other users, including the default meti admin account. Once deleted, this account cannot be recovered. Please ensure users with the System Management or User Management privilege take care not to delete the default meti admin account. 100 Using the Software Creating a New Group Create a new Group to have an alternative to the preconfigured Groups. To create a new Group:

1. 2. 3. From the Groups screen, click The Group Name field appears. New. Create Group. Enter the name of the Group in the Click The group appears in the Groups panel on the Groups screen. Privileges can now be selected. Group Name field. 4. 5. Select the privilege(s) to be assigned to the Group. Click Save. Deleting a Group Delete a group when it is no longer needed. Once a Group is deleted, all users who were affiliated with the Group default to the Deactivated Users Group. To permanently delete a Group:

1. 2. 3. Delete. The Group Deletion warning box appears asking if you want to From the Groups screen, click the group to be deleted. Click continue. Click Yes. The Group is deleted. 101 Using the Software Maintenance From the Maintenance screen, users can flush the fluids from their METIman simulators. For more instructions on how to flush the simulator, see the Care and Maintenance section. Click Maintenance to access the Maintenance screen The Maintenance Screen 102 Using the Software System Settings From the System Settings screen, users can view system information, back up and restore data, manage product licensing, view the error log and change the language of the Mse software. To access the System Settings screen, from the System Administration screen, click System Settings. Click System Settings to access the System Settings screen The System Settings Screen System Configuration Under System Configuration, Disk Space and System Time are displayed. Data Management The Data Management feature allows users to back up data to an external device. Users can also restore the backup data. Backing Up Data Back up data to protect and store content and user data. To back up data:

1. On the System Settings screen, click the A Save dialog box appears. Back Up Data button. 2. 3. Select a location to save the backed up data. Click Save. 103 Using the Software Restoring Data Restore data when the backed up data needs to be replaced on the software. Restoring data only restores the last backup and does NOT merge the backup data with the current data. To restore backup data:

1. 2. 3. Restore Data. On the System Settings screen, click The System Restore warning box appears stating that restoring data erases all current data and asks if you want to continue. Click A select file dialog box appears. Yes. 4. 5. Locate the appropriate file to restore the data. Click Select. The data is restored. Product Licensing To view product licensing information for your simulator or to enter a license key to activate your software, click Product Licensing. Error Log The Error Log is available for technicians and is used when diagnosing the Mse software. Localization To change the language of the Mse software, click Change Language, select a language and click OK or Accept. NOTE: Only the English version of the User Guide is available via the software, regardless of the Mse language selection. To access the User Guide in other languages, please visit www.caehealthcare.com and click the Support link. 104 Using the Software Account Profile From the Account Profile screen, users can view, update and reset personal profile information. From the Account Profile screen, users can also view and add favorite SCEs. Click the Account Profile button to access the Account Profile features. The Account Profile Button Profile Information From the Account Profile screen, click Profile Information to access the Profile Information screen. From this screen, users can change their profile information and reset their passwords. Click Profile Information to access the Profile Information screen The Profile Information Screen To change profile information, enter the new information in the appropriate field and click Update Profile when finished. To reset a password, enter the new password in the New Password field and re-enter the new password in the Confirm Password field. Click Change Password when finished. 105 Using the Software Favorite SCEs To access the Favorite SCEs screen, click Favorite SCEs from the Account Profile screen. All of the logged-in users favorite SCEs appear in the Favorite SCEs panel. Click Favorite SCEs to access the Favorite SCEs screen Add Favorites button The Favorite SCEs Screen To add SCEs to the Favorite SCEs panel, click Add Favorites. The SCE Library appears. Select the desired SCE, and it automatically appears in the Favorite SCEs panel. 106 Using the Software Medication Preferences From the Medication Preferences screen, found under Account Profile, users can import customized medication response files created in the Pharmacology Editor software. Click Medication Preferences to access the Medication Preferences screen The Medication Preferences Screen 107 Using the Software Profile Preferences Profile preferences allow users to change the font size. Click Profile Preferences to access the Profile Preferences screen The Profile Preferences Screen 108 Using the Software Using TouchPro The TouchPro software enables users to view the patients physiology. The software can be used from the Instructor Workstation or on another computer provided that computer has joined METImans wireless network. Accessing the TouchPro Software Like the Mse software, the TouchPro software is compatible with computers that have touch-

screen capabilities. To run the TouchPro software, the Instructor Workstation must be connected to the METIman network. An SCE must be running on the Mse software for any physiological data to be displayed on the TouchPro software. The TouchPro software can only show one Patient at a time. 1. Using the Instructor Workstation, with the Mse software running, open a new tab in the web browser and go to the Home page of the web browser. The Mse Start Screen appears. The Mse Start Screen 2. Select the TouchPro icon. 109 Using the Software When TouchPro opens, the simulated patient monitor appears. The TouchPro Display NOTE: If using TouchPro on a separate computer other than the Instructor Workstation, the additional computer must be on METImans network. For instructions on how to join the TouchPro computer to the METIman configuration, please refer to page 34. 110 Using the Software Modifying the TouchPro Display The layout of the waveforms and numeric data shown on the TouchPro software can be customized. Changing the Layout The TouchPro software can show up to six waveforms plus an additional four numeric readouts. There are five preconfigured layouts:

EMS-ED-Telemetry - preconfigured with a waveform and numeric readout for ECG Lead II and numeric readouts for SpO2 and noninvasive blood pressure (NIBP). ICU-OR Arterial Line Only - preconfigured with waveform and numeric readouts for ECG Lead II, ECG Lead V, ABP, Pleth and a numeric readout for Body Temperature. ICU-OR No CVP - preconfigured with waveform and numeric readouts for ECG Lead II, ECG Lead V, ABP, PAP and Pleth, and numeric readouts for NIBP, Thermodilution C.O., Blood Temperature and Body Temperature. ICU-OR - preconfigured with waveform and numeric readouts for ECG Lead II, ECG Lead V, ABP, PAP, CVP and Pleth, and numeric readouts for NIBP, Thermodilution C.O., Blood Temperature and Body Temperature. Saturation-Pulse - preconfigured with numeric readouts for SpO2 and pulse. 111 Using the Software Selecting a Preconfigured Layout To select a preconfigured layout, click Settings, select the layout from the Layouts panel and click the Close Settings button. Close Settings button Select a layout from the Layouts panel Settings Menu NOTE: Preconfigured layouts must be enabled in the Mse TouchPro Setup for the currently running SCE to be accessible in the Layouts panel. For more information, see TouchPro Setup on page 73. 112 Using the Software Changing a Waveform or Numeric Display Waveforms and numeric displays can be changed to suit the users needs. To change a waveform or numeric display:

1. Click the waveform or numeric to be changed. The Wave Vital Selection menu or the Numeric Vital Selection menu appears, displaying all the available waveforms or numerics. Wave Vital Selection Menu 2. Select the desired waveform or numeric. The new waveform or numeric is reflected on the screen. From the Wave Vital Selection menu, the alarm, color and scale can be set for the waveform using the Set Alarm, Set Color and Set Scale buttons. From the Numeric Vital Selection menu, the color and alarm for the numeric can also be established using the Set Color and Set Alarm buttons. 113 Using the Software Adding a Waveform The TouchPro software supports up to six waveforms. To add a waveform:

1. Click the Settings button in the bottom right corner of the TouchPro display. The Settings Button The Settings menu opens and the Add Waveform and Remove Waveform buttons appear. 2. Click the plus button in the location above which you want the empty waveform to appear. An empty waveform field appears. Add or Remove Waveform buttons An empty waveform field Adding an Empty Waveform Field 114 3. Click the empty waveform field. The Wave Vital Selection menu appears. Using the Software The Wave Vital Selection Menu 4. Select the desired waveform from the Wave Vital Selection menu. The new waveform or numeric is reflected on the screen. Adding a Numeric Display The TouchPro software contains four numeric display fields. All four numeric display fields are located on one row beneath the waveform displays. When fewer than four numeric readouts are being displayed, the remaining fields are blank. To add a numeric to a blank display field:

1. Click a blank numeric display field. Click a blank numeric display field Clicking a Blank Numeric Display Field 115 Using the Software The Numeric Vital Selection menu appears. The Numeric Vital Selection Menu 2. Select the desired numeric. The new numeric vital display is reflected on the screen. Moving a Waveform or Numeric Display Waveforms and numerics can be moved on the screen to suit the users needs. To move a waveform or numeric, click the desired waveform or numeric, and drag and drop the display to a desired location. Drag and drop a waveform to a desired location Moving a Waveform 116 Using the Software Saving a Layout Once a desired layout has been configured, it can be saved and reused. To save a layout:

1. 2. 3. Ensure the correct waveforms and numerics are in place. Click The Settings menu appears. Settings. Save As. Click The Save Layout window appears. 4. In the Save Layout window, in the Layout Name field, enter a name for the layout. Enter the name for the layout in the Layout Name field Entering a Layout Name 5. 6. Save. Click Click the Close button to exit the Settings menu. Saved layouts can be deleted from the Settings menu by dragging and dropping them in the Trash. NOTE: When a layout is saved, it is available for use only with the current SCE. To enable the layout for use with any other SCE, enable the layout from the TouchPro Setup panel for the desired SCE. See TouchPro Setup on page 73 for more information. 117 Using the Software Sounds All sounds can be silenced by clicking Mute. To set up the audio for the TouchPro, from the Settings menu, click Audio Setup. The Mute Button The Audio Setup Menu From the Audio Setup window, select a waveform to set it as the pulse sound. Once a waveform is selected, the Audio Setup window automatically closes. Clicking the Mute button from the Audio Setup window mutes all alarms. Click the Mute button again to return the alarms to their original state. 118 12-Lead ECG To view a 12-lead ECG report, click the 12-Lead ECG button at the bottom of the TouchPro screen. Using the Software The report appears. The 12-Lead ECG Button A 12-Lead ECG Report The report can be printed or saved by clicking the Print button in the bottom right corner of the 12-

lead ECG report.. To close the report, click the Close button. IMPORTANT: Prior to saving the report as a PDF or printing to a network printer, the print presets must be adjusted. The page oritentation must be set to Landscape and the margins must be set to .25 inches on all sides. These settings vary in location depending on the operating system (i.e., Macinstoh, Windows). To save the report to a PDF file on a Macintosh Instructor Workstation:

1. 2. 3. From the 12-lead ECG report screen, click the Print button located in the bottom right corner of the 12-lead ECG report. Select the Save As PDF option. The report saves as a PDF on the Macintosh Instructor Workstation. To save the report to a PDF file on a Windows Instructor Workstation:

1. 2. 3. 4. From the 12-lead ECG report screen, click the Print button located in the bottom right corner of the 12-lead ECG report. The Print dialog box appears. From the drop-down menu, select Microsoft XPS Document Writer. The report saves on the Windows Instructor Workstation. To print a report:

1. From the 12-lead ECG report screen, click the Print button located in the bottom right corner of the 12-lead ECG report. Select the appropriate network printer. 2. NOTE: A network printer must be configured in order to appear as an option. 3. 4. Click the Print button. The report prints to the designated network printer. 119 Using the Software NIBP Cycling and Manual NIBP When non-invasive blood pressure (NIBP) is displayed, the patients NIBP can be updated at specified intervals using NIBP Cycling, or the current NIBP can be displayed immediately using the Manual NIBP button. To set the patients NIBP to be updated at regular intervals, from the Settings menu, click NIBP Cycling. The NIBP Cycling menu appears. From the NIBP Cycling menu, select the desired interval for the cycling and click Start. Custom cycling is also available. The NIBP Cycling Menu 120 To display the patients current NIBP, click the Manual NIBP button. Using the Software The Manual NIBP button The Manual NIBP Button The current NIBP is displayed. NOTE: Manual NIBP can be used at any time during cycling. However, this turns off auto-

cycling. 121 Using the Software Patients To view the available Patients, click the Settings button in the bottom, right-hand corner of the TouchPro screen to access the Settings menu. From the Settings menu, click Patients to view the current Patient. NOTE: When connected to the simulator, the TouchPro only displays the active Patient. Available Patients 122 Using the Software Configuring the TouchPro Software Configure the background color, alarm suspension time and language selection of the TouchPro from the Configure panel. To access the Configure panel:

1. 2. 3. Settings button in the bottom, right-hand corner of the TouchPro screen. Configure button from the Settings menu. Click the Click the From the Configure panel, set the background color and alarm suspension time. Exit button The Configure Panel 4. Click the Exit button to exit the Configure panel when finished. 123 Using the Software Changing the Language of the TouchPro Software To change the language of the TouchPro software:

1. 2. 3. Settings button in the bottom, right-hand corner of the TouchPro screen. Language Selection button from the Settings menu. Click the Click the From the Language Selection panel, select a language. The Language Selection Panel Click Accept. Exiting the TouchPro Software To exit the TouchPro Software, Settings button from the bottom, right-hand corner of the TouchPro Shutdown. A warning box appears asking if you Click the screen. From the Settings menu, click want to exit. Click Shutdown. 1. 2. 3. 124

Using METIman Using METIman Once METIman has been set up (see the Setup section) and the software has been launched

(see the Using the Software section), the simulator is ready for learner interventions. The features of METIman are broken down by Neurological, Respiratory, Cardiovascular, Gastrointestinal and Genitourinary systems. The Run Screen 125 Using METIman Neurological The clinical features that can be controlled from the Neurological Assessment view are Blinking Eyes, Reactive Pupils, Convulsions, Neuromuscular Block, Body and Blood Temperature and Speech. To access the Neurological view, from the Run screen, click the brain on the human form. Click the brain to access the Neurological view The Neurological View Neurological parameters 126 Using METIman Eyes The pupil diameter, pupil reactivity, blinking and blink speed of the simulators eyes can be controlled from the software. Click the Reactive drop-down menus of each eye to determine reactivity: Reactive, Non-

Reactive, Pinpoint or Blown. Click Auto to have the eyes blink while the patient is conscious. Click Closed to close the eyes. Click Blinking to force the eyes to be open and blinking regardless of patient consciousness. These features can be controlled on both eyes. Click Slow, Normal or Fast to control the blink speed. Convulsions METIman simulates convulsions when the feature is activated on the software. To activate the Convulsions feature, click the Convulsions switch. The Convulsions feature is activated when On appears. To deactivate the convulsions feature, click the switch again. The feature is deactivated when Off appears. Neuromuscular Blockade To manually adjust the Neuromuscular Blockade (NMB: Set), click NMB. The NMB slider appears. Set the percentage by dragging the arrow up or down. Click Accept to exit and save the changes. Body Temperature To control a patients body temperature, click Temperature: Body. The Body Temperature slider appears. Set the body temperature by dragging the arrow up or down. Click Accept to exit and save the changes. Blood Temperature To manually control a patients blood temperature, click Temperature: Blood. The Blood Temperature slider appears. Set the temperature by dragging the arrow up or down. Click Accept to exit and save the changes. 127 Using METIman Head Secretions (Prehospital Only) Secretions of the eyes, nose and mouth are manually controlled with a gravity feed. NOTE: An IV bag is needed for each site in use. To use the head secretion features:

1. 2. 3. 4. 5. 6. Using a 60 mL syringe, prime the line of the desired secretion by injecting fluid into the NOSE, MOUTH or EYES port on METImans left shoulder until fluid emerges from the secretion sites. Set up the IV pole near the simulator. Fill an IV bag with the clinically appropriate fluid. Use distilled water only, with food coloring, if desired. Hang the IV bag on the IV pole. Ensure the roller clamp is closed and insert the IV spike into the IV bag. Connect to the simulator by attaching the end of the IV spike set tubing to the NOSE, MOUTH or EYES port on the simulators left shoulder. (Repeat for each site necessary.) The NOSE, MOUTH and EYES ports METIman Prehospitals Left Shoulder 7. 8. Open the clamp and allow fluid to flow into the simulator. Keep the IV bag attached. Adjust the flow rate manually using the roller clamp. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. 128 Using METIman Respiratory METIman Prehospitals Respiratory system is comprised of the airway management, spontaneous breathing and ventilation features. On METIman Nursing, various clinical signs such as breath sounds, chest excursion and airway patency can be physically demonstrated. A series of speakers inside each simulator can generate a range of breath and throat sounds used in diagnosing conditions. To access the Respiratory parameters of METIman, on the Run screen, click the lung on the human form. The respiratory parameters appear on the Run screen. Click the lung to access the Respiratory view Respiratory parameters The Respiratory View 129 Using METIman Airway Various clinical signs such as breath sounds, chest excursion and airway patency can be physically demonstrated. A series of speakers inside the simulator can generate a range of breath and throat sounds used in diagnosing conditions. METIman Prehospitals anatomically realistic upper airway provides for the opportunity to intubate the patient as well as apply other airway interventions. In addition, the METIman Prehospital airway was designed to be a difficult airway that teaches learners to use the best technique when encountering clinical situations with real patients. The airway is best visualized when using the Sellick maneuver, which is performed when a patient is undergoing the intubation procedure. The METIman Nursing airway has the ability to produce secretions to allow for suctioning. 130 Using METIman Anatomy, Physiology and Clinical Signs Realistic Upper Airway (Oropharynx, Nasopharynx and Larynx)

(Prehospital only) Airway Features Clinical Interventions, Patient Monitoring and Scenarios. Allows direct laryngoscopy, oral and nasal intubation and use of specialty airway devices. Simulator detects and responds appropriately to right mainstem intubation. Endobronchial intubation results in unilateral chest excursion and breath sounds. Software Control Manual Control None required. None required. Trachea, Left and Right Mainstem Bronchi Tracheal intubation results in bilateral chest excursion and breath sounds. None required. None required.

(Prehospital only) Airway Management and Ventilation Gastric Distention

(Prehospital only) Breakaway Teeth

(Prehospital only) Tongue Edema

(On/Off) Posterior Pharynx Swelling

(Prehospital only) Laryngospasm

(Prehospital only) Cricothyroid Membrane Alveolar and arterial gas concentrations appropriately reflect the efficacy of ventilation and oxygen administration. Oxygen administration input by the instructor. None required. Esophageal intubation results in gastric distension and the absence of breath sounds, chest excursion and CO2 output. VIEW: Respiratory None required. None required. Upper front teeth can be dislodged if laryngoscopy is performed incorrectly. None required. See Breakaway Teeth Hinders, but does not prevent, intubation. Obstructs view of larynx to prevent intubation, but allows mask ventilation cant intubate, can ventilate scenario. Closes vocal cords and prevents intubation and ventilation. When used with posterior pharynx swelling, creates a cant intubate, cant ventilate scenario. Allows needle cricothyrotomy, transtracheal jet ventilation, retrograde wire techniques and cricothyrotomy. VIEW: Respiratory None required. VIEW: Respiratory None required. VIEW: Respiratory None required. None required. See Cricothyrotomy, 131 Using METIman Swollen Tongue The swollen tongue feature is activated on the Respiratory view by setting the Swollen Tongue switch to Swollen. Posterior Pharynx Swelling (Prehospital Only) Swelling of the posterior oropharynx (posterior airway occlusion) can be activated to obstruct the view of the larynx and prevent intubation, but allow mask ventilation of the patients lungs, thereby creating a cannot intubate, can ventilate scenario. Click the Airway Occluder switch to activate the feature. 132 Using METIman Realistic Upper Airway (Prehospital Only) The upper airway of METIman Prehospital is designed to allow for intubation and laryngoscopy. Oral and nasal intubation can be performed using a variety of airway devices, including LMAs (3), endotracheal tubes (6.5 mm to 7.5 mm), nasal-pharyngeal airways (30 mm) and oropharyngeal airways (90 mm). Intubation The simulator detects and responds appropriately to right mainstem intubation, and an event is recorded in the Event Log. Intubation incorrectly applied into the esophagus causes abdominal distension. IMPORTANT Airways can be damaged by improper insertion of an airway adjunct (e.g. endotracheal tube). To protect the airway, lubricate the adjunct prior to insertion using the silicone spray provided. Use ONLY the provided SILICONE SPRAY to lubricate the adjunct. NEVER use a water-based lubricant because of resulting residue damage. 133 Using METIman Laryngospasm (Prehospital Only) A laryngospasm actuator closes the patients vocal cords and prevents both ventilation and intubation. Click the Laryngospasm switch to activate the feature. Teeth with Breakaway Incisors (Prehospital Only) METIman Prehospital is equipped with Breakaway Teeth whose front incisors become dislodged with improper handling of a laryngoscope. The teeth are tied to the upper denture with a lanyard, which prevents losing the teeth down the airway or misplacing them during storage. 134 Airway Secretions (Nursing Only) METIman Nursing allows for suctioning of fluids from the airway using a manual feed. Ensure all fluids have been removed from previous uses before each new use to prevent overfilling. Using METIman Tracheostomy Suction To use the airway secretion feature, inject up to 40 mL of clinically appropriate colored fluid into the AIRWAY FILL port on METIman Nursings left shoulder. The AIRWAY FILL port METIman Nursings Left Shoulder The trachea is now ready to be suctioned. Using the proper clinical technique, insert the suction catheter (14 Fr) until resistance is encountered at the bifurcation. Withdraw and apply suction. Fluid can be suctioned over a distance of approximately 4 cm distal to the bifurcation. NOTE: Use only distilled water with food coloring, if desired. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. 135 Using METIman Cricothyrotomy Cricothyrotomy can be simulated on METIman. Before performing a needle cricothyrotomy, the Cricothyrotomy plug must be removed, and a 2.25-inch (6-cm) length of red tape from the roll provided must be placed over the hole. To replicate a needle cricothyrotomy:

1. 2. 3. 4. 5. Spray the silicone lubricant onto the airway adjunct prior to the simulation session. To prevent damage to the simulator, always spray silicone lubricant into the airway. Locate the simulated cricothyroid membrane sealed with tape underneath the neck skin. Follow standard clinical techniques and palpate to find the cricothyroid space. Puncture the space through the neck skin of the patient simulator and into the tape membrane. This puncture goes all the way through to the trachea, simulating the clinical procedure. Users must replace the tape that simulates the cricothyroid membrane after each cricothyrotomy. NOTE: Replacement components are available in the Inventory Kit. NOTE: When ventilating through a surgical airway, the Laryngospasm feature must be deactivated, or the chest rise is not observed. NOTE: When finished using the Cricothyrotomy feature, replace the Crichothyrotomy plug. Replacing the Cricothyrotomy Tape Remove the old, punctured tape completely from the cricoid feature and use alcohol to clean the glue residue from the surface. (An alcohol prep pad works well.) Allow to dry. Cut an approximately 2.25-inch (6 cm) length of the double-sided tape from the roll provided. Carefully remove the paper backing and lightly stretch the newly revealed adhesive side of the tape over the cricoid hole and down the far side of the cricoid feature. Use the non-stick paper backing to press the tape against the cricoid feature. Cut a 2.5-inch to 3-inch (7 cm to 8 cm) length of red tape and apply it over the cricoid feature and the tape. 136 Using METIman Resealing the Membrane After a Puncture To reseal the cricoid feature, apply a small piece of red tape over the punctured area. This can be repeated a brief number of times, but when the number of layers impedes the cricothyrotomy, all existing tape must be removed and replaced with new tape. 137 Using METIman Pulmonary METIman uses both physical and mathematical models to achieve an extremely accurate simulation of respiration. METImans chest rises and falls, mimicking inspiration and expiration. METIman Prehospitals lungs also react realistically to intubation as well as to pathophysiologic states. Anatomy, Physiology and Clinical Signs Spontaneous Breathing Pulmonary System Clinical Interventions, Patient Monitoring and Scenarios. Normal tidal breathing and pathophysiological conditions such as atelectasis, pneumothorax, asthma and COPD. Exhaled CO2

(Prehospital only) Pneumothorax or Hemothorax Measure the presence or absence of CO2 during positive pressure ventilation. Increase in intrapleural volume, leading to asymmetrical breathing. Chest Excursion Breath Sounds Bronchial Occlusion Pulse Oximetry Arterial Blood Gases Synchronized with ventilation (spontaneous or positive pressure ventilation). Excursion depth proportional to tidal volume. Normal and abnormal breath sounds are independently synchronized with ventilation of the right and left lungs. Breath sounds can be auscultated over anterior and posterior anatomic locations. Completely obstructs right and/or left mainstem bronchi, simulating a lower airway obstruction

(e.g. mucus plug). This yields an inability to ventilate the lungs and asymmetric chest excursion. Oxyhemoglobin saturation (SpO2) automatically correlates with the oxygen concentration in the lungs and the intrapulmonary shunt fraction. PaO2, PaCO2 and pH are continuously calculated, and the Patient Status Display can be configured to show them. Software Control Manual Control None required, but adjustable VIEW: Respiratory None required. None required, but adjustable VIEW: Respiratory CONTROL: Intrapleural Volume

(Left or Right) None required. None required, but adjustable VIEW: Sounds None required. CO2 canister is inserted None required. None required. None required. VIEW: Respiratory None required. None required, but adjustable SpO2 probe is attached. None required, but adjustable None required. Venous Blood Gases PvO2 and PvCO2 are continuously calculated, and the Patient Status Display can be configured to show them. None required, but adjustable None required. 138 Needle Decompression

(Prehospital Only) Decompression of a pneumothorax can be performed bilaterally by inserting a needle at the midclavicular line of the second intercostal space. Pulmonary System Using METIman See Needle Decompression setup,. The instructor must adjust the amount of physiologic intrapleural air present. VIEW: Respiratory CONTROL: Needle Decompression, Intrapleural Vol: Left, Intrapleural Vol: Right Needle Decompression (Prehospital Only) Needle decompression can be performed bilaterally into a small hole located in the midclavicular line of the second intercostal space using a 14-gauge needle. To enable the Needle Decompression feature, activate the switch for the appropriate side(s). From the Respiratory view, turn the desired Needle Decompression switch to On. Needle Decompression Switch Needle Decompression When a needle is inserted in the second intercostal space, along the midclavicular line, air is released while intrapleural volume is present. Needle Decompression and Chest Tube When using the METIman Prehospital system, the Needle Decompression and Chest Tube features can be enabled simultaneously. Intrapleural volume will decrease when both are in use. 139 Using METIman Bronchial Occlusion (Prehospital Only) When bronchial occlusion is enabled, unilateral chest excursion is observed during spontaneous breathing or positive pressure ventilation. To stop airflow to the bronchi, creating a bronchial occlusion, the switch for the appropriate side(s) must be activated. From the Respiratory view, turn the desired Bronchial Occlusion switch to On. Bronchial Occlusion Switch Respiratory Rate To adjust the respiratory rate manually, from the Respiratory view, click Respiratory Rate. The Respiratory Rate slider appears. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled. Respiratory Rate Parameter Pulse Oximetry To adjust the SpO2 percentage manually, from the Respiratory view, click SpO2. The SpO2 slider appears. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled. SPO2 Parameter The SpO2 probe is integrated with the TouchPro (optional) and the physiological model. The connection for the SpO2 probe is located on the left side of the simulator. The SpO2 probe must be connected for pulse oximetry data to be displayed. CO2 Exhalation (Prehospital Only) Whether supplied via a portable canister or from an external source, the simulator exhales CO2 during positive pressure ventilation. NOTE: An optional regulator kit must be purchased to use CO2 from an external source. To use the CO2 Exhalation feature, connect the CO2 canister to the CO2 canister socket or connect the external source on the simulators right shoulder, and METIman Prehospital exhales CO2 gas. There are approximately 15 minutes of CO2 gas available once the canister is connected. 140 Using METIman Positive Pressure Ventilation When positive pressure ventilation is administered, the process is automatically detected by the simulator, and the physiologic model is sensitive to the volume administered. Gastric Distention (Prehospital Only) During esophageal intubation or overly aggressive bag valve mask ventilation, gastric distention occurs. Gastric distention is relieved by putting pressure on the abdomen. Chest Tube: METIman Prehospital METIman Prehospital has the ability to simulate chest tube drainage. The Chest Tube sites are located bilaterally in the fifth intercostal space. Use only a 28 Fr chest tube. Ensure all fluids have been removed from previous uses before each new use to prevent overfilling. Please refer to the Care and Maintenance section for directions on fluid removal. To simulate continuous chest tube drainage:

1. 2. 3. 4. 5. 6. Insert the METIman Priming Tube in the Chest Tube site. Set up the IV pole near the simulator. Fill an IV bag with the clinically appropriate fluid. Use distilled water only, with food coloring if desired. Hang the IV bag on the IV pole. Ensure the roller clamp is closed and insert the IV spike into the IV bag. Connect to the simulator by attaching the end of the IV spike set tubing to the corresponding CHEST TUBE port (LEFT or RIGHT) on the simulators right shoulder. Chest Tube ports METImans Right Shoulder 7. Open the clamp and allow fluid to flow into the simulator until fluid is seen in the METIman Priming Tube. 141 Using METIman 8. 9. Once fluid appears in the METIman Priming Tube, remove the METIman Priming Tube. The simulator is ready for chest tube insertion. Keep the IV bag attached and adjust the flow rate manually using the roller clamp. The chest tube must be fully inserted for the fluid to flow. Chest Tube Insertion NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. When the Chest Tube feature is used on METIman Prehospital, the simulator automatically detects the tube insertion and creates a log entry. On METIman Prehospital, if a small volume of fluid is needed to simulate proper chest tube insertion, the internal reservoir may be filled. To insert a small amount of fluid into the Chest Tube reservoir:

1. 2. 3. 4. 5. Insert the METIman Priming Tube in the Chest Tube site. Using a 60 mL syringe filled with clinically appropriate fluids, inject the contents into the CHEST TUBE port (LEFT or RIGHT) until fluid is seen in the METIman Priming Tube. Use distilled water only, with food coloring, if desired. Remove the METIman Priming Tube. Inject the remaining contents of the syringe into the Remove the syringe. CHEST TUBE port. Chest Tube and Needle Decompression The Chest Tube and Needle Decompression features can be enabled at the same time on the METIman Prehospital system. Intrapleural volume will decrease when both are in use. 142 Using METIman Chest Tube: METIman Nursing METIman Nursing has the ability to simulate chest tube drainage. The Chest Tube sites are located bilaterally in the fifth intercostal space. Use only a 28 Fr chest tube. Ensure all fluids have been removed from previous uses before each new use to prevent overfilling. Please refer to the Care and Maintenance section for directions on fluid removal. To simulate continuous chest tube drainage:

1. 2. 3. 4. 5. 6. Insert the METIman Priming Tube in the Chest Tube site. Set up the IV pole near the simulator. Fill an IV bag with the clinically appropriate fluid. Use distilled water only, with food coloring if desired. Hang the IV bag on the IV pole. Ensure the roller clamp is closed and insert the IV spike into the IV bag. Connect to the simulator by attaching the end of the IV spike set tubing to the corresponding CHEST TUBE port (LEFT or RIGHT) on the simulators right shoulder. Chest Tube ports METImans Right Shoulder 7. 8. 9. Open the clamp and allow fluid to flow into the simulator until fluid is seen in the METIman Priming Tube. Once fluid appears in the METIman Priming Tube, remove the METIman Priming Tube. The simulator is ready for chest tube insertion. Keep the IV bag attached and adjust the flow rate manually using the roller clamp. The chest tube must be fully inserted for the fluid to flow. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. 143 Using METIman Cardiovascular With METImans Cardiovascular system, users can replicate the clinical signs associated with cardiac activity, including palpable pulses, heart sounds and electrical activity. Anatomy, Physiology and Clinical Signs Heart Sounds 5-Lead ECG Myocardial Ischemia Palpable Pulses Non-Invasive Blood Pressure Measurement Cardiovascular System Clinical Interventions, Patient Monitoring and Scenarios. Software Control Manual Control Normal and abnormal heart sounds are synchronized to the cardiac cycle and audible to a standard stethoscope. Heart sounds can be auscultated over the left and right upper sternal border, right lower sternal border and apex. ECG waveforms can be viewed on a standard monitor and/or on the TouchPro Patient monitor. Normal and abnormal cardiac rhythms are linked to patient physiology (e.g. blood pressure, cardiac output). Myocardial oxygen supply and demand automatically influence the cardiac rhythm, yielding response to hypoxemia. Carotid, brachial, radial, femoral, popliteal, posterior tibial and dorsalis pedis pulses can be palpated bilaterally and are synchronous with the cardiac cycle. A pulse deficit automatically occurs if the systolic arterial blood pressure falls below specified thresholds. Systemic blood pressure can be measured using the return-to-flow technique. Korotkoff sounds can also be auscultated. None required;

specific sounds can be selected. VIEW: Cardiovascular None required;

specific rhythms can be selected. None required. ECG monitor may be utilized. None required, but adjustable. None required. None required, but adjustable. VIEW: Available on all views on the Run screen None required. None required. Use of modified blood pressure cuff. 144 To access the Cardiovascular parameters of METIman, on the Run screen, click the heart on the human form. The cardiovascular features appear on the Run screen. Using METIman Click the heart to access the Cardiovascular view Pulses Cardiovascular parameters The Cardiovascular View (Prehospital) 145 Using METIman Pulses: METIman Prehospital METIman Prehospital has 14 pulse sites that are activated by touch. Carotid (2) Brachial (2) Radial (2) Femoral (2) Popliteal (2) Posterior Tibial (2) Dorsalis Pedis (2) NOTE: The Dorsalis Pedis and Posterior Tibial pulses are controlled together. The left and right Carotid pulses are also controlled together. Pulses are visible and can be controlled from any physiological view. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again. Activated pulse Deactivated pulse Pulses: METIman Prehospital Active and Inactive 146 Using METIman Pulses: METIman Nursing METIman Nursing has 14 pulse sites that are activated by touch. Carotid (2) Brachial (2) Radial (2) Femoral (2) Popliteal (2) Posterior Tibial (2) Dorsalis Pedis (2) NOTE: The left and right Carotid pulses are controlled together. Pulses are controlled from the Cardiovascular view only. All pulses, unless altered by an SCE, are enabled by default. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again. Activated pulse Deactivated pulse Pulses: METIman Nursing Active and Inactive 147 Using METIman Blood Pressure METIman supports non-invasive blood pressure measurements, and systolic and diastolic readings can be obtained and manipulated through the software. Systolic and Diastolic Blood Pressure To manually adjust the systolic and/or diastolic blood pressure:

1. 2. 3. 4. Accept to exit and save the changes. The switch is now orange, indicating a From the Cardiovascular view, click the parameter of desired blood pressure. Set the pressure by dragging the arrow up or down. Click change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled. Non-Invasive Blood Pressure Measurement Blood pressure can be taken manually on either arm. Non-invasive blood pressure (NIBP) monitoring techniques can be used by attaching the standard cuff modified with a T-fitting and adapters. To modify a standard blood pressure cuff:

1. 2. Cut the blood pressure cuff tube approximately 9 cm from the cuff. Insert the barbed end tubing connectors into the cut ends of the blood pressure cuff tubes. 148 3. Secure the tubing connectors with cable ties. Using METIman An Attached Tubing Connector 4. Attach the blood pressure adapter to the connectors. An Attached Blood Pressure Cuff Adapter 149 Using METIman To get a blood pressure reading, connect the extension from the T-fitting on the blood pressure cuff adapter to either of the NIBP ports on METImans left and right shoulders. NIBP LEFT port METIman Prehospitals Left Shoulder NIBP LEFT port METIman Nursings Left Shoulder NIBP RIGHT port METImans Right Shoulder 150 Using METIman Connect the T-fitting extension to the hose. Take the non-invasive blood pressure reading using the return-to-flow technique. At appropriate cuff pressures, Korotkoff sounds are produced, and the radial pulse disappears. Attached Blood Pressure Cuff 151 Using METIman Heart Rate To manually adjust the heart rate, from the Cardiovascular view, click Heart Rate. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled. Five-Lead ECG On METIman, a 5-lead ECG is emitted from the appropriate positions for display on a standard monitor. A contact is available on METImans chest for each of the five cables. Five-Lead ECG sites 5-Lead ECG Sites The simulator generates a normal sinus ECG, as well as a broad range of abnormalities such as myocardial ischemia, sinus tachycardia and bradycardia, ventricular fibrillation and asystole. The hemodynamic response to the arrhythmias is physiologically correct. Myocardial oxygen balance and cardiac ischemia automatically influence the cardiac rhythm resulting in a realistic and automatic response of the rhythm to hypoxemia. The degree of influence can be controlled or completely overridden by the instructor. 152 Using METIman Cardiovascular Interventions/Therapy METIman can simulate chest compressions and three types of electrical therapy: defibrillation, cardioversion and pacing. Realistic Cardiovascular Interventions Clinical Interventions, Patient Monitoring and Scenarios. Software Control Manual Control Anatomy, Physiology and Clinical Signs Chest Compression Cardiac Monitoring Effective chest compression results in artificial circulation, cardiac output, central and peripheral blood pressures, palpable pulses, and CO2 return. The desired arrhythmia can be selected. Defibrillation METIman supports operation with a variety of manual and automatic external defibrillators. Cardiac Pacing Transthoracic cardiac pacemaker can be used with METIman. Pacing results in appropriate physiological changes in blood pressure and cardiac output. None required, but adjustable. None required. The response to clinical intervention must be controlled by the instructor. VIEW: Cardiovascular Defibrillation can be simulated by the instructor under the Interventions palette VIEW: Cardiovascular None required. None required. See Defibrillation below for defibrillation disk locations and instructions. See Pacing below for cardiac pacing disk locations and instructions. 153 Using METIman Chest Compressions METIman supports normal hand placement and standard compression techniques, and chest compressions can be performed. METIman can detect the compressions, and the physiology responds accordingly. Defibrillation and Cardioversion Manual defibrillation and cardioversion can be performed on METIman. Additionally, defibrillation and cardioversion are available virtually through the software. METIman is designed to safely absorb the energy discharged from manual and automatic defibrillators. Standard defibrillation energy levels should be used for positive learning reinforcement and to avoid negative training transfer. Defibrillation sites Defibrillation Sites However, use of a defibrillator for training purposes represents an operational hazard equivalent to use of a defibrillator on a real patient. Consequently, ALL SAFETY PRECAUTIONS for the use of defibrillators MUST BE FOLLOWED as if the simulator were a patient. Consult the specific defibrillators user manual for further information. 154 Using METIman The following cautions should be observed:

Defibrillation should be performed on the defibrillation electrodes only. If defibrillation is performed over any ECG electrode, high voltage may be present on the remaining connectors during the shock. This may also damage ECG circuitry. To prevent overheating, do NOT provide more than three (3) defibrillator discharges

(maximum 200 joules with a biphasic defibrillator) in a sequence. Do NOT exceed an average of two (2) defibrillator discharges per minute during the training session. Avoid a large number of consecutive discharges. For example, 20 or 25 discharges without any recovery interval may damage the system. Do NOT let the simulator come in contact with electrically conductive surfaces or objects during defibrillation. A flame-supporting atmosphere, for example, with a high content of oxygen, should be avoided during defibrillation. Keep the simulators chest dry. Special attention should be taken when using the urinary system or the chest tube feature. To prevent pitting of the chest skin electrode, do NOT apply conductive gel or conductive defibrillation pads intended for patient use. Do NOT use cables or connectors having visible damage. Do NOT spill fluids over any component inside the simulator torso. This could damage the system and may also present a possible hazard for the operator. When using a manual defibrillator, the ECG can be monitored via the defibrillator paddles. Coarse ventricular fibrillation and high-rate ventricular tachycardia cardiac rhythms are automatically recognized as shockable rhythms. With each defibrillation, the METIman automatically records the amount of energy discharged and the time defibrillation was performed. The simulated patient response to defibrillation is determined by the scenario script or instructor intervention. Thus, cardioversion is not automatically determined by the physiological models. The minimum electrical charge recognized by the circuitry within the simulator is 20 joules. For paddle placement on the chest, the simulator has two anterior defibrillation disks, which can be unscrewed, leaving threaded connections, if required. Biphasic defibrillators can be used with either paddles or hands-free connectors. Pacing Pacing can be achieved virtually by selecting the appropriate intervention in the Interventions palette. A standard transthoracic cardiac pacemaker can be connected to the simulator using the anterior contacts. The simulator automatically detects and responds to pacing signals (from 20 mA to 200 mA, in increments of 10). 155 Using METIman Subclavian Catheter (Nursing Only) The Subclavian Catheter feature allows for cleaning and dressing practice. When using the Subclavian Catheter feature, users can infuse up to 50 mL of distilled water in the line. Subclavian Catheter NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. Intramuscular Injection METIman allows for the administration of a deltoid intramuscular (IM) injection. Injection sites are located on both of METimans arms. Use only a 20- to 22-gauge needle. Intramuscular Injection 156 Using METIman IV Cannulation Veins for the IV Cannulation feature are located in the dorsum of the hands, forearms and antecubital region of the arms. Use only a 20- to 22-gauge needle. To simulate realistic flashback, the system must be primed prior to use. Ensure all fluids have been removed from previous uses before each new use to prevent overfilling. Please refer to the Care and Maintenance section for directions on fluid removal. IV Cannulation To prime the IV access ports, connect a 60 mL syringe filled with distilled water (with clinically appropriate food coloring if desired) to the IV FILL port on METImans right shoulder and firmly inject all 60 mL. This primes the arms and charges the system for Flashback and Venipuncture support. WARNING: If a flash does NOT occur, do NOT inject any fluid and remove the needle immediately. Repeat the priming directions and ensure you have injected the needle properly and into the simulated vein. IV FILL and IV DRAIN ports METImans Right Shoulder Fluids and medications can be administered intravenously. Approximately 50 mL of fluid may be infused. To support infusion of larger volumes, connect an empty IV bag or other receptacle to the IV DRAIN port located on METIman right shoulder. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. 157 Using METIman Fluids METIman is capable of bleeding simultaneously at two sites from an internal tank. Arterial and venous bleeding can be simulated. Venous settings produce a continuous bleed at three user-adjustable flow rates. Arterial settings produce a pulsing flow synchronized with the cardiac cycle at three user-

adjustable flow rates. The flow rate is determined by the selected bleeding vessel size and the blood pressure. In addition, the simulator features auto-sensing of hemorrhage control (e.g., tourniquet application or direct pressure). Bleeding results in an automatic loss of blood from the physiologic models with subsequent changes in hemodynamics. Blood loss occurs at a rate dependent on wound size and Mean Arterial Pressure (MAP). Setup must be completed before using the bleeding feature. To enable bleeding, on the Run screen, click the blood droplet. The Fluids view appears. Bleeding parameters Click the blood droplet to access the Bleeding view The Fluids View Simulated blood MUST be removed from the simulator after each use. Failure to remove simulated blood from the simulator can void the warranty. For instructions on how to clean the simulator after using the Bleeding feature, please refer to the Care and Maintenance section for directions on fluid removal. 158 Using METIman Hemorrhage Setup The user determines the type and placement of the bleeding moulage for the lesson. An optional Moulage Kit can provide molded gunshot wounds, broken and protruding bones, amputations and an abdominal wound as well as theatrical components. To decrease the likelihood of staining, apply a thin coat of petroleum to the area of bleeding. To use one of the moulage wounds from the Moulage Kit:

1. 2. Secure the wound over the simulator using the integrated straps. Connect the wound haptic to the one of the moulage ports located on METImans right shoulder (UPPER MOULAGE) or right hip (LOWER MOULAGE). UPPER MOULAGE port METImans Right Shoulder LOWER MOULAGE port METImans Right Hip 3. Bleeding: Upper or Bleeding: Lower on the Fluids view of the Mse Enable software, as desired. Hemorrhage Control When bleeding is controlled (e.g., hemostat, tourniquet), the action is detected and logged, and the physiology responds accordingly. 159 Using METIman Tourniquet Application A tourniquet may be applied to stop the flow of blood. The wound umbilical contains an 18-inch section of soft tubing that allows the use of a tourniquet to stop the flow of blood. For added realism, the simulator should be dressed in clothing that can be torn to conform with the type of injury being demonstrated. Bleeding moulages and the wound umbilical should be concealed under the victims clothing with only the wound showing. Tourniquet Application Fluid Loss Blood To manually control a patients blood loss, from the Fluids view, click the Fluid Loss Blood parameter. The Fluid Loss Blood slider appears. Set the amount of blood loss by dragging the arrow up or down. Click Accept to exit and save the changes. Fluid Loss Plasma To manually control a patients plasma loss, from the Fluids view, click the Fluid Loss Plasma parameter. The Fluid Loss Plasma slider appears. Set the amount of Plasma loss by dragging the arrow up or down. Click Accept to exit and save the changes. 160 Using METIman Gastrointestinal METIman produces realistic bowel sounds. In addition, on METIman Nursing, gastric lavage, gavage and suction can be administered. Gastrointestinal Gavage, Lavage and Suction (Nursing Only) METIman Nursing has a gastric reservoir that allows for simulated gavage, lavage and gastric suction. Before each use, ensure the reservoir has been drained completely. The reservoir should be primed with 60 mL of fluid before performing gastric suction (see Gastric Suction on page 162 for more information). A maximum of 100 mL of fluid may be added to the gastric reservoir once the reservoir is primed. Gavage (Nursing Only) To perform gastrointestinal gavage, ensure the reservoir is empty and infuse fluid according to procedure using a 14 Fr nasogastric tube. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. NOTE: Ice the nasogastric tube if extra rigidity is needed for insertion. Lavage (Nursing Only) To perform gastrointestinal lavage, ensure the reservoir is empty and infuse fluid normally using a 14 Fr nasogastric tube. Fluids can then be removed according to proper clinical procedure. Gastric Lavage NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. NOTE: Ice the nasogastric tube if extra rigidity is needed for insertion. 161 Using METIman Gastric Suction (Nursing Only) To perform gastric suction, the reservoir must be primed prior to use. To prime the gastrointestinal reservoir, attach a syringe with a luer-lock extension set (provided) and inject 60 mL of distilled water into the GASTRIC FILL port on the simulators left shoulder. The GASTRIC FILL port METIman Nursings Left Shoulder Fluids can then be removed according to procedure using a 14 Fr nasogastric tube. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. 162 Using METIman Genitourinary System METIman may be configured with either male or female genitalia, either of which allows for the insertion of a urinary catheter. The genitourinary system also provides for the excretion of urine. Urinary Catheterization Catheterize the simulator using a standard 16-Fr urinary catheter lubricated with silicone spray. The bladder for the simulated urine is accessed directly via the urethra. Urinary Catheterization 163 Using METIman Simulating Urine Output METIman allows urinary catheterization and simulation of urinary output. Ensure all fluids have been removed from previous uses before each new use to prevent overfilling. Please refer to the Care and Maintenance section for directions on fluid removal. To simulate continuous urinary output:

1. 2. 3. 4. 5. Set up the IV pole near the simulator. Fill an IV bag with the clinically appropriate fluid. Use distilled water only, with food coloring if desired. Hang the IV bag on the IV pole. Ensure the roller clamp is closed and insert the IV spike into the IV bag. Connect to the simulator by attaching the end of the IV spike set tubing to the port on the simulators left shoulder. GU The GU port METIman Prehosptials Left Shoulder The GU port METIman Nursings Left Shoulder 164 Using METIman 6. 7. 8. Open the clamp and allow fluid to flow into the simulator. There is a reservoir inside the simulator that fills up with the fluid. Keep the IV bag attached. Adjust the flow rate manually using the roller clamp. Catheterize the simulator using a 16-Fr urinary catheter lubricated with silicone spray. The urinary catheter must be fully inserted for the fluid to flow. NOTE: Cleanup is very important when using simulated fluids. Please refer to the Care and Maintenance section for directions on fluid removal. If a small volume of fluid is needed to simulate proper urinary catheterization in a field location, the internal reservoir may be filled. To fill the genitourinary reservoir, attach a syringe with a Luer-lock extension set (provided) and inject 60 mL of distilled water into the GU port on the simulators left shoulder. Changing the Simulators Genitalia METIman comes with male and female genitalia. To switch genitalia:

1. 2. 3. 4. 5. Pull apart the Velcro holding the genitalia. Loosen and remove the urethra connector. This connection may be tight when genitalia are removed the first time. Remove the genitalia. Attach urethra tube to the urethra connector. Attach the desired genitalia using the Velcro. 165 Using METIman Sounds A variety of simulated sounds are available to enhance realism. A patient must be running on METIman for any sounds to be available. Speech Speech can be added to simulations using the Vocal Sounds and Speech Sounds features on the software or by using an external microphone. Vocal Sounds A variety of programmable vocal sounds are available. Vocal sounds are male or female based on the gender of the active patient. Vocal Sounds None Audible Wheezing Crying Gagging Gasping Groaning Long loud cough Long soft cough Mumbling 166 Using METIman To select a sound from the Vocal Sounds drop-down menu, click the Sounds button on the Run screen. The Sounds panel appears. Vocal Sounds Menu Click Vocal Sounds and select the type of sound desired from the Vocal Sounds drop-down menu. Vocal Sounds play continuously when selected and are emitted immediately when selected from the Vocal Sounds drop-down menu. To stop playing one of the vocal sounds, select None from the list. 167 Using METIman Speech Sounds Speech Sounds include a male or female voice that can utter pain rating indicators from 0 to 10, various phrases and a series of other utterances. Unlike Vocal Sounds, Speech Sounds only play once. Speech Sounds Loud Cough Soft Cough Short Loud Cough Short Soft Cough Scream Grunt Yes No Sometimes Ouch My leg hurts My belly hurts My chest is tight I cant breathe Ow, that hurts 0 through 10 - Pain Ratings Sharp Pressure Aching Dull Stabbing 168 To play a Speech Sound, click the Speech balloon. A list of Speech Sounds appears. Using METIman The Speech Sounds menu The Speech Sounds Menu Select the desired sound. The sound plays, and the list disappears. To replay the last sound, click the Play button in the Speech balloon. 169 Using METIman Wireless Voice Capability In addition to the pre-programmed speech, any response can be transmitted through the speakers using the wireless microphone. Wireless Microphone The microphone volume can be adjusted on the microphone itself using the volume control. Wireless Voice Link If a wireless voice link package was included with the METIman simulator, see Appendix B -

Wireless Voice Link on page B-1 for additional instructions. 170 Using METIman Throat Sounds Stridor throat sounds can be enabled using the software. Throat sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Throat Sounds. The Throat Sounds Menu Click the Throat Sounds drop-down menu to change the type of sound. Click and drag the slider to adjust the volume. 171 Using METIman Breath Sounds Breath sounds are independently synchronized with ventilation of the left and right lungs. Fourteen speakers, eight anterior and six posterior, provide breath sounds that can be auscultated. Each of the four quadrants of the torso can be set independently to produce a particular breath sound. Breath Sounds Normal Crackles Diminished Gurgling Pleura Rub Rhonchi Wheezing Click any one of the Breath Sounds drop-down menus that each control one of four quadrants to change the type of sound. Click and drag the slider for each location to adjust the volume. A patient must be running on a METIman simulator for any sounds to be available. By default, Normal breath sounds are heard. Breath sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Breath Sounds. The Breath Sounds Menu 172 Using METIman Heart Sounds Heart sounds emanate from four speakers and are synchronized with the cardiac cycle. Heart sounds can be auscultated over the left and right sternal border, right lower sternal boarder and apex. By default, heart sounds are set to the Normal sound. The following sounds are available:

Heart Sounds Normal S1-S2 S3 S4 S3 and S4 Early Systolic Murmur Mid Systolic Murmur Late Systolic Murmur Pan Systolic Murmur Late Diastolic Murmur Heart sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Heart Sounds. The Heart Sounds Menu Click the Heart Sounds drop-down menu to change the type of sound. Click and drag the slider to adjust the volume. 173 Using METIman Bowel Sounds Learners can auscultate bowel sounds over each of four intestinal quadrants: the Upper Right, Upper Left, Lower Right and Lower Left. The sounds can be independently set in each anatomical region to Normal, Hypoactive, Hyperactive or None (bowel sounds are absent). The Bowel Sounds Menu Bowel sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Bowel Sounds. Click any one of the Bowel Sounds drop-down menus that each control one of four quadrants to change the type of sound. Click and drag the slider for each location to adjust the volume. Normal bowel sounds are present by default. 174 Care and Maintenance Care and Maintenance Maintaining METIman requires careful treatment of the electronic and mechanical components. Each time METIman is assembled or disassembled, make sure all components are properly handled and either removed from or placed into storage correctly. 175 Care and Maintenance METIman Warranty Programs General Information CAE Healthcare patient simulator products come with a one-year Manufacturers Warranty

(excluding batteries and consumables). All warranties begin at date of shipment or CAE Healthcare installation. You may upgrade your first year Warranty to an Enhanced Warranty and receive remedial and planned maintenance. To prevent equipment downtime and delays after your warranty expires, we encourage you to contract for extended maintenance services for all subsequent years. Units Out of Agreement For units no longer under warranty requiring repairs, the Time and Materials service plan will apply (see Time and Materials section). To place an out-of-warranty unit under a warranty contract, CAE Healthcare reserves the right to have the patient simulator inspected by a CAE Healthcare-approved technician at the customers expense. If necessary, the unit would have to be repaired at the customers expense prior to issuance of a warranty contract. The repairs required as the result of the examination will be quoted on a time and material basis. 176 Care and Maintenance How to Contact Customer Service CAE Healthcare Customer Service Headquarters - United States and Latin America Monday - Friday from 7:00 a.m. to 6:00 p.m. ET Toll Free 24-hour Hotline Fax Email Address: customerservice@caehealthcare.com Web URL:

+1 (866) 462-7920

+1 (941) 342-5605

+1 (941) 342-5600 www.caehealthcare.com CAE Healthcare Customer Service - Canada Monday - Friday from 8:00 a.m. to 5:00 p.m. ET Toll Free Email Address: can.service@caehealthcare.com

+1 (877) 223-6273 CAE Healthcare Customer Service - Europe, Middle East and Africa (EMEA) Monday - Friday from 8:00 a.m. to 5:00 p.m. CET Phone Fax Email Address: international.service@caehealthcare.com

+49 (0) 6131 4950354

+49 (0) 6131 4950351 CAE Healthcare Customer Service - UK and Ireland Monday - Friday from 9:00 a.m. to 5:00 p.m. GMT

+44 (0)800-917-1851 Phone Email Address: uk.service@caehealthcare.com Principal hours of operation exclude holiday and non-business days. 177 Care and Maintenance Contract Period Warranty contracts are not ordinarily offered for periods of less than one year. However, multiple-year warranty contracts may be arranged for up to an additional three years. Discounts are available for purchase of multiple-year contracts. Limitations of Agreement Your exclusive remedy for any defective patient simulator is limited to the repair or replacement of the defective patient simulator. CAE Healthcare may elect which remedy or combination of remedies to provide at its sole discretion. CAE Healthcare shall have a reasonable time after determining that a defective material exists to repair or replace defective material. CAE Healthcares replacement material will be manufactured from new and/or serviceable parts. CAE Healthcares agreement applies to repaired or replaced materials for the balance of the applicable period of the original warranty or ninety days from the date of shipment of a repaired or replaced material, whichever is longer. CAE Healthcare warrants its LABOR for 30 days or the balance at the applicable period of the original warranty, whichever is greater. CAE Healthcare shall not be liable under this warranty for incidental or consequential damages, or in the event of any unauthorized repairs or modifications have been made or attempted, or when the product, or any part thereof, has been damaged by accident, misuse or abuse. This warranty does not cover normal wear and tear, staining, discoloration or other cosmetic irregularities that do not impede or degrade product performance. Any damage or malfunction as a result of the installation of software or hardware, not authorized by CAE Healthcare, will be repaired under the Time and Materials service plan (see Time and Materials section). CAE Healthcares warranty does not cover products that have been received improperly packaged, altered or physically damaged. Products will be inspected upon receipt. Some states in the USA do not allow the exclusion or limitations of incidental or consequential damages, so the limitations above may not apply to you. This warranty gives you specific legal rights and you may also have other rights, which vary from state to state. Return Materials Authorization (RMA) No product may be returned directly to CAE Healthcare without first contacting CAE Healthcare for an RMA number. If it is determined that the product may be defective, you will be given an RMA number and instructions for product return. An unauthorized return, e.g., one for which an RMA number has not been issued, will be returned at your expense. Authorized shipments are to be shipped prepaid to the address on the RMA. Your original box and packaging materials should be kept for storing or shipping your product. To request an RMA, please contact Customer Service. 178 Care and Maintenance System Software Upgrade Support Customers with current warranty contracts are entitled to receive upgrades to applications software previously purchased. Installation of the system software is the users responsibility. The System Software Upgrades Support includes software upgrades for base software and purchased optional software modules.

**This does not apply for major upgrades or technological enhancements.**

Pricing Structure Time and Materials For those systems not under agreement, service will be provided as required on a Time and Material basis:

Description In-House On-Site Technical Support As quoted at time of repair Material Travel As quoted at time of repair N/A CAE Healthcares prevailing labor rate with a minimum of four hours labor As quoted at time of repair Priced at CAE Healthcares fully burdened cost plus fee Principal period of on-site support (customers local time) is:

Monday through Friday, 8:00 AM to 5:00 PM (customers time zone) Holiday and non-business days excluded Support outside the principle period is billed at the premium rate (hourly rate x 1.5) A minimum of 48 hours notice is required for scheduling an on-site support call. Urgent on-

site support with less that 48 hours notice will be charged at the premium hourly rate. On-site time is described as the time period commencing from arrival at customer site through departure from customer site. 179 Care and Maintenance Breakdown After each use, METIman should be properly disassembled and stored in a secure place. To ensure that METIman remains in good working condition, follow the prescribed CAE Healthcare breakdown procedures below. These procedures are estimated to take less than 30 minutes. Breakdown Steps Stop All Running SCEs Clean the Simulator and the Fluid System Shut Down the Software Power off the Simulator 1 2 3 4 Step 1: Stop All Running SCEs Stop any running SCEs using the Stop button in the upper right corner of the Mse software for each SCE. Step 2: Clean the Simulator and the Fluid System Refer to the Maintenance Advice on the following pages for detailed instructions. Step 3: Shut Down the Software To shut down the Mse software:

1. 2. Click the Account Name in the lower, right-hand corner of the screen. The Logout/

Shutdown dialog box appears. Click Logout to exit the software, or click Shutdown to shut down the computer. To shut down the TouchPro software (optional):

1. 2. Click the Settings button from the bottom, right-hand corner of the TouchPro screen. From the Settings menu, click exit. Shutdown. A warning box appears asking if you want to 3. Click Shutdown. 180 Care and Maintenance Step 4: Power Off the Simulator 1. Carefully pull back the skin on METImans left hip and hold the power switch for two seconds. The light on the button begins to blink, indicating shutdown is in progress. After approximately 30 seconds, the light is off, and shutdown is complete. If the simulator fails to shut down when the above steps are performed correctly, hold the power button for five seconds to force the system to power off 2. Carefully put the skin back into place for storage. Maintenance Advice Simple care and maintenance helps to ensure that METIman stays in good working condition. Many problems are caused by inadequate or improper maintenance. Perform a thorough check of the various components each time the simulator is used. Failure to follow these guidelines can lead to damage not covered by warranty. General Simulator Care Avoid the use of writing instruments and sharp objects near the patient simulator to prevent unattractive markings on or tears in the skin. Lubricate airway adjuncts, urinary catheters and chest tubes with silicone spray (NOT a water-

based lubricant) prior to insertion. A mild detergent and warm water will remove most marks and stains. Gently rub the soiled area with a soft cloth. Do NOT use ABRASIVE soaps or pads. Prior to using moulage of any kind, CAE Healthcare suggests the application of a very light coating of petroleum jelly, followed by a light dusting of baby powder, to the simulators skin. This application makes cleaning the skin easier. If any of METImans fluid systems have been used, flush out the simulator as described in the following pages. Failure to flush the systems may cause damage to the simulator. Storage When in regular use, METImans breakdown procedure and general cleanup should be sufficient to prepare the simulator for storage. In addition, be certain to follow these instructions:

Storage temperature should not exceed 122 F (50 C) or fall below 41 F (5 C). If a soft-sided simulator case is being used, the simulator should lie flat. The simulator should NEVER be stored or shipped with fluids in the system. 181 Care and Maintenance Care of Electronic Equipment Install any CAE Healthcare software updates as soon as they become available. Airway Inspection METIman is equipped with an anatomically accurate airway that supports the practice of difficult airway management techniques. In the process of performing these techniques improperly or aggressively, the upper airway can be damaged. Because damage can occur, occasional visual inspection of the airway is recommended. Using the light of a laryngoscope blade or a flashlight, visually examine the airway. While tears in the upper airway resulting from intubation may be obvious, needle holes in the lower trachea resulting from techniques such as transtracheal jet ventilation may not be readily apparent. If damage to the airway is found, small cuts or tears may be reparable with silicone adhesive. However, for permanent repair of damaged simulators, contact CAE Healthcare Customer Service. Replacing the Battery After approximately four hours of use, the simulators battery must be removed to be recharged or replaced with a charged battery. WARNING : When handling METImans batteries, be sure to adhere to all the cautions and warnings. To replace the battery:

1. Unzip the chest skin. Unzipping the Chest Skin 182 Care and Maintenance 2. Lift the abdominal insert. Lifting the Abdominal Insert 3. Remove the abdominal support. Remove the abdominal support Removing the Abdominal Support 4. Release the Velcro battery tie-down. Release the Velcro battery tie-down Releasing the Battery Tie-Down 183 Care and Maintenance 5. Disconnect the battery leads. Disconnect the battery leads Disconnecting the Battery Leads 6. Remove the uncharged battery. Remove the uncharged battery Removing the Battery 7. 8. 9. Insert a charged battery and affix the battery tie-down. Connect the battery leads and replace the abdominal support, ensuring both ends are secure in the slits. Replace the abdominal insert and chest skin. Recharging the Battery The battery should be recharged after approximately four hours of use. To recharge the battery, disconnect and remove the battery from the simulator and connect to the external charger provided. WARNING: When handling METImans batteries, be sure to adhere to all the cautions and warnings 184 Care and Maintenance Recharging should take approximately four hours. IMPORTANT: Never recharge the battery while it is connected to METIman. Draining Condensation from the Simulator As part of a regular preventive maintenance schedule, condensation should be drained from the simulator. Depending on environmental conditions, moisture may condense inside the compressed air lines and tanks within the simulator. It is recommended that this fluid be drained every 40 hours of operation. In outside, high-humidity conditions, the system should be drained more frequently. To drain condensation:

1. Locate the Condensation Drain Hose included with the Inventory Kit. Condensation Drain Hose 2. 3. 4. 5. 6. 7. 8. 9. 10. Bring the hose and a small bucket to the simulator location. EXTERNAL AIR port on METImans left shoulder. Locate the With assistance, place METIman into a supine position. Power on METIman. Do NOT launch the Mse software. Allow 60 seconds for the internal compressor to pressurize the system. Power down METIman. With assistance, raise the left leg 45 degrees. Place the tubing end of the Condensation Drain Hose into the small bucket and then connect the fitting onto the simulators drain connector. There will be a sudden release of pressure into the bucket. Any condensation within the system drains with this exhaust. Disconnect the Condensation Drain Hose from the simulator. 185 Care and Maintenance Cleaning the Simulator and the On-Board Bleeding System NOTE: A small bucket is recommended to collect wastewater during cleaning and flushing operations. To clean and maintain the simulator and On-Board Bleeding system:

Flush System. The fluid begins to drain. System Administration button in the top Remove and clean the wound haptics. Connect the beige-colored fill connector from the Trauma Fill Tank to the hip, but do not connect the white vent connection. Open the yellow Pressure Relief knob clockwise on the Trauma Fill Tank or loosen its Fill Lid so the tank is able to vent during this draining process. With the wound umbilicals in place, put the ends of both wound umbilicals into a wastewater bucket. From the Mse home screen, click the right of the screen. From the Maintenance screen, click Verify both channels produce a high, steady flow. When fluid stops flowing from either wound umbilical, detach the Fill Tank from the simulator. When fluid stops flowing from the lower wound umbilical, detach from the simulator. When fluid stops flowing from the upper wound umbilical, detach from the simulator. Click Empty the wastewater bucket. Rinse out the Trauma Fill Tank and fill with approximately 1 liter of clean, distilled water. Pump this fluid into the simulator Repeat Steps 3 through 7 and 9 through 15 until the fluid exiting the simulator runs clear. Empty the Fill Tank and dry the wound umbilicals with a towel before storage. NOTE: It takes two to three minutes for this final flush. Done on the Maintenance screen. The fluids are now drained. Once a month, it is advised to flush the system with a mix of 50% distilled water and 50% white vinegar to keep mineral and algae buildup to a minimum. Always perform the steps for Flushing the Simulator afterward to remove vinegar. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 186 Care and Maintenance Cleaning the Trauma Fill Tank To prolong the life of the Trauma Fill Tank assembly and the fluid reservoirs, wash and flush the tank and connections after each use with clean distilled water. NOTE: A small bucket is recommended to collect wastewater during cleaning and flushing operations. Do NOT store liquids in the Trauma Fill Tank. If simulated blood mixtures are stored in the tank, they may clog the system when they dry and possibly damage the seals, filter and other components. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Remove and rinse the Overflow Bottle. Remove and rinse the Pump Assembly. Rinse the tank to remove all traces of the simulated blood. Pour 480 mL (16 oz) of distilled water into the tank and reinstall the Pump Assembly. (The Overflow Bottle holds 16 ounces.) Place the Overflow Bottle lid with umbilical attached into the wastewater bucket. Attach the fill (blue-labeled) and vent (yellow-labeled) fittings together at the other end of the umbilical. Pump the tank 25 times while making sure the wastewater is going into the bucket. Allow the tank to empty completely (the remaining air pressure will purge the fluid from the lines. Reinstall the lid onto the Overflow Bottle and place the bottle back onto the tank assembly. Remove the Pump Assembly and pour any remaining fluid out of the tank. Then, reinstall the pump. Disconnect the fill and vent fittings from each other and wrap the Trauma Tank Umbilical around the neck of the tank. Always depressurize the tank, remove trauma fluid and clean the tank before performing maintenance. The pump assembly may need periodic lubrication. Call CAE Healthcare Customer Service for details if the pump loses the ability to create pressure, squeaks loudly or is difficult to move. 187 Care and Maintenance Cleaning the In-Line Filter To clean the in-line filter:

1. 2. 3. 4. 5. 6. Grasp both ends of the in-line filter and twist counterclockwise. Pull apart both ends of the filter to separate. Remove the blue filter cone from the encasement. Do NOT remove the black rubber seal. Using a 60 mL syringe with distilled water, push fluid from the outside of the blue filter cone to the inside, removing all debris. Repeat process until all debris is removed. Re-assemble the in-line filter, ensuring the black rubber seal is in place at the base of the blue filter cone. The In-Line Filter 188 Care and Maintenance Troubleshooting the Trauma Fill Tank Before making any repairs, ALWAYS depressurize the tank, remove all trauma solution and clean the tank. Problem Cause Solution Tank can be pressurized, but only air comes out. Pressure does not build up. No fluid is transported to simulator. Siphon tube has detached from insert.

(1) Pump assembly not sealed tightly into tank or

(2) Damaged pump cylinder gasket or o-ring or

(3) Tank pressure relief valve is set to open. Simulator fill time is too long

(more than 5 minutes).

(1) Not enough strokes applied to create pressure or Remove hose from tank and reinsert siphon tube.

(1) Thoroughly clean pump cylinder gasket or o-ring and surrounding area and apply a light coating of silicone to pump gasket or o-ring.

(2) Contact CAE Healthcare for service.

(3) Turn valve until it returns to a sealed position.

(1) Pump 25 to 35 times for best performance.

(2) The in-line filter is dirty or

(2) Clean filter.

(3) The umbilical is disconnected at Overflow Bottle or

(4) Too much fluid in fill tank.

(3) Reconnect the overflow fitting.

(4) The Trauma Fill Tank works best with 1 gallon (3.6 liters) of fluid inside. If greater amounts of fluid are used, tank may require additional pumps as fluid is transported to simulator. 189 Care and Maintenance Emptying and Flushing the Chest Tube Reservoir Removing fluids from the Chest Tube reservoir and the Chest Tube system requires the same steps. To empty the Chest Tube reservoir or flush the Chest Tube system, have a chest tube and a basin to catch fluid in place. Use a syringe to slowly push air through the appropriate CHEST TUBE port until only air flows through the chest tube. Flushing the IV Lines To flush the IV lines:

1. 2. 3. Connect an empty IV bag to the Using a syringe, slowly push air into the DRAIN port. Continue to push air until empty. IV DRAIN port. IV FILL port. The fluid drains out of the IV Emptying the Genitourinary Reservoir To empty the Genitourinary reservoir, have a catheter in place and a basin to catch fluid. Use a syringe to slowly push air through the GU port until only air flows through the catheter. Emptying the Head Secretions Lines (Prehospital Only) To remove fluid from the Head Secretions lines, connect a syringe to the NOSE port and vacuum out fluid until empty. Repeat this process for the MOUTH and EYES ports. Emptying the Airway Secretions Reservoir (Nursing Only) To empty the Airway Secretions reservoir, connect a 60 mL syringe to the AIRWAY FILL port and vacuum out fluid until empty. Flushing the Subclavian Catheter (Nursing Only) When flushing the Subclavian Catheter, the catheter must be in place. To flush the Subclavian Catheter:

IV DRAIN port and place a basin to catch fluid. Connect an external drain to the Using a syringe, slowly push air into the DRAIN port. Continue to push air until empty. Using the same syringe, push air through the Subclavian Catheter until empty. IV FILL port. The fluid drains out of the IV 1. 2. 3. 4. 190 Care and Maintenance Handling CO2 Canisters (Prehospital Only) Careful handling is required in the use of CO2 canisters. Please read and follow all appropriate cautions and warnings. Removing CO2 Canisters from the Regulator The following instructions describe how to safely remove the CO2 canister from the regulator assembly for replacement or shipping. CAUTION: If unsure that CO2 canister is empty, eye and hand protection must be worn to protect from release of freezing gas or liquid. 1. 2. 3. 2 regulator assembly from the simulator. Remove the CO While holding the regulator assembly firmly, slowly unscrew the CO 2 canister from the regulator. There is a small relief hole in the side of the regulator from which any remaining CO2 will bleed. If this should happen, no harm will be done to system, but it is rather noisy and the rapid release of CO2 gas can freeze the canisters surface and cause frostbite to unprotected skin. Continue unscrewing the canister until it is free from the assembly. 191 Care and Maintenance Important Canister Information The 16 Gram CO2 Canister with threaded neck is available at most sports equipment retailers

- most often used for bicycle tire inflators. We recommend purchasing Leland brand canisters

(P/N 82122Z), which are also available from CAE Healthcare. Punctured canisters are considered to be empty. No residue remains in the canister after use. The steel used is a low carbon type, which rusts if disposed in a landfill. If your community requires recycling, then place with normal household recycling. CO2 Canisters are considered by the U.S. Department of Transportation to be Other Regulated Materials - Domestic (ORM-D). Ground shipping containers must be clearly marked with this label. CO2 Canisters are considered hazardous material when offered for air transportation, so different rules apply. Contact carrier for details and instructions. Related CAUTIONS/WARNINGS CO2 Canister Store the CO Do not expose the CO Never point the CO Use only CAE Healthcare specified CO 2 canisters in a dry location between 32 and 104 F (0 to 40C). 2 canister to heat above 140 F, as rupture may occur. 2 canister towards your face or someone nearby. 2 canisters. CO2 Regulator Assembly Care must always be taken when using high-pressure equipment. Do not disassemble or alter regulator. Dry completely if the regulator becomes wet. Discontinue use of this equipment if leakage or visible damage is evident. Use of Equipment Canister end becomes punctured when screwed into regulator base and therefore should not be removed until empty. Unscrewing canister before it is empty will result in sudden release of all high-pressure gas with a possibility of liquid CO2 spray. Unprotected skin could receive freezing burns. Wear protective gloves and eye protection when removing canister from regulator assembly. Remove CO 2 canister from regulator assembly when shipping simulator. 192 Condition Guidelines for Programming METIman Condition Guidelines for Programming METIman This card is intended to help you select Mse conditions to achieve desired vital signs within each programmed state. All four conditions should be programmed into each state in the order presented below. Respiratory: Desaturation Cardiovascular: Blood Pressure Cardiovascular Heart Rate Respiratory: Respiratory Rate The Mse software is physiologically driven. When using multiple conditions

(e.g., Desaturation + Hypertension + Tachycardia + Tachypnea), physiological regulatory mechanisms such as the baroreceptor reflex and ventilatory control cause compensatory changes within parameters. To achieve the desired vital sign, select one condition level, above (greater) or below (less), to achieve the desired physiological effect. Respiratory: Desaturation Desaturation Reset High 90s Mid 90s Low 90s High 80s Mid 80s Low 80s High 70s Mid 70s Low 70s Less than 70 SpO2 Value 98%

96-97%

94-96%

91-93%

87-90%

84-86%

80-83%

77-80%

74-77%

69-71%

<69%

193 Condition Guidelines for Programming METIman Cardiovascular: Blood Pressure Hypertension Reset Increased Pre-Borderline Borderline Mild Moderate Severe Profound Extreme 110s/70s 120s/80s 130s/80s 140s/90s 150s/90s 160s/100s 170s/100s 190s/110s 220s/120s Hypotension Reset Decreased Pre-Borderline Borderline Mild Moderate Severe Profound Extreme 110s/70s 100s/70s 100s/60s 90s/50s 80s/40s 70s/40s 60s/30s 50s/30s 40s/30s 194 Condition Guidelines for Programming METIman Cardiovascular: Heart Rate Tachycardia Reset Increased Elevated Pre-Borderline Borderline Intermediate Mild Moderate Severe Supra Profound Extreme Acute 70s High 70s 80s 90s 100s 110s 120s 130s 140s 150s 160s 170s High 170s Bradycardia Reset Decreased Pre-Borderline Borderline Intermediate Mild Moderate Severe Extreme Acute 70s Mid 60s Low 60s Mid 50s Low 50s High 40s Mid 40s Low 40s Mid 30s Low 30s 195 Condition Guidelines for Programming METIman Respiratory: Respiratory Rate Tachypnea Reset Increased Elevated Borderline Intermediate Mild Moderate Severe Profound Extreme 11 15 18 20 22 25 28 31 33 36 Bradypnea Reset Increased Intermediate Mild Moderate Severe Profound Extreme 11 10 9 7 6 5 3 2 196 Appendix A Parameter Descriptions Appendix A Mse Parameter Descriptions The Mse software has a number of parameters that control the physiological features of METIman The parameters are grouped by category: Neurological, Respiratory, Cardiovascular, Fluids and Sounds. The following is a brief description of each parameter. Each parameter description lists the default settings for the Stan D. Ardman II and Norma L. Female patients as well as the ranges, if available, for all patients. Neurological METIman can simulate a variety of neurological clinical indicators, such reactive eyes and convulsions. Neurological Parameters Eyes: Pupil Size Ey es: Blink Speed Convulsions ICP NMB Te mperature: Body Te mperature: Blood Eyes Each eye has reactive pupils and eyelids that blink and close. A-1 Appendix A Parameter Descriptions Eyes: Pupil Diameter These parameters are used to control the diameter of the pupils in the eyes. Each eye has reactive pupils and functional eyelids that blink. Currently, there are four pupil options that are used to control the diameter of the pupils in both eyes: Reactive, Non-Reactive, Pinpoint or Blown. When the Eyes are set to Reactive, the pupils re-size in response to changes in lighting condition. If both pupils are set to Reactive, both pupils re-size in a consensual manner. The Non-Reactive, Pinpoint and Blown settings allow the user to fix one or both pupils to a specific size. The Non-Reactive setting fixes pupils to a normal size, the Pinpoint setting fixes pupils in the pinpoint position and the Blown setting fixes pupils in the blown position. Default: Reactive Eyes: Blinking In Auto mode, the eyelids are normally blinking under the following conditions: Minute Ventilation is greater than 1500 mL, SpO2 is greater than 70% and neuromuscular blockade

(NMB) is less than 30%. The Blinking and Closed settings allow the user to have one or both eyes either blinking or closed and override the automatic response. Default: Auto The Slow, Normal and Fast parameters control the eyelid blinking frequency. Presently, blinking frequency is not linked to the physiological models. However, the response can be done on the fly or scripted using the Scenario Designer. Default: Normal Convulsions The Convulsions parameter is used to simulate the presence of convulsions. They are either ON or OFF. Default: Off A-2 Appendix A Parameter Descriptions Intracranial Pressure (ICP) The ICP parameter is used to set the ICP displayed as a numeric value on the TouchPro monitor. The base value is set at 8 mmHg. This parameter is uninfluenced by physiological models. Default: 8 mmHg Range: 0.0 mmHg - 65.0 mmHg Neuromuscular Blockade (NMB) The pharmacokinetic and pharmacodynamic models based on the neuromuscular blocking agents administered and the time course of their injection automatically determines the degree of NMB. For some educational applications, however, the instructor may wish to set a fixed degree of neuromuscular blockade that remains stable for an indefinite period. This can be accomplished using the NMB parameter. The default setting instructs the pharmacologic models to determine the degree of neuromuscular blockade based upon the drugs injected and their pharmacologic properties. When a positive numeric value is assigned to this parameter, the degree of NMB is set to that level. For example, 80% NMB causes the simulator to set the degree of NMB to 80%, regardless of the presence (or absence) of neuromuscular blocking drugs. Clinically, the spontaneous tidal volume is markedly reduced. Default: Modeled Range: 0% - 100%

Temperature: Body The temperature measured at the body surface can be set using this parameter and can be displayed on the Patient Status Display and TouchPro software. The body temperature is not linked to the physiologic models. However, changes can be made on the fly or scripted using the Scenario Designer. Default: 36.5 C Range: 32.0 C - 42.0 C A-3 Appendix A Parameter Descriptions Temperature: Blood The arterial blood temperature can be set using the Temperature: Blood parameter. The arterial blood temperature can then be displayed on the Patient Status Display and TouchPro software. Note that changes in arterial temperature may alter the shape of the standard oxyhemoglobin dissociation curve. As temperature increases or pH decreases, more oxygen is released from hemoglobin and thus the patients saturation decreases. The inverse is also true. Default: 37 C Range: 32.0 C - 42.0 C Respiratory Parameters Respiratory Parameters Swollen Tongue Airway Occluder (Prehospital Only) Laryngospasm (Prehospital Only) Ne edle Decompression (Left and Right) (Prehospital Only) Br onchial Occlusion Respiratory Rate A-4 Appendix A Parameter Descriptions Respiratory Parameters SpO2 NMB Tidal Volume In trapleural Volume: Left In trapleural Volume: Right Chest Tube Flow: Left Ch est Tube Flow: Right Swollen Tongue This parameter is used to create tongue swelling. The tongue is either Swollen or Not Swollen. The Not Swollen setting returns the tongue to its normal anatomic state. Default: Not Swollen Options: Not Swollen, Swollen A-5 Appendix A Parameter Descriptions Airway Occluder (Prehospital Only) Using the Airway Occluder parameter, swelling of the posterior oropharynx can be activated to obstruct the view of the larynx and prevent intubation but allow mask ventilation of the patients lungs, thereby creating a cannot intubate, can ventilate scenario. Default: Off Laryngospasm (Prehospital Only) Use the Laryngospasm parameter to simulate a laryngospasm. A laryngospasm actuator closes the patients vocal cords and prevents both ventilation and intubation. When activated with the Airway Occluder parameter, a cannot ventilate, cannot intubate crisis scenario is achieved. Default: Off Needle Decompression (Left and Right) (Prehospital Only) The Needle Decompression parameter is used to activate the Needle Decompression hardware in the simulator to relieve a pneumothorax in the simulator. This causes a rush of air to be heard on successful decompression. The amount of decompression is automatically subtracted from the Intrapleural Volume set. Default: Off Bronchial Occlusion Turning on the Bronchial Occlusion parameter completely obstructs the right or left bronchi, simulating a lower airway obstruction (e.g., mucus plug). Improper intubation creates a main-

stem occlusion, yielding an inability to ventilate the lungs. However, the right and left bronchi are not occluded individually. Default: Off Respiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute. Once set, arterial oxygen and carbon dioxide values have no effect on the resulting respiratory rate, but continue to influence other components of the physiological models. The patient continues to breathe at the set number of breaths per minute, regardless of the arterial oxygen or carbon dioxide levels. A-6 Appendix A Parameter Descriptions For example, when the respiratory rate is set to 10 breaths per minute, the respiratory rate remains at 10 breaths per minute, regardless of arterial oxygen or carbon dioxide levels. In such situations, the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter. Default: Modeled Range: 4 breaths per minute - 40 breaths per minute SpO2 The SpO2 parameter is used to override the normal pulmonary circulation and set the SpO2 at a fixed numeric value, regardless of the oxygen applied. Resetting to Modeled returns control of the underlying SpO2 to the physiological models. Default: Modeled Range: 0% - 100%

Neuromuscular Blockade (NMB) The degree of NMB is automatically determined by pharmacokinetic and pharmacodynamic models, which are based on the neuromuscular blocking agents administered and the time course of their injection. For some educational applications, however, the instructor may wish to set a fixed degree of neuromuscular blockade that remains stable for an indefinite period. This can be accomplished using the NMB parameter. The default value instructs the pharmacologic models to determine the degree of neuromuscular blockade based on the drugs injected and their pharmacologic properties. When a positive numeric any other positive value is assigned to this parameter, the degree of NMB is set to that level. For example, 80% NMB causes the simulator to set the degree of NMB to 80%, regardless of the presence (or absence) of neuromuscular blocking drugs. Clinically, the spontaneous tidal volume is markedly reduced. Default: Modeled Range: 0% - 100%

Tidal Volume The Tidal Volume parameter is used to set the tidal volume to a given volume per breath. Once Tidal Volume is set to a numeric value, arterial oxygen and carbon dioxide values have no effect on the tidal volume, but continue to influence other components of the physiological models. For example, with the tidal volume set to 600 mL in the adult simulator, the tidal volume A-7 Appendix A Parameter Descriptions remains a constant (set) 600 mL even in the event of falling arterial oxygen levels. In such situations, the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted. Default: Modeled Range: 0 mL- 2500 mL Intrapleural Volume (Vol): (Left and Right) The Intrapleural Vol parameters allow intrapleural volume to accumulate, for example, as happens during pneumothorax, hydrothorax or hemothorax. To simulate a pneumothorax, set the corresponding Intrapleural Vol to a value greater than 0 mL. Values more than 1500 mL reduce the corresponding lung volume significantly. The breath sounds are automatically diminished on the appropriate side due to decreased ventilation of the affected lung. Default: 0 Range: 0 mL - 2500 mL Chest Tube Flow: (Left and Right) The Chest Tube Flow parameter is used with the chest tube feature of the simulator. The Chest Tube Flow specifies the rate at which fluid can be removed from the simulated pleural space via a chest tube drainage system. As the chest tube drains, the volume is automatically subtracted from the set amount of Intrapleural Volume. Default: 50 mL per minute Range: 0 mL per minute - 50 mL per minute Cardiovascular Parameters Cardiovascular Parameters Blood Pressure Heart Rate Cardiac Rhythm A-8 Appendix A Parameter Descriptions Cardiovascular Parameters Arterial Catheter Ce ntral Venous Catheter PA Catheter PA Balloon Defib Pacing Current Pacing Rate Pa cing Capture Threshold Cold Fluid Inject Blood Pressure The Blood Pressure parameter is used to override the physiological modeling for blood pres-

sure. The systolic and diastolic blood pressures can both be set to fixed numeric values, regard-

less of interventions performed. Resetting the parameter to Modeled returns control of the underlying Blood Pressure to the physiological models. Default: Modeled Range: Systolic 20 mmHg - 200 mmHg Diastolic 10 mmHg - 200 mmHg Heart Rate The Heart Rate parameter is used to set the heart rate to a given (fixed) number of beats per minute. Once the heart rate is set to a numeric value, administered drugs or intravascular volume changes have no effect on the heart rate, but continue to influence other components of the physiological models. Use this parameter to fix or set the heart rate to a specific number. Default: Modeled Range: 30 beats per minute - 220 beats per minute A-9 Appendix A Parameter Descriptions Cardiac Rhythm The Cardiac Rhythm parameter is used to change the patients underlying cardiac rhythm displayed on the Patient Status Display, TouchPro software or physiological monitor. To change the cardiac rhythm, click the Cardiac Rhythm parameter and select the desired rhythm from the available list. If a number appears following the cardiac rhythm on the list, this overrides the heart rate to the rate indicated. Default: Modeled Options: Modeled Asystole Atrial Enlargement, Left Atrial Enlargement, Right Atrial Fibrillation Atrial Fibrillation: HR 120 Atrial Fibrillation: HR 80 Atrial Flutter with 2:1 AV Conduction Atrial Flutter: HR 150 Atrial Tachycardia AV Block, First-Degree AV Block, Second-Degree - Mobitz I AV Block, Second-Degree - Mobitz II AV Block, Third-Degree Bundle Branch Block, Incomplete Right Bundle Branch Block: Left Bundle Branch Block, Left with PVC 25%

Bundle Branch Block: Right Hypercalcemia Hyperkalemia Hypertrophy, Biventricular Hypertrophy, Left Ventricular Hypertrophy, Right Ventricular Hypocalcemia Hypokalemia Hypothermia Junctional Junctional: HR 50 Long QT Syndrome Myocardial Infarction with LBBB Myocardial Infarction, Anterior A-10 Appendix A Parameter Descriptions Myocardial Infarction, Anterolateral Myocardial Infarction, Inferior Myocardial Infarction, Lateral Myocardial Infarction, Posterior Myocardial Infarction, Septal Myocardial Ischemia: Mild Myocardial Ischemia: Moderate Myocardial Ischemia: Moderate with PVC 10%

Myocardial Ischemia: Severe Paroxysmal Junctional Tachycardia Paroxysmal Junctional Tachycardia: HR 130 Pericarditis Premature Atrial Contraction Premature Ventricular Contraction 10%

Premature Ventricular Contraction 25%

Pulseless Electrical Activity Sinus Sinus Bradycardia Sinus Bradycardia: HR 40 Sinus Tachycardia Sinus Tachycardia: HR 120 ST Elevation with Chest Pain Torsade de Pointes Trifascicular Block Ventricular Fibrillation: Coarse Ventricular Fibrillation: Fine Ventricular Tachycardia Ventricular Tachycardia: Pulseless Ventricular Tachycardia: HR 151 Ventricular Tachycardia: Pulseless HR 151 Wellens Syndrome WPW Syndrome, Left Lateral Pathway A-11 Appendix A Parameter Descriptions Arterial Catheter The arterial pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the arterial pressure waveform, if desired. The Left Ventricle position is useful for simulating cardiac catheterization procedures, or for demonstrating left ventricular end-diastolic pressure and its relationship to pulmonary artery occlusion (wedge) and central venous pressure. Default: Peripheral Artery Peripheral Artery Left Ventricle Options: Atmosphere Central Venous Catheter The venous pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the central venous pressure waveform, if desired (i.e., beginning of an SCE with an unmonitored patient). Default: Intrathoracic Vein Extrathoracic Vein Intrathoracic Vein Options: Atmosphere Pulmonary Artery (PA) Catheter The pulmonary artery pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the pulmonary artery pressure waveform, if desired (i.e., beginning of an SCE with an unmonitored patient). The pulmonary artery catheter can be floated into position by sequencing through the right heart positions. This may also be scripted into a scenario using the Scenario Designer. Default: Pulmonary Artery Options: Atmosphere Intrathoracic Vein Right Atrium Right Ventricle Pulmonary Artery A-12 Appendix A Parameter Descriptions PA Balloon Inflation of the pulmonary artery catheter balloon is simulated by switching to the Inflated option of the PA Balloon parameter. The appropriate pulmonary artery occlusion or wedge waveform is then displayed on the Patient Status Display or TouchPro software. Default: Deflated Inflated Options: Deflated Defibrillation (Defib) The Defib parameter is used to simulate a specified amount of energy discharged via an external cardiac defibrillator. Setting this parameter results in the characteristic spike in the ECG, followed by a return to the pre-defibrillation rhythm. Defib has no direct effect on the electrical conduction system of the heart. Thus, synchronized cardioversion may be done on the fly or scripted using the Scenario Designer. Default: 0 Joules Range: 0 Joules- 360 Joules Pacing Current The Pacing Current parameter is used to simulate a specified amount of current discharged via an external cardiac pacer. Setting this parameter results in the characteristic pacing signal on the ECG waveform when the pacing current is at or above the capture threshold. Also, see Pacing Capture Threshold. Default: 0 mA Range: 0 mA- 200 mA Pacing Rate The Pacing Rate parameter determines the cardiac rate (in beats/minute) when the pacing current is at or above the pacing capture threshold. Also, see Pacing Current and Pacing Capture Threshold. Default: 80 beats per minute Range: 0 beats per minute - 119 beats per minute A-13 Appendix A Parameter Descriptions Pacing Capture Threshold The Pacing Capture Threshold parameter determines the minimum pacing current necessary to pace the heart via an external cardiac pacer. Also see Pacing Current. Pacing current values below the pacing capture threshold have no effect on the patients heart rate. Default: 50 mA Range: 0 mA - 119 mA Cold Fluid Inject The Cold Fluid Inject parameter is used to simulate the injection of 10 mL iced saline into the pulmonary artery catheter. The appropriate Thermodilution waveform and cardiac output measurement are then displayed on the Patient Status Display or TouchPro software. A-14 Appendix A Parameter Descriptions Pulses The tables below show the defaults and ranges for the pulses and pulse deficits for METIman Prehospital and METIman Nursing. METIman Prehospital Pulse Default Left Carotid Right Carotid Carotid Deficit Left Brachial Right Brachial Brachial Deficit Left Radial Right Radial Radial Deficit Left Femoral Right Femoral Femoral Deficit Left Popliteal Right Popliteal Popliteal Deficit Left Dorsalis Pedis/

Left Posterior Tibial Right Dorsalis Pedis/

Right Posterior Tibial Dorsalis Pedis/

Posterior Tibial Deficit On On 60 On On 80 On On 90 On On 70 On On 80 On On 80 Range N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 A-15 Appendix A Parameter Descriptions METIman Nursing Pulse Default Left Carotid Right Carotid Carotid Deficit Left Brachial Right Brachial Brachial Deficit Left Radial Right Radial Radial Deficit Left Femoral Right Femoral Femoral Deficit Left Popliteal Right Popliteal Popliteal Deficit Left Dorsalis Pedis Right Dorsalis Pedis Dorsalis Pedis Deficit Left Posterior Tibial Right Posterior Tibial Posterior Tibial Deficit On On 60 On On 80 On On 90 On On 70 On On 80 On On 80 On On 80 Range N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0 - 300 N/A N/A 0-300 All pulses, unless altered by an SCE, are enabled by default. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again. Click and hold a pulse location to adjust the pulse deficit. A-16 Appendix A Parameter Descriptions Fluids The blood droplet provides a means of controlling the amount of fluid lost by or infused into the patient. The amount of fluid to be lost or infused and the time frame during which the fluid loss or infusion takes place can be entered. Fluid Parameters Fluid Loss Blood Fluid Loss Plasma Colloid Infusion Crystalloid Infusion PRBC Infusion Whole Blood Infusion Bleeding: Upper Bleeding: Lower Fluid Loss Blood When used, the Fluid Loss Blood parameter reflects a decrease in total blood volume. Blood loss proportionally decreases both the red blood cell volume and the plasma volume according to the current hematocrit. Range: 0 mL - 4000 mL Fluid Loss Plasma When used, the Fluid Loss Plasma parameter reflects a decrease in plasma volume. Plasma loss decreases the plasma volume without changing the red blood cell volume. It refers collectively and generically to all fluid losses, including evaporative, transcellular, bowel and third space fluid losses. Range: 0 mL - 4000 mL Colloid Infusion When used, the Colloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume. Colloids include modified fluid gelatin starch solutions, dextran and human albumin. Range: 0 mL - 4000 mL A-17 Appendix A Parameter Descriptions Crystalloid Infusion When used, the Crystalloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume. The term crystalloid is used to describe salt solutions for infusion (i.e., normal saline, dextrose in water and Ringers Lactate). Range: 0 mL - 4000 mL PRBC Infusion Packed red blood cells are a preparation of 70% red blood cells and 30% liquid plasma, often administered in severe anemia to restore adequate levels of hemoglobin and red cells without overloading the vascular system with excess fluids. Range: 0 mL - 4000 mL Whole Blood Infusion The term whole blood is used to refer to blood that has not been separated into its various components. It represents a preparation of 40% red blood cells and 60% liquid plasma. Range: 0 mL - 4000 mL Bleeding: Upper The Bleeding: Upper parameter is used to activate the site of bleeding. Default: Off Bleeding: Lower The Bleeding: Lower parameter is used to activate the site of bleeding. Default: Off A-18 Appendix A Parameter Descriptions Sounds A variety of simulated sounds are available to enhance realism. Bowel Sounds Bowel Sounds Normal Hypoactive Hyperactive None Normal, Hypoactive, Hyperactive and absent bowel sounds (None) are selected using this parameter. Independent control of the type and volume of bowel sounds may be selected in each anatomical region. Bowel Sounds Locations All Bowel Sounds LUQ Bowel Sounds RUQ Bowel Sounds LLQ Bowel Sounds RLQ Bowel Sounds To affect the bowel sounds simultaneously in all anatomical regions, select All Bowel Sounds and the desired sound. Default: Normal NOTE: The volume control slider underneath each area may be used to adjust the amplitude of the sound. A-19 Appendix A Parameter Descriptions Breath Sounds Normal and abnormal breath sounds are selected using this parameter. Breath sounds are independently synchronized with ventilation of the left and right lungs. Independent control of the type and volume of breath sounds may be selected in each anatomical region. Breath Sounds Locations All Breath Sounds Breath Left Upper Sounds Breath Right Upper Sounds Breath Left Lower Sounds Breath Right Lower Sounds Breath Sounds Normal Crackles Diminished Gurgling Pleural Rub Rhonchi Wheezing To affect the breath sounds simultaneously in all anatomical regions, select All Breath Sounds and the desired sound. Default: Normal NOTE: The volume control slider underneath each area may be used to adjust the amplitude of the sound. A-20 Appendix A Parameter Descriptions Heart Sounds Normal and abnormal heart sounds are selected using this parameter. Heart sounds are synchronized with the cardiac cycle. Heart Sounds Normal S3 S4 S3 and S4 Early Systolic Murmur Mid Systolic Murmur Late Systolic Murmur Pan Systolic Murmur Late Diastolic Murmur Default: Normal NOTE: The volume control slider may be used to adjust the amplitude of the sound. A-21 Appendix A Parameter Descriptions Speech Sounds Speech Sounds include a male or female voice, based on the gender of the active patient, that can utter pain rating indicators from 0 to 10, various phrases and a series of other utterances. Unlike Vocal Sounds, Speech Sounds only play once. Speech Sounds Loud cough Soft cough Short Loud Cough Short Soft Cough Scream Grunt Yes No Sometimes Ouch 10, 9, 8, 7, 6... My leg hurts My belly hurts My chest is tight I cant breathe Ow, that hurts 0 through 10 - Pain Ratings Sharp Pressure Aching Dull Stabbing To play a Speech Sound, click the Speech balloon. A list of Speech Sounds appears. Select the desired sound. The sound plays once, and the list disappears. To replay the last sound, click the Play button in the Speech balloon. A-22 Appendix A Parameter Descriptions Throat Sounds The Stridor throat sounds option from the simulator is selected using the Throat Sounds parameter. The stridor is synchronized with ventilation of both lungs. Default: None NOTE: The volume control slider may be used to adjust the amplitude of the sound. A-23 Appendix A Parameter Descriptions Vocal Sounds To have the simulator emit the various vocal sounds, select the one desired. It immediately begins to play in a continuous loop until None is selected. A variety of programmable Vocal Sounds are available. Vocal Sounds are male or female based on the gender of the active patient. Vocal Sounds None Crying Gagging Gasping Groaning Long Loud Cough Long Soft Cough Wheezing Mumbling To select a sound from the Vocal Sounds drop-down menu, click the Sounds button on the Run screen. The Sounds panel appears. Click Vocal Sounds and select the type of sound desired from the Vocal Sounds drop-down menu. Default: None NOTE: The volume control slider may be used to adjust the amplitude of the sound. A-24 Appendix B Wireless Voice Link Appendix B - Wireless Voice Link This information is intended to assist in preparing Wireless Voice Link (WVL) devices for use in conjunction with METIman. Cautions and Warnings This device complies with part 15 of the FCC Rules and with Industry Canada licence-exempt RSS standard(s). Operation is subject to the following two conditions:

1. 2. This device may not cause interference. This device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme aux normes dIndustrie Canada exempts de licence RSS (s). Son fonctionnement est soumis aux deux conditions suivantes:

1. 2. Cet appareil ne doit pas provoquer dinterfrences. Cet appareil doit accepter toute interfrence, y compris les interfrences pouvant provoquer un fonctionnement indsirable de lappareil. Any modifications made to this device without the express approval of CAE could void the users authority to operate this equipment. B-1 Appendix B Wireless Voice Link Whats Included The WVL package includes the following items:

Wireless Voice Link Handset (1) Olympus ME52W Standalone Microphone (1) AAA Alkaline Batteries (2) Quick Start Guide (1) How It Works The WVL is a radio pair that operates in the 2.4 GHz unlicensed radio band. The handset communicates wirelessly with the base station located inside the simulator. The base station converts the digitized microphone stream from the handset and outputs it via the base station to the headphone and line out jacks. The output projects through the head speakers inside the simulator. To accommodate multiple WVL pairs in close proximity, each WVL is assigned two RF channels on which to operate. The RF channels divide up the 2.400 2.4835 GHz spectrum in 80 single frequencies to prevent the WVLs from interfering with each other. Due to the nature of the unlicensed 2.4 GHz band, there may be other devices such as Wi-Fi, microwave ovens or Bluetooth radios operating in the 2.4 GHz band as well. Therefore, two channels are used to transmit the audio stream redundantly to avoid interference. In case there is an interference in one channel, the other can be used to extract the audio stream. To operate correctly, both the handset and base station should be set to the same frequency using the DIP switches located in the devices. If the interference is too high, the WVL firmware has the ability to change channels automatically to avoid interruption. This process occurs simultaneously in both the handset and the base station without the need for user intervention. The units revert back to the original frequency set on the DIP switches when both devices are restarted using the power switch. Recommendations for Use To receive the best sound quality from the WVL, please note the following recommendations:

Do not separate the WVL pair with more than two walls. Use channels 0 through 11 for the best sound quality. Use channels 12 through 31 if more than 12 simulators are present in one area. B-2 Appendix B Wireless Voice Link Wireless Voice Link Devices There are two unique devices that make up a WVL pair: the handset device and the base station device. The base station device is located inside the simulator, while the handset device is battery powered and carried by the user. The handset transmits voice input through a microphone to the base station receiver, where it is transmitted to the speakers in the simulators head. The two different devices can be identified by their cases. The handset device has a cover that extends over the length of the antenna. The base station device antenna is almost fully exposed. Figure 1: WVL Handset Figure 2: WVL Base Station B-3 Appendix B Wireless Voice Link Physical Features The following features are located on the top of the WVL devices:

Used to plug in headphones or an iPhone compatible headphone/

Used to plug in a standalone microphone Indicates when the unit is powered on by blinking. Also indicates when Headphone jack:

Microphone jack:

Red power light:

microphone combination the Mute button is activated by solidly staying on. station by blinking. Green connection light:

Indicates an RF link connection between the handset and base Microphone jack Red power light Green connection light Headphone jack The following features are located on the side of the WVL devices:

Figure 3: WVL Front View Houses two AAA batteries and the DIP switch. Accommodates a 5VDC/0.2A power source. Turns WVL handset power on or off. Connects the WVL to the simulators audio amplifier. Battery compartment:

DC power jack:

ON/OFF switch:

Line out jack:

Volume/mute dial:

Special Handset Settings on page B-9 Controls microphone gain and microphone mute on the handset. See Battery compartment Line out DC Power ON/OFF switch Figure 4: WVL Side View Volume/mute dial (Handset) Volume/mute dial (Base Station) On the WVL handset, the volume/mute dial controls the microphone volume or mutes the microphone. See Special Handset Settings on page B-9. On the WVL base station, the dial serves as the volume control for the speakers inside the simulator. Moving the dial toward the plus sign increases the volume. Moving the dial toward the minus sign decreases the volume and setting. On the handset, pressing straight down on the volume dial in the center mutes the microphone. B-4 Appendix B Wireless Voice Link Preparing the Base Station in the Simulator When using the base station in the simulator, ensure the batteries are removed and the following items are attached:

Power cable Line out cable Serial Connector The DIP switch is located in the battery compartment of the base station (Figure 5: DIP Switch Settings). DIP Switch Settings The serial connector is located on the side of the base station (Figure 6: Serial Connector). Figure 5: Dip Switch Settings Serial Connector Figure 6: Serial Connector on base station B-5 Appendix B Wireless Voice Link The base station should come already connected and installed inside the METIman. Base Station Connected and Installed in METIman To prepare the base station:

Figure 7: Base Station in METIman 3. 4. 5. Set the base station DIP switch positions 6 and 7 to OFF, and 8 to ON. Turn the power off and on using the power switch on the outside of the base station to ensure the DIP switch changes take effect. Leave the power switch on the outside of the base station in the on position. Figure 8: DIP Switch Settings for the Base Station NOTE: Since the base station receives power from the simulator, the power switch on the outside of the base station must remain in the ON position. Use this power switch to refresh DIP switch settings. Do not turn the simulator off and on to refresh the DIP switch settings. B-6 Appendix B Wireless Voice Link Preparing the Handset for Use To prepare the handset for use:

1. 2. 3. Insert two AAA batteries into the battery compartment. Set the handset DIP switch positions 6 and 7 to OFF and position 8 to ON. Turn the power switch off and back on to ensure the DIP switch changes take effect. Figure 9: DIP Switch Settings for the Handset While DIP switch positions 6 through 8 affect the handset and base station settings, DIP switch positions 1 through 5 are used to set the radio frequency channel used for communication between the handset and the base station. Selecting the Radio Frequency Channel There are two ways to configure the radio frequency (RF) channel spacing. The first method reduces channel-to-channel interference, but allows only 12 channels to operate simultaneously in the same vicinity. The second method increases the number of channels that can be used simultaneously to 20 channels. However, this method diminishes the channel-to-

channel noise immunity. All of the WVL pairs in the same vicinity must use channels from RF Channel Group 1 or RF Channel Group 2, and channels must belong to the same group. The DIP switch determines the initial communication frequencies that the WVL pair use to communicate when the power of the base station and handset is first turned on. If there is too much interference at the initial channel, the WVL pair changes frequency automatically and continues operating. The WVL pair repeats this process automatically as needed and changes frequencies when interference is too high. Multiple WVL pairs can be set to the same initial frequency. However, setting different initial frequencies helps the WVL pairs quickly find a stable operating frequency. For example, if there are 12 or fewer simulators in the same vicinity, set all of the WVL pairs to use channel 0 of RF Channel Group 1. To give unique initial RF frequencies, assign each WVL pair to its own RF channel with the settings found in CH 0 through CH 11. B-7 Appendix B Wireless Voice Link If you have 13 to 20 simulators in the same vicinity, set all of the WVL pairs to use channel 12 or RF Channel Group 2. To give unique initial RF frequencies, assign each WVL pair to its own RF channel with the settings found in CH 12 through CH 31. Figure 10: RF Channel Selection Methods For a complete list of the initial frequencies associated with the RF Channels, see RF Channel Initial Operating Frequencies on page B-12. B-8 Appendix B Wireless Voice Link Powering Up the WVL Pair To power up the WVL pair:

Power on the base station by turning on the simulator. The base station power switch is in the on position by default. Power on the handset by setting the power switch to the on position. The red power light on each unit blinks when the unit is on. Once both units are powered on and communicating with each other, the green connection light flashes once every second. If the green connection light fails to blink, ensure both units are set to the same RF channel. See Selecting the Radio Frequency Channel on page B-6. If you make changes to the DIP switch settings, toggle the power switches of the handset and base station off and back on to ensure the changes takes effect. Using the iPhone/Standalone Microphone DIP switch position 6 on the handset determines if the iPhone microphone input or the standalone microphone input is enabled. When DIP switch position 6 is set to the OFF position, the standalone microphone jack is enabled for the standalone microphone, provided by CAE Healthcare. Figure 11: Handset and CAE Healthcare-provided Microphone To use a microphone compatible with an iPhone (three-pole jack), set DIP switch position 6 to ON. Please note that an iPhone-compatible microphone is not provided as part of the product package. Any microphone with a common 3.5 mm input jack can be used with the handset when DIP switch position 6 is set to ON. B-9 Appendix B Wireless Voice Link Special Handset Settings Advanced settings for the handset DIP switch are available. iPhone microphone enable Base station volume control enable Noise reduction enable (default) Noise reduction disable Microphone gain control enable (default) Standalone microphone enable (default) Figure 12: Advanced DIP Switch Settings DIP switch settings are only refreshed when the handset is powered on. To ensure the DIP switch changes take effect, turn the power off and back on after making changes. To enable noise reduction and minimize background noise in high ambient noise environments, place the position 8 DIP switch in the ON position. Battery Capacity Indicator The red power light flashes one time every second when the battery capacity is good. When the battery capacity is nearly depleted, the red power LED flashes twice in quick succession every second. This indicates the batteries need to be replaced. To get the most battery life out of the handset, the handset should be powered down when it is not in use. B-10 Appendix B Wireless Voice Link Troubleshooting CAE Healthcare Customer Service is available to help with iStan problems, should they arise. However, sometimes you can speed up the customer service process by performing diagnostics before calling, and eliminating some problems on your own with the help of the following instructions. Power Problems The red power light on the handset does not flash when power switch is turned on. Check that the batteries are inserted correctly. Install a fresh set of batteries, if needed. The red power light on my base station is not flashing when the simulator is powered on. Check that the cables from the simulator are installed in the base station correctly. Communication Problems The simulator and handset are turned on, but the green connection light is not blinking. Verify that DIP switch positions 1 through 5 are all set to OFF, which is the default position set in the simulator base station and handset at the factory. If you have modified this setting, verify positions 1 through 5 on the handset and the simulator base station are the same. Be sure to turn the power off and back on for the changes to take effect on both the handset and the base station. Check if the green connection light is flashing after turning the power off and back on each time to see if communication has been established between the base station and the handset. Im experiencing static or dropouts in the simulator audio output. Reduce the range between the base station and the handset. Most likely, the handset is out of range of the base station, or there may be too many obstacles (walls, windows, doors) between the handset and the simulator. Audio Problems The sound output from the simulator is low when using a microphone on my lapel. Increase the microphone gain on the handset by moving the dial towards the plus sign. DIP switch 7 must be in the OFF position for this to work. Im hearing feedback from the microphone when I am close to the simulator. Decrease the microphone gain on the handset by moving the dial towards the minus sign. DIP switch 7 must be in the OFF position for this to work. B-11 Appendix B Wireless Voice Link The sound output from the simulator is too high or too low. The volume level is configured at the factory for optimal performance. However, if you want to adjust the volume level of the base station (located inside the simulator), set the handset DIP switch 7 to ON. Remember to turn the handset power off and on after each DIP-switch change. After this step is complete, you will be able to adjust the volume level of the base station by adjusting the handset volume dial. The sound output from the simulator is noisy when the speaker is not speaking. You can use the noise reduction feature by setting the handset DIP switch position 8 to ON. The simulator voice output is cut off when the speaker is speaking quietly. In this case, there are three possible options:

- Attempt to talk louder

- Increase the microphone gain

- Disable the noise reduction feature by setting the handset DIP switch 8 to OFF. B-12 Appendix B Wireless Voice Link RF Channel Initial Operating Frequencies RF Channel 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Frequency 1 (GHz) 2.402 2.405 2.408 2.411 2.414 2.417 2.420 2.423 2.426 2.429 2.432 2.435 2.402 2.404 2.406 2.408 2.410 2.412 2.414 2.416 2.418 2.420 2.422 2.424 2.426 2.428 2.430 2.432 2.434 2.436 2.438 2.440 Frequency 2 (GHz) 2.480 2.477 2.474 2.471 2.468 2.465 2.462 2.459 2.456 2.453 2.450 2.447 2.480 2.478 2.476 2.474 2.472 2.470 2.468 2.466 2.464 2.462 2.460 2.458 2.456 2.454 2.452 2.450 2.448 2.446 2.444 2.442 B-13 Appendix B Wireless Voice Link Specifications Frequency of operation: 2.400 2.4835 GHz Wireless range: 100 ft clear line of sight RF power output: 0dBm Batteries: 2 AAA Alkaline, NiCd, NiMH, Lithium Handset battery life with base station on: 25 hours with alkaline batteries Handset battery life with base station off: 100 hours with alkaline batteries DC voltage input: 5 VDC, 0.2A Line out jack: 3.5 mm Headphone/iPhone jack: 3.5 mm Standalone microphone jack: 3.5 mm Mechanical dimensions with antenna: 6.17 x 2.52 x 0.65 Mechanical dimensions without antenna: 4.2 x 2.52 x 0.65 B-14 caehealthcare.com For more information about CAE Healthcare products, contact your regional sales manager or the CAE Healthcare distributor in your country, or visit caehealthcare.com. Tel +1 941-377-5562 or 866-233-6384 For customer service, please contact CAE Healthcare. Customer Service Headquarters - United States and Latin America Monday - Friday from 7:00 a.m. to 6:00 p.m. ET Phone 1-866-462-7920 Email: customerservice@caehealthcare.com Customer Service - Canada Monday - Friday from 8:00 a.m. to 5:00 p.m. ET Phone 1-877-223-6273 Email: can.service@caehealthcare.com Customer Service - Europe, Middle East, Africa, India, Asia and Australia Monday - Friday from 8:00 a.m. to 5:00 p.m. CET Phone +49 (0) 6131 4950354 Email: international.service@caehealthcare.com Customer Service - United Kingdom and Ireland Monday - Friday from 9:00 a.m. to 5:00 p.m. GMT Phone +44 (0)800-917-1851 Email: uk.service@caehealthcare.com 2012 CAE Healthcare 165k360110 v.4.1