British Association for Immediate Care

The British Association for Immediate Care (BASICS) is a national charity that promotes and facilitates pre-hospital immediate care through a series of internationally recognized training courses. The organisation also looks after nearly 40 regional affiliated Immediate Care schemes that voluntarily support medical practitioners and NHS ambulance services around the UK.

Tony Kemp, Chief Officer at BASICS, approached Protolabs for help providing vital components for training their specialist immediate care responders. Protolabs, as the world-leading digital manufacturer, were able to advise on design for additive manufacturability before supplying a number of 3D printed parts in rapid time so that pre-hospital immediate care skills could be learned more effectively.

Specialist training is one of the primary focuses of the charity, offered to a range of healthcare professionals who want to enhance their first response skills for the pre-hospital period. These are senior-level practitioners such as doctors, nurses and paramedics who provide advanced clinical care for the NHS ambulance services as well as support at large events such as football matches. BASICS also offers emergency education training to practitioners who want to further hone their skills in order to progress their career - to helicopter emergency care, for instance.

In very serious incidents where a patient has taken a blow to the face, they may have lost integrity in the architecture of their face, collapsing their upper airway. In these extreme circumstances, BASICS teach a last-ditch advanced airway management skill to keep the patient breathing. It’s an important technique that’s rarely used in the civilian world and more commonly deployed by the military in combat conditions and entails creating a surgical airway, or cricothyroidotomy.

This field operation involves practitioners making an incision in an area of the mid-neck where the trachea has a ‘window’ in it created by the cricothyroid membrane. Through an incision at this point it is possible for a practiced clinician to insert a breathing tube below the blockage that is preventing the patient from breathing. It’s delicate surgery that needs to be performed by an individual who not only understands the anatomy of the area but also is able to perform this life-saving operation, at the scene, before the patient dies.

Traditionally this life-saving skill has been taught by using dissected cadaveric sheep trachea from a specialist supplier. However, this has not been a convenient option. Sheep tracheas are relatively expensive and need to be kept frozen until they are used in training. Although specially treated, once defrosted they will deteriorate and need to be disposed of carefully. And being just a dissected part, although the tissue feels realistic they’re not anatomically authentic compared to operating in a real-life scenario on a human trachea that also involves negotiating around a potentially rising chest, bobbing chin and moving head. In addition, many people object to the idea of using animal parts to practice on.

Tony Kemp was keen to find an alternative solution. This was a unique problem to be resolved by digital manufacturing. He found a CAD design of an anatomically realistic trachea that had been created by a group in the USA called The Airway APP and could be downloaded for free, as open source, from their website. Armed with the CAD design, Tony approached Protolabs for their help with creating the 3D printed trachea model that would enable the charity to train more people across the UK in this life-saving skill.

Whilst Tony has been appointed as an MBE by the Queen for his long-standing services to pre-hospital emergency care, he is not an engineer and has no manufacturing background. But the growing availability of free CAD models, with CAD design becoming increasingly common in product launches, design and engineering, and the movement within the design community to share ideas and resources has greatly benefitted those who lack the technical skills for modeling

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Tony did have a very clear vision of what physical parts he needed for the training manikins and how this would transform them into more realistic tools. Tony’s biggest obstacle was working out which material to use for the parts. He discussed the matter with Protolabs, explaining that he needed a material for a part that would be reused multiple times and have a very sharp scalpel coming within close proximity so it needed to be flexible for realism but to remain durable.

In response, Protolabs advised the use of PA 12 white, a highly durable polyamide that’s a good choice for functional prototypes due to its high impact resistance and suitability under a number of environmental conditions. In addition, Protolabs advised Tony to use their Selective Laser Sintering (SLS) 3D printing technology – well suited to nylon materials such as PA 12 white and effective in creating accuracy and functionality in the parts produced. Plus there’s no build structure around the parts when using SLS, so this saved time in getting the parts quickly shipped out, ready for use as soon as they arrived with the customer. This proved to work well for Tony’s needs.

Altogether, 16 parts were manufactured – tube-shaped replicas of the human trachea that are inserted in the specific anatomical location under the heads of the life-saving training manikins.

These trachea models contain a window that is covered by duct tape. The tape simulates the amount of pressure required for a scalpel to make an incision and replicates the sound of cutting into the cricothyroid membrane in a real life. On top of the tape, packing foam is layered, mimicking the fatty layer under the skin, and over this goes imitation skin – a product used by tattoo artists to practice on and innovatively sourced by Tony to create his new and improved tool for medical professionals. This fake skin is malleable and can be manipulated just like real skin, allowing students to feel the structure underneath the skin of the manikin ‘patient’ and find the correct area to make an incision.

To further enhance the authenticity of the training, Tony inventively added a connective tube to the bottom of the part created by Protolabs and inserted it into the lung bag of the dummy, so practitioners can now ‘breathe’ for the patient, thus making the training scenario feel very real indeed.

The result is a first response manikin that is far more anatomically accurate and realistic than anything Tony believes has been previously used for training in the UK – thanks in part to the excellent digital manufacturing services of Protolabs.

The plastic part created by Protolabs has enabled Tony to create an advanced training tool that better replicates the reality of what medical practitioners will face in a real-life emergency scenario. This allows them to hone their skills more effectively in order to successfully meet a unique challenge and hopefully more lives will be saved as a result.

The parts have been inserted into the training manikins and have to date been used on 5 courses, so helping to train 60 people so far and the response has been very positive.

“They were most recently used on a high-level training course where we are teaching very complex skills and the new manikins worked brilliantly. Everybody has been very enthusiastic,” explains Tony. “The training tutors feel it adds a much greater level of fidelity to the whole training scenario. This is a very rarely used skill so anything we can do to really help people rehearse this in circumstances that feel as close as possible to the reality is absolutely phenomenal and will ultimately help to save lives.“

Tony was delighted by Protolabs’ service, not least by their quote. “I was very pleasantly surprised by the quote from Protolabs as I thought 3D printing was going to be expensive. However, the cost of the parts was extremely cost effective, especially when compared to the cost of ordering animal parts for each person in training.” 

Going forward, Tony has more innovative ideas about how BASICS can adapt and further augment the realism of their training manikins. “I will definitely return to Protolabs for help with what I’m planning next. I found their website and my account manager to be very helpful, their service was excellent and the parts they produced are fantastic. I’m very pleased.”