1. A low cost cesarean-section trainer on a live model to teach the procedure of resuscitative hysterotomy R Bryant MD, J Wagner MD, C Sampson MD University of Utah, Washington University School of Medicine, University of Missouri-Columbia. INTRODUCTION  Resuscitative hysterotomy is a low frequency, high-risk procedure that has the potential to be lifesaving when performed Correctly, and in a timely fashion.  Rare, time critical procedures present a unique learning challenge, as they are likely to occur less than once per career.  Providing residents with cost effective, replaceable trainers to allow skill acquisition, and the development of muscle memory for the procedures represents a significant financial challenge for most residency programs.  A once per career procedure is more likely to be successful in practice if the proceduralist has performed the procedure in simulated fashion during training. EDUCATIONAL OBJECTIVE  We provide a description of the use of a novel teaching method for the procedure of resuscitative hysterotomy on a live volunteer using a model previously described by J Wagner MD.

2. A low cost cesarean-section trainer on a live model to teach the procedure of resuscitative hysterotomy R Bryant MD, J Wagner MD, C Sampson MD University of Utah, Washington University School of Medicine, University of Missouri-Columbia. METHODS  During a didactic session on the management of critical illness in pregnancy RB described the procedure of resuscitative hyserotomy to the class.  The resuscitative hysterotomy model was fitted to a senior resident, and a surprise cardiac arrest was staged.  A resident playing the role of paramedic delivered an arresting patient into the room.  The ‘pregnant patient feigned lifelessness, had a cut-off endotracheal tube in her mouth, and was receving bag valve mask ventilations, and light chest compressions from two other residents.  RB then gave a live demonstration of a resuscitative hysterotomy to the class.  At the conclusion of the class 3 resuscitative hysterotomy models were made available to the residents in attendance to then practice the procedure themselves.

3. A low cost cesarean-section trainer on a live model to teach the procedure of resuscitative hysterotomy R Bryant MD, J Wagner MD, C Sampson MD University of Utah, Washington University School of Medicine, University of Missouri-Columbia. https://vimeo.com/141966248

4. A low cost cesarean-section trainer on a live model to teach the procedure of resuscitative hysterotomy R Bryant MD, J Wagner MD, C Sampson MD University of Utah, Washington University School of Medicine, University of Missouri-Columbia. IMPACT / EFFECTIVENESS  The university of Utah Emergency Medicine residency program uses the E-value Program to provide feedback to presenters.  Anonymous feedback from the teaching session was universally favorable.  Attendees commented on the quality and realism of the resuscitative hysterotomy model, and the improved educational benefit from the opportunity to see and do the procedure, rather than just have it described to them.  Comments:  ‘ I am not getting pregnant!  ‘Very cool hands on simulation. It’s one thing to read about how this would go down, it’s another to see what it would actually look like.’  ‘Great SIM, Great lecture’  ‘Loved the hands on aspect at the end of the lecture.’ POST PRESENTATION SURVEY  The content presented was relevant to the practice of emergency medicine  The speaker presented material at an appropriate level for resident training

5. A low cost cesarean-section trainer on a live model to teach the procedure of resuscitative hysterotomy R Bryant MD, J Wagner MD, C Sampson MD University of Utah, Washington University School of Medicine, University of Missouri-Columbia. REFERENCES CONCLUSIONS  Maternal cardiac arrest and perimortem cesarean delivery: Evidence or expert based? Resuscitation, 2012 Oct; 83(10):1191-200  Sampson CS, Renz NR, Wagner JC. An inexpensive and novel model for perimortem cesarean section. Simul Healthc. 2013 Feb;8(1):49-51 PDIM 23288030  The benefit of using this model on a live volunteer, rather than a manikin is the extra degree of realism that it brings to the procedure.  This novel approach that uses a realistic patient, and attempts to reproduce a clinical scenario that will result in a resuscitative hysterotomy has the potential to improve the learner’s recollection of the procedure to allow improved performance when the opportunity arises in clinical practice.  The use of this model with a $13 cost to replace disposables, and $23 initial set up cost is extremely cost effective when compared to comparable commercially available models.