Special effects that can save a life | Peter Weinstock | TEDxNatick
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0:17 - 0:21What if I told you
there was a new technology -
0:21 - 0:26that, when placed in the hands
of doctors and nurses, -
0:26 - 0:31improved outcomes for children
and adults, patients of all ages; -
0:32 - 0:35reduced pain and suffering,
-
0:35 - 0:38reduced time in the operating rooms,
-
0:38 - 0:41reduced anesthetic times,
-
0:41 - 0:43had the ultimate dose-response curve
-
0:43 - 0:44that the more you did it,
-
0:44 - 0:47the better it benefitted patients?
-
0:48 - 0:50Here's a kicker: it has no side effects,
-
0:52 - 0:55and it's available no matter
where care is delivered. -
0:56 - 0:59I can tell you as an ICU doctor
at Boston Children's Hospital, -
0:59 - 1:02this would be a game changer for me.
-
1:03 - 1:06And the good news is that I'm here
to tell you about this technology -
1:06 - 1:11and that we're finding, as we apply
this technology in health care, -
1:11 - 1:14we are having these exact outcomes
I've just described to you. -
1:15 - 1:20That technology is lifelike rehearsal.
-
1:21 - 1:23Just in the times that matter most,
-
1:23 - 1:27and in the places that matter most,
and for the teams that matter most, -
1:27 - 1:30and ultimately, for the patients
that matter most. -
1:30 - 1:31And this technology,
-
1:31 - 1:33this lifelike rehearsal,
-
1:33 - 1:36is being delivered
through medical simulation. -
1:37 - 1:41I thought I would start with a case,
-
1:41 - 1:44just to really describe
the challenge ahead, -
1:44 - 1:48and why this technology is not just
going to improve health care -
1:48 - 1:50but why it's critical to health care.
-
1:51 - 1:54This is a child that's born, young girl.
-
1:54 - 1:56"Day of life zero," we call it,
-
1:56 - 1:58the first day of life,
just born into the world. -
1:58 - 1:59And just as she's being born,
-
2:00 - 2:02we notice very quickly
that she is deteriorating. -
2:02 - 2:05Her heart rate is going up,
her blood pressure is going down, -
2:05 - 2:07she's breathing very, very fast.
-
2:08 - 2:12And the reason for this
is displayed in this chest X-ray. -
2:16 - 2:19You can see here,
it's a quick study in radiology. -
2:19 - 2:22As you see here, the upper portion
of this child's -- -
2:22 - 2:23That's called a babygram,
-
2:23 - 2:26a full X-ray of a child's body,
a little infant's body. -
2:26 - 2:28As you look on the top side of this,
-
2:28 - 2:31that's where the heart and lungs
are supposed to be. -
2:31 - 2:33As you look at the bottom end,
that's where the abdomen is, -
2:34 - 2:36and that's where the intestines
are supposed to be. -
2:36 - 2:39And you can see how
there's sort of that translucent area -
2:39 - 2:42that made its way up into the right side
of this child's chest. -
2:42 - 2:46And those are the intestines --
in the wrong place. -
2:46 - 2:48As a result, they're pushing on the lungs
-
2:48 - 2:51and making it very difficult
for this poor baby to breathe. -
2:52 - 2:53The fix for this problem
-
2:53 - 2:56is to take this child immediately
to the operating room, -
2:56 - 2:58bring those intestines
back into the abdomen, -
2:58 - 2:59let the lungs expand
-
2:59 - 3:01and allow this child to breathe again.
-
3:02 - 3:04But before she can go
to the operating room, -
3:04 - 3:07she must get whisked away
to the ICU, where I work. -
3:07 - 3:09I work with surgical teams.
-
3:09 - 3:11We gather around her,
-
3:11 - 3:15and we place this child
on heart-lung bypass. -
3:16 - 3:18We put her to sleep,
-
3:18 - 3:20we make a tiny
little incision in the neck, -
3:20 - 3:23we place catheters into the major
vessels of the neck -- -
3:23 - 3:27and I can tell you that these vessels
are about the size of a pen, -
3:27 - 3:29the tip of a pen --
-
3:29 - 3:31and then we have blood
drawn from the body, -
3:31 - 3:34we bring it through a machine,
it gets oxygenated, -
3:34 - 3:35and it goes back into the body.
-
3:36 - 3:37We save her life,
-
3:37 - 3:40and get her safely to the operating room.
-
3:41 - 3:43Here's the problem:
-
3:44 - 3:46these disorders --
-
3:46 - 3:49what is known is congenital
diaphragmatic hernia -- -
3:49 - 3:53this hole in the diaphragm that has
allowed these intestines to sneak up -- -
3:53 - 3:55these disorders are rare.
-
3:56 - 4:00Even in the best hands in the world,
-
4:00 - 4:03there is still a challenge
to get the volume -- -
4:03 - 4:05the natural volume of these patients --
-
4:05 - 4:08in order to get our expertise
curve at 100 percent. -
4:08 - 4:10They just don't present that often.
-
4:11 - 4:14So how do you make the rare common?
-
4:16 - 4:18Here's the other problem:
-
4:19 - 4:23in the health care system
that I trained for over 20 years, -
4:23 - 4:24what currently exists,
-
4:25 - 4:27the model of training is called
the apprenticeship model. -
4:27 - 4:29It's been around for centuries.
-
4:29 - 4:33It's based on this idea that you see
a surgery maybe once, -
4:33 - 4:35maybe several times,
-
4:35 - 4:38you then go do that surgery,
-
4:38 - 4:41and then ultimately you teach
that surgery to the next generation. -
4:43 - 4:46And implicit in this model --
-
4:46 - 4:48I don't need to tell you this --
-
4:48 - 4:53is that we practice on the very patients
that we are delivering care to. -
4:55 - 4:56That's a problem.
-
5:00 - 5:02I think there's a better approach.
-
5:02 - 5:06Medicine may very well be the last
high-stakes industry -
5:06 - 5:09that does not practice prior to game time.
-
5:11 - 5:15I want to describe to you a better
approach through medical simulation. -
5:17 - 5:20Well, the first thing we did is we went
to other high-stakes industries -
5:20 - 5:23that had been using this type
of methodology for decades. -
5:23 - 5:25This is nuclear power.
-
5:25 - 5:29Nuclear power runs scenarios
on a regular basis -
5:29 - 5:32in order to practice
what they hope will never occur. -
5:32 - 5:36And as we're all very familiar,
the airline industry -- -
5:36 - 5:40we all get on planes now,
comforted by the idea -
5:40 - 5:45that pilots and crews have trained
on simulators much like these, -
5:45 - 5:48training on scenarios
that we hope will never occur, -
5:48 - 5:50but we know if they did,
-
5:50 - 5:53they would be prepared for the worst.
-
5:53 - 5:58In fact, the airline industry has gone
as far as to create fuselages -
5:58 - 5:59of simulation environments,
-
5:59 - 6:02because of the importance
of the team coming together. -
6:03 - 6:05This is an evacuation drill simulator.
-
6:06 - 6:10So again, if that ever were to happen,
these rare, rare events, -
6:10 - 6:13they're ready to act
on the drop of a dime. -
6:15 - 6:20I guess the most compelling for me
in some ways is the sports industry -- -
6:20 - 6:22arguably high stakes.
-
6:23 - 6:26You think about a baseball team:
baseball players practice. -
6:26 - 6:29I think it's a beautiful example
of progressive training. -
6:29 - 6:31The first thing they do
is go out to spring training. -
6:31 - 6:34They go to a spring training camp,
-
6:34 - 6:36perhaps a simulator in baseball.
-
6:37 - 6:40They're not on the real field,
but they're on a simulated field, -
6:40 - 6:42and they're playing in the pregame season.
-
6:42 - 6:45Then they make their way to the field
during the season games, -
6:45 - 6:49and what's the first thing they do
before they start the game? -
6:49 - 6:53They go into the batting cage
and do batting practice for hours, -
6:53 - 6:56having different types of pitches
being thrown at them, -
6:56 - 7:01hitting ball after ball
as they limber their muscles, -
7:01 - 7:03getting ready for the game itself.
-
7:03 - 7:06And here's the most
phenomenal part of this, -
7:07 - 7:09and for all of you who watch
any sport event, -
7:09 - 7:11you will see this phenomenon happen.
-
7:12 - 7:15The batter gets into the batter's box,
-
7:15 - 7:17the pitcher gets ready to pitch.
-
7:17 - 7:20Right before the pitch is thrown,
-
7:20 - 7:21what does that batter do?
-
7:21 - 7:23The batter steps out of the box
-
7:25 - 7:26and takes a practice swing.
-
7:29 - 7:30He wouldn't do it any other way.
-
7:33 - 7:37I want to talk to you about how
we're building practice swings like this -
7:37 - 7:38in medicine.
-
7:38 - 7:42We are building batting cages
for the patients that we care about -
7:42 - 7:43at Boston Children's.
-
7:43 - 7:46I want to use this case
that we recently built. -
7:46 - 7:50It's the case of a four-year-old
who had a progressively enlarging head, -
7:50 - 7:52and as a result,
-
7:52 - 7:55had loss of developmental milestones,
neurologic milestones, -
7:55 - 7:58and the reason for this problem is here --
-
7:58 - 8:00it's called hydrocephalus.
-
8:01 - 8:04So, a quick study in neurosurgery.
-
8:04 - 8:05There's the brain,
-
8:05 - 8:08and you can see the cranium
surrounding the brain. -
8:08 - 8:12What surrounds the brain,
between the brain and cranium, -
8:12 - 8:15is something called
cerebrospinal fluid or fluid, -
8:15 - 8:17which acts as a shock absorber.
-
8:17 - 8:19In your heads right now,
-
8:19 - 8:22there is cerebrospinal fluid
just bathing your brains -
8:22 - 8:24and making its way around.
-
8:24 - 8:26It's produced in one area
and flows through, -
8:26 - 8:28and then is re-exchanged.
-
8:28 - 8:31And this beautiful flow pattern
occurs for all of us. -
8:31 - 8:33But unfortunately in some children,
-
8:33 - 8:36there's a blockage of this flow pattern,
-
8:36 - 8:37much like a traffic jam.
-
8:38 - 8:41As a result, the fluid accumulates,
-
8:41 - 8:43and the brain is pushed aside.
-
8:44 - 8:46It has difficulty growing.
-
8:46 - 8:50As a result, the child loses
neurologic milestones. -
8:50 - 8:52This is a devastating disease in children.
-
8:52 - 8:55The cure for this is surgery.
-
8:56 - 8:58The traditional surgery is to take
a bit of the cranium off, -
8:59 - 9:00a bit of the skull,
-
9:00 - 9:03drain this fluid out,
stick a drain in place, -
9:03 - 9:05and then eventually bring
this drain internal to the body. -
9:05 - 9:07Big operation.
-
9:08 - 9:12But some great news is that advances
in neurosurgical care -
9:12 - 9:16have allowed us to develop
minimally invasive approaches -
9:16 - 9:17to this surgery.
-
9:17 - 9:21Through a small pinhole,
a camera can be inserted, -
9:22 - 9:25led into the deep brain structure,
-
9:25 - 9:29and cause a little hole in a membrane
that allows all that fluid to drain, -
9:29 - 9:31much like it would in a sink.
-
9:31 - 9:34All of a sudden, the brain
is no longer under pressure, -
9:34 - 9:36can re-expand
-
9:36 - 9:39and we cure the child
through a single-hole incision. -
9:40 - 9:42But here's the problem:
-
9:42 - 9:44hydrocephalus is relatively rare.
-
9:44 - 9:47And there are no good training methods
-
9:47 - 9:50to get really good at getting
this scope to the right place. -
9:50 - 9:55But surgeons have been quite creative
about this, even our own. -
9:55 - 9:57And they've come up with training models.
-
9:57 - 9:59Here's the current training model.
-
9:59 - 10:01(Laughter)
-
10:01 - 10:02I kid you not.
-
10:02 - 10:03This is a red pepper,
-
10:05 - 10:06not made in Hollywood;
-
10:06 - 10:08it's a real red pepper.
-
10:08 - 10:11And what surgeons do is they stick
a scope into the pepper, -
10:11 - 10:14and they do what is called a "seedectomy."
-
10:14 - 10:16(Laughter)
-
10:16 - 10:22They use this scope to remove seeds
using a little tweezer. -
10:23 - 10:25And that is a way to get under their belts
-
10:25 - 10:28the rudimentary components
of doing this surgery. -
10:29 - 10:31Then they head right into
the apprenticeship model, -
10:31 - 10:34seeing many of them
as they present themselves, -
10:34 - 10:36then doing it, and then teaching it --
-
10:36 - 10:38waiting for these patients to arrive.
-
10:39 - 10:41We can do a lot better.
-
10:41 - 10:46And I want to take you now into
what is veritably the Willy Wonka shop -
10:46 - 10:48at Boston Children's Hospital,
-
10:48 - 10:53where we are manufacturing
reproductions of children -
10:53 - 10:57in order for surgeons and surgical
teams to rehearse -
10:57 - 11:00in the most relevant possible ways.
-
11:00 - 11:01Let me show you this.
-
11:03 - 11:05Here's my team
-
11:05 - 11:09in what's called the SIM Engineering
Division of the Simulator Program. -
11:10 - 11:13This is an amazing team of individuals.
-
11:13 - 11:15They are mechanical engineers;
-
11:15 - 11:18you're seeing here, illustrators.
-
11:18 - 11:22They take primary data
from CT scans and MRIs, -
11:22 - 11:25translate it into digital information,
-
11:26 - 11:27animate it,
-
11:27 - 11:32put it together into the components
of the child itself, -
11:32 - 11:35surface-scan elements of the child
that have been casted as needed, -
11:35 - 11:38depending on the surgery itself,
-
11:38 - 11:42and then take this digital data
and be able to output it -
11:42 - 11:46on state-of-the-art,
three-dimensional printing devices -
11:46 - 11:48that allow us to print the components
-
11:48 - 11:54exactly to the micron detail of what
the child's anatomy will look like. -
11:54 - 11:55You can see here,
-
11:55 - 11:58the skull of this child being printed
-
11:58 - 12:00in the hours before
we performed this surgery. -
12:01 - 12:04But we could not do this work
-
12:04 - 12:08without our dear friends on the West Coast
in Hollywood, California. -
12:09 - 12:13These are individuals
that are incredibly talented -
12:13 - 12:15at being able to recreate reality.
-
12:15 - 12:20It was not a long leap for us.
-
12:20 - 12:21The more we got into this field,
-
12:21 - 12:25the more it became clear to us
that we are doing cinematography. -
12:26 - 12:27We're doing filmmaking,
-
12:28 - 12:30it's just that the actors are not actors.
-
12:31 - 12:33They're real doctors and nurses.
-
12:34 - 12:37So these are some photos
of our dear friends at Fractured FX -
12:37 - 12:39in Hollywood California,
-
12:39 - 12:42an Emmy-Award-winning
special effects firm. -
12:42 - 12:45This is Justin Raleigh and his group --
-
12:45 - 12:47this is not one of our patients --
-
12:47 - 12:49(Laughter)
-
12:49 - 12:52but kind of the exquisite work
that these individuals do. -
12:52 - 12:55We have now collaborated
and fused our experience, -
12:55 - 12:58bringing their group
to Boston Children's Hospital, -
12:58 - 13:00sending our group
out to Hollywood, California -
13:00 - 13:02and exchanging around this
-
13:02 - 13:05to be able to develop
these type of simulators. -
13:05 - 13:09What I'm about to show you
is a reproduction of this child. -
13:09 - 13:11This is not a real child.
-
13:20 - 13:25You'll notice here that every hair
on the child's head is reproduced. -
13:25 - 13:29And in fact, this is also
that reproduced child -- -
13:29 - 13:32and I apologize for any queasy stomachs,
-
13:32 - 13:35but that is a reproduction and simulation
-
13:35 - 13:37of the child they're about to operate on.
-
13:39 - 13:42Here's that membrane we had talked about,
-
13:42 - 13:44the inside of this child's brain.
-
13:44 - 13:49What you're going to be seeing here
is, on one side, the actual patient, -
13:49 - 13:51and on the other side, the simulator.
-
13:51 - 13:56As I mentioned, a scope, a little camera,
needs to make its way down, -
13:56 - 13:57and you're seeing that here.
-
13:57 - 14:00It needs to make a small hole
in this membrane -
14:00 - 14:02and allow this fluid to seep out.
-
14:04 - 14:08I won't do a quiz show to see
who thinks which side is which, -
14:10 - 14:12but on the right is the simulator.
-
14:13 - 14:17So surgeons can now produce
training opportunities, -
14:17 - 14:21do these surgeries
as many times as they want, -
14:21 - 14:24to their heart's content,
until they feel comfortable. -
14:24 - 14:27And then, and only then,
bring the child into the operating room. -
14:27 - 14:28But we don't stop here.
-
14:28 - 14:33We know that a key step to this
is not just the skill itself, -
14:33 - 14:37but combining that skill with a team
who's going to deliver that care. -
14:37 - 14:40Now we turn to Formula One.
-
14:40 - 14:44And here is an example
of a technician putting on a tire -
14:44 - 14:47and doing that time and time
again on this car. -
14:47 - 14:50But that is very quickly
going to be incorporated -
14:50 - 14:52within team-training experiences,
-
14:52 - 14:56now as a full team orchestrating
the exchange of tires -
14:56 - 14:59and getting this car back on the speedway.
-
15:00 - 15:04We've done that step in health care,
-
15:04 - 15:10so now what you're about to see
is a simulated operation. -
15:11 - 15:13We've taken the simulator
I just described to you, -
15:13 - 15:17we've brought it into the operating room
at Boston Children's Hospital, -
15:17 - 15:21and these individuals --
these native teams, operative teams -- -
15:21 - 15:24are doing the surgery before the surgery.
-
15:24 - 15:26Operate twice;
-
15:26 - 15:27cut once.
-
15:27 - 15:29Let me show that to you.
-
15:32 - 15:35(Video) Surgical team member 1:
You want the head down or head up? -
15:35 - 15:37STM 2: Can you lower it down to 10?
-
15:37 - 15:39STM 3: And then lower
the whole table down a little bit? -
15:39 - 15:41STM 4: Table coming down.
-
15:43 - 15:46STM 3: All right, this
is behaving like a vessel. -
15:46 - 15:48Could we have the scissors back, please?
-
15:48 - 15:51STM 5: I'm taking my gloves,
8 to 8 1/2, all right? I'll be right in. -
15:51 - 15:54STM 6: Great! Thank you.
-
15:55 - 15:57Peter Weinstock: It's really amazing.
-
15:57 - 15:59The second step to this,
which is critical, -
15:59 - 16:02is we take these teams out
immediately and debrief them. -
16:03 - 16:04We use the same technologies
-
16:04 - 16:09that are used in Lean
and Six Sigma in the military, -
16:09 - 16:12and we bring them out
and talk about what went right, -
16:12 - 16:14but more importantly,
-
16:14 - 16:16we talk about what didn't go well,
-
16:16 - 16:18and how we're going to fix it.
-
16:18 - 16:21Then we bring them right back in
and do it again. -
16:21 - 16:26Deliberative batting practice
in the moments when it matters most. -
16:28 - 16:30Let's go back to this case now.
-
16:30 - 16:32Same child,
-
16:32 - 16:34but now let me describe
how we care for this child -
16:34 - 16:36at Boston Children's Hospital.
-
16:36 - 16:38This child was born
at three o'clock in the morning. -
16:38 - 16:40At two o'clock in the morning,
-
16:40 - 16:42we assembled the team,
-
16:42 - 16:44and took the reproduced anatomy
-
16:44 - 16:48that we would gain
out of scans and images, -
16:49 - 16:51and brought that team
to the virtual bedside, -
16:51 - 16:53to a simulated bedside --
-
16:53 - 16:57the same team that's going to operate
on this child in the hours ahead -- -
16:57 - 16:59and we have them do the procedure.
-
17:00 - 17:01Let me show you a moment of this.
-
17:06 - 17:08This is not a real incision.
-
17:10 - 17:12And the baby has not yet been born.
-
17:13 - 17:15Imagine this.
-
17:21 - 17:25So now the conversations
that I have with families -
17:25 - 17:28in the intensive care unit
at Boston Children's Hospital -
17:28 - 17:29are totally different.
-
17:30 - 17:32Imagine this conversation:
-
17:33 - 17:38"Not only do we take care of this disorder
frequently in our ICU, -
17:38 - 17:40and not only have we done surgeries
-
17:40 - 17:42like the surgery we're going
to do on your child, -
17:42 - 17:46but we have done your child's surgery.
-
17:47 - 17:50And we did it two hours ago.
-
17:50 - 17:52And we did it 10 times.
-
17:52 - 17:56And now we're prepared to take them
back to the operating room." -
17:58 - 18:00So a new technology in health care:
-
18:01 - 18:04lifelike rehearsal.
-
18:04 - 18:08Practicing prior to game time.
-
18:09 - 18:10Thank you.
-
18:10 - 18:17(Applause)
- Title:
- Special effects that can save a life | Peter Weinstock | TEDxNatick
- Description:
-
Medicine may be the only high stakes industry left that does not routinely practice prior to game time. Critical Care Doctor and Medical Simulation Expert, Peter Weinstock shows how a unique blend of simulation, Hollywood special effects and 3D-printing are used to create amazingly lifelike reproductions of real patients and for the first time give surgical teams the power to "operate twice, but cut once” to improve outcomes for infants and children.
Peter is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children’s Hospital/Harvard Medical School. He is committed to improving the surgical outcomes of neonates and children. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D print technologies to create lifelike simulations of complex surgeries.
This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDxTalks
- Duration:
- 18:26
Krystian Aparta edited English subtitles for Special Effects That Can Save a Life | Peter Weinstock | TEDxNatick | ||
Krystian Aparta edited English subtitles for Special Effects That Can Save a Life | Peter Weinstock | TEDxNatick | ||
Krystian Aparta edited English subtitles for Special Effects That Can Save a Life | Peter Weinstock | TEDxNatick |