Caution Do not mark on the model and other components
with pen nor leave printed materials contacted
on surface.
Ink marks on the models cannot be removed.

MW13

Difficult Airway Management Simulator
Training Model

Instruction
ManualContents● Introduction

P. 1

Manufacturer’s Note
DOs and DON’Ts● Before You Start

P. 2

Set Includes● Before Training

P. 3

Check points before training
Difficult Airway Management Simulator Light tone

● Preparation

Setting of DAM (Neck flexibility)

P.4

Setting of DAM (Degree of the mouth opening)

P. 5

Setting of DAM (Tongue Edema)

P. 6

Setting of DAM (Laryngospasm)

P. 7● Training

P.8-P.10● Replacement of the Consumable Parts● After Training

P.11-P.19
P.20

Difficult Airway Management Simulator Dark tone

Movie Site
English Site
https://youtu.be/J1BGUiUwxvUIntroduction

Manufacturer ’s note
The Difficult Airway management (D.A.M.) Simulator offers not only excellent reality in airway
management training but also varying degrees of challenge to trainees through a combination ofcontrollable degree of mouth opening, changeable limit of neck flexibility, and inflatable tongue.
It provides wide variations of training experiences in difficult airway management including use ofdiverse types of devices. Its portable design and durable structure allow training in emergency,
pre-hospital, and clinical settings. This innovative simulator facilitates acquiring basic skills, improving
the skills to advanced level and attaining ability to respond real-life situations.
● Features-Robust structure and the stable base for training in various settings including those for pre-hospitalscenario-Anatomically correct airway structure and realistic laryngeal view
-The upper teeth are removable with excess force-A variety of possible airway skills that include: intubation with a laryngoscope, BVM ventilation, nasal
intubation, Laryngeal mask ventilation, and use of a video laryngoscope-The optional bronchus model that allows for bronchofiberscopy training
This D.A.M simulator Training Model has been developed for the training of medical andparamedical professionals only. Any other use, or any use not in accordance with the enclosed
instructions, is strongly discouraged. The manufacturer cannot be held responsible for any accident
or damage resulting from such use. Please use this model carefully and refrain from subjecting to any
unnecessary stress or wear. Should you have any questions on this simulator, please feel free to contact
our distributor in your area or KYOTO KAGAKU at any time. (Our contact address is on the back coverof this manual)

DOs and DON’Ts
DOs

DON’Ts・Handle the manikin and the components with care.

・Do not let ink from pens, newspapers, this manualor other sources contact with the manikin, as theycannot be cleaned off the manikin skin.

・Storage in a dark, cool space will help prevent theskin colours from fading.

・Never use organic solvent like paint thinner to clean

・The manikin skin may be cleaned with a wet cloth,

the skin, as this will damage the simulator.

if neccessary, using mildly soapy water or diluted
detergent.

・Even if color on its surface might be changed acrossthe ages, this does not affect the quality of its
performance.

１

Before You Start

Set includes

Set Includes
Before you start, ensure that you have all components listed below.
c

a
d
e

b

a. Torso bodyb. Replacement upper incisors
c. Replacement tongueⅡd. Lubricant

name

code

11392-010

11392-040-D

Chest cover Dark tone 1

11392-090
11392-090-D

Face maskⅡ Light tone 1
Face maskⅡ Dark tone 1
Replacement tongueⅡ 1
Chest cover Light tone 1

11392-050
11392-060
11229-050

Lung (right and left) (a set of 5)
Stomach (a set of 5)
Lubricant 111392-080
11392-040

11392-010

e. Syringe (50mL) 1
1 bag for model, instruction manual

Upper incisors (set of 10)

code

Consumable
parts

1
2
1
1

11392-090/090-D

11384-10011392-080

11392-040/040-D

Bronchofiberscope training unit

Optional
part

２

name

11392-050

11392-060

11229-050

Before training

Check Points before Training

１ Check points before training
1. Open the mouth of the model to check the installation condition of the tongue.
Ensure that the tongue has not fallen out from the pin.
(When the product is delivered, the tongue has already been installed on the model.)The pin is ﬁxed to the jaw side.
The tongue is correctly installed

2. Turn up the skin of the model's neck to check whether the tongue fixing part and the throat part are
correctly installed.

Incorrect installation
Tongue fixing
part (white)(* The photo is taken while the head is removed
to allow to see the condition clearly.)
BronchiTongue fixing
part (white)

TongueTongueJugular part (red)Transparent tube

Caution
3. Ready for training session.

３

If the parts enclosed in the dotted circle are
not correctly engaged with each other, thetongue will fall out during training.

Preparation
1

Setting of DAM (Neck Flexibility)

Neck Flexibility
Change the range of motion of the neck with the black level-switching knobs on the both sidesof the neck of the model.
Turn the knobs while pulling them to the outside to adjust the depth to which the knobs are inserted.
You can select either of two levels of difficulty: normal neck and rigid neck.
1. To conduct training for the normal condition, align the knobs to the position where you can see
the green seal as shown in the photo. Always set up the knobs on both sides identically to eachother.
the neck side

the black knob

the neck side

the black knob

the green seal
the green seal

the green seal
The triangles
intersect eachother.

Normal condition(the insertion depthof the neck is shallow.)

The triangles
are positioned
in the same
direction.
Condition of rigid neck(the insertion depth of
the neck is deep.)

2. To change the setting to the condition of difficulty in neck recurvation, turn the knob whilepulling it to align the foot of the triangle to the same direction as that of the receptacle partson the model. Push the knob until the green seal disappears. You can also lock the setting by
returning the position of the head to the direction indicated in the photo below.

CautionConduct any training after setting the knobs on both sides to the same setting.
If the knobs are set in different settings, it might cause breakage and/or failure.

NormalRigid

４

Preparation

Setting of DAM(Degree of the Mouth Opening)

1 Degree of the Mouth Opening
Set the mouth opening limitation with the black level-switching knob on the top of the head of themodel. Move the knob up or down while pulling it, and then release it on either of the indicatedlevel lines to lock the setting. You can select one of three levels of difficulty: Easy (Normal) [normal
condition], Intermediate [mouth opening difficulty level 1] and Difficult [mouth opening difficultylevel 2].
1. To conduct training for the normal condition, align the knob to the Easy (Normal) position.

2. To change the condition of the mouth opening difficulty level, move the knob up while pulling it,
and then release it on the Intermediate position [mouth opening difficulty level 1] or Difficult
position [mouth opening difficulty level 2].

Intermediate

Normal (easy)

５

DifficultPreparation

1

Setting of DAM(Tongue Edema)Tongue Edema
To adjust the condition of the swollen tongue, inject/extract air to/from the tongue by using
the attached syringe to change the size of the tongue.
The size of the tongue can be set in two levels: normal tongue and swollen tongue.
1. To set the tongue to normal condition, do not inject air.
2. To simulate the condition of swollen tongue, intake 20mL of air into the attached syringe andthen connect it to the flat tube located in the neck of the model. The syringe is provided witha lock mechanism. Insert the tip of the syringe to the connector on the end of the tube andthen turn the syringe clockwise. After injecting the air into the tongue to simulate swollen
tongue condition, turn the syringe counter-clockwise to detach it from the tube.

Syringe

Syringeconnector

connector

Tube from the model

Tube from the model

Connecting

Detaching

Rotate while pressing connector

Rotate connector counter-clockwise

3. To restore the tongue to the normal condition, connect an empty syringe to the tube byusing the procedure in the step 2 to extract the air in the tongue to restore the size of the
tongue to normal.

Normal6

SwollenPreparation
1

Setting of DAM(Laryngospasm)

Laryngospasm
By pressing the pump on the end of the tube attached to the main body, you can simulate thelaryngospasm.
1. The condition of laryngospasm is simulated while the pump is being pressed. The condition
returns to normal when the pump is released.

The condition returns to normal when thepump is released.

Laryngospasm is simulated while the pumpis being pressed.

* The photos show the tongue component that is detached from the model to allow visibilityof the condition.

Normal７

Laryngospasm

Training

Training skills

１ Airway Opening Techniques
True-to-life articulation allows for head-tilt/
chin-lift and jaw-thrust techniques.

２ Bag-Valve-Mask ventilation
Successful ventilation can be confirmedby the movement of the chest.

８

Training

Training skills

３ Intraoral Intubation with Laryngoscope
Setting the head at "sniffing position", intubation
with laryngoscope can be performed.
The upper incisors are removable with excess
force.

Put enough lubricant to the model before inserting the tracheal tube.
For nasotracheal airway, spray the lubricant in the cavitas nasi and the tube. For oral route airway,
in the mouth and the tube.

CautionRecommended tools: Macintosh laryngoscope Size: No.3
Tracheal tube: 7.0, 7.5 mm (inside diameter)
Use the lubricant included in the set. Others like gel type may remain in the modeland become irremovable.

４ Laryngeal mask ventilation
Put enough lubricant to the laryngeal mask and the oral cavity before training.

Caution９

Recommended laryngeal mask:
type

size

LMA

4

i-gel

4

Training

Training skills

5 Confirmation Successful Intubation
The placement of the tube can be confirmed by
auscultation or movement of thoracoabdominal
area. (Five auscultation points are configured.)

６ Intubation by the Video Laryngoscope
Put enough lubricant to the video laryngoscope and the oral cavity before training.

7 Securing the Tracheal Tube

Caution

Do not leave the tapes on the model. If the tapes remain on the model for long time,
its skin surface will become sticky with adhesive of tapes.

10Replacement of theconsumable parts

Upper Incisors
Tongue１ Upper Incisors
Widen the mouth and then place the protruded
part behind the part where the incisor
component is installed into the groove on theupper jaw.
Then push up the incisor component toward
the front direction until you hear a "click" sound.

２ Tongue
1. Set the range of motion in neck recurvation to the normal condition. Then set the mouth opening
limitation to the Easy (Normal) condition.
(Refer to P. 4 and P. 5 respectively for the setting procedures.)the green seal

Turn the black knob to the normal position where
the green seal appears.

11

Move the black knob to the Easy (Normal) position.

Replacement of theconsumable parts

Tongue２ Tongue
2. Remove the band of the back of the head and then remove the face mask from buttons at ears.

3. Remove the mask from the head.

4. Remove the chest skin.

5. Remove the chest cover.
Lift the chest cover by pulling up the upper part ofthe cover, and detach the tube connected to theback of the cover from the lung bag (two points)
at first, then from the stomach bag. The tube canbe detached by pulling down it while pushing up
the ring in the connector part where the tube isconnected as shown in the figure. Then remove
the chest cover from the main body.
Pull out the esophagus (bronchi) tube
from the stomach (lung)
Stomach (lung) bag
chest transparent
cover
Connector
Pull out

Push the ring toward
the cover.
Esophagus (bronchi) tube

12

Replacement of theconsumable parts

Tongue２ Tongue
6. Disconnect the transparent tube and bronchi part by pulling the bronchi part. Then disconnect
the tube for laryngospasm.

7. To remove the tongue, pull the tongue to one
side to expand the hole and remove from the pin.

8. Loosen the head connection bolts (there are
two bolts).

Insert a hand from the trunk side and loosen theconnection bolts by rotating it counter-clockwise.

9. Pull the head horizontally to detach it fromthe trunk.

CautionLoosen the bolts until the head can be detached. It is not necessary to loosen andremove it completely.

13

Replacement of theconsumable parts

Tongue２ Tongue
10. Disengage the lower part of the throat from the tongue fixing part, then pull down the tongue
component to detach. It becomes easy to pull out the whole tongue component when the
tongue is pushed into the mouth while pulling it out.

TongueJugular part(red)

Transparent
tube

CautionTongue fixing
part (white)

BronchiSlowly pull out the tongue component from the throat with care. If it is pulled out
forcibly, it could break.

14

Replacement of theconsumable parts

Tongue２ Tongue
11. After confirming the tongue direction, insert half of it into the throat from the opening. Insertionis more easily facilitated by applying training model lubricant on it.

12. Push the tongue component into the throat from the throat side. Open the mouth, hold the
tongue when a certain portion of it comes into the oral cavity, then pull it until the tip of the
tongue touches the incisors. Ensure that the air bag installed in the tongue is not displaced.

Air bag for size changes of the tongue

13. Widen the lower part of the throat and engage it with the lower part of the tongue fixing part.
Ensure that the entire perimeter is engaged properly.
TongueJugular part(red)

Tongue fixing
part (white)
BronchiTransparent
tube

Example of inappropriate installationof tongue component

14. Hook one side of the hole on the tongue to the edge of the pin and pull the tongue in the opposite
direction to expand the hole. Once the hole is large enough, fit the pin through the hole to secure
the tongue in place.
Pull in this direction(when attaching)

tonguePull in this direction(when removing)

Upper view of the pin

hole

pin
pin

Lower jaw

15

Plastic tube

Plastic tube

Lower jaw

Replacement of theconsumable parts

Tongue２ Tongue
15. Store the transparent pipe on the tongue
component and the tube for laryngospasm
simulation into the neck part.

16. Install the head to the trunk.

17. Align the slit on the neck and the bolt, thenfasten the head connection bolts (there are
two bolts) to connect the head with the trunk
part.

18. Connect the bronchus component.

19. Connect the laryngospasm tube.

Ensure that the lung tube and the esophagus
tube are connected correctly. The tube sizes
are different.
Attach the esophagus (bronchi) tube to thestomach (lung) bag

20. Connect the stomach tube and the lung tube
(at two points).The tube is fixed only byinserting it to the connector.

21. After installing the chest cover on the model,
attach the chest skin and the mask. The mask
must not lap over the neck flexibility setting
knobs.

Stomach (lung) bag

chest transparent
cover
Connector
InsertEsophagus (bronchi) tube

16

Replacement of theconsumable parts

Face Mask and Chest Cover

３ Face Mask and Chest CoverFace mask
1. Remove the band of the back of the head and then remove the face mask from buttons at ears.
2. Take off the face mask .

3. Set the new mask on the face.
4. Tilt the head, run the band attached on a side of the occipital part of the face mask behind theneck, and put it into the hole on the skin of the other side. Fit the both of the ear holes on themask to the head of the model.

Chest cover
1. Remove the cover from the buttons on shoulders and sides of the body.

2. Set the new cover on the chest andfix it at the buttons on shoulders andsides of the body.

17

Replacement of theconsumable parts

Lung and Stomach Bag

４ Lung Bag
1. Remove the chest cover.

2. Take off the lung bag from the body. Ensure to remove the double-sided tape and adhesiveleft on the body.

3. Tear off the paper backing of the double-sided tape attached to the new lung bag, align thehole on the bag to the hole on the trunk part, and then tightly stick them together to avoid
air leakage. After sticking them together, install the chest skin on the trunk component.

18Replacement of theconsumable parts

Lung and Stomach Bag

５ Stomach Bag
1. Remove the chest cover.

2. Take off the stomach bag from the body. Ensure to remove the double-sided tape and adhesiveleft on the body.

3. Tear off the paper backing of the double-sided tape attached to the new lung bag, align the holeon the bag to the hole on the trunk part, and then tightly stick them together to avoid air leakage.
After sticking them together, install the chest skin on the trunk component.

CautionStick the lung bag and the stomach bag together
after aligning them into the correct direction asshown in the photos above.

19

After Training
After Training
Clean and remove the lubricant on the body with water or diluted detergent.
Talcum powder may be used on the face mask and chest cover and body after use to preserve
suppleness of the skin and prevent it from being stained. Before storage, ensure that model is dry.

20

Caution

Don’t mark on the model and other components with pen or leave printed
materials contacted on their surface.
Ink marks on the models will be irremovable.

・For inquiries and service, please contact your distributor or KYOTO KAGAKU CO., LTD.

KyotoKagaku America Inc.
USA,Canada,and South America

The contents of the instruction manual are subject to change without prior notice.
No part of this instruction manual may be reproduced or transmitted in any form without permission from the manufacturer.
Please contact manufacturer for extra copies of this manual which may contain important updates and revisions.
Please contact manufacturer with any discrepancies in this manual or product feedback. Your cooperation is greatly
appreciated.
2022.10