User Manual
Ver.1.1

22nd August 2023
Penguin System Co.,Ltd.

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Content
1. What is [EmerSim®]?........................................................ 3
2. About procedure to use [EmerSim®] .......................................... 4
3. Let us start! ............................................................. 4
3.1 Preparing “Monitor”...................................................... 4
3.2 Operating “Controller”................................................... 6
A) About volume related icons................................................. 7
B) About defibrillator (electroshock) related icons ........................... 8
C) About Scenario and scene................................................... 9D) About ON/OFF display on “Monitor” side .................................. 10
E) Reflect blood pressure at any time ........................................ 13
F) About stopwatch function.................................................. 14
G) About changing vital sign values .......................................... 15
H) Specify "-/-" as the unmeasurable blood pressure notation ................. 16
I) Selecting Waveform........................................................ 17
J) Displaying custom image................................................... 19
4. Adding / Editing scenario, various settings ............................... 22
4.1 Adding / Editing scenario................................................. 24
A) Adding scenario........................................................... 24
B) Adding Scene ............................................................. 25
C) Editing / Deleting scenario or scene ...................................... 26
D) Input method for unmeasurable blood pressure in scenario scene ............ 28
4.2 Common Settings........................................................... 29
4.3 Image Settings ........................................................... 30
5. FAQ ...................................................................... 31

Manual version

Date of issue

Content

1.0

2021/7/7

First edition

1.1

2023/8/21

Updated to latest EmerSim® version[EmerSim®] is a registered trademark of Penguin System Co.,Ltd.
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1. What is [EmerSim®]?
[EmerSim®] is a product which used for emergency and lifesaving training. In[EmerSim®], the simulated vital sign monitor which is used by the students iscalled "Monitor". The trainer (instructor) in addition to the “Monitor”, canuse the screen called "Controller" and can freely change the vital signs value.
“Monitor” screen“Controller” screen[EmerSim®] does not require special equipment, use it with your computer,tablet, or other devices with WEB browser.
In WEB browser, “Monitor” or “Controller” will be displayed.
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2. About procedure to use [EmerSim®]
Please refer to separate [Quick Start Guide].
This [User Manual] explains actual [EmerSim®] usage.

3. Let us start!
As explained in [Quick Start Guide], by reserving training in “Training
reservation”, it is possible to get “Controller” and “Monitor” URL.
(URL example)
Controller URL:https://xxx.xxx.emersim.jp/xxxxxxxxxxxxxxxxxxxxxxxxxx/

Monitor URL:https://xxx.xxx.emersim.jp/yyyyyyyyyyyyyyyyyyyyyyyyyy/

This “Controller” and “Monitor ” URL set is referred as “Training” in[EmerSim®]. For a simulation training (scenario training), it is anticipated tohave 1 training, a trainer (instructor) and students training together.

“Controller” screen example“Monitor” screen example

3.1 Preparing “Monitor”
By accessing “Monitor” URL with computer or tablet browser, following page
will be displayed“Monitor” URL example: https://xxx.xxx.emersim.jp/yyyyyyyyyyyyyyyyyyyyyyyyyy/
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On top of the screen the training name will be displayed (up to 12
characters) that was set in “Training reservation”. On right side is volume
button. Let us press “Monitor” button in middle of the screen.

This is “Monitor” screen, as displayed initially. There are 4 types of vital
signs displayed, actual numbers and waveforms are not yet displayed.
As students apply heart rate meter, SpO2 meter or other vital sign sensor
devices, trainer (instructor) would display corresponding vital sign in the“Controller” by switching it “On”, the numbers and waveform of the vital
sign will be displayed. Details will be explained in the next section.

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3.2 Operating “Controller”
By accessing “Controller” URL with computer or tablet browser, following
page will be displayed“Controller” URL example：https://xxx.xxx.emersim.jp/xxxxxxxxxxxxxxxxxxxxxxx/

On top of the screen the training name will be displayed (up to 12
characters) that was set in “Training reservation”. On right side is volume
button. In middle of the screen, select a scenario for the training fromregistered scenario list. As scenario is selected, press on “Controller”
button to proceed to “Controller” screen. (It is possible to change scenario
from “Controller” screen later)“Controller” screen is explained below.

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A) About volume related icons
On top of the screen, there are 3 volume icons, the functions are following
Volume adjustment / mute (red means muted, blue means unmuted)
Vital sign sound is played on “Monitor” side, by default “Controller” side
is muted.

It is possible to play different types of sound effects. As of September
2021, there are 2 “Alert sound”, “Ambulance”, “Newborn crying”, “Nursecall”, “phone calling” and “vomiting” sound effects. It is also possible tostop these sound effects and alarm.

As each vital sign exceeds its thresholds, alert sound will be played.
This button is used to stop the alert sound. It may be useful in situations
where trainer (instructor) pauses training for explanation without changing
vital signs.

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B) About defibrillator (electroshock) related icons
On top of the screen, there are 2 defibrillator (electroshock) related icons,
the functions are following

By pressing “charge” icon on left side, defibrillator charging
sound effect will be played.
As electroshock becomes possible, “charge” icon changes to grey color, and“shock” icon on the left side will change to yellow and blink.
In addition, when the “charging” or “charge complete” sound effects areplaying, vital signs volume gets lower. This volume adjustment aimed to assist
students firmly recognize charging related sounds.

By pressing “shock” button on the right, electroshock sound will
be played. The waveform will also be disturbed because of it.
In addition, these 2 defibrillator (electroshock) related icons are also
displayed in the “Monitor”. If “Monitor” device supports touch panel,
students may also press it.

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C) About Scenario and scene
As “Controller” starts up, preset scenario window will be displayed on top
right of the screen. [EmerSim®] is a simulated vital sign monitor to perform
simulation training (scenario training). Here, the term "scenario" means that,for example, when you want to perform simulation training for emergency
response during "anaphylaxis", you will proceed with training according to one
scenario. This scenario is described below.

The scenario part is enlarged and displayed. Here, a scenario for training on"anaphylaxis" is used as an example. Under the scenario name "[Emergency]
Anaphylaxis", there is a column that outlines the scenario. It is also possible
to create your own scenario (which mentioned in later chapter), enter thehospital situation, patient information, etc.
It is possible to set [4 sets of vital sign values]. In [EmerSim®] it iscalled a “scene”.
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In example, the first “scene” is “Beginning (normal)”. Heart rate, SpO2,
blood pressure and respiratory rate values are already preset. Waveforms ofheart rate and SpO2 are also preset.
Further, “Onset”, “Aggravation”, “Intervention” etc. scenes areprepared. By using slide on the right side, it is possible to scroll to view
further scenes.
Trainer (instructor) inspects students corresponding situation and changes“scene” accordingly. It is possible to change 4 preset vital sign values witha single click (tap).
Each “scene” has its own situation or patient information. (It is possible
to set it)
It is also possible to start scenario over, by selecting scenario from [▼]selection on right side of “scenario” name.
By clicking on “CLOSE” on top right of the screen, scenario list will beclosed, like on the screen below.

D) About ON/OFF display on “Monitor” side
In addition, each of the four types of vital signs has an icon for switching
ON/OFF display on "Monitor". As students shows action or intention to measure
the vital sign, trainer (instructor) may press on corresponding icon of thevital sign to display the vital sign on "Monitor" side.

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This is initial state. The display on "Monitor" side is OFF.
In this state the display on "Monitor" side is ON
In image below, by setting HR and BP state to “display ON” in “Controller”
HR values and waveform, BP values are displayed on “Monitor” as example

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As students further shows action or intention to measure SpO2 or respiratory,
by setting “display ON” in “Controller”, “Monitor” will be displayed as
below.

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E) Reflect blood pressure at any time
On left bottom side of the “Controller”, there is a “change bloodpressure” button. (marked in red circle.)

One of the convenient things about ‘EmerSim’ is that you can switch to a setof vital sign values preset as a ‘scene’ in a ‘scenario’ on the controller
side with a single tap. However, blood pressure will not be reflected on the“Monitor” right away. Instead, the button will turn yellow and flash as shown
below (red circle).

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By pressing the yellow button when the trainee clearly expresses his/her
intention to "measure the blood pressure" or makes an action, the bloodpressure changes to the preset value.

F) About stopwatch function
On bottom right on “Controller” there is “Timer”, it is not intended for a
specific purpose, so please use it freely.
There is “Start” / ”Stop” toggle and “Reset” buttons.

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G) About changing vital sign values
Beside changing the 4 vital sign values at once from the scenario
function, it is also possible to freely change each vital sign values.
There are three ways to do it.
(1) Using slider bar
Move slider bar to the left
to decrease target vital value.
Move slider bar to the rightto increase target vital value.

(2) Using keypad

By pressing on vital sign
displayed value,
a keypad will be displayed
After entering the number in
keypad, press "OK" to update
the vital value.

(3) Using “+”/“-”buttons
Press on “+” button
to increase target vital value.
Press on “-” button
to decrease target vital value.

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H) Specify "-/-" as the unmeasurable blood pressure notation
It is possible to specify a state in which both blood pressure (systolicblood pressure and diastolic blood pressure) cannot be measured.
Click (tap) the number part of the blood pressure notation on thecontroller screen (in the example below, the display part "120/80" will
display the number pad. Enter "-" here and click "OK".

It will be displayed as below:

In this state, if you press the yellow "blood pressure monitor reflection"
button (the button surrounded by a red circle) on the left side of the screen,
it will be reflected on the monitor as follows.

It is possible to set this in Scenario. Refer to [Input method for unmeasurable
blood pressure in scenario scene].
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I)

Selecting Waveform
Below are waveforms that prepared in [EmerSim®]● Available waveforms for Heart Rate
1) Normal - NSR (Normal Sinus Rhythm)
2) 1°block (First-degree atrioventricular block)3) 2°block (Mobitz l) (Second-degree atrioventricular block)4) 2°block (Mobitz ll) (Second-degree atrioventricular block)5) Asystole
6) Atrial fibrillation
7) Atrial flutter8) Junctional
9) LBBB (Left bundle branch block)10) RBBB (Right bundle branch block)11) ST elevation
12) SVT (Supraventricular Tachycardia)
13) Torsades de pointes
14) VF (Ventricular fibrillation)15) VT (Ventricular tachycardia)● Available waveforms for SpO2
1) Normal2) Poor perfusion

To change waveform, click on “waveform name” or “waveform” section in“Controller ” screen, as shown as red circles in image below.

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Waveform selection menu will be displayed, please select waveform.
(Example view with PC)(Example view with smartphone)

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J)

Displaying custom image
It is possible to display already set custom image over vital sign values.
(Image setting is explained later in 4-3 chapter)
On top right of “Controller” screen, press 2nd button from the right, whichis named “PICS”.

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It will be displayed as below. On this screen, click on “Not selected
select image.

In “Controller”, select an image like below, as example.

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▼” toIn “Monitor” it will be displayed like below.

It is a convenient function for trainers (instructors) to set an arbitrary
image, such as an X-ray photograph or a photograph that shows the state of thepatient and explain it according to the training situation.

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4. Adding / Editing scenario, various settings
Adding / Editing scenario and various settings can be done from “Training
management site”. About accessing “Training management site”, please refer toseparate [Quick Start Guide].

Above is image of “Training management site”. On left side of the screen,
there is “Scenario settings”. Please select it, the screen below will be
displayed.

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Press on “SETTINGS” button. The following menu will be displayed.

Each 3 items in the menu will be explained in next page.

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4.1 Adding / Editing scenario
Below is a screen of “Scenario settings”. It is possible to change scenarios
order by drag and drop 3-line icon on left side of scenario name.

A) Adding scenario
Press “+” red icon to add scenario, which located on left side ofscreen, in bottom part of “Scenario” section.

Enter “Scenario Name”, “Description” and press “SAVE”.
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Additionally, by setting “Display” switch OFF, it is possible hidescenario from scenario list. It is convenient function when having many
scenarios or there need to limit scenario list in “Controller”.

B) Adding Scene

To add “Scene”, first select “Scenario” from left side of the screen.
Next, press on red “+”icon, which located in middle of the screen, inbottom part of “Scene” section.

Enter “Scene name”, “Description”, each vital sign value and press“SAVE”.
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C) Editing / Deleting scenario or scene

From scenario or scene section select an item to “edit / delete” by pressing
on “pen” icon. Following screen for editing will be displayed.

It is possible to freely edit the content. After editing, press on “SAVE”
button.

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It is also possible to duplicate “Scenario” or “Scene" by pressing the“DUPLICATE” button. Duplicated "scenarios" and "scenes" will be placed at thebottom of the list, so please change the order as appropriate. "Duplicate" isuseful to create a slightly different “Scenario” or “Scene”.

To delete “Scenario” or “Scene”, display target “Scenario” or “Scene”
and press on red “trash can” icon.

Before deleting a "Scenario", it is required to delete all the "scenes" in it.
If “Scenario” still contains a “scene”, the “trash can” icon is displayedin gray, instead of red, and it cannot be deleted. Delete all included "Scenes"
before deleting "Scenario".

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D) Input method for unmeasurable blood pressure in scenario scene
It is possible to specify a state in which both blood pressure (systolic bloodpressure and diastolic blood pressure) cannot be measured.

When registering a vital signs value set as a "scene" in a scenario, enter "-"in the numeric pad as the blood pressure (BP) value and confirm with "OK". It
becomes the following notation

Refer to [Specify "-/-" as the unmeasurable blood pressure notation] to set BP
values during the training.

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4.2 Common Settings

It is possible to change vital signs font or waveform color, alert soundplaying range (upper / lower limit), enable / disable blinking during alert andalert sound type.

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4.3 Image Settings
It is possible to preset up to 12 custom images and display it during
training on the "Monitor". Setup image in 3 steps.

Step 1. Select an image slot
Select a slot from 12 possible, where image will be saved. If image is nolonger needed, delete it with “DELETE IMAGE” button.
Step 2. Select an image file
From “Browse” button, select image file. Supported file formats are[png] and [jp(e)g].
Step 3. Upload
Press on “Upload” button to set image in the slot. Maximum upload filesize is 3MB.

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5. FAQ
Many frequently asked questions are posted in the "Frequently Asked Questions(FAQ)" section of our [EmerSim®] site. We are adding more from time to time, so
please have a look.
https://emersim.jp/faq-1

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