Abstract:
Devices, systems, and methods appropriate for use in combat medical training are provided. In some instances, the combat medical simulators facilitate training of common field medical techniques including tracheostomy, wound care, tourniquet use, pneumothorax, cardiopulmonary resuscitation, and/or other medical treatments. Further, the combat medical simulators have joints that provide realistic ranges of motions to enhance the realism of the training experience.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application claims priority to and the benefit of U.S. Provisional Patent Application No. 61/591,851, filed on Jan. 27, 2012, which is hereby incorporated by reference in its entirety. 
    
    
     BACKGROUND 
     As medical science has progressed, it has become increasingly important to provide non-human interactive formats for teaching patient care. Non-human interactive devices and systems can be used to teach the skills needed to successfully identify and treat various patient conditions without putting actual patients at risk. Such training devices and systems can be used by medical personnel and medical students to learn the techniques required for proper patient care, including those techniques used in war or combat zones where time is often of the essence in successful to both patient and medical personnel survival. In that regard, the training of medical personnel and patients is greatly enhanced through the use of realistic hands-on training with devices and systems, such as those of the present disclosure, that mimic characteristics of natural human and, in particular, allow training of procedures commonly performed in war and/or combat zones. 
     In view of the foregoing, there remains a need for devices, systems, and methods appropriate for use in combat medical training. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The present disclosure can be better understood from the following detailed description when read with the accompanying figures. 
         FIG. 1  is a perspective view of a patient simulator according to one embodiment of the present disclosure. 
         FIG. 2  is a perspective view of a neck mechanism of the patient simulator of  FIG. 1  according to an embodiment of the present disclosure. 
         FIG. 3  is a front view of a neck support of the neck mechanism of  FIG. 2  according to one embodiment of the present disclosure. 
         FIG. 4  is a front, exploded view of the neck support of  FIG. 3 . 
         FIG. 5  is a perspective front view of a mounting structure of the neck mechanism of  FIG. 2  according to one embodiment of the present disclosure. 
         FIG. 6  is a perspective rear view of the mounting structure of  FIG. 5 . 
         FIG. 7  is a perspective view of the mounting structure of  FIGS. 5 and 6  attached to a head portion of the patient simulator of  FIG. 1 . 
         FIG. 8  is a front view of a neck portion of the patient simulator of  FIG. 1  according to an embodiment of the present disclosure. 
         FIG. 9  is a top view of components of a trachea device of the neck portion of the patient simulator of  FIG. 1  according to an embodiment of the present disclosure. 
         FIG. 10  is a perspective view of a trachea housing according to an embodiment of the present disclosure. 
         FIG. 11  is a top view of the trachea housing of  FIG. 10 . 
         FIG. 12  is a perspective view of a trachea box according to an embodiment of the present disclosure. 
         FIG. 13  is a perspective view of supports of the trachea box of  FIG. 12  according to an embodiment of the present disclosure. 
         FIG. 14  is a side view of a trachea insert according to an embodiment the present disclosure. 
         FIG. 15  is a side view of components of the trachea insert of  FIG. 14  according to an embodiment the present disclosure. 
         FIG. 16  is an end view of the components of the trachea insert shown in  FIG. 15 . 
         FIG. 17  is an end view of the components of the trachea insert similar to that of  FIG. 16 , but showing the trachea insert mated with the supports of the trachea box shown in  FIG. 13 . 
         FIG. 18  is a top view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12 . 
         FIG. 19  is an end view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12 . 
         FIG. 20  is an end view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12  similar to that of  FIG. 19 , but from an opposing end. 
         FIG. 21  is a perspective view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12  positioned within the trachea housing of  FIG. 10 . 
         FIG. 22  is a top view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12  positioned within the trachea housing of  FIG. 10 . 
         FIG. 23  is an end view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12  positioned within the trachea housing of  FIG. 10 , where only portions of the trachea box and trachea housing are illustrated. 
         FIG. 24   a  is a perspective, cross-sectional view of the trachea insert of  FIG. 14  positioned within the trachea box of  FIG. 12  positioned within the trachea housing of  FIG. 10 . 
         FIG. 24   b  is a perspective view of trachea tube positioned through an opening created in the trachea device. 
         FIG. 25  is a top view of a chest cavity of the patient simulator of  FIG. 1  illustrating support structures and a pneumothorax simulation system according to an embodiment of the present disclosure. 
         FIG. 26  is a perspective view of the chest cavity of  FIG. 25 , but illustrating an intraosseus simulation component mounted on a support structure along with the pneumothorax simulation system. 
         FIG. 27  is a perspective view of the support structures and portions of the pneumothorax simulation system of  FIGS. 25 and 26 . 
         FIG. 28  is a perspective, exploded view of the support structures and portions of the pneumothorax simulation system of  FIG. 27 . 
         FIG. 29  is a perspective view of a portion of the pneumothorax simulation system according to an embodiment of the present disclosure. 
         FIG. 30  is a perspective, exploded view of the portion of the pneumothorax simulation system of  FIG. 29 . 
         FIG. 31  is a bottom view of a portion of a pneumothorax simulation system according to an embodiment of the present disclosure. 
         FIG. 32  is a perspective view of a mounting support structure according to an embodiment of the present disclosure. 
         FIG. 33  is a perspective, exploded view of the mounting support structure of  FIG. 32 . 
         FIG. 34  is a perspective view of a mounting support structure for an intraosseus device according to an embodiment of the present disclosure. 
         FIG. 35  is a perspective view of an intraosseus device according to an embodiment of the present disclosure. 
         FIG. 36  is a cross-sectional side view of an intraosseus device according to an embodiment of the present disclosure. 
         FIG. 37  is a front view of an upper arm assembly according to an embodiment of the present disclosure. 
         FIG. 38  is a front cross-sectional view of the upper arm assembly of  FIG. 37 . 
         FIG. 39  is a side view of a shoulder joint assembly of the upper arm assembly of  FIGS. 37 and 38  according to an embodiment of the present disclosure. 
         FIG. 40  is a side cross-sectional view of the shoulder joint assembly of  FIG. 39 . 
         FIG. 41  is a perspective, exploded view of the shoulder joint assembly of  FIGS. 39 and 40 . 
         FIG. 42  is an end view of a component of the shoulder joint assembly of  FIGS. 39-41  according to an embodiment of the present disclosure. 
         FIG. 43  is a front view of an upper leg assembly according to an embodiment of the present disclosure. 
         FIG. 44  is a perspective cross-sectional view of the upper leg assembly of  FIG. 43 . 
         FIG. 45  is a side view of a hip joint assembly of the upper leg assembly of  FIGS. 43 and 44  according to an embodiment of the present disclosure. 
         FIG. 46  is a side cross-sectional view of the hip joint assembly of  FIG. 45 . 
         FIG. 47  is a perspective, exploded view of the hip joint assembly of  FIGS. 45 and 46 . 
         FIG. 48  is a top view of a portion of the patient simulator of  FIG. 1  illustrating portions of the hip joint assembly of  FIGS. 45-47  assembled with a torso of the patient simulator. 
         FIG. 49  is a perspective side view of the upper leg assembly of  FIG. 43 , but illustrating inner components received within the upper leg assembly according to an embodiment of the present disclosure. 
         FIG. 50  is a perspective view of a reservoir holder of the upper leg assembly of  FIG. 43  according to an embodiment of the present disclosure. 
         FIG. 51  is a perspective, exploded view of the reservoir holder of  FIG. 50 . 
         FIG. 52  is a perspective view of a pump and valve system of the upper leg assembly of  FIG. 43  according to an embodiment of the present disclosure. 
         FIG. 53  is a perspective, exploded view of the pump and valve system of  FIG. 52 . 
         FIG. 54  is a perspective view of the reservoir holder and the pump and valve system of the upper leg assembly, connected to corresponding tubing and electrical connections outside of the upper leg assembly. 
         FIG. 55  is a perspective view of the upper leg assembly of  FIG. 43  with the reservoir holder and the pump and valve system positioned therein 
         FIG. 56  is a perspective view of an upper arm assembly according to an embodiment of the present disclosure. 
         FIG. 57  is a perspective, exploded view of a mold system for forming the upper arm assembly of  FIG. 56  according to an embodiment of the present disclosure. 
         FIG. 58  is a perspective, assembled view of the mold system of  FIG. 57 . 
         FIG. 59  is a side view of the upper arm assembly of  FIG. 56  attached to a torso of the patient simulator of  FIG. 1  having a wound according to an embodiment of the present disclosure. 
         FIG. 60  is a perspective, transparent view of a mold for forming a portion of the wound of the upper arm assembly of  FIG. 59  according to an embodiment of the present disclosure. 
         FIG. 61  is a perspective, transparent view of a mold for forming another portion of the wound of the upper arm assembly of  FIG. 59  according to an embodiment of the present disclosure. 
         FIG. 62  is a perspective, transparent view of a mold for forming yet another portion of the wound of the upper arm assembly of  FIG. 59  according to an embodiment of the present disclosure. 
         FIG. 63  is a top view of the mold of  FIG. 60 . 
         FIG. 64  is a top view of the mold of  FIG. 61 . 
         FIG. 65  is a top view of the mold of  FIG. 62 . 
         FIG. 66  is a perspective view of the structure of a wound created using the molds of  FIGS. 60-65 . 
         FIGS. 67-71  illustrate a series of steps to enhance the realism of the wound based on the wound structure of  FIG. 66  created using the molds of  FIGS. 60-65  according to an embodiment of the present disclosure. 
         FIG. 72  illustrates the attachment of tubing to the wound structure of  FIGS. 66-71  according to an embodiment of the present disclosure. 
         FIG. 73  is a perspective view of an arm tourniquet housing according to an embodiment of the present disclosure. 
         FIG. 74  is a perspective, exploded view of a mold system for forming the tourniquet housing of  FIG. 73  according to an embodiment of the present disclosure. 
         FIG. 75  is a perspective, side view of an upper leg assembly according to an embodiment of the present disclosure. 
         FIG. 76  is a perspective, bottom view of the upper leg assembly of  FIG. 75 . 
         FIG. 77  is a perspective view of a mold system for forming the upper leg assembly of  FIG. 76  according to an embodiment of the present disclosure. 
         FIG. 78  is a perspective view of a mold of the mold system of  FIG. 77  according to an embodiment of the present disclosure. 
         FIG. 79  is a perspective view of another mold of the mold system of  FIG. 77  configured to mate with the mold of  FIG. 78  according to an embodiment of the present disclosure. 
         FIG. 80  is a perspective side view of an upper leg assembly manufactured using the mold system of  FIGS. 77-79 . 
         FIG. 81  is a perspective, transparent view of a mold for forming a portion of the wound of the upper leg assembly of  FIG. 80  according to an embodiment of the present disclosure. 
         FIG. 82  is a perspective, transparent view of a mold for forming another portion of the wound of the upper leg assembly of  FIG. 80  according to an embodiment of the present disclosure. 
         FIG. 83  is a perspective, transparent view of a mold for forming yet another portion of the wound of the upper leg assembly of  FIG. 80  according to an embodiment of the present disclosure. 
         FIG. 84  is a top view of the mold of  FIG. 81 . 
         FIG. 85  is a top view of the mold of  FIG. 82 . 
         FIG. 86  is a top view of the mold of  FIG. 83 . 
         FIG. 87  is a perspective view of a wound structure created using the molds of  FIGS. 81-86 . 
         FIGS. 88-97  illustrate a series of steps to assemble a wound structure based on the components created using the molds of  FIGS. 81-86  according to an embodiment of the present disclosure. 
         FIGS. 98-103  illustrate a series of steps to enhance the realism of the wound structure of  FIGS. 87 and 97  according to an embodiment of the present disclosure. 
         FIG. 104  illustrates the attachment of tubing to the wound structure of  FIGS. 87-103  according to an embodiment of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the embodiments illustrated in the drawings, and specific language will be used to describe the same. It is nevertheless understood that no limitation to the scope of the disclosure is intended. Any alterations and further modifications to the described devices, systems, and methods, and any further application of the principles of the present disclosure are fully contemplated and included within the present disclosure as would normally occur to one skilled in the art to which the disclosure relates. In particular, it is fully contemplated that the features, components, and/or steps described with respect to one embodiment may be combined with the features, components, and/or steps described with respect to other embodiments of the present disclosure. For the sake of brevity, however, the numerous iterations of these combinations will not be described separately. 
     Referring initially to  FIG. 1 , shown therein is a patient simulator  100 . In the illustrated embodiment, the patient simulator  100  is a full body patient simulator. To that end, the patient simulator  100  includes a torso  102 , legs  103  and  104 , arms  105  and  106 , a neck  107 , and a head  108 . The various anatomical portions of the patient simulator  100  are sized, shaped, and formed of a suitable material to mimic natural human anatomy. The patient simulator  100  can be either a male simulator or a female simulator and will include appropriate anatomical features based on the simulated gender. Further, in some instances, the patient simulator  100  includes a simulated circulatory system, a simulated respiratory system, and/or other simulated aspects. In that regard, the patient simulator  100  is in communication with a control system configured to control the circulatory system, respiratory system, and/or other aspects of the patient simulator. For example, in some instances, the control system is configured to adjust parameters associated with the circulatory system, respiratory system, and/or other aspects of the patient simulator  100  in accordance with a simulation scenario and/or a user&#39;s application of treatment to the patient simulator  100  based on the simulation scenario. 
     Accordingly, in some instances, the patient simulator  100  includes one or more features as described in In some instances, aspects of the present disclosure are configured for use with the simulators and the related features disclosed in U.S. patent application Ser. Nos. 13/223,020, 13/031,116, 13/031,087, 13/031,102, 12/856,903, 12/708,682, 12/708,659, 11/952,606, 11/952,669, 8,016,598, U.S. Pat. Nos. 7,976,313, 7,976,312, 7,866,983, 7,114,954, 7,192,284, 7,811,090, 6,758,676, 6,503,087, 6,527,558, 6,443,735, 6,193,519, 5,853,292, 5,472,345, each of which is hereby incorporated by reference in its entirety. 
     Further, in some instances, the patient simulator  100  includes one or more features as provided in medical simulators provided by Gaumard Scientific Company, Inc. based out of Miami, Fla., including but not limited to the following models: S 1000  Hal®, S 1020  Hal®, S 1030  Hal®, S 3000  Hal®, S 2000  Susie®, S 221  Clinical Chloe, S 222  Clinical Chloe, S 222 . 100  Super Chloe, S 303  Code Blue®, S 304  Code Blue®, S 100  Susie®, S 100  Simon®, S 200  Susie®, S 200  Simon®, S 201  Susie®, S 201  Simon®, S 203  Susie®, S 204  Simon®, S 205  Simple Simon®, S 206  Simple Susie®, S 3004  Pediatric Hal®, S 3005  Pediatric Hal®, S 3009  Premie Hal®, S 3010  Newborn Hal®, S 110  Mike®, S 110  Michelle®, S 150  Mike®, S 150  Michelle®, S 107  Multipurpose Patient Care and CPR Infant Simulator, S117 Multipurpose Patient Care and CPR Pediatric Simulator, S157 Multipurpose Patient Care and CPR Pediatric Simulator, S 575  Noelle®, S 565  Noelle®, S 560  Noelle®, S 555  Noelle®, S 550  Noelle®, S 550 . 100  Noelle, and/or other patient simulators. 
     Referring now to  FIGS. 2-4 , shown therein are aspects of a neck mechanism having a neck support structure  110  according to an embodiment of the present disclosure. In that regard,  FIG. 2  is a perspective view of the neck mechanism illustrating the support structure;  FIG. 3  is a front view of a neck support structure  110  according to one embodiment of the present disclosure; and  FIG. 4  is a front, exploded view of the neck support structure  110 . As shown the neck support structure  110  comprises a spring  112  that threadedly mates with two threaded tubular structures  114  and  116 . In that regard, the ends of the tubular structures  114  and  116  that are not threadingly engaged with the spring  112  are configured to be fixedly secured to a mount within a portion of the head  108  of the patient simulator  100  and a mount within a portion of the torso  102  of the patient simulator, respectively. The resulting neck support structure  100  provides realistic range of motion to the patient simulator&#39;s neck  107  and head  108 , while also acting as a shock absorber to prevent unwanted damage to the patient simulator&#39;s head and inner components during rough handling. 
     Referring now to FIGS.  2  and  5 - 7 , shown therein are aspects of a neck mechanism having a mounting structure  120  according to an embodiment of the present disclosure. In that regard,  FIG. 2  is a perspective view of the neck mechanism illustrating the mounting structure  120 ;  FIG. 5  is a perspective front view of the mounting structure  120 ;  FIG. 6  is a perspective rear view of the mounting structure  120 ; and  FIG. 7  is a perspective view of the mounting structure  120  attached to a head portion  108  of the patient simulator. Generally, the mounting structure  120  includes two platforms  122  and  124  connected by a variable length support  126 . The platform  124  is configured to be fixedly secured to the head  108  of the patient simulator  100 . In some instances, the platform  124  also interfaces with the end of the tubular structure  114  connected to the spring  112  of the neck support structure  110  that is to be fixedly secured to the head  108 . The platform  122  is configured to allow a trachea device  150  (discussed in greater detail below) to be mounted thereto, as shown in  FIG. 2 , for example. In that regard, the mounting structure  120  is adjustable such that the position of the platform  122  can be adjusted longitudinally and rotationally (see series of locking screws  128  along length of tube extending between platforms that allow such movement when loosened and prevent such movement when tightened) as well as pivotally (see locking screw  130  at pivot point of platform  122 ). Accordingly, a specifically desired orientation and/or position of the platform  122  can be selected and achieved for any number of reasons (e.g., simulate a specific condition, simulator manufacturing tolerance, different size trachea devices, etc.). 
     Referring now to  FIGS. 8-24   b , shown therein are aspects of a trachea device  150  according to an embodiment of the present disclosure. In that regard,  FIG. 8  is a front view of a neck portion  107  of the patient simulator  100  containing the trachea device  150 ;  FIG. 9  is a top view of components of the trachea insert;  FIG. 10  is a perspective view of a trachea housing according to an embodiment of the present disclosure.  FIG. 11  is a top view of the trachea housing;  FIG. 12  is a perspective view of a trachea box according to an embodiment of the present disclosure;  FIG. 13  is a perspective view of supports of the trachea box according to an embodiment of the present disclosure;  FIG. 14  is a side view of a trachea insert according to an embodiment the present disclosure;  FIG. 15  is a side view of components of the trachea insert;  FIG. 16  is an end view of the components of the trachea insert;  FIG. 17  is an end view of the components of the trachea insert similar to that of  FIG. 16 , but showing the trachea insert mated with the supports of the trachea box;  FIG. 18  is a top view of the trachea insert positioned within the trachea box;  FIG. 19  is an end view of the trachea insert positioned within the trachea box;  FIG. 20  is an end view of the trachea insert positioned within the trachea box similar to that of  FIG. 19 , but from an opposing end;  FIG. 21  is a perspective view of the trachea insert positioned within the trachea box, which is positioned within the trachea housing;  FIG. 22  is a top view of the trachea insert of positioned within the trachea box, which is positioned within the trachea housing;  FIG. 23  is an end view of the trachea insert positioned within the trachea box, which is positioned within the trachea housing;  FIG. 24   a  is a perspective, cross-sectional view of the trachea insert positioned within the trachea box, which is positioned within the trachea housing; and  FIG. 24   b  is a perspective view of trachea tube positioned through an opening created in the trachea device. 
     The trachea device allows training of combat medics on proper tracheostomy procedures, including insertion of a trachea tube. In that regard, the trachea device includes a trachea housing  152 , a trachea box  154 , a surgical cricoid insert  156  with anatomical landmarks, and a skin cover  158 . As shown in  FIGS. 10 and 11 , the housing  152  includes a recess  160  sized and shaped to receive the trachea box  154 . As shown in  FIG. 12 , the trachea box  154  includes a recess  162  sized and shaped to receive the cricoid insert  156 . In that regard, the trachea box  154  includes projections  164  that are configured to mate with corresponding recesses in the cricoid insert  156 . To this end, the trachea box  154  includes support structures  166  each having a projection  164  over which a suitable flexible material is overmolded/injected around to form the trachea box  154 . In that regard, the support structures  166  are formed of a more rigid material than the overmolded/injected material. As shown in  FIG. 14 , two pieces  170  and  172  of the cricoid insert are connected by a silicon layer  174  that simulates human cartilage. Piece  170  of the cricoid insert  156  includes recesses  176  for engaging with the projections  164  of the trachea box  154  when positioned within the recess  162  of the trachea box. The surgical cricoid insert  156  is formed of sufficiently durable materials to be repeatedly subjected to a tracheostomy hook. In that regard, in typical use the combat medic will make two incisions (one medial, one lateral) through the trachea skin cover  158  over the surgical cricoid  156 . Then the medic will insert the tracheostomy hook into the cricoid cartilage at the intersection of the incisions and lift upward towards a 45 degree position. The tracheostomy hook is utilized to hold the trachea steady during the tracheostomy procedure. As shown in  FIG. 24   b , once the opening has been created, the combat medic inserts a tracheostomy tube  180  thru the cricoid cartilage such that oxygen can be provided to the wounded soldier. As shown, each of the components of the trachea device are replaceable and easily assembled. 
     Referring now to  FIGS. 25-36 , shown therein are various aspects of a chest cavity of a patient simulator according to embodiments of the present disclosure. In that regard,  FIG. 25  is a top view of a chest cavity of the patient simulator illustrating support structures and a pneumothorax simulation system according to an embodiment of the present disclosure;  FIG. 26  is a perspective view of the chest cavity of  FIG. 25  illustrating an intraosseus simulation component mounted on a support structure;  FIG. 27  is a perspective view of the support structures and portions of the pneumothorax simulation system;  FIG. 28  is a perspective, exploded view of the support structures and portions of the pneumothorax simulation system;  FIG. 29  is a perspective view of a portion of the pneumothorax simulation system according to an embodiment of the present disclosure;  FIG. 30  is a perspective, exploded view of the portion of the pneumothorax simulation system of  FIG. 29 ;  FIG. 31  is a bottom view of a portion of a pneumothorax simulation system according to an embodiment of the present disclosure;  FIG. 32  is a perspective view of a mounting support structure according to an embodiment of the present disclosure;  FIG. 33  is a perspective, exploded view of the mounting support structure;  FIG. 34  is a perspective view of a mounting support structure for an intraosseus device according to an embodiment of the present disclosure;  FIG. 35  is a perspective view of an intraosseus device according to an embodiment of the present disclosure; and  FIG. 36  is a cross-sectional side view of an intraosseus device according to an embodiment of the present disclosure. 
     As shown in  FIG. 25 , the chest cavity includes a spring system  200  to facilitate the performance of chest compression on the patient simulator. In some implementations, the spring system  200  is an energy and/or air harvesting system as disclosed in U.S. Provisional Patent Application No. 61/757,137, titled “MEDICAL SIMULATORS WITH ENERGY HARVESTING POWER SUPPLIES,” filed on Jan. 26, 2013, which is hereby incorporated by reference in its entirety. The chest cavity also includes a pneumothorax simulation system  202 . The chest cavity of the patient simulator also includes a mounting structure  204  for a device  206  (see  FIG. 26 , for example) that is positioned where the sternum would be located. 
     Further, the patient simulator breathes in accordance with a respiratory pattern. In that regard, the patient simulator has chest rise and fall corresponding to the respiratory pattern. To simulate some scenarios, one or both of the left and right lungs can be disabled to simulate pneumothorax. To that end, the patient simulator includes the pneumothorax simulation system  202  in some instances that allows training of pneumothorax procedures. In particular, in some instances the patient simulator facilitates training of needle chest decompressions using a 3¼ inch long and 14 gauge needle, or other suitable needles, at the 2nd intercostal space bilaterally. In that regard, proper insertion of the needle is detectable by the pneumothorax system such that the respiratory pattern of the patient simulator can be adjusted accordingly. In this regard,  FIGS. 27-33  illustrate aspects of the pneumothorax system and associated mounting components. As shown, mounting brackets  210  and  212  are coupled together by components  214  and  216 . Each side of the patient simulator includes switch mechanisms  218  to which plates  220  are mounted. As described below, depression of the plate  220  in response to a proper needle puncture actuates the associated switch mechanism  218  such that the controller or processing system is alerted and the corresponding respiratory pattern of the patient simulator can be adjusted. As shown, the mounting structure  204  for device  206  is also coupled to the mounting bracket  210 . The mounting structure  204  includes a spring  222 , a threaded tubular member  224 , and a mount  226 . The mount  226  is sized and shaped to mate with the device  206  such that the device  206  is fixedly secured to the mounting structure  204  via mount  226 . 
       FIGS. 29-31  illustrate additional aspects of the switch mechanism  218 . As shown, the switch mechanism  218  includes support arms  230  to which the plate  220  are secured. The supports arms  230  (and plate  220 ) pivot about rod  232  such that when the plate  220  is depressed a switch  234  is activated. More specifically, as the plate  220  is depressed a movable contact piece  236  of the switch  234  comes into contact with a base portion  238  of the switch  234 , thereby activating (or deactivating) the switch. The rotational orientation of the switch relative to the plate  220  is adjustable in some instances such that the amount of travel of the plate necessary to activate/deactivate the switch  234  is selectable. The support members  230 , rod  232 , and switch  234  are mounted to a support structure  240 . Springs  242  and washers  244  are utilized in some embodiments to couple the components together. Springs  242  are utilized in some instances to bias the plate  220  back to the original starting position (non-depressed position). The skin of the patient positioned over the pneumothorax locations is durable with respect to needle punctures such that these procedures can be performed multiple times without needing to change the skin of the patient simulator. Sensors detect the needle insertion and communicate the action to the controller or control system that controls the respiratory pattern of the patient simulator. Accordingly, the controller or control system adjusts the respiratory pattern based on the treatment administered to the patient simulator in some instances. 
     The device  206 , shown in  FIGS. 26 ,  35 , and  36 , is configured to accept fluids and can be used multiple times without needing to replace the device such that the device  206  can be utilized for the infusion of medication. In that regard, referring to  FIG. 36 , in some instances the device  206  has a housing  250  with a reservoir  252  that is configured to accept fluids. Further, the reservoir  252  is in communication with tubing  254  that allows drainage of the received fluids from the reservoir  252  of the device  206 . In some instances, the device  206  is configured to be used with the FAST-1 intraosseous device. In some instances, the device  206  is positioned on a mounting structure, such as mounting structure  204  that includes a spring  222 , threaded tubular member  224 , and mount  226 . The mount  226  is sized and shaped to mate with the device  206  such that the device  206  is fixedly secured to the mounting structure  204  via mount  226 . 
     Referring now to  FIGS. 37-42 , shown therein are aspects of an upper arm assembly  300  according to an embodiment of the present disclosure. In that regard,  FIG. 37  is a front view of an upper arm assembly  300  according to an embodiment of the present disclosure;  FIG. 38  is a front cross-sectional view of the upper arm assembly  300 ;  FIG. 39  is a side view of a shoulder joint assembly  302  of the upper arm assembly  300  according to an embodiment of the present disclosure;  FIG. 40  is a side cross-sectional view of the shoulder joint assembly  302 ;  FIG. 41  is a perspective, exploded view of the shoulder joint assembly  302 ; and  FIG. 42  is an end view of a component of the shoulder joint assembly according to an embodiment of the present disclosure. 
     As shown, in some instances the shoulder connections of the arms are configured to provide natural motion/flexibility, yet provide strength and durability sufficient to allow the simulator to be dragged by the arms. In some embodiments, the shoulder connections include openings extending therethrough to allow passage of communication cables and/or tubing for introduction of fluids (e.g., simulated blood). Further, still, in some instances the shoulder connections allows arm range of motion to a natural range (e.g., approximately 270 degrees), but prevents full rotation of the arm to prevent unwanted kinking and/or damage to the communication cables and/or tubing going through the shoulder connection and into the arm. 
     To this end, in some implementations the arm assembly  300  includes a shoulder joint  302  that includes a spring  304  and mounting structures  306  and  308  for securing the shoulder joint  302  to the arm assembly  300  and torso  102  of the patient simulator  100 , respectively. As shown, mounting structure  306  includes a component  306  having tapered outer surfaces and an internal passage that receives a portion of the spring  304 . The spring  304  threadingly engages an end piece  310  that mechanically secures the spring  304  to the component  306 . The mounting structure  308  includes components  312 ,  314 , and  316  along with a pin system  318 . In that regard, the pin system  318  extends through an opening  320  in component  314  such that the rotation of the pin system  318  along the length of the opening  320  allows rotation of the shoulder joint in a manner that simulates the natural rotation of a human shoulder, including limiting total range of motion to approximate 270 degrees. Component  312  provides pivoting motion to the shoulder joint  302 . The spring  304  engages a threaded opening within component  316  as shown in  FIG. 40 . 
     Referring now to  FIGS. 43-48 , shown therein are aspects of an upper leg assembly  350  according to an embodiment of the present disclosure. In that regard,  FIG. 43  is a front view of an upper leg assembly  350  according to an embodiment of the present disclosure;  FIG. 44  is a perspective cross-sectional view of the upper leg assembly  350 ;  FIG. 45  is a side view of a hip joint assembly  352  of the upper leg assembly according to an embodiment of the present disclosure;  FIG. 46  is a side cross-sectional view of the hip joint assembly  352 ;  FIG. 47  is a perspective, exploded view of the hip joint assembly  352 ; and  FIG. 48  is a top view of a portion of the patient simulator illustrating portions of the hip joint assembly  352  assembled with a torso  102  of the patient simulator  100 . 
     As shown, in some instances the hip connections of the legs  103  and  104  of the patient simulator  100  are configured to provide natural motion/flexibility, yet provide strength and durability sufficient to allow the simulator to be dragged by the legs. In some embodiments, the hip connections include openings extending therethrough to allow passage of communication cables and/or tubing for introduction of fluids (e.g., simulated blood). Further, still, in some instances the connections limit range of motion to a natural range, but prevents full rotation of the legs to prevent unwanted kinking and/or damage to the communication cables and/or tubing going through the shoulder connection and into the arm. As shown in  FIGS. 45-47 , the hip joint assembly  352  includes a spring  354  that is threadingly engaged with an inner portion of a component  356 . A locking ring  358  having locking pin  360  clamps onto an outer portion of the component  356 . Collectively, the component  356  and locking ring  358  are utilized to secure the spring  354  to the torso  102  of the patient simulator. The hip joint assembly  352  also includes a threaded member  362  that extends through components  364  and  366  and engages a locking ring  368  having locking pin  360 . The locking ring  368  clamps onto an outer portion of the member  362 . The spring  354  threadingly engages an inner portion of the member  362 . Component  366  provides pivoting motion to the hip joint  302  in some instances. 
     Referring now to  FIGS. 49-55 , shown therein are aspects of inner components of the upper leg assembly  350  according to an embodiment of the present disclosure. In that regard,  FIG. 49  is a perspective side view of the upper leg assembly  350  illustrating components received within the upper leg assembly according to an embodiment of the present disclosure;  FIG. 50  is a perspective view of a reservoir holder of the upper leg assembly according to an embodiment of the present disclosure;  FIG. 51  is a perspective, exploded view of the reservoir holder;  FIG. 52  is a perspective view of a pump and valve system of the upper leg assembly according to an embodiment of the present disclosure;  FIG. 53  is a perspective, exploded view of the pump and valve system;  FIG. 54  is a perspective view of the reservoir holder and the pump and valve system of the upper leg assembly connected to corresponding tubing and electrical connections outside of the upper leg assembly; and  FIG. 55  is a perspective view of the upper leg assembly with the reservoir holder and the pump and valve system positioned therein. 
     A fluid reservoir houses the blood that is utilized to simulate the bleeding of the wounds is contained in one or both of the legs in some instances. In some instances, the reservoir contains 1.5 liters or more of simulated blood that is utilized to cause simulated bleeding of axilla wound, groin wound, amputation arm, and/ amputation leg. In that regard, in some instances the patient simulator bleeds at a rate of approximately 0.25 liters per minute. Accordingly, in some instances the reservoir holder includes a sensor to monitor the amount of blood within the reservoir so that a user or instructor can be aware when the simulator is running low on blood and replenish the reservoir as needed. The valves and pumps are configured to supply blood to the appropriate wound(s) in response to control system and/or actions by the user. 
     As shown in  FIG. 49 , the upper leg assembly  350  includes a collection of components  400  configured to facilitate operation of these bleeding features. For example,  FIGS. 50 and 51  show a reservoir mounting system  402  according to an embodiment of the present disclosure. The reservoir mounting system  402  includes a tray  404  configured to receive the fluid reservoir (such as rigid or flexible fluid container) that is pivotally mounted to a mounting support  406  by pivot joint  408 . A sensor  410  is provided to monitor the amount of the fluid present in the reservoir (e.g., by monitoring changes in weight/pressure imparted on the sensor  410  by the fluid reservoir and the tray  404 ).  FIGS. 52 and 53  show a pump and valve system  420  configured to interface with the fluid reservoir held by the reservoir mounting system  402 . The pump and valve system  420  includes pumps  422  and associated mounts  424 ,  426 , and  428 . The pump and valve system  420  also includes one or more valves  432  and an associated mount  430 . The pumps  422 , valves,  432 , and fluid reservoir(s) are connected via a plurality of tubes or other fluid passageways as necessary to facilitate the desired bleeding functionalities of the patient. In that regard, the controller or processing system controls operation of the pumps  422  and/or valves  432  in some instances to simulate desired bleeding scenarios (including the user&#39;s responses thereto in some implementations).  FIG. 55  shows the reservoir mounting system  402  and the pump and valve system  420  mounted within the upper leg assembly  350  with a reservoir  434  according to an implementation of the present disclosure. 
     Referring now to  FIGS. 56-74 , shown therein are aspects of an upper arm assembly  300  and corresponding manufacturing components and techniques according to embodiments of the present disclosure. In that regard,  FIG. 56  is a perspective view of an upper arm assembly  300  according to an embodiment of the present disclosure.  FIG. 57  is a perspective, exploded view of a mold system  500  for forming the upper arm assembly according to an embodiment of the present disclosure, while  FIG. 58  is a perspective, assembled view of the mold system. As shown, the mold system  500  includes a plate  502 , portion  504 , and portion  506  that are to be assembled together. To that end, a spacer  508  is utilized to separate a section of portion  506  from the plate  502 . The mold system  500  also includes plugs  510  and  512  that are positioned within openings in the portion  506 , as shown. 
       FIG. 59  is a side view of the upper arm assembly  350  attached to the torso  102  of the patient simulator having a wound  520  positioned within a recess of the arm assembly according to an embodiment of the present disclosure. To that end,  FIGS. 60-65  illustrate aspects of mold systems for forming various arm wounds and/or arm blanks according to embodiments of the present disclosure. More specifically,  FIG. 60  is a perspective, transparent view of a mold  530  for forming a portion of the wound of the upper arm assembly according to an embodiment of the present disclosure. As shown, the mold  530  includes a recess  532  configured to receive a material that is to form at least a portion of the wound and a plurality of members  534 . The plurality of members  534  are configured to define passages through the resulting wound structure that can be utilized to pass fluid in a manner that simulates bleeding.  FIG. 61  is a perspective, transparent view of a mold  540  for forming another wound and/or another portion of a wound of the upper arm assembly according to an embodiment of the present disclosure. Likewise,  FIG. 62  is a perspective, transparent view of a mold  550  for forming yet another wound and/or another portion of the wound of the upper arm assembly according to an embodiment of the present disclosure.  FIG. 63  is a top view of the mold  530  of  FIG. 60 ;  FIG. 64  is a top view of the mold  540  of  FIG. 61 ; and  FIG. 65  is a top view of the mold  550  of  FIG. 62 . 
       FIG. 66  is a perspective view of a wound structure  600  created using one or more of the molds of  FIGS. 60-65 . However, in some instances the realism of the wound is enhanced by providing surface treatments to the wound structure  600 . To that end,  FIGS. 67-71  illustrate a series of surface treatment steps to enhance the realism of the wound based on the wound structure  600  according to an embodiment of the present disclosure. Additional aspects of these exemplary features are described below. Further,  FIG. 72  illustrates the attachment of tubing  602  to the wound structure  600  according to an embodiment of the present disclosure. In some instances, the tubing  602  is fluidly coupled to the pump and valve system described above in order to selectively provide simulated blood to the wound structure  600  to further enhance the realism of the wound. 
       FIG. 73  is a perspective view of an arm tourniquet housing  610  according to an embodiment of the present disclosure. To that end, in some implementations tubing (such as tubing  602 ) extending through the arm and/or leg of the patient simulator is positioned within tourniquet housing  610  such that upon proper application of a tourniquet around the arm/leg the flow of fluid through the tubing will be stopped. In particular, the compression of the tourniquet compresses the tubing, which prevents the flow of fluid through the tubing.  FIG. 74  provides a perspective, exploded view and a perspective, assembled view of a mold system  620  for forming the tourniquet housing  610  according to an embodiment of the present disclosure. As shown, the mold system  620  includes a component  622  that is configured to receive an insert  624  to collectively define a space corresponding to the shape of the tourniquet housing  610 . 
     Referring now to  FIGS. 75-104 , shown therein are aspects of the upper leg assembly  350  and corresponding manufacturing components and techniques according to embodiments of the present disclosure. In that regard,  FIG. 75  is a perspective, side view of the upper leg assembly  350  according to an embodiment of the present disclosure, while  FIG. 76  is a perspective, bottom view of the upper leg assembly. As shown, the leg assembly  350  includes a recess  630  for receiving a wound and a recess  632  for receiving the tourniquet housing  610  described above.  FIGS. 77-79  illustrate aspects of a mold system  650  for forming the upper leg assembly  350  according to an embodiment of the present disclosure. As shown, the mold system  650  includes an upper component  652  and a lower component  654  that mate with one another and/or a central plate.  FIG. 80  is a perspective side view of the upper leg assembly  350  manufactured using the mold system  650  shown with a wound  660  received within the recess  630 . 
       FIGS. 81-86  illustrate aspects of mold systems for forming various leg wounds and/or leg blanks according to embodiments of the present disclosure. More specifically,  FIG. 81  is a perspective, transparent view of a mold  670  for forming a portion of the wound of the upper leg assembly  350  according to an embodiment of the present disclosure. As shown, the mold  670  includes a recess  672  configured to receive a material that is to form at least a portion of the wound and a plurality of members  674 . The plurality of members  674  are configured to define passages through the resulting wound structure that can be utilized to pass fluid in a manner that simulates bleeding.  FIG. 82  is a perspective, transparent view of a mold  680  for forming another wound and/or portion of the wound of the upper leg assembly according to an embodiment of the present disclosure. Similarly,  FIG. 83  is a perspective, transparent view of a mold  690  for forming yet another wound and/or portion of the wound of the upper leg assembly according to an embodiment of the present disclosure.  FIG. 84  is a top view of the mold  670  of  FIG. 81 ;  FIG. 85  is a top view of the mold  680  of  FIG. 82 ;  FIG. 86  is a top view of the mold  690  of  FIG. 83 .  FIG. 87  is a perspective view of a wound structure  700  created using the molds of  FIGS. 81-86 . 
       FIGS. 88-97  illustrate a series of steps to assemble a wound structure according to an embodiment of the present disclosure, while  FIGS. 98-103  illustrate a series of steps to enhance the realism of the wound structure according to an embodiment of the present disclosure. These steps are discussed in greater detail below with respect to the exemplary manufacturing techniques described herein.  FIG. 104  illustrates the attachment of tubing to the wound structure according to an embodiment of the present disclosure. 
     The combat wounds and tourniquet site composition and assembly for the arm and the leg described herein will allow a pioneering, dynamic and interactive scenario simulating fatal hemorrhaging battle wounds that require immediate attention and adequate care. Combat wounds that go untreated or incompetently overseen can ultimately result in terminal consequences. Providing the proper care is a vital point in the healing process as well as the patient recovery, immediate cautious procedure such as packing the wound can cease the bleeding and allow the medical practitioner to focus in stabilizing the patient&#39;s vital signs. The user will be immersed in a realistic scenario produced from a combat patient experiencing deadly hemorrhaging where applying the proper packing pressure as well as, alternatively, implementing an adequate tourniquet at the suitable site can stop the wounds from further blood loss. 
     The combat wounds and tourniquet site composition and assembly&#39;s goal is to offer a realistic interpretation of a human experiencing lesions or laceration from similar nature caused by battle, combat, explosion or trauma with or without blood supply for added realism. Delivering combat wounds and tourniquet site relevant in anatomical size, organic shape, natural feel and adequate pigmentation medical recognition and familiarity can be obtained in order to successfully perform the procedures being it proper tourniquet or adequate wound packing as well as attain the skills of tactile and recognize the adequate amount of applied pressure and packing technique in a stress free environment apt for troubleshooting and trial and error learning approaches. The products outlined in this disclosure include the combat arm wound (A), combat leg wound (B), arm tourniquet site (C) and leg tourniquet site (D) for medical procedures resulting in hemorrhaging from but not limited to combat and/or accidental occurrences. 
     The combat wounds and the tourniquet site composition and its assembly properly adapts to the wound location as well as the tourniquet location for the patient simulator and simultaneously connects to its hi fidelity system in order to provide an accurate anatomical medical platform that works in harmony as an overall training mechanism. 
     The combat wounds and tourniquet sites consistency portrays a relatively soft feel representative of the common human tissue in the hardness range of 30 in the 00 scale and 10 in the A scale under the Rockwell hardness standard using platinum cured silicon as primary material as well as the appropriate life-like flesh pigmentation and geometry composition of a natural wound. For platinum cured silicone it is preferred but not strictly assigned to a 1:1 ratio of Ecoflex® 0030 and Dragon Skin® 10 Medium, Smooth-On, Inc., Easton, Pa. as the most successful for the use and construction of the uterine material due to its effective endurance to pressure, tear, needle puncture, cutting, and suture retention while maintaining relevant to a high degree of realism. 
     Alternatively, the inside wound composition is consistent and depict a softer feel characteristic of that found in the typical human flesh in the hardness range of 10 in the 00 scale and 10 in the A scale under the Rockwell hardness standard using platinum cured silicone as its material composition as well as the proper red pigmentation. The selected platinum cured silicone material but not limited to represent the inner flesh wound is Ecoflex® 0030, Smooth-On, Inc., Easton, Pa. as the most effective for the added softness in comparison to the wound and its consistency to the human tissue. For the blood makeup, the opted but not required platinum cured silicone material used in its composition is Dragon Skin® 30, Smooth-On, Inc., Easton, Pa. as the most efficient in order to compensate the fibroid hollow construction and the needed hardness to resemble those found in the human body. Additionally, selected featured hardness can be achieved with a mixture of different silicone hardness under the Rockwell hardness standards. 
     In essence the wounds are constructed from designed layers, starting with the outer wound housing the assembly, followed by open cell foam to allow blood-like fluid to enter, diffuse and disperse evenly throughout the cross-sectional area to ultimately enter the inner wounds pores and discharge out of the wound. Therefore, one wound will be conformed of three independent components and utilize 2 separate molds in its manufacturing. 
     Inner wounds are conformed of open pores that cover most of the top surface of the piece and go through to its bottom side allowing simulation of the hemorrhaging effect of an inflicted laceration. The pores are effectively achieved by the arrangement of permanent pins of approximately 1/16 inches within the mold assembly. The benefit of producing or forming the pores of the inner wounds directly from the mold versus that of punching or extruding its cut include adequate pore placement and higher tear strength resistance therefore sustaining a larger load before tearing. The following solid models further expose the mold and its pin organization for the inner wound of both, the arm and the leg. 
     Manufacturing Procedures 
     Cleaning and Prepping the Molds 
     
         
         
           
             a. Lightly we cloth with isopropanol and wipe inside of mold cavity as well as exterior regions and mold core (for tourniquet molds only) in order to remove any dust particles and/or silicone residues from previous use. 
             b. Use air hose gun to remove silicone residues from Inner Wound Molds blowing in between pins. 
             c. Lightly coat mold cavity and core with mold release agent.
 
Materials and Utensils Setup
 
             a. Organize and collect all materials required for the manufacturing of Combat Hal&#39;s wounds, blanks and tourniquet site.
           i. Tubing No. 2 (Dimensions: ID ⅛″, OD ¼″, wall thickness 1/16″; Excelon™ RNT Tubing)   ii. Super Glue   iii. Silicone Primer (Loctite 770)   iv. Open Cell Foam cutouts of 0.50 and 0.25 inches wide   v. Ecoflex® 30 Silicone Part A and B   vi. Dragon Skin® 10 Silicone Part A and B   vii. Slo-Jo® (Smooth-On)   viii. Sil-Poxy® (Smooth-On)   ix. Slic-Pig® (Smooth-On) “Old Blood”   x. Slic-Pig® (Smooth-On) “Red”   xi. Slic-Pig® (Smooth-On) “Blue”   xii. Slic-Pig® (Smooth-On) “Black”   xiii. Slic-Pig® (Smooth-On) “Off White”   xiv. Slic-Pig® (Smooth-On) “Flesh”   
         
             b. Organize and collect all utensils required for the manufacturing of Combat Hal&#39;s wounds, blanks and tourniquet site.
           i. Q-tips   ii. Paintbrush   iii. Rags for cleaning   iv. Rubber bands   v. Exacto   vi. Tongue depressors   vii. Mixing buckets
 
Outer Wounds, Blanks and Tourniquet Sites of the Arm and Leg
   
         
             i. Dragon Skin 10 and Ecoflex 30 Mixing Ratio 1:1 (600 grams: 600 grams)
           Place clean mixing bucket on scale and pour:   
         
           
         
       
    
     
       
         
               
               
               
             
           
               
                   
               
             
             
               
                 1. 
                 Ecoflex ® 30 Part B 
                 300 grams 
               
               
                 2. 
                 DragonSkin ® 10 Part B 
                 300 grams 
               
               
                 3. 
                 Slo-Jo ® 
                  12 grams 
               
               
                 4. 
                 Slic-Pig ® “Flesh” 
                  3.6 grams 
               
               
                   
               
             
          
         
       
         
         
           
             ii. Hand mix thoroughly for approximately 2 minutes and skin flesh tone is homogeneous throughout the material. 
             iii. Place bucket at scale and pour: 
           
         
       
    
     
       
         
               
               
               
             
           
               
                   
               
             
             
               
                 1. 
                 Ecoflex ® 30 Part A 
                 300 grams 
               
               
                 2. 
                 DragonSkin ® 10 Part A 
                 300 grams 
               
               
                   
               
             
          
         
       
         
         
           
             iv. Hand mix once more thoroughly for approximately 2 minutes and skin flesh tone is homogeneous throughout the material. 
             v. Place bucket inside vacuum until pressure inside reaches approximately 27 psi and turn off vacuum, close valve and allow material to sit for approximately 3 minutes before valve is opened and air enters chamber. 
             vi. Remove bucket from vacuum and pour into:
           1. Outer Leg Wound   2. Outer Arm Wound   3. Leg Blank   4. Arm Blank   5. Leg Tourniquet Site   6. Arm Tourniquet Site   
         
             vii. Pouring is to be made up to mold surface level avoiding any inner mold wall to be exposed. 
             viii. Place poured molds in 66° C. oven to accelerate curing time for 45 minutes. 
             ix. Retrieve molds from oven and allow cooling down for 30 minutes before de-molding. 
             x. Once piece is de-molded, carefully use scissors to clip additional side flashing.
 
Inner Wounds
 
             i. Place clean mixing bucket on scale and pour: 
           
         
       
    
     
       
         
               
               
               
             
           
               
                   
               
             
             
               
                 1. 
                 Ecoflex 30 Part B 
                 100 grams 
               
               
                 2. 
                 Slic-Pig “Old Blood” 
                  0.6 grams 
               
               
                   
               
             
          
         
       
         
         
           
             ii. Hand mix thoroughly for approximately 1 minutes and old blood tone is homogeneous throughout the material. 
             iii. Place bucket at scale and pour: 
           
         
       
    
     
       
         
               
               
               
             
           
               
                   
               
             
             
               
                 1. 
                 Ecoflex 30 Part A 
                 100 grams 
               
               
                   
               
             
          
         
       
         
         
           
             iv. Hand mix once more thoroughly for approximately 1 minutes and old blood tone is homogeneous throughout the material. 
             v. Place bucket inside vacuum until pressure inside reaches approximately 27 psi and turn off vacuum, close valve and allow material to sit for approximately 1 minute before valve is opened and air enters chamber. 
             vi. Remove bucket from vacuum and pour into:
           1. Inner Leg Wound.   2. Inner Arm Wound.   
         
             vii. Pouring is to be made up to mold surface level avoiding any inner mold wall to be exposed. 
             viii. Place poured molds in 66° C. oven to accelerate curing time for 20 minutes. 
             ix. Retrieve molds from oven and allow cooling down for 15 minutes before de-molding. 
             x. Once piece is de-molded use blow hose gun to blow from top of pores to allow flashing to be exposed and clip with finger tips. 
             xi. Carefully use scissors to clip additional side flashing.
 
Assembling the Leg and Arm Wounds
 
             i. Dremel shinny film from open-cell foam cut-outs off from both sides in order to open the flowing channel through foam. (See step  710  in  FIG. 88 ) 
             ii. Prior to all use clean Sil-Poxy dispensing tip from dried or old silicone adhesive residues. 
             iii. Use Q-tip to spread Sil-Poxy on the inside bottom of the Leg/Arm Outer Wound piece. Avoid Sil-Poxy adhesive to enter the molds designed flowing channels and localized reservoirs. (See step  720  in  FIG. 89 ) 
             iv. Place Leg/Arm corresponding open-cell foam cut-out inside Leg/Arm Outer wound piece and press firmly to enhance the surface adhesion. (See step  730  in  FIG. 90 ) 
             v. Use Q-tip to spread Sil-Poxy in between foam wall and Mold inside wall to firmly fix foam in place and seal side gaps that will affect the function of the final product. (See step  740  in  FIG. 91 ) 
             vi. Secure rubber band on the perimeter of the Leg/Arm Outer Wound at foam level, Use Q-tip to push in foam into edges to avoid any gaps that will create a reservoir and cause the fluid to create a damming pressure prior to entering the foam. (See step  750  in  FIG. 92 ) 
             vii. Clean excess silicone adhesive with Q-tip. 
             viii. Place 200 gram weight on center of partially assembled wound and transfer system to 100° C. oven for 3-5 minutes. 
             ix. Remove system from oven and allow 1-2 minutes for cooling before rubber band is removed. 
             x. Use Q-tip to spread Sil-Poxy on the bottom and around the Leg/Arm Inner Wound piece pores. Avoid Sil-Poxy adhesive to enter any of the designed pore openings as this will block the fluid flow and disrupt the wound&#39;s function. (See step  760  in  FIG. 93 ) 
             xi. Place Leg/Arm Inner Wound piece on top of foam and inside wound partial assembly and press firmly. (See step  770  in  FIG. 94 ) 
             xii. Use Q-tip to spread Sil-Poxy in between Leg/Arm Inner Wound wall and Mold inside wall to firmly fix silicone parts together and seal side gaps. (See step  780  in  FIG. 95 ) 
             xiii. Secure rubber band on the perimeter of the Leg/Arm Outer Wound at Leg/Arm Inner Wound level, Use Q-tip to push in Silicone inner wound into edges to avoid any gaps. (See step  790  in  FIG. 96 ) 
             xiv. Clean excess silicone adhesive with Q-tip. 
             xv. Place 200 gram weight on center of partially assembled wound and transfer system to 100° C. oven for 3-5 minutes. 
             xvi. Remove system from oven and allow 1-2 minutes for cooling before rubber band is removed. 
             xvii. Semi-finished good is now available for final aesthetic manufacturing procedure. (See step  800  in  FIG. 97 )
 
Application of Pigmentation to the Leg Wound for Realism
 
           
         
       
    
     For the application of pigmented silicone prefabricated mixture of Ecoflex 30 part B must be available. Using the materials specified three shades of red are created, one off white and one bluish black. Alternatively, Ecoflex 30 part A must be available. Note that in order to allow pigmented silicone to properly cure, equal amounts of Part A and B must be mixed together to allow the catalyzation process to take place. Ultimately, the bare model must look real as in the injury caused by an explosion where tissue is exposed and torn ligaments, dried blood as well as fresh bleeding blood is observed. Accordingly, in some instances, the following steps are utilized to enhance the realism of the leg wound(s).
         i. Filling in the borders with “fresh blood” (See step  810  in  FIG. 98 )
           1. Mix in a plate a small amount consisting of:   2. 1 part Old Blood pigmented Ecoflex 30 Part B   3. 2 parts Red pigmented Ecoflex 30 Part B   4. 3 parts Ecoflex 30 Part A   
           ii. Creating Injury depth (See step  820  in  FIG. 99 )
           1. Mix in the plate a small amount consisting of:   2. 1 part Black pigmented Ecoflex 30 Part B   3. 1 part Blue pigmented Ecoflex 30 Part B   4. 2 parts Ecoflex 30 Part A   
           iii. Produce ligament simulation (See step  830  in  FIG. 100 )
           1. Mix in the plate a small amount consisting of:   2. 1 part Off White Pigmented Ecoflex 30 Part B   3. 1 part of Ecoflex 30 Part A   
           iv. Create blood layering and dulling (See step  840  in  FIG. 101 )
           1. Mix in the plate a small amount consisting of:   2. 1 part old blood pigmented Ecoflex 30 Part B   3. 1 part of unpigmented Ecoflex 30 Part B   4. 2 parts of Ecoflex 30 Part A   
           v. Create illusion of fresh blood (See step  850  in  FIG. 102 )
           1. Mix in the plate a small amount consisting of:   2. 1 part of red pigmented Ecoflex 30 Part B   3. 1 part of Ecoflex 30 Part A   
           vi. Old Blood overtone (See step  860  in  FIG. 103 )
           1. Mix in the plate a small amount consisting of:   2. 1 part old blood pigmented Ecoflex 30 Part B   3. 1 part of unpigmented Ecoflex 30 Part B   4. 2 parts of Ecoflex 30 Part A   
           vii. Assembling fluid tubing port (See step  870  in  FIG. 104 )
           1. Using an exacto, carefully make an “x” incision on the foam through the bottom opening.   2. Brush primer generously on wound opening as well as the no. 2 tubing.   3. Insert No. 2 tubing through hole and inside the foam at the “x” incision.   4. Squeeze in “super glue” at sides in between the wound opening and the tube wall.   5. Hold assembly in place to allow glue to set in and dry.
 
Application of Pigmentation to the Arm Wound for Realism
   
               

     For the application of pigmented silicone prefabricated mixture of Ecoflex 30 part B must be available. Using the materials specified three shades of red are created, one off white and one bluish black. Alternatively, Ecoflex 30 part A must be available. Note that in order to allow pigmented silicone to properly cure, equal amounts of Part A and B must be mixed together to allow the catalyzation process to take place. Ultimately, the bare model must look real as in the injury caused by an explosion where tissue is exposed and torn ligaments, dried blood as well as fresh bleeding blood is observed. Accordingly, in some instances, the following steps are utilized to enhance the realism of the arm wound(s).
         i. Filling in the borders with “fresh blood” (See  FIG. 67 )
           Mix in a plate a small amount consisting of:
               1. 1 part Old Blood pigmented Ecoflex 30 Part B   2. 2 parts Red pigmented Ecoflex 30 Part B   3. 3 parts Ecoflex 30 Part A   
               
           ii. Produce ligament simulation (See  FIG. 68 )
           Mix in the plate a small amount consisting of:
               1. 1 part Off White Pigmented Ecoflex 30 Part B   2. 1 part of Ecoflex 30 Part A   
               
           iii. Create illusion of fresh blood (See  FIG. 69 )
           Mix in the plate a small amount consisting of:
               1. 1 part of red pigmented Ecoflex 30 Part B   2. 1 part of Ecoflex 30 Part A   
               
           iv. Creating Injury depth (See  FIG. 70 )
           Mix in the plate a small amount consisting of:
               1. 1 part Black pigmented Ecoflex 30 Part B   2. 1 part Blue pigmented Ecoflex 30 Part B   3. 2 parts Ecoflex 30 Part A   
               
           v. Create blood layering and dulling (See  FIG. 71 )
           Mix in the plate a small amount consisting of:
               1. 1 part old blood pigmented Ecoflex 30 Part B   2. 1 part of unpigmented Ecoflex 30 Part B   3. 2 parts of Ecoflex 30 Part A   
               
           vi. Assembling fluid tubing port (See  FIG. 67 )
           1. Using an exacto, carefully make an “x” incision on the foam through the bottom opening.   2. Brush primer generously on wound opening as well as the no. 2 tubing.   3. Insert No. 2 tubing through hole and inside the foam at the “x” incision.   4. Squeeze in “super glue” at sides in between the wound opening and the tube wall.   5. Hold assembly in place to allow glue to set in and dry.   
               

     One or more of the features of the present disclosure can be combined into a patient simulator to help train combat medics who must quickly perform a few, very critical steps before the soldier is transported. In some embodiments, the patient simulator is sized and shaped to simulate an adult male. Further, in some embodiments, the patient simulator is operable without physical connection to an external device. In that regard, in some instances the patient simulator includes one or more devices configured to facilitate wireless communication with one or more other components. In some instances, the patient simulator is configured to communicate wireless over a distance of 300 meters or more. Wireless communication can include audio, video, sensor data, control signals, and/or any other information associated with the patient simulator. For example, in some implementations the patient simulator wireless communicates with a controller and/or control system configured to control one or more aspects of the patient simulator. To facilitate tetherless operation, the patient simulator includes an onboard power supply, such as a single battery or a plurality of batteries, that is configured to provide at least 6 hours of simulator operation on a single charge. Further, the patient simulator must be designed, assembled, and constructed in a manner to withstand the rigors associated with combat medic scenarios without adversely affecting performance of the patient simulator. In some instances, the patient simulator includes one or more wounds. In some instances, the patient simulator includes wounds that require proper tourniquet application to stop the wound from bleeding. 
     Further, in some instances the patient simulator includes a trachea device that allows training on proper tracheostomy procedures, including insertion of a trachea tube such as a Shiley tracheostomy tube, size 8. In that regard, the trachea device includes a surgical cricoid insert with anatomic landmarks. The surgical cricoid insert is formed of sufficiently durable materials to be repeatedly subjected to a tracheostomy hook. In that regard, in typical use the combat medic will make two incisions (one medial, one lateral) through the trachea skin cover over the surgical cricoid. Then the medic will insert the tracheostomy hook into the cricoid cartilage at the intersection of the incisions and lift upward. The tracheostomy hook is utilized to hold the trachea steady during the tracheostomy procedure. Once the opening has been created, the combat medic inserts a tracheostomy tube thru the cricoid cartilage such that oxygen can be provided to the wounded soldier. Further, the neck of the patient simulator provides the carotid pulse in some instances. 
     In some instances, the patient simulator includes device positioned where the sternum would be located that is configured to accept fluids, can be used multiple times without needing to replace the device, and provides for the infusion of medication. In some instances, the device is configured to be used with the FAST-1 intraosseous device. Further, the patient simulator breathes in accordance with a respiratory pattern. In that regard, the patient simulator has chest rise and fall corresponding to the respiratory pattern. To simulate some scenarios, one or both of the left and right lungs can be disabled to simulate pneumothorax. To that end, the patient simulator includes pneumothorax simulation components in some instances that allows training of pneumothorax procedures. In particular, in some instances the patient simulator facilitates training of needle chest decompressions using a 3¼ inch long and 14 gauge needle, or other suitable needles, at the 2nd intercostal space bilaterally. The skin of the patient is durable with respect to needle punctures such that these procedures can be performed multiple times without needing to change the skin of the patient simulator. Sensors detect the needle insertion and communicate the action to the controller or control system that controls the respiratory pattern of the patient simulator. Accordingly, the controller or control system adjusts the respiratory pattern based on the treatment administered to the patient simulator in some instances. 
     In some instances, an arm of the patient simulator includes a venous network to allow the start an IV drip. Further, a drain in the arm allows large volumes of fluid to be infused. Further, in some instances an arm simulates a severe wound, such as a partial limb loss. In one specific embodiment, half of the left forearm has been lost. The resulting wound looks realistic and bleeds as a function of blood pressure and heart rate. In that regard, use of a standard tourniquet, if applied correctly, will trigger a sensor that causes the bleeding to stop. Further, still, in some instances the shoulder connections of the arms are configured to provide natural motion/flexibility, yet provide strength and durability sufficient to allow the simulator to be dragged. In some embodiments, the shoulder connections include openings extending therethrough to allow passage of communication cables and/or tubing for introduction of fluids (e.g., simulated blood). Further, still, in some instances the should connections limits arm range of motion to a natural range (e.g., approximately 270 degrees), but prevents full rotation of the arm to prevent unwanted kinking and/or damage to the communication cables and/or tubing going through the shoulder connection and into the arm. In some embodiments, an arm of the patient simulator includes a large bleeding wound near axilla, inside of arm beneath bicep. The wound is configured to accept packing material and applying pressure to the wound stops the bleeding of the wound. In that regard, a sensor detects the application of pressure, which in turn causes the control system to stop sending blood to the wound. One or both of the arms of the patient simulator may include radial and brachial pulses that are controlled by the controller or control system. 
     In some instances, the patient simulator includes a groin wound and a sensor located at femoral location where pressure (usually Medic&#39;s knee) is applied to decrease bleeding at groin wound. Again, the sensor detects the application of pressure, which in turn causes the control system to stop sending blood to the wound. Similar to the arms, one or both of the legs may includes bleeding wounds that accept packing material and where application of pressure stops the bleeding of the wound. In that regard, the fluid reservoir housing the blood that is utilized to simulate the bleeding of the wounds is contained in one or both of the legs in some instances. In some instances, the reservoir contains 1.5 liters or more of simulated blood that is utilized to cause simulated bleeding of axilla wound, groin wound, amputation arm, and/amputation leg. In that regard, in some instances the patient simulator bleeds at a rate of approximately 0.25 liters per minute. Accordingly, in some instances a sensor is included to monitor the amount of blood within the reservoir so that a user or instructor can be aware when the simulator is running low on blood and replenish the reservoir as needed. Also, similar to the arms, an embedded sensor in the leg detects when a standard tourniquet is properly applied and can stop the flow of blood accordingly. In some instances, one of the legs contains a compressor that is utilized to control various pneumatic aspects of the patient simulator including, for example, portions of the respiratory and circulatory systems of the patient simulator. 
     The foregoing outlines features of several embodiments so that those skilled in the art may better understand the aspects of the present disclosure. Those skilled in the art should appreciate that they may readily use the present disclosure as a basis for other devices that simulate medical scenarios and situations, including those involving human tissue. Those skilled in the art should also realize that such equivalent constructions do not depart from the spirit and scope of the present disclosure, and that they may make various changes, substitutions, and alterations to the embodiments disclosed herein without departing from the spirit and scope of the present disclosure. Also, it will be fully appreciated that the above-disclosed features and functions, and variations thereof, may be combined into other methods, systems, apparatus, or applications.