Abstract:
The Tactical Combat Casualty Care Trainer For Hyper-Realistic™ Emergency Medical Training (“TCCC”) of the present invention includes a tactical combat training device for the purpose of providing an emergency medical services provider hands-on training. The TCCC includes an artificial human skeleton having specific anatomical features which provide the trainee or provider with appropriate tactile response analogous to a real human patient, thereby increasing the fidelity of training and improving the skills necessary to conduct procedures such as cricothyrotomy, intrasosseous infusion, CPR and other medical services to human patients. The skeleton is covered by a realistic coating that simulates human skin, which adds to the TCCC&#39;s training value. The TCCC also includes a removable trachea module and training pucks located at the sternum as well as the left and right proximal humeral heads to simulate the use of infusion-type devices.

Description:
RELATED APPLICATIONS 
       [0001]    This application is a divisional of, and claims the benefit of priority to, the U.S. Utility patent application for “Tactical Combat Casualty Care (TCCC) Trainer For Hyper-Realistic™ Emergency Medical Training,” Ser. No. 13/898,436, filed on May 20, 2013, and currently co-pending, which in turn claims the benefit of priority to the U.S. Provisional Patent Application for “Tactical Combat Casualty Care (TCCC) Trainer For Hyper-Realistic™ Emergency Medical Training,” Ser. No. 61/649,357, filed on May 20, 2012, and currently expired. 
     
    
     FIELD OF THE INVENTION 
       [0002]    The present invention relates generally to casualty simulation and medical response team training systems. The present invention is more particularly, though not exclusively, a Hyper-Realistic™ head and torso simulator to simulate injuries for purposes of tactical combat casualty care simulation and medical response training. 
       BACKGROUND OF THE INVENTION 
       [0003]    The United States military spends hundreds of millions of dollars annually training thousands of Sailors, Marines, Soldiers, and Airmen for combat operations, while other civilian specialized first responder programs do the same for paramedics and other first responder teams. Because real world accidents, life and death situations, or combat situations are not always an effective or desirable manner to conduct for training events, simulation of events has long been an indispensable training tool. 
         [0004]    Acquisition of expertise in any discipline requires practice. Simulation of combat situations minimizes costs; at the same time simulation provides military personnel and civilian first responders with realistic training scenarios. From armored vehicle and flight simulators to cardiopulmonary resuscitation (CPR) mannequins, the United States government conserves many resources by using computers and other training aids to simulate actual operational conditions allowing procedural training in a controlled environment. Simulators of all kinds minimize risk of loss of assets and save on fuel costs, ammunition, and even the lives of the very people being trained. 
         [0005]    Combat medical or first responder teams are groups that benefit greatly from simulation. It is not practical, nor realistic, to expect Corpsmen, Medics, or Paramedics to hone their skills exclusively on real people in real life-threatening situations. Thus, individuals with such responsibilities derive significant training value from implementation of tactics, techniques, and procedures in a realistic, but simulated, operating environment, prior to being faced with a real world scenario. Many systems have been developed to fulfill necessary training requirements by simulation. A wide range of technologies are currently employed, from complex simulation environments that fully recreate an operating room experience, to computer programs and table-top equipment that allow technicians to rehearse medical decision-making and the performance of specific tasks. 
         [0006]    Many of these systems are cost prohibitive due to the level of technology involved in the device. Further, many systems are too big, bulky, or are simply not conducive to mobility or training in the field. Due to the current state of the economy and the fiscally constrained environment within which government agencies continue to work, compact, less expensive, versatile, and realistic training aids are necessary to complete efficient and effective training of medical response personnel. 
         [0007]    In light of the above, it would be advantageous to provide a compact, versatile, and portable injury simulation system that provides a realistic experience to emergency medical teams in a controlled training environment. 
       SUMMARY OF THE INVENTION 
       [0008]    The Tactical Combat Casualty Care Training System (“TCCC”) of the present invention provides a portable and versatile answer to on-the-ground training needs for military Corpsmen and Medics, and civilian first responder teams. The TCCC is comprised of a single Hyper-Realistic™ head and upper torso mannequin that allows for practicing at least the following six skill sets: (1) insertion of a Nasopharyngeal Airway (“NPA”) for airway management; (2) performing head tilt, chin lift, visual inspection of mouth and physical sweep to remove foreign bodies from the mouth in support of airway management; (3) performing a surgical airway (“cricothyrotomy”) for airway management; (4) performing needle chest decompression (“NCD”) for tension pneumothorax; (5) insertion of an Intraosseous Infusion (“IO”) System into the sternum; and (6) insertion of an IO System into the proximal humerus. 
         [0009]    The TCCC of the present invention includes a tactical combat training device for the purpose of providing an emergency medical services provider hands-on training. The TCCC includes an artificial human skeleton having specific anatomical features which provide the emergency medical service trainee or provider with appropriate tactile response analogous to a real human patient, thereby improving the skills necessary to provide these medical services to human patients. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]    The novel features of this invention, as well as the invention itself, both as to its structure and its operation, will be best understood from the accompanying drawings, taken in conjunction with the accompanying description, in which similar reference characters refer to similar parts, and in which: 
           [0011]      FIG. 1  is a front view of a preferred embodiment of the Tactical Combat Casualty Care Training System (“TCCC”) of the present invention, showing the torso construction of the TCCC, with an articulable head, moveable jaw, and cutaway of the skin showing an anatomically correct skeletal construction; 
           [0012]      FIG. 2  is a front view of a preferred embodiment of the internal skeletal components of a preferred embodiment of the TCCC of the present invention showing the anatomically correct interior skeletal components, the location of the intraosseous infusion (“IO”) training puck at the sternum, various intercostal spaces between the ribs for needle decompression procedure, and an articulable head, jaw, and neck for medical training procedures; 
           [0013]      FIG. 3  is a side view of the internal skeletal components of the TCCC of  FIG. 1 , showing the location of a training puck at the proximal humerus for humeral IO training, the various intercostal spaces between the ribs, and an articulable head, jaw, and neck; 
           [0014]      FIG. 4  depicts a back view of the internal skeletal components of the TCCC of  FIG. 1 , showing the internal skeletal components and the articulable neck vertebrae allowing for motion of the head relative to the torso, facilitating airway cleaning and other medical training procedures; 
           [0015]      FIG. 5  is a front view of a preferred embodiment of the TCCC of  FIGS. 1-3  with the exterior features and the skin-like covering resembling a human patient installed, showing the tracheal insertion area sized to receive a trachea training aid; 
           [0016]      FIG. 6  is a front view of the preferred embodiment of  FIG. 4 , showing a trachea training aid installed in the tracheal insertion area, and the articulable head and jaw, allowing airway cleaning and management procedures and breathing tube insertion for medical training; 
           [0017]      FIG. 7  is a side view of the preferred embodiment of  FIG. 4 , showing the anatomically correct simulated human torso and head with accurate anatomical landmarks and access to the open mouth and nasal cavity for medical training; 
           [0018]      FIG. 8  is a back view of the preferred embodiment of  FIG. 4 , showing the anatomically correct simulated human torso with accurate anatomical landmarks on the back for medical training; 
           [0019]      FIG. 9  is a close up front view of the preferred embodiment of  FIG. 4 , showing the airway hole at the bottom of the tracheal insertion area that connects to the trachea training aid for surgical airway procedures, and the articulable mouth and tongue for medical training; 
           [0020]      FIG. 10  is a diagrammatic view of a of the trachea training aid and the anatomical structure of a portion of a human neck, showing the location of the laryngeal prominence, thyroid cartilage, the cricothyroid membrane, and cricoid cartilage that overly the trachea; 
           [0021]      FIG. 11  is a front view of the preferred embodiment of the TCCC of  FIGS. 4-8 , showing the neck skin applied to the neck of the TCCC and points of access to airways in the mouth and nasal cavity, depicting the nasal breathing tube partially inserted into the TCCC nasal passage as would be completed during nasotracheal intubation training; 
           [0022]      FIG. 12  is a front view of the preferred embodiment of the TCCC of  FIG. 9 , showing the nasal breathing tube completely inserted into the left nostril of the TCCC; 
           [0023]      FIG. 13  is a close up front view of the TCCC of  FIG. 9 , showing the articulable head rotated to the side with the mouth open, allowing a trainee to clear the airway of any simulated foreign bodies during medical procedures training; 
           [0024]      FIG. 14  is a front view of the TCCC of  FIG. 9  showing an orotracheal breathing tube inserted in the mouth of the TCCC as would be completed during orotracheal intubation training; 
           [0025]      FIG. 15  is a front view of the TCCC of  FIG. 9  showing a trainee&#39;s preparation for insertion of a needle and catheter into the chest cavity of the TCCC through an intercostal space, as would be completed during a chest needle decompression procedure of a pneumothorax; 
           [0026]      FIG. 16  is a front view of the preferred embodiment of the TCCC of the previous Figures, showing a needle and catheter inserted into the chest cavity of the TCCC through the intercostal space, as would be completed during a chest needle decompression procedure of a pneumothorax; 
           [0027]      FIG. 17  is a front view of the preferred embodiment of the TCCC of previous Figures, showing a trainee utilizing the anatomically correct features to visually and manually identify anatomical landmarks of the TCCC to allow a correct incision during the establishment of a surgical airway as would be completed during a cricothyrotomy; 
           [0028]      FIG. 18  is a front view of the preferred embodiment of the TCCC of previous embodiments showing the insertion of a manufactured airway through the incision made in the cricothyroid membrane into the trachea as would be conducted during a surgical intubation; 
           [0029]      FIG. 19  is a front view of the preferred embodiment of the TCCC of  FIG. 19 , showing manufactured airway inserted into the trachea and secured to the neck of the TCCC as would be conducted during a surgical intubation; 
           [0030]      FIG. 20  is a perspective view of the preferred embodiment of the TCCC of previous embodiments showing the use of the anatomically correct features of the TCCC to visually and manually identify anatomical landmarks to facilitate proper sternal interosseous infusion system (IO device) placementon the sternum of the TCCC during training; 
           [0031]      FIG. 21  is a perspective view of the preferred embodiment of the TCCC of previous embodiments showing the application of a sternal IO device to the chest of the TCCC; 
           [0032]      FIG. 22  is a perspective view of the preferred embodiment of the TCCC of previous embodiments showing a catheter that remains in place within the chest of the TCCC, following removal of the sternal IO device; 
           [0033]      FIG. 23  is a perspective view of the preferred embodiment of the TCCC of previous embodiments showing utilization of the anatomically correct features of the TCCC to visually and manually identify anatomical landmarks to facilitate proper humeral IO device placement at the proximal humerus during training; and 
           [0034]      FIG. 24  is a perspective view of the preferred embodiment of the TCCC of  FIG. 24  showing a humeral IO device applied to the left shoulder of the TCCC, in addition to the tracheal intubation described in the Figures above. 
       
    
    
     DETAILED DESCRIPTION 
       [0035]    Referring initially to  FIG. 1 , the Tactical Combat Casualty Care for the Hyper-Realistic™ Emergency Medical Training System (“TCCC”), of the present invention is shown and generally labeled  100 . In a preferred embodiment, the TCCC  100  of the present invention includes an internal skeleton  102  (shown below) with a skin-like exterior (“skin”)  104 . Further TCCC  100  is formed with a head  106  and a torso  108 . A cutaway of the skin  104  is shown in this Figure, providing a view of the internal skeleton  102 . TCCC  100  incorporates a method and apparatus for simulating real world casualties in a training environment. 
         [0036]    A preferred embodiment of TCCC  100  enables training in a number of particular tactical combat casualty care skill sets designed to target priority medical training procedures presently in demand, including but not limited to: needle chest decompression for tension pneumothorax, nasal and oral airway management, cricothyrotomy, and humeral and sternum intraosseous infusion and fluid delivery. It is to be appreciated by those skilled in the art that the preceding list of skill sets should not be considered limiting; rather the TCCC  100  of the present invention may be formed with any variety of priority skill sets practical for the application and feasible for training use. 
         [0037]    In a preferred embodiment, the TCCC  100  has an anatomically correct internal and external human-like construction, featuring true-to-life look and feel, enhancing the Hyper-Realistic™ training simulations. TCCC  100  has an internal bone structure that comprises skeleton  102  (discussed below) and a two-part, liquid silicone, tin-based polymer rubber that is cast from a life-like mould to produce a skin-like exterior  104  that provides procedural task training with heightened realism. In a preferred embodiment, TCCC  100  can be adapted and equipped for execution of many other emergency medical procedures other than those listed above. 
         [0038]    Referring now to  FIG. 2  the internal skeleton  102  of the TCCC  100  of the present invention is shown with the skin  104  removed in order show the skeletal anatomy. A preferred embodiment of the skeleton  102  comprises a simulated skeleton of a human torso  108  that accurately models the bone structure of the human anatomy. Skeleton  102  has a rib cage  110 , a skull  112 , with an anatomically correct nasal cavity  114 , and an articulable jaw  116  with full set of teeth  118 , all mounted on a flexible cervical spine  120  permitting the skull  112  and spine  120  to articulate relative to the rest of the torso  108 . The rib cage  110  has individual ribs (not individually labeled here) that define the first, second, third, and fourth intercostal spaces labeled  122 ,  124 ,  126 , and  128  respectively on the TCCC&#39;s  100  left and right sides. 
         [0039]    In keeping with the Hyper-Realistic™ theme, the skeleton  102  features an anterior-superior sternum intraosseous (“IO”) puck (“sternum puck”)  130  located at the junction of the ribs of the rib cage  110  at the chest. As will be discussed in more detail below, sternum puck  130  is user replaceable, being designed as a sacrificial target for the emergency medical training. Two humeral IO pucks  132  and  134  are formed similar to the sternum puck  130 , and are located on either shoulder of the skeleton  102  at the left and right proximal humeral heads  131  and  133 . It is to be appreciated by those skilled in the art that the skeleton  102  components and TCCC  100  as a whole can incorporate additional features and extremities to those listed. 
         [0040]    The skeleton  102  is cast from, 4-Methylene diphenyl diisocyanate rigid polyurethane. It has a low density rigid urethane foam as a void filler. The skeleton has a weight and density approximating human anatomy. The flexure in the cervical spine  120  is provided through a flexible wire (not shown) embedded within the skeletal spine. The skeletal spine consists of the cervical spine  120 , the thoracic spine  141 , and the lumbar spine  142   
         [0041]    Referring now to  FIG. 3 , the right hand side of skeleton  102  is shown, with a clear view of the IO humeral puck  134  inserted, while a profile view of the sternum puck  130  is also visible.  FIG. 3  further shows the skull  112  and jaw  116  that is hingeably attached to the skull  112 , allowing some articulation similar to a real human jaw. The moveable jaw  116  in conjunction with the flexible cervical spine  120  provides additional realism allowing a trainee to practice procedures such as airway clearing, (described in detail below in reference to  FIG. 13 ) or the head tilt/chin lift procedures while administering emergency medical assistance, such as cardio pulmonary resuscitation (“CPR”). 
         [0042]    The IO training pucks utilized at the sternum puck site  130  and left and right proximal humeral head pucks sites  132  and  134 , are comprised of polycarbonate resin thermoplastic and a layer of polystyrene, fastened to the skeleton with silicone elastomer. The puck approximates human bone density and is useful for approximately ten to fifteen IO insertions before it needs to be replaced. 
         [0043]    Referring now to  FIG. 4 , a back view of the skeleton  102  is shown, depicting the back of skull  112 , the back of the jaw  116 , and the cervical spine  120 , in addition to many other features of the skeleton&#39;s  102  back  140 . The thoracic spine  141  and lumbar spine  142  is further shown, in addition to left and right scapulae  144  and  146 , respectively. The rib cage  110  is also accentuated in skeleton  102  and given individual contours in the back  140  in order to provide further anatomical landmarks (“landmarks”) distinguishable through skin  104 , for increased visual and tactile realism when a trainee manipulates the complete TCCC  100 . 
         [0044]    Identification of landmarks, musculature, and anatomical index points as a means of initiating casualty care is well known among those skilled in the art of medical procedure and assessment training and is meant to establish the location of the treatment area. Further references to anatomical index points, musculature, and landmarks are not specifically enumerated but are fully contemplated herein. 
         [0045]    While the use of flexible resin as a method to facilitate airway clearing and fabricate the skeletal body  100  is particularly well suited for the TCCC of the present invention, it is to be appreciated that other construction materials and methods of facilitating airway clearing may be incorporated herein without departing from the scope of the present invention. 
         [0046]    Now referring to  FIG. 5 , a TCCC  100  of the present invention is shown with the skin  104  formed over the skeleton  102 , providing a realistic human torso  108 , head  106 , left shoulder  148  and right shoulder  149 . The jaw  116  is articulated downward, leaving the mouth  154  slightly agape, revealing a complete set of teeth  118 , adding to the realism of the simulation. 
         [0047]    Skin  104  is made of a repairable two-part, liquid silicone, tin-based polymer rubber composition that is resilient, yet pliable, allowing a trainee to identify portions of the skeleton  102  beneath the skin  104  as the trainee conducts medical procedures. The skin  104  completely covers the front and back of the TCCC  100 , allowing use of the entire torso  108  and head  106 . 
         [0048]    In an embodiment, specific multiple layers of skin  104  with different densities and weights are applied to the exterior of the skeleton  102 , providing a way to simulate human musculature, which also serves as anatomical landmarks during medical procedures. 
         [0049]    During construction of the TCCC, the skeleton  102 , the skull  112 , and the cervical spine  120 , is placed inside the mold for the skin. Voids for the nasal and oral passages are created by placing removable plugs into the void area. Rib intercostals voids are sealed with polyethylene plastic resin sheets. The mold is then filled with a two-part, liquid silicone, tin-based polymer rubber to cast the head and torso as a single unit. After casting, the plugs for the oral and nasal passages are removed. 
         [0050]    A trachea module insertion area  150  is formed in the neck  151  between the head  106  and torso  108  of skin  104  and is sized to receive an anatomically similar trachea module  152  (shown in  FIG. 6 ). The user-replaceable, user-repairable trachea module  152  allows simulation of emergency medical procedures, specifically a cricothyrotomy and surgical intubation. 
         [0051]    Now referring to  FIG. 6 , a trachea module  152  has been inserted into the trachea module insertion area  150  for use in simulation. In use, the trachea module  152  is held in place by a lip of skin material  153  around the periphery of the insertion area  150  to secure it. In a preferred embodiment, the trachea module  152  is also constructed from silicone, rubber, plastics, and other materials, providing a realistic, tactile experience for the user. Such a construction allows for realistic feedback for users when palpating index points such as the laryngeal prominence (Adam&#39;s Apple)  168 , and making incisions on the simulated cricothyroid membrane  170 , both described in  FIG. 10 . The simulated skin  104  includes an open mouth  154  and an open nasal passage  156  in the nose  157  for airway check and breathing tube insertion described in further detail below. 
         [0052]    Now referring to  FIG. 7 , a right side view of the TCCC  100  is shown, looking at the right shoulder  149 . The anatomically similar musculature for the simulated skin  104  is shown to extend to the side and back of the TCCC  100  of the present invention possessing proper anatomical landmarks for medical assessment and procedure training. The arrows indicated by designator  159  indicate the fore and aft flexibility of the head  106 , simulating a real patient. 
         [0053]    Now referring to  FIG. 8 , the back of the TCCC  100  is shown, again with anatomically correct musculature and skin  104  definitions. Head  106  may further move in direction  161 , or left and right, simulating a real patient. The head  106  of the TCCC  100  may further rotate slightly (direction not shown). 
         [0054]    Now referring to  FIG. 9 , a close up of the head  106  and the upper torso  108  is shown, focusing on the trachea module insertion area  150  and the open mouth  154 . A bottom airway hole  158  is formed in the bottom of the trachea insert area  150 , and top airway hole  159  (not visible from this angle) is formed in the top. Similarly, the trachea module  152  (see  FIG. 10 ) has a central lumen  160  (not shown) providing a continuous path from the nasal passage or mouth, anatomically similar to a human trachea, in use. This function of the TCCC  100  allows insertion of a breathing tube (described below) as would be accomplished during an intubation procedure through the nasal passage, mouth, or via cricothyrotomy. 
         [0055]    The open mouth  154  contains a tongue  155  for natural airway check. The tongue is made from a two-part liquid silicone to form a semi-rigid foam organ that is affixed to the mouth with a sealant, such as, for example, silicone. 
         [0056]    Now referring to  FIG. 10 , a perspective view of the trachea module  152  is shown. Trachea module  152  is formed as a flexible tubular structure, having a central lumen  160  that is continuous through the center of the trachea module  152  from the top  162  at the [simulated] hyoid bone, to the bottom  164  where the [simulated] cricoid cartilage meets the rest of the trachea as it progresses toward the lungs (not shown). When inserted in the trachea insertion area  150 , the top  162  of trachea module  152  is adjacent to the top airway hole  159  (not shown), while the bottom  164  of the trachea module  152  is adjacent to the bottom airway hole  158 , providing the continuous passage from mouth  154  and nasal cavity  114  through the trachea module  152 , and into the torso  108  of TCCC  100 , through bottom airway hole  158 . 
         [0057]    Trachea module  152  is formed with the various components of a real human trachea, including a thyrohyoid ligament  166 , laryngeal prominence  168  (or Adam&#39;s Apple), cricothyroid membrane  170 , and thyroid cartilage  172 . In reality, bones, cartilage, and connective tissue each have a different texture and strength. In order to provide the Hyper-Realistic™ level of training, a preferred embodiment of the trachea module  152  can be made with different density polymers or elastomers in order to give an anatomically correct look and feel to the component. It is to be appreciated by those skilled in the art that other suitable materials providing a high degree of realism can be utilized to manufacture such components. 
         [0058]    Referring now to  FIG. 11 , a preferred embodiment of the TCCC  100  of the present invention is shown with simulated neck skin  176  installed. Neck skin  176  covers the trachea module  152  (shown in dashed lines) providing an appropriate simulation for a trainee conducting an exercise. Neck skin  176  further conceals the trachea module  152  and requires a trainee to palpate the neck  151  of TCCC  100  to manually find the appropriate locations to incise, in the case of a cricothyrotomy, for instance. 
         [0059]      FIG. 11  further shows a commercially manufactured nasopharyngeal airway (“nasal airway”)  178  inserted at the nose  157  through the nostril  156  into the nasal cavity  114 , proceeding into the nasal pharynx (not shown). The nasal airway  178  can be any standard commercially available nasopharyngeal airway. The nasal airway  178  is inserted through the nostril into the nasal cavity  114 , proceeding into the nasal pharynx, and into the trachea module  152 , as it would in reality, providing a realistic simulation of airway management. 
         [0060]    Now referring to  FIG. 12 , the nasal airway  178  is completely inserted into the nasal cavity, providing a realistic simulation of a nasal intubation. 
         [0061]    Referring now to  FIG. 13 , TCCC  100  is shown with a trainee  200  executing an oral sweep of the TCCC&#39;s  100  mouth  154 . In a preferred embodiment, the tongue  155  (not visible in this Figure) as shown in  FIG. 9 , is formed of an elastomeric material that closely replicates the look and feel of a real human tongue. In a given medical training scenario, the trainee  200  may be required to extract a foreign object from the mouth of the TCCC  100  prior to oral intubation. This Figure is representative of such a procedure. 
         [0062]    In a preferred embodiment, the flexibility of cervical spine  120  and neck  151 , and jaw  116  provide the ability to manipulate the mouth  154  and provide the ability to perform “head tilt/chin lift” procedures for visual inspection of the mouth  154  and a physical sweep to remove foreign bodies in support of airway management or CPR. Due to the flexibility of cervical spine  116 , skull  112  has a moderate articulation  159  and  161 , allowing a trainee  200  to manipulate the skull  112  and head  106  as required by a given scenario. This flexibility, in conjunction with the force of gravity, simulates the lack of head control of an unconscious patient. The medical trainee  200  may then perform a head tilt/chin lift by utilizing the freedom of movement of skull  102  and the flexible spine  116 . In an embodiment, the skull  102  may further be weighted to accurately model a typical human head. 
         [0063]    Referring now to  FIG. 14 , once the airway check has been performed, a manufactured oral airway  180  may be inserted to facilitate and support airway management. The mouth  154  allows the trainee  200  to conduct intubation training, where the TCCC  100  of the present invention is shown with a full oral intubation completed. In an embodiment, the oral airway  180  is a commercially available orotracheal device such as the TaperGuard™ Evac Oral Tracheal Tube. Alternative training methods and devices for oral airway management are well known to those skilled in the art and are fully contemplated herein. 
         [0064]    In a preferred embodiment, when conducting simulated intubation procedures with either the nasal airway  178  or oral airway  180 , the instrument is inserted into a respective orifice in the TCCC&#39;s  100  head  106 . In order to simplify TCCC  100  construction, the distal ends of airways  178  and  180  penetrate their respective orifices and enter the nasal cavity  114  within skull  112 . This allows realistic medical training simulation even though the airways  178  and  180  do not actually enter the appropriate anatomical nasal passageways or the trachea. 
         [0065]    In an alternative preferred embodiment, additional internal construction within the skull provides further Hyper-Realistic™ training, allowing the nasal airway  178  or oral airway  180  in use to follow a correct anatomical path from either the nose  157  or mouth  154  into the trachea module  152 . In such an embodiment, the interior of the skull  112  is formed with specific pathways, replicating the human oral cavity, palate, nasal passageways, epiglottis, and esophagus (not shown), allowing either a nasal intubation or oral intubation. 
         [0066]    Now referring to  FIG. 15 , needle chest decompression (NCD) for tension pneumothorax training ability of the TCCC  100  is demonstrated. In an embodiment, the intercostal spaces  122 ,  124 ,  126 , and  128  accommodate anterior thoracic needle catheters for tension pneumothorax treatment procedures. 
         [0067]    In preparation for insertion of a standard 14-gauge, 3 inch needle and catheter  182 , a trainee  200  physically locates the appropriate intercostal space  124  within rib cage  110 . In a preferred embodiment, this is easily accomplished as the TCCC  100  of the present invention includes essential landmarks such as the clavicle, ribs, and other appropriate anatomical structures tactilely distinguishable by the trainee  200 . As is known in the art, during an NCD, the trainee locates the midclavicular line, represented by a dashed line  202  and the second intercostal space  124 , which will be the insertion point for the needle and catheter  182 . This device is capable of accepting up to a 14 gauge, 3¼ inch over-the-needle catheter. 
         [0068]    Referring to  FIG. 16 , the needle and catheter  182  are inserted into the TCCC&#39;s  100  chest at the second intercostal space  124  to complete the training evolution. After ensuring the needle entry site is not medial to the nipple line, the trainee will slowly advance the needle and catheter  182  into the simulated thoracic cavity of the skin  104  until the tip of the needle gives way upon entering the simulated pleural space (not shown) of the skeleton  102 . The needle is removed leaving the catheter hub in place and stabilized by gauze tape (not shown). 
         [0069]    In an embodiment, the TCCC  100  skeleton  102  can further be constructed with a tough, membranous material on the interior of the skeleton, beneath the skin  104  to simulate the pleura space of the human anatomy. In reality, there is a perceptible “pop” as a needle penetrates the parietal pleura, or the outer layer of the pleural cavity that lies against the interior of the chest wall. A membranous layer on the interior of the skeleton  102  adds further realism to the simulation. 
         [0070]    Other thoracic needle catheters are commercially available for training, are well known among those skilled in the art, and are completely contemplated herein. For example, in an alternative embodiment, a 16 or 18 gauge needle and catheter may be used to extend the lifetime of the skin covering  104 . 
         [0071]    Now referring to  FIG. 17 , the capability of the TCCC  100  of the present invention to simulate performing a Hyper-Realistic™ surgical intubation, or cricothyrotomy for airway management is demonstrated. A cricothyrotomy is necessary when orotracheal or nasophangeal intubations are not practical due to foreign body airway obstruction, laryngeal edema caused by thermal injuries, and facial injuries resulting in airway distortion. 
         [0072]    The entry point for an emergency cricothyrotomy is the cricothyroid membrane  170 , a soft depression between hard thyroid cartilage  172  and cricoid cartilage  164  and must be identified by locating the laryngeal prominence  168 . Because injury to the highly vascular thyroid gland (not shown) may cause hemorrhaging, persistent training and proficiency evaluation is vital to realize successful surgical airway management. 
         [0073]    A cricothyrotomy procedure can be conducted in multiple ways, as is known in the art. For example, an “open cricothyrotomy,” which includes an incision through the cricothyroid membrane with a scalpel and placement of an endotracheal (“ET”) tube or tracheostomy tube can be simulated. In a prototypical cricothyrotomy, the skin at the neck just below the laryngeal prominence  168  is cut vertically to expose the cricothyroid membrane  170 . The cricothyroid membrane  170  is then cut horizontally providing access to the interior of the trachea  174  for insertion of a manufactured airway such as an ET tube or as known in the art. 
         [0074]    Alternatively, a “percutaneous cricothyrotomy,” involving a needle and introducer/dilator (not shown) to pierce through the cricothyroid membrane can be conducted using the TCCC  100  of the present invention. In both procedures, the anatomical landmarks of the TCCC  100  are critical, providing the required indications of proper procedures training. 
         [0075]    In a preferred embodiment, trachea module  152  is anatomically similar to human trachea, with the same or similar texture and contours. These characteristics can be visually and physically identified as landmarks for initial surgical airway incision as described above. Identifying locations of landmarks by physical means can be accomplished by applying hand  204  to the neck skin  176  to palpate the neck  151  in order to locate the laryngeal prominence  168 , or other appropriate landmark, as required. 
         [0076]    Referring now to  FIG. 18 , once the appropriate incisions are made, access to the trachea module  152  is possible through the simulated cricothyroid membrane  170 . A manufactured airway  190  is prepared and inserted into the incision on the neck skin  176  through the cricothyroid membrane  170  into trachea module  152 , analogous to an identical procedure on a real human in similar distress. 
         [0077]    In a preferred embodiment, the manufactured airway  190  may be a commercially available surgical intubation kit. A variety of intubation kits can be incorporated into the manufactured airway of the present invention, and are fully contemplated herein. 
         [0078]      FIG. 19  illustrates the above mentioned manufactured airway  190  having been prepared and inserted fully through the neck skin  176  and into the trachea module  152 . After complete insertion into the trachea module  152 , the manufactured airway  190  is fastened around the neck  151  and firmly held in place to provide reliable airway management. The TCCC  100  of the present invention includes the capability to train medical personnel in other alternative surgical or tracheal intubation procedures and skills related to cricothyrotomy, which are well known among those skilled in the art and are fully contemplated herein. 
         [0079]    Referring to  FIG. 20 , the trainee  200  is preparing an intraosseous infusion (“IO”) device  210  for use on TCCC  100 . Patients with traumatic or life-threatening injuries often require immediate intravenous access for the delivery of medications and for fluid replacement including blood and blood components. Obtaining intravenous access may become impossible because of collapsed peripheral blood vessels and hypovolemia. IO infusion is one method by which medical professionals are capable of delivering fluids and required medications to individuals with such conditions. As is known in the art, the sternum, humerus, and tibia are three locations within the human body that are both accessible and well-suited for such a procedure. This is because these particular bones are comprised of soft, sponge-like cancellous bone (trabueculae), in the middle, a loose bone lattice filled with bone marrow and commonly referred to as the medullary canal. A hard compact bone surrounds the medullary canal, which provides the structural strength of the bone. The composition of the bones and the various canals throughout haversian canal (Volkmann canals) secure a direct delivery access route to central vascular circulation. Thus, introduction of fluids and medication to the medullary canal flows directly through the vascular plexus of the bones to the larger vascular system. 
         [0080]    Commercial systems for sternum applications and the Bone Injection Gun for alternate IO delivery points are usable with the TCCC  100 . In a preferred embodiment, the TCCC  100  of the present invention accommodates placement of IO infusion devices in two of the three above mentioned bones: sternum and humerus. It is to be appreciated by those skilled in the art that these options should not be considered limiting, as further addition of a leg (for tibia IO) or other extremities is possible without departing from the scope or intent of the present invention. 
         [0081]    The trainee  200  uses a hand  204  to physically locate the sternum for insertion of an IO device  210 . This is done by palpating the skin  104  of the torso  106 , in order to find the appropriate landmarks in the chest and locate the sternum, or in the case of the TCCC  100 , the sternum puck  130 . 
         [0082]      FIG. 21  shows the trainee  200  introducing the IO device  210  to the sternum puck  130  of the TCCC  100 . The sternum puck allows the user to feel the introduction of the IO device as it is introduced into the puck. 
         [0083]    Referring now to  FIG. 22 , the IO device  210  has been inserted into the sternum puck  130 , and subsequently removed by the trainee  200 . A catheter  212  remains protruding from the sternum puck  130  as it would in a real world medical scenario. The trainee can then complete simulated fluid or medication delivery through the catheter  212  as required by a given scenario. 
         [0084]    Referring now to  FIG. 23 , trainee  200  is using his hand  204  to palpate the left shoulder  148  for introduction of an IO device  220  to the humeral puck  132  (shown in dashed lines). This is completed in an identical fashion as a similar, real world IO device would be inserted into the proximal humeral head  131  or  133  of a patient in distress. The trainee  200  again palpates the shoulder of the TCCC  100  and uses appropriate landmarks to locate the humeral puck  132 . The trainee  200  may then insert the IO device  220  into the humeral puck  132  as desired to complete a given medical procedure. 
         [0085]    Referring finally to  FIG. 24 , the TCCC  100  of the present invention is shown with an IO device  220  inserted into the humeral puck  132 , simulating insertion into the left proximal humerus  131 , allowing vascular access for supply of medication, blood, or other fluids. 
         [0086]    While there have been shown what are presently considered to be preferred embodiments of the present invention, it will be apparent to those skilled in the art that various changes and modifications can be made herein without departing from the scope and spirit of the invention. 
         [0087]    While there have been shown what are presently considered to be preferred embodiments of the present invention, it will be apparent to those skilled in the art that various changes and modifications can be made herein without departing from the scope and spirit of the invention.