Christopher Jorge isn’t a doctor, but that’s not stopping Victoria.
“The baby is coming, the baby is coming,” she says, demanding an epidural, but it’s a little late for that.
“Push, push, push,” says Jorge, coaching her through the contractions, as two “nurses” hold Victoria’s hand and watch her vital signs and fetal heart tones on several monitors.
A few minutes later, out pops the bundle of joy. Luckily, the birth has no complications.
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The process doesn’t always go so smoothly, which is why Gaumard Scientific — where Jorge is a product specialist — is in demand. Gaumard, a 68-year-old family business headquartered near the Tamiami Airport in Miami-Dade has quietly grown to 300 employees producing medical simulators used to train specialists at hospitals, universities, nursing schools and the military as well as first responders. Victoria is the newest and most technologically advanced of the company’s 300 simulators for healthcare education.
On this day, Jorge and his colleagues were giving a demonstration of Victoria in the company’s extensive simulation center. Victoria can have any number of complications. As in real life, her condition can change on the spot and could need the attention of the emergency room, operating room or neonatal intensive care staffs.
“Simulators are designed to let people practice in a safe environment,” said John Eggert, executive vice president of Gaumard. “It’s all about reducing mistakes. How do you decrease mistakes? [With simulators] you have a great opportunity to practice not just individual skills and team dynamics but you also have the opportunity to move the simulator from one team to another.”
Eggert explains that medical mistakes account for 2 percent to 4 percent of patient deaths in this country. In obstetrics — just one of the areas of healthcare for which Gaumard makes simulators — a mistake can also easily cost $1.5 million in settlement costs in the United States, he said. Often mistakes are made during hand-offs between the emergency room, operating room or neonatal intensive care unit.
“The U.S. also ranks 47th in treatment of PPH, which is postpartum hemorrhaging. “We have a real women’s health issue that simulation can help,” added Johnathan Cabral, the company’s vice president of sales and marketing for the U.S. and Canada.
The first three Victorias are being installed this month at Adena Health System in Ohio, the Carolinas Healthcare System in North Carolina and the Billings Clinic in Montana. Others have been ordered by major medical centers, including one by the University of Miami.
The Victorias, as well as all of Gaumard’s simulators, are manufactured and assembled by hand at Gaumard’s Miami-Dade facilities. But technology lends a hand in manufacturing too: Six 3D printers are working all the time to help create new prototypes or produce parts needed in the simulators, said Eggert, who has a background in engineering.
Gaumard, which is run by Eggert’s wife, Daphne, traces its history to 1946 when its founder, Dr. George Blaine, who was a World War II trauma physician and Daphne Eggert’s father, recognized how polymers used in reconstructive and battlefield surgery could be used to create simulators for healthcare education.
The company’s first product was a synthetic human skeleton. “It replaced the use of human skeletons in medical schools,” said John Eggert. In 1949, Gaumard introduced a birthing torso — its first childbirth simulator — created at the request of the international health community to improve the clinical competence of village midwives to reduce maternal and infant mortality and morbidity, which at the time was 40 percent, he said. Since then, Gaumard has stayed true to its roots with the continued development of “innovative simulators for healthcare education all designed to help the instructors teach the students better, ... reduce mistakes and reduce costs,” Eggert said.
Along with very advanced simulators, Gaumard also produces a number of lower-priced “task trainers” and also simulators that don’t need the Internet or electricity that teach care out in the field. Often powered by hand-cranks and air power, “they are easy to carry around, they teach the basics, they get the job done, they save lives,” Eggert said. These are big sellers in the developing world, and 60 percent of Gaumard’s overall sales are overseas.
For the most part, the high-tech simulators started coming onto the market in mid-’90s with the advances of the PC. Gaumard introduced the world’s first untethered, or moveable, simulator, Hal, in 2004, then came a tetherless Noelle, who could birth babies, and simulators of infants and kids. Gaumard’s simulators, which have been used at UM and Florida International University, cover three areas — pre-hospital, such as trauma situations, nursing care and obstetrics.
At FIU’s Nicole Wertheim College of Nursing & Health Sciences, Henry Henao is director of FIU’s STAR (Simulation Teaching And Research) Center, one of the largest simulation centers in the Southeast. He said the center uses a number of Gaumard simulators, including a "family of five" – mother (Noelle), father (Hal), 1 year-old, 5-year-old and infant – that were gifted by Gaumard. The STAR Center, which is modeled after a real hospital, also now includes a Gaumard preemie and others.
"High-fidelity human patient simulation offers a high degree of realism, and students can suspend disbelief. We surround them with ‘family member’ actors to put on a very realistic experience for the students. They can learn from those experiences and obviously the mistakes that come with them so they make fewer mistakes when they go into clinical practice," said Henao, also a clinical assistant professor of nursing, adding that the simulators are used by med students and student nurses, physical therapists and nursing practitioners.
Over the past five years, through 2013, Gaumard Scientific sold more than 80,000 total patient simulators worldwide, with an average year-over-year growth in product unit sales of 10 percent. In terms of revenue, the growth year over year was in the high teens, the company said. Gaumard declined to disclose revenues, but Eggert said Gaumard is one of the top three leading simulator makers and that the privately held company’s top competitors are CAE Healthcare of Canada and Laerdal of Norway.
How big is the overall market? CAE, a publicly traded company, said in its 2014 financial report to shareholders that the global healthcare simulation market “is estimated at upwards of $850 million. Of that, the largest share of the market is represented by the human patient simulation market, which is expected to grow in the double-digit range over the next five years,” the report said. As to potential customers, CAE also said “in addition to the 850,000 active physicians and 67,000 medical students, there are approximately 3 million nurses and 250,000 nursing students in the United States and 8.8 million physicians and 14.5 million nurses worldwide.”
CAE also cites a study that projects the strongest growth rates will be in the U.S. market. Gaumard sees that trend, too.
In 2013, Gaumard sold more than 17,000 simulators worldwide, the company said. With the roll-out of Victoria plus the company also ramping up marketing efforts in the pre-hospital segment with products such as “Trauma Hal,” Gaumard expects to sell more than 19,000 simulators globally in 2015 and projects an increase in revenue of more than 20 percent during this period. Eggert attributes these projections to the focus on a “richer product mix with an emphasis on building up Gaumard’s sales in the U.S.”
But of Gaumard’s 300 products all showcased in a 232-page catalog, its flagship is now Victoria, the most lifelike simulator yet. And she looks real — she blinks, her eyes dilate and she converses with the medics. Her baby cries and moves and it can change color and go into distress, all to simulate this is real.
To do all this, Victoria is endowed with 17 enhancements to technologies and 10 new technologies and is upgradable. “It’s a platform we will use with other simulators,” Cabral said.
Victoria starts at $56,500, and that includes mom, baby, a tablet PC, a monitor and 48 OB birthing scenarios, including normal births, breech deliveries, c-sections, shoulder dystocia, postpartum hemorrhage and others. Customer can also modify the scenarios or create their own. “The students know there is going to be a birth but they don’t know what it will be like. The simulator can be manipulated to make it more difficult — a real teachable moment,” Cabral said.
One of Victoria’s innovations is that it can be used by the hospital or school’s real medical equipment, such as a fetal monitor, ECG monitor, blood pressure monitor, defibrillator and others. “We have electronics in Victoria that frankly tricks a fetal heart monitor into thinking that’s a real patient and that’s a real fetus,” said Eggert. Another innovation, he said, is its 3D imaging software that is used during the debrief — “the play back is an incredible teaching tool.”
With a growing emphasis on lowering healthcare costs, Gaumard believes the market will continue to grow. A comprehensive study published this summer in the Journal of Nursing Regulation found that replacing up to 50 percent of traditional clinical hours with high-quality simulation achieves the same training results “and new graduates that are ready for clinical practices.”
Dave Smith is a believer. “If you have a good product and atmosphere, students will go from ‘this is just a simulator” to ‘we have to save her’ as soon you hit the start button,” said the simulation coordinator at the PACCAR Medical Education Center at the Adena Health System, where Victoria was just installed. And that is what happened in Victoria’s first week with nursing students.
Smith said that during a postpartum hemorrhage, with “blood” coming from the abdomen while the trainer was demonstrating what to do, “you could see the students getting antsy and just wanting to make it stop.” He said another trainer, a labor and delivery nurse using Victoria, was about to explain to the students what they belly should feel like right after a certain type of delivery. “What it should feel like is... well, this is exactly like it feels like,” she told the students, while touching Victoria’s belly.
Adena has used other Gaumard products including Noelle, its earlier-generation obstetrics simulator. “Victoria is pretty amazing,” Smith said. “All of the changes I would have made to Noelle were made. Gaumard really did its homework.”
Business: Develops, manufactures and sells patient simulators for healthcare education.
Year founded: 1946
Headquarters: Miami-Dade County
Top management: Daphne Eggert, CEO and president; John Eggert, executive vice president; Jonathan Cabral, vice president of sales and marketing, U.S. and Canada.
Newest product: Victoria, for simulating births.
Other key products: Trauma Hal, for first responders, as well as simulators such as Susie for nursing care. In addition to male and female adult simulators, there are also ones for newborns and premies, 1-year-olds and 5-year-olds. There are also simulators for remote locations with no electricity or Internet.