title: Setting standards for simulation in anesthesia: the role of safety criteria in accreditation standards.
abstract: OBJECTIVE
  In this article, we describe a critical event which occurred in a simulation centre, and we also review possible safety issues for participants and staff involved in medical simulation training.
  
  
  RESULTS
  The authors report an incident with the potential of harming trainees and staff which occurred during a full-scale simulation. The episode raised the question of training safety in simulation centres. In this instance, the computer program controlling the mannequin enabled a continuous and non-regulated outflow of carbon dioxide which led to an intense reaction in the soda lime canister. The absorbent canister became too hot to be touched (a temperature probe, later placed in the centre of the front canister, measured 53°C). All activities involving the mannequin and anesthesia machine were stopped immediately.
  
  
  CONCLUSIONS
  Simulation in healthcare is a valuable educational tool to train for a variety of clinical encounters in a safe environment without harming a patient. Due to technological progress and the use of authentic equipment recreating near real environments, simulation training has become exceedingly realistic. The Society for Simulation in Healthcare (SSH) has published revised accreditation standards for simulation centres which incorporate training safety sub-criteria to address and manage. By highlighting recommendations of other high-risk industries on this issue, SSH proposes a possible approach to enhance safety in medical simulation.
authors.affiliation: Department of Anesthesiology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON M5B 1W8, Canada. nriem@aol.com
authors.forename: Nicole
authors.initials: N
authors.lastname: Riem
authors.forename: Sylvain
authors.initials: S
authors.lastname: Boet
authors.forename: Deven
authors.initials: D
authors.lastname: Chandra
mesh_terms: D000062:Accidents, Occupational / Q000517:prevention & control; D000068:Accreditation / Q000592:standards*; D000758:Anesthesia / Q000379:methods; D000776:Anesthesiology / Q000193:education*; D017610:Calcium Compounds / Q000737:chemistry; D002245:Carbon Dioxide / Q000737:chemistry; D004868:Equipment Failure; D006358:Hot Temperature; D006801:Humans; D008348:Manikins; D010087:Oxides / Q000737:chemistry; D017751:Safety Management / Q000458:organization & administration*; D012972:Sodium Hydroxide / Q000737:chemistry; D012984:Software / Q000592:standards*
chemical_list: D017610:Calcium Compounds; D010087:Oxides; D002245:Carbon Dioxide; C004569:soda lime; D012972:Sodium Hydroxide