CIs are very common in pediatric intensive care. Knowledge of them is a precious source for quality improvement through changes in the system.

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Intraosseous infusion (IO) remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients. In rural and remote areas, shortage of training equipment and human capacity (i.e., simulators) are the main contributors to the shortage of local training courses aiming at the development and maintenance of IO skills. Specifically, current training equipment options available for trainees include commercially available simulators, which are often expensive, or animal tissues, which lack human anatomical features that are necessary for optimal learning and pose logistical and ethical issues related to practice on live animals. Three-dimensional (3D) printing provides the means to create cost-effective, anatomically correct simulators for practicing IO where existing simulators may be difficult to access, especially in remote areas. This technical report aims to describe the development of maxSIMIO, a 3D-printed adult proximal tibia IO simulator, and present feedback on the design features from a clinical co-design team consisting of 18 end-point users. Overall, the majority of the feedback was positive and highlighted that the maxSIMIO simulator was helpful for learning and developing the IO technique. The majority of the clinical team responders also agreed that the simulator was more anatomically accurate compared to other simulators they have used in the past. Finally, the survey results indicated that on average, the simulator is acceptable as a training tool. Notable suggestions for improvement included increasing the stability of the individual parts of the model (such as tightening the skin and securing the bones), enhancing the anatomical accuracy of the experience (such as adding a fibula), making the bones harder, increasing the size of the patella, making it more modular (to minimize costs related to maintenance), and improving the anatomical positioning of the knee joint (i.e., slightly bent in the knee joint). In summary, the clinical team, located in rural and remote areas in Canada, found the 3D-printed simulator to be a functional tool for practicing the intraosseous technique. The outcome of this report supports the use of this cost-effective simulator for simulation-based medical education for remote and rural areas anywhere in the world.

Simulation-based medical education (SBME) employs realistic simulators to allow physicians and medical students to learn and practice high acuity, low occurrence (HALO) skills such as the intraosseous (IO) infusion. Previous research was done to develop and evaluate a three-dimensional (3D)-printed adult proximal tibia IO simulator and was rated as a valuable and realistic medical education training tool. This report focuses on implementing this IO simulator for neonatal resuscitation program (NRP) training purposes, as well as to explain the process of redeveloping the previous adult IO simulator and the development of a stand, called the maxSIMbox, to hold the simulators, as well as the tools needed to perform an IO infusion. The feedback provided from stakeholders was helpful, with an emphasis on providing stability to both the infant IO simulator and the maxSIMbox. From this feedback, a functional and cost-effective simulator was developed to practice this HALO skill and is currently being used for NRP training.