Training for Real

With one hand on the back of a patient’s skull—about the same heft as a bowling ball—the Seattle Fire Department paramedic’s other hand held an intubation device, called a video laryngoscope, probing for the right angle to guide it down the patient’s trachea to pump air into their lungs. 

“Until you grow a third arm, you want this hand free,” says a fellow paramedic, conducting the training and advising on how best to perform the life-saving procedure. 

The “patient” in this training scenario isn’t human, but rather a state-of-the-art training manikin called the Advanced Joint Airway Management System, or AJAMS, one of just 12 in existence, six male and six female, created by Seattle University engineering graduate DJ Traina, ’18. 

This manikin no dummy meant to model clothes at a department store. In fact, the “patient” is actually a cutting edge, advanced computer powered by a lithium battery and controlled with a tablet, inhabiting a high-tech torso made to look, feel, moan and struggle like a real human unable to breathe. First envisioned to ready combat medics for the chaos of a battlefield, the AJAMS have been conscripted locally as a training tool for paramedics. 

The room across the street from Harborview Medical Center’s emergency department is quiet except for the calm voices of the paramedics, members of Seattle Fire/ Medic One, a highly trained cadre of paramedics. 

Standing nearby, eyes fixed on the action, is Traina, who led the visual and mechanical design and assembly of the advanced prototype. As its maker he compares it to a 1,200-piece jigsaw puzzle, which took about nine months to complete the first model, with the puzzle pieces being nuts, bolts, steel and silicone. 

Later, when reflecting on what goes through his mind while watching paramedics training to save lives with his creation, he says there are two modes of thought occurring, almost simultaneously. 

“First, it’s ‘What can I learn to apply to this or future designs?’” Traina says. “Second, is a mutual admiration of what paramedics do and how we can help them help us.” 

By themselves, naked of limbs and flesh and stripped down to the “chassis,” the manikins can be as unsettling to behold as the endoskeleton of the cyborg from Terminator. They are meant to be outfitted with modular skin and limbs to add different capabilities based on what is being trained that day. They are even outfitted with replaceable patches of faux flesh that mimics human tissue that bleeds when cut. 

Keeping it Real 

Traina’s backstory reveals a unique skill set developed as a mechanical engineering undergrad at SU, closing the gap between the wizardry of theater and the miracle of medical science, leading directly to the unique job he landed after graduating in 2018.

“It bridges all the things I’m really interested in,” he says of his role as a simulation scientist and senior mechanical design engineer for the Center for Research in Education and Simulation Technologies, or CREST, at the UW Medical Center. “Making things that combine engineering, art, medicine.” 

“I had no idea that this was even a thing five years ago until I stepped in the lab for the first time,” he adds. 

The backstory of AJAMS comes from combat medics—many of them men—and starts when the military discovered that many male medics were hesitating when treating female soldiers who had sustained chest wounds in combat. 

“Historically there have not been a lot of anatomically correct female trainers on the market,” Traina says. “Often, companies have started with a male model and ‘retrofitted’ the manikin for female anatomy.” 

From the start, AJAMS were designed with patient-specific imaging of both men and women to make it as anatomically correct as possible. 

Starting with a female model also provided an additional engineering benefit. 

“We knew that if we could fit all of the components into the smaller frame of the female, then the systems integration into the male would be much simpler than the other way around,” Traina says. 

From Combat to Heart Attacks 

Locally, the manikins are hard at work and that’s because each year every one of King County Medic One’s 270 members undergoes complex airway training that includes using simulators. 

Eric Timm, director of paramedic training, says realism—known as “fidelity” in the world of medical simulators—is essential to keeping paramedics’ skills sharp. 

“If you think about it, what skill level do you want for your family?” Timm says. “If your loved one, partner or family member needed the life-saving intervention of intubation, how skilled would you want that provider to be?” 

CREST received a U.S. Department of Defense contract to build the first four prototypes. The subsequent eight were funded by Medic One and various partners. Whereas most medical manikins are generally white males, both the male and female AJAMS manikins can be outfitted to any skin tone or ethnicity. 

This kind of fidelity, too, aligns with Medic One’s mission, Timm says. 

“We treat people of all backgrounds,” Timm says. “We need training tools and educational strategies that prepare our students to care for all patients, not just the white male manikins that have been the standard.” 

Of the 12 manikins in existence, the military has four, King County Medic One has four, two went to a simulation company in Florida and two remain with Traina in the CREST lab. 

Setting the Stage 

Originally from the Silicon Valley town of Saratoga, Traina never intended to leave California, to move someplace more known for rain than sun or to live in a big city. 

“Which was weird, because I stepped on the Seattle U campus and was like, ‘Oh yeah, this is the right spot.’” 

Traina has long been passionate about making. It was in the theater where he first honed his craft, eventually taking it to new levels as a machine shop assistant in the Mechanical Engineering department of SU where he built various fixtures and apparatuses for the Mechanical Engineering and Physics departments. His involvement in theater started in high school but carried over into SU. 

“Anytime you’re engineering something, there’s also an artistic component to it,” says Traina, who credits a painting class he took at SU with further awakening a talent for fine arts that he didn’t know he had. “Always in the background I’m thinking of merging the two together.” 

For Traina, there is no left vs. right brain dichotomy and ideally art and engineering should work together toward the common ground between medical simulation and stagecraft. 

Traina compares it to the intense emotions that can come from watching a play, where audience members give themselves over to the tragedy and comedy, suspending disbelief, allowing themselves to laugh and cry. 

“When a learner gives themselves over to the ‘reality’ of the simulation and is fully immersed in it both physically and emotionally, that’s when the best learning happens,” Traina says. 

‘A Consummate Maker’ 

During Traina’s senior design project, for which Associate Professor of Engineering Joshua Hamel, PhD, served as his advisor, Traina’s team designed a counter for a spirometer, a medical device used to help reduce the likelihood of a patient contracting pneumonia after a lengthy surgery under general anesthesia. The counter allows patients groggy from sedation the ability to track how many cycles they’ve completed. 

“Otherwise, you hand it to a patient, come back an hour later and they may or may not have done it,” Traina says. “But with our little add-on, you could tell how much they’ve done and if they’ve done it successfully or not.” 

Hamel said while advising the team he took note of Traina’s talents. 

“His real strength started to show up, which was that he’s a consummate maker,” Hamel says. 

At the same time that Traina graduated and began looking for a job, Hamel visited the CREST lab and later, when they started looking to hire, he knew Traina would be a good fit. 

“‘Hey, I’ve got a bachelor’s engineer for you that I think would be perfect,’” Hamel recalls telling his contacts. “‘You should talk to him.’” 

And, as Hamel says, “The rest is history.”

This story originally appeared in the Fall edition of Seattle University Magazine, out now. Want more content like this? Check out the issue in its entirety.