WO2024121573A1

WO2024121573A1 - A thoracotomy training model

Info

Publication number: WO2024121573A1
Application number: PCT/GB2023/053173
Authority: WO
Inventors: Irini YANNY
Original assignee: Individual
Current assignee: Individual
Priority date: 2022-12-08
Filing date: 2023-12-08
Publication date: 2024-06-13
Anticipated expiration: 2025-06-08
Also published as: GB202218495D0; GB2626910A

Abstract

A medical training model (1) comprising an enclosure defining a thoracic cavity (4), a rib cage within the thoracic cavity formed of a plurality of resilient members (6), a pair of inflatable lungs (2) located in the enclosure and within the rib cage; a model heart (3) located between the lungs (2). The model (1) may also comprise a Y-shaped tubing (16) comprising two lateral branches (16a, 16b) connected to a supply line (16c) at a proximal end and sealed at a distal end, the Y-shaped tubing located anterior to the rib cage and within or adjacent to the thoracic cavity (4) and a fluid supply attached to the supply line (16c) such that the Y-shaped tubing (16) contains pressurized fluid; and/or the model may comprise an artificial aorta (17), wherein the artificial aorta (17) comprises a fluid filled tube located adjacent to the model heart (3). The model (1) also comprises a backboard (5) defining a posterior side of the enclosure and the resilient members (6) are mounted at a lateral side to the backboard (5).

Description

A Thoracotomy Training Model

Field of the Invention

The present invention relates to the training of medics and provides a model for assisting in that training. The model can be used for training medics in clamshell thoracotomies in particular.

Background to the Invention

An emergency thoracotomy is a procedure that can be performed in an attempt to resuscitate a patient who has suffered severe trauma and is in cardiac arrest. The procedure involves directly accessing the thoracic cavity to repair heart injuries and/or to perform direct cardiac massage or defibrillation. The procedure is relatively rare and only usually indicated in the case of major trauma. This means that emergency medical practitioners rarely experience emergency thoracotomies during the usual practice. Further they are time-critical procedures that are required to be carried out within 15 minutes of a cardiac arrest.

In light of the above, there is a need for an improved method of, and apparatus for, training medics in emergency thoractomies. Expensive anatomically correct mannequins are available. These are generally made from high grade silicones, with accurate weight distributions, and with anatomically correct organs located within a chest cavity. However, these mannequins are extremely expensive, costing upwards of £50,000 to buy and £5,000 to hire per day. Whilst superficially lifelike, don’t replicate the bleeding on return of spontaneous circulation, cardiac activity and respiration of real patients. They do not allow a provider to complete every step of the procedure to allow practitioners to acquire the important psychomotor skill set.

An alternative to the use of mannequins is the use of animal carcasses. However, as for the mannequins, whilst animal carcasses have the correct anatomy the animals are deceased and so do not bleed in the same manner.

As a result, several people have attempted to make low cost models that can be used to train medics in emergency thoracotomies. These models are typically quite basic containing structural elements that generally correlate with the anatomical features of the chest cavity but without any particular or relevant functionality. For example, simple models of lungs, blood vessels, and the heart may be positioned within a thoracic cavity defined by a plurality of ribs, possibly with an external membrane acting as skin. However, the models of the lungs, blood vessels, and heart are generally functionless and do not act in the same manner as those of a live patient.

In light of the above, there is a need for an improved model for training medics in emergency thoracotomies. Any such model should provide improved functionality and preferably be capable of construction at relatively low cost, be easily accessible, re-usable and portable. Preferably with a focus on providing the step-wise approach of completing a clamshell thoracotomy and gaining the psychomotor skillset for a high acuity, low occurrence procedure.

Summary of the Invention

The present invention provides a medical training model comprising: an enclosure defining a thoracic cavity; a rib cage within the thoracic cavity formed of a plurality of resilient members; a pair of inflatable lungs located in the enclosure and within the rib cage; a model heart located between the lungs; and a backboard defining a posterior side of the enclosure and the resilient members are mounted at a lateral side to the backboard

The model may further comprise Y-shaped tubing comprising two lateral branches connected to a supply line at a proximal end and sealed at a distal end, the Y-shaped tubing located adjacent to the rib cage, either side of a sternum, if present, and within or adjacent to the thoracic cavity and a fluid supply attached to the supply line such that the Y-shaped tubing contains fluid. Advantageously, the Y-shaped tubing is independently supplied with fluid, such that it the supply is only utilized once a practitioner utilizing the model has successfully completed all the necessary steps to replicate the return of spontaneous circulation.

The model may further comprise an artificial aorta, wherein the artificial aorta comprises a fluid filled tube located adjacent to the model heart.

The present invention is advantageous in that it can provide a simple and low-cost model for training medics in clamshell thoracotomies. The model is also advantageous in that it may provide structures that are capable of mimicking the bleeding of the mammary arteries and/or the aorta. This allows the use of the model to better replicate real-life conditions. Specifically, Y-shaped tubing may be formed and positioned to mimic the mammary arteries of a patient’s thorax and/or the artificial aorta may be formed and positioned to mimic a patient’s aorta. By providing the Y-shaped tubing and/or the aorta with fluid they will mimic bleeding of the mammary arteries and/or the aorta. In embodiments of the invention only the Y-shaped tubing may be provided and not the artificial aorta. In other embodiments of the invention only the artificial aorta may be provided and not the Y-shaped tubing. Advantageously, in embodiments of the invention both the Y-shaped tubing and the artificial aorta will be provided.

Y-shaped tubing may be positioned and shaped to mimic the mammary arteries of a patient and be positioned relevant to the resilient members, any sternum, and the model heart appropriately. In embodiments of the invention, Y-shaped tubing may be located on an outer side of the rib cage and laterally adjacent to a sternum.

Fluid within Y-shaped tubing may be pressurized or the tubing may simply be filled with fluid without pressurization. Similarly, an artificial aorta may either be pressurized or may be filled with fluid without pressurization. An artificial aorta and any other arteries are provided may be formed in such a way that they may be clamped during use. This is to replicate the clamping of the arteries during real-life situations to prevent the patient from suffering further blood loss on return of circulation.

An artificial aorta may be attached to the model heart or may simply be located adjacent to the model heart in an appropriate position, preferably the position in which the aorta is found within the human body.

The thoracic cavity is formed by a plurality of resilient members. The resilient members may be formed and shaped in any appropriate manner. Preferably, the resilient members will be formed and shaped to replicate the shape and size of a typical rib cage. For example each resilient member may be formed to be the size and shape of an individual rib. Alternatively, one or more resilient members may be formed to be the size and shape of two or more ribs.

The lungs of the present invention are inflatable, preferably independently inflatable. That is the model comprises a pair of lungs that are each inflatable and deflatable such that they can mimic pneumothorax when in use. The lungs may be formed and may be inflatable in any manner apparent to the person skilled in the art. In embodiments of the invention the model may further comprise one or more pumps used to inflate the lungs. Any such pumps may be manual or mechanical. Pumps may be internal within the model or may be external and connected to the lungs via tubing. A separate pump may be provided for each lung or a single pump may operate both lungs. If a single pump operates both lungs one or more valves may be provided to allow the lungs to be inflated separately. If the pumps are connected to the lungs via tubing it may be advantageous that the tubing is formed and located in a manner analogous with the size, shape and positioning of the bronchi of the human body. Additionally or alternatively the model may be provided with a suitably formed and located bronchi and trachea extending from the pair of lungs. Having the lungs independently inflatable is preferable as it can allow the model to replicate medical situations where one lung has collapsed.

The model comprises a backboard defining a posterior side of the enclosure and the resilient members are mounted at a lateral side to the backboard. That is, the model is provided with a ribcage extending outward in an anterior direction from a backboard. The backboard may, for example, be a flat board formed from wood, plastic, or any other suitable material. A flat backboard may be preferable as it makes the construction of the model simpler and allows the model to be securely positioned on a table or other similar surface.

A flat backboard may be foldable to allow the backboard to be folded and easily carried. For example, the backboard may have a central hinge mechanism that allows board to be folded in half such that a first end to be brought into contact with a second end. If the backboard is formed in this manner then a locking mechanism may be provided to secure the first end of the backboard to the second end. Any suitable locking mechanism may be provided, for example a hook and latch. A handle may be provided at one or more sides of the backboard to allow the backboard to be carried. If the backboard is foldable using a central hinge mechanism in the manner set out above one or more handles may be provided at the first end and/or at the second end.

A backboard may be formed to allow drainage of fluids generated during use of the model. For example, the backboard may have drainage apertures and/or drainage channels formed therein or therethrough.

In embodiments of the invention a backboard may be formed of one or more layers. A layer may comprise a drainage/collection tray for collecting fluids generated during use of the model. A lowermost layer may have an outer lower surface that comprises a grip or non-slip material to allow the model to be securely positioned on a surface during use. An upper layer may be formed with drainage channels and/or drainage apertures to allow fluid to drain therethrough to a lower layer. A backboard may have apertures formed therein for securing the resilient members thereto or may have any other suitable fixtures for securing the resilient members thereto.

In embodiments of the invention a backboard may be formed such that fluids drain through an upper layer of the backboard by means of one or more drainage channels and/or drainage apertures, are collected in a drainage/collection tray positioned below the upper layer and are then directed to a fluid outlet from which the fluids may be collected. A fluid outlet may be positioned at a lateral outer edge of the backboard or at a lower side of the backboard.

If the model comprises a backboard, in order to replicate the clamshell opening of an emergency thoracotomy it may be advantageous that one or more of the resilient members are attached to the backboard by means of a hinge. The hinge may be formed in any appropriate manner. Preferably the or each hinge is formed such that the relevant resilient member(s) can be opened outwards in the same manner a ribcage would be separated in a clamshell thoracotomy. In particular, the or each resilient member may be able to be pivoted laterally outwards from an initial position to an open position.

The resilient members may be attached to a backboard using an aperture formed through the backboard. For example, a cooperatively positioned aperture may be formed adjacent the position of a base of a rib. Then a fixing may be passed through the aperture to hold the base of a rib in position. This may be done by passing a wire or other equivalent fixing though the aperture in the baseboard and then tying the base of the rib to the wire or equivalent fixing. The base of each rib may have an aperture formed therethrough for fixing the rib to the baseboard. This may be used in conjunction or separately from a cooperatively positioned aperture formed in the baseboard. For example, a first fixing may be passed through an aperture formed in the baseboard and a second fixing may be passed through a cooperative aperture formed in the base of a rib and the first and second fixings may be attached to one another to form a hinged mounting. To reinforce the resilient members a reinforcing member may be provided between the base of laterally opposing ribs. For example, a wire or rigid member may be attached at a first end to a base of a first resilient member and extend across an upper side of a backboard to the base of a second resilient member that laterally opposes the first member. A reinforcing member may be provided between each laterally opposing pair of resilient members or only a portion of laterally opposing resilient members.

In order to better replicate a human ribcage the model may further comprise a rigid breakable sternum located anterior to the rib cage. If the model comprises Y-shaped tubing as discussed above, then it is advantageous that the rigid breakable sternum is located between the lateral branches of the Y-shaped tubing. A sternum may be made of any suitable material that mimics a human sternum in that it is rigid but breakable with suitable surgical tools. In embodiments of the invention the sternum may be formed of plaster of paris or any other similar material. Advantageously, the sternum is sized and shaped to be the same size and shape as a typical adult human sternum. As an alternative to a breakable sternum a rigid, removable, and replaceable sternum may be provided. As a further alternative a fixed sternum may be provided.

Advantageously, the model of the present invention is formed such that a sternum can be removed and replaced for repeated use. In embodiments of the invention a single sternum may be removed and thereafter quickly replaced for future use. Alternatively the sternum may be breakable, as discussed above, such that they are single use and after the single use a replacement sternum may be provided in position. In order to hold a sternum in position the two or more of laterally opposing resilient members may be provided with an attachment at an inner end for holding the sternum in position. For example, one or more mounting brackets may be formed between the inner end of laterally opposing ends of resilient members to allow a sternum to be slotted into position thereon. The one or more mounting brackets may, together form a slot into which a sternum may be positioned. Alternatively or additionally a laterally inner end of the resilient member may be formed to allow temporary fixing to a sternum, for example by one or more ties or bolts or wires. In embodiments of the invention the sternum and/or the resilient members may comprise a magnet with the other of the sternum and/or the resilient members having a cooperatively positioned magnet or magnetic material to allow a magnetic attachment between the sternum and the resilient members and/or an opposing resilient member. A model according to the present invention may comprise an appropriate number of resilient members to replicate a human ribcage. In embodiments of the invention seven pairs of resilient members may be provided. Each resilient member may be sized and shaped to correspond to the size and shape of a corresponding human rib. In embodiments of the invention seven pairs of resilient members may be provided. In such embodiments the model may be formed such that there is a gap between fourth and fifth pairs and/or the fifth and sixth resilient members so that when a sternum is removed or broken there is a suitable gap to access the interior of the model in the same manner as in a human body.

In order to better replicate the pericardium and tamponade it may be advantageous that the model heart is located within a sealed fluid-filled bag. For example, the model heart may be located within a sealed plastic bag or a bag of any other suitable flexible material that mimics the pericardium. The fluid within the bag may be water or any other suitable fluid. The fluid may be coloured to mimic blood, for example the fluid may contain water that is dyed red or it may contain a blood substitute. In embodiments of the invention the fluid may be slime (such as that commonly used in children’s toys) as this better replicates the consistency of congealed blood. Slime may also be coloured appropriately.

In order to replicate phrenic nerves on the pericardium a fluid-filled bag, as discussed immediately above, may comprise one or more filaments mounted thereon and extending at least partially around the bag. The filaments may be formed in any suitable manner and may be adhered to the bag in any suitable manner. In embodiments of the invention the filaments are formed of plastic string. Any filament may be taped, glued, or attached to the bag in any other manner. The filaments may be appropriately coloured to imitate nerves. For example, it may be advantageous that the filaments are yellow coloured to better imitate the phrenic nerves. Any filament may be shaped and located to imitate a phrenic nerve.

A medical training model according to the present invention may further comprise an adhesive wrapping providing over the rib cage. If the model comprises Y-shaped tubing the adhesive wrapping may be positioned beneath the Y-shaped tubing. The adhesive wrapping may be formed of any suitable adhesive material and may extend completely over and arogund the rib cage. Any adhesive material may be intended to replicate the intercostal musculature and, as such, is bound to and around the rib cage. A medical training model according to the present invention may further comprise an outer cladding layer provided over the rib cage, any sternum, and any Y-shaped tubing. The outer cladding layer is intended to replicate the fat layer of a human sternum and may be formed of any suitable material that will replicate the fat layer. In embodiments of the invention the cladding may be formed of a foam-type or other insulating sheet material.

A medical training model according to the present invention may further comprise an outermost skin layer that is formed over all of the other components of the model on the anterior side. The skin layer may be formed of any appropriate material and may, for example, be formed of silicone or any other material commonly used as a skin substitute in other medical models.

If the medical training model of the present invention comprises an aorta it may be advantageous that the aorta is provided with an external fluid supply. Any external fluid supply may be pressurized to replicate the pressure in a human aorta. The fluid in the aorta may be a fluid selected to best replicate blood and may be coloured and/or have a consistency matched with blood. The fluid supply for an aorta and/or any pump for the aorta may be provided externally to the training model. The aorta may be capable of being clamped.

In order to better replicate a human aorta, an aorta of a training model according to the present invention may comprise an inner flexible fluid-filled tube located within an outer fabric or foam casing. This construction has been found to replicate the human aorta well. However, any other construction that replicates a human blood vessel may be utilized. For example, the outer casing may be formed of plastic or any other suitable material, rather than fabric.

In order to better replicate a traumatic injury it may be advantageous that a wound is provided on the model heart. This can be provided in any suitable manner. For example, the wound may be formed in the model heart by cutting or opening the model heart. Alternatively or additionally a model wound may be adhered or otherwise attached to the outer side of the model heart. Suitable wounds are readily available and will be apparent to the person skilled in the art.

If the Y-shaped tubing is provided it may be provided with one or more pumps to maintain pressure within the tubing should they be punctured. This will act to replicate bleeding from the mammary arteries should they be punctured. Any pump may be located externally to the model or in any other suitable location.

A model according to the present invention may be modular such that it allows for different components to be provided or omitted depending on which procedure is being carried out. Whilst the model is primarily intended for clamshell thoracotomies it may also be used for training for alternative procedures such as pericardiocentesis or chest drain insertion. When used for alternative procedures only the components necessary to replicate those procedures may be provided and/or utilized.

The resilient members of the present invention may be provided in such a manner that they provide a variable geometry skeleton. For example, different sizes and shapes may be provided and/or they may be able to fixed in different positions to vary the geometry of the model’s skeleton. The resilient members of the present invention may also be provided such that they can be folded flat to the backboard when the model is not in use. They may be folded individually, in pairs or in groups. Folding may be achieved by mounting the resilient members to the backboard in a suitable manner.

As will be readily understood, it is advantageous that the model of the present invention is lightweight and to achieve this suitable lightweight materials may be used to form the model.

Further features and advantages of the present invention will be apparent from the embodiment shown in the Figures and described below. Unless otherwise indicated by the claims or the description any feature of the embodiment shown in the drawings can be included in an embodiment of the invention independent of any other feature.

Drawings

Figure l is a schematic of a cross-section through a first exemplary embodiment of the present invention;

Figure 2 is a schematic of the embodiment of Figure 1 showing the internal features of the model;

Figure 3 shows the ribcage of the embodiment of Figure 1 mounted on the backboard;

Figure 4 shows the internal construction of some of features of the embodiment of Figure 1; and Figure 5 shows the embodiment of Figure 1 in use;

Figure 6 shows details of the sternum and the ribs of an amebodiment of the present invention; Figure 7 shows a backboard of an embodiment of the present invention; and

Figure 8 shows the details of the sternum, backboard, and the ribs of an embodiment of the present invention.

An exemplary embodiment of a medical training model according to the present invention is shown in the Figures.

The model 1 comprises a pair of lungs 2 located either side of a model heart 3 and within a thoracic cavity 4. The thoracic cavity is defined by a backboard 5 and a plurality of ribs 6. The ribs 6 are wrapped in an adhesive wrap 7 that acts to imitate the intercostal muscles. The model heart 3 is located within a fluid filled bag 8. Filaments 9 are adhered to the outer side of the fluid filled bag 8 to imitate the phrenic nerves. A silicone wound 10 is adhered to the outer side of the model heart 3. Model bronchi 11 and a trachea 12 extend from the lungs 2.

A breakable sternum 13 is provided centrally above the model heart 3. The sternum 13 is formed of plaster of paris. Outward of the sternum 13 and the ribs 6 a layer of padding 14 is provided to imitate the fat layer of a human thorax. Outward of the layer of padding 14 a silicone skin layer 15 is provided to cover the whole of the upper side of the model 1.

Y-shaped tubing 16 comprising two lateral branches 16a, 16b connected to a supply line 16c at a proximal end and sealed at a distal end is provided such that each lateral branch 16a, 16b is located laterally either side of the sternum 13. The Y-shaped tubing 16 contains fluid and imitates the mammary arteries.

An artificial aorta 17 is also provided. The artificial aorta 17 is located in a position in which it would be found in the human body and extends from proximal end adjacent to the model heart 3 and downwardly to a distal end. The artificial aorta is formed of an inner fluid filled tube 18 located inside a knitted outer tube 19.

For clarity Figure 2 shows a schematic of a training model 1 according to the present invention without the outer layers. In particular the silicone skin layer 15, the padding layer 14, the sternum 13, and the adhesive layer 7 are omitted from this Figure. Whilst the ribs 6 are shown the number and positioning of the ribs is purely schematic and is not accurate with those provided in an actual model 1 according to the present invention. In an actual model 1 according to the present invention the number and positioning of the ribs would more closely conform to a human ribcage.

Figure 2 shows the position of the Y-shaped tubing in relation to the ribs 6. In particular, the position of the lateral branches 16a, 16b of the Y-shaped tubing imitating the mammary articles is clearly shown. Each rib 6 is hinged at its attachment to the backboard 5 to allow them to be opened outwards in the manner they would be in a clamshell thoracotomy. Figure 2 also shows that the Y-shaped tubing 16 is connected to a fluid filled bag 20 to provide a fluid supply.

The ribs 6 and the backboard 5 of the model 1 are shown in Figure 3. Each rib 6 is positioned to correspond to a rib of a human ribcage and is mounted to the backboard at a proximal end by a wired hinge. Each rib 6 is then fixed to a corresponding rib at a distal end. Wire 21 can then be used to reinforce the ribcage by joining the distal ends of the ribs 6 to one another along a centre-line of the ribcage.

Figure 4 shows the model of Figures 1 and 2 without the padding layer 14 or the silicone skin layer 15. The adhesive layer 7 over the ribs 6 is shown. The positioning of the Y-shaped tubing 16 is shown in relation to the sternum 13. As set out above, the sternum 13 is formed of plaster of paris and is breakable.

The lungs 2 are shown in position within the thoracic cavity 4. Each lung 2 is attached via a tube 22 that extends through a bronchi 11 to a manual pump 23. These manual pumps 23 can be operated to inflate and deflate the lungs 2 during use of the model 1.

The model heart 3 is shown most clearly in Figure 2. The model heart 2 may be a simple anatomical model heart 3 that can be purchased cheaply from an appropriate store. The model heart 3 has a silicone wound 10 adhered on an outer side to replicate a traumatic cardiac injury. The model heart 3 is located within a fluid filled bag 8. This may be a simple plastic bag that is filled with coloured water and that is sealed in an appropriate manner. Yellow filaments 9 are adhered to an outer side of the bag and imitate phrenic nerves. The aorta 17 is attached to the fluid filled bag 8 at a proximal end. The use of the model 1 is illustrated in Figure 1. The model 1 is intended for training in clamshell thoracotomies. During use the manual pumps 23 will be used to operate the lungs which may mimic pneumothorax. The medic will then “operate” on the model in the same manner as they would on a real patient undergoing a clamshell thoracotomy. This includes cutting through the silicone skin layer 15 and padding 14 to expose the sternum 13. The sternum 13 will then be broken and the ribs 6 will be spread to access the thoracic cavity and the model heart 3 in particular. The medic will then need to access the model heart 3 by piercing the fluid filled bag 8, which mimics the pericardium whilst avoiding the filaments 9, which mimic the phrenic nerves. Whilst using the model 1 the medic will need to avoid puncturing either the aorta 17 or the Y-shaped tubing 16, which mimics the mammary arteries and will be required to clamp them off before carrying out the steps that would result in the return of circulation.

The model of the present invention can be made simply with low cost materials. Further, the model more accurately replicates pneumothorax, phrenic nerves, mammary arteries and the aorta than models according to the prior art.

The model of the present invention may be packable and/or provided as a flat pack or kit of parts. For example, the resilient members may be able to folded flat onto the backboard or may be removable when the model is not in use and attached when desired. For example, the ribs may be attached to the backboard in a hinged manner such that they may be folded flat.

A schematic of a backboard 5 according to a further embodiment of the invention is shown in Figure 7. The backboard 5 is foldable and has a central hinge (not shown) that allows it to be folded in half. Apertures 30 are provided in the baseboard for mounting the resilient members 5, which are indicated schematically only. A handle 31 is provide at a first end and a second end of the backboard 5 to allow it to be carried when it is folded. A latch 32 is provided at the first end for securing the backboard 5 in a folded position. The backboard 6 consists of three layers. A non-stick surface 33 is provided as a lowermost layer at a lower side of the backboard. An uppermost layer 34 is formed as a resilient layer and is the layer on which the components of the model are mounted. The apertures 30 extend through the uppermost layer 34 only. Drainage apertures 36 are also provided in the uppermost layer 34. An intermediate layer 35 is a drainage layer for collecting fluids passing through the drainage apertures 36. A fluid outlet (not shown) for draining from the intermediate layer is also provided. Figure 8 shows features of the ribs 6 and backboard 5 of an embodiment of a model of the present invention. Figure 8 is a schematic diagram intended to illustrate a few specific features of the embodiment of the present invention. Each illustrated feature can be incorporated into embodiments of the present invention separate from any of the other features.

Seven pairs of ribs 6 are provided corresponding to a human rib cage. A laterally outer end of each rib 6 is affixed to the backboard 5. A laterally inner end of the first, second, third, sixth, and seventh rib 6 are attached to the laterally inner end of the opposing rib. The laterally inner end of the fourth and fifth ribs 6 are free. The fixing of the laterally inner end of the ribs 6 to the backboard 5 is shown only for the first and second ribs 6 but it is to be understood that each of the ribs 6 are attached in this manner. Fixing apertures 30 are formed through the backboard 5. A wire 40 is passed through the aperture 30 to form a fixing loop 41 at an upper side of the backboard 5. A cable tie 42 is then passed through an aperture 43 formed at the laterally outer end of the rib 6 and through the fixing loop 41 and closed to fix the rib 6 to the backboard 5 in a hinged manner.

A reinforcing member 44 is provided between the laterally outer end of each rib and extends to the laterally outer end of the opposing rib. A reinforcing member 44 is only shown for the third and fourth ribs but it is to be understood that a reinforcing member is provided for each pair of ribs. The reinforcing member 44 consists of a wire that is tied to a laterally outer end of a first rib 6 at a first end and to a laterally outer end of an opposing rib at a second end and is pulled taut therebetween. This acts to reinforce the ribs 6 and securely hold them in position.

A first fixing member 45 is provide at a laterally inner end of the first, second, and third pairs of ribs 6 and acts to fix the laterally inner end of these ribs together. A second fixing member 46 is provided at a laterally inner end of the sixth and seventh pairs of ribs 6 and acts to fix the laterally inner end of these ribs together.

Figure 6 is a schematic of ribs 6 and sternum according to an embodiment of a model according to the invention. In particular Figure 9 shows an arrangement by which a sternum 13 can be fixed in position. There are seven pairs of ribs 6. The first pair of ribs 6 are directly fixed to one another to form a substantially contiguous rib. The second and third pairs of ribs 6 and the sixth and seventh pairs of ribs 6 are attached to one another by means of a sternum mounting bracket 50. The fourth and fifth pairs of ribs are not attached to one another. It is to be understood that is an exemplary arrangement only. In other arrangements any of the first, second, third, sixth, and seventh ribs by either contiguous or attached to one another by means of a sternum mounting bracket. The fourth and fifth pairs of ribs may either be completely separate from one another as shown in the Figure or may be removably attached to one another.

The sternum mounting brackets 50 form a mounting for the sternum in which a sternum may be removable mounted and replaced when needed. The brackets 50 may be substantially rigid and form a slot in which the sternum 13 can be mounted or may be formed as a clip for gripping each lateral side of the sternum 13. It is to be understood that the gap or removable attachment of the fourth and fifth pairs or ribs 6 is provided as this is the position of the thorax in which a medic would access the thoracic cavity. The sternum 13 is shaped to correspond to the typical shape of a human sternum and should be aligned in the model appropriately. In particular, the sternum 13 is shaped to have a manubrium and a body and is intended to be appropriately aligned with the ribs 6.

Claims

1. A medical training model comprising: an enclosure defining a thoracic cavity; a rib cage within the thoracic cavity formed of a plurality of resilient members; a pair of inflatable lungs located in the enclosure and within the rib cage; a model heart located between the lungs; and a backboard defining a posterior side of the enclosure and the resilient members are mounted at a lateral side to the backboard.

2. A medical training model according to claim 1 further comprising Y-shaped tubing comprising two lateral branches connected to a supply line at a proximal end and sealed at a distal end, the Y-shaped tubing located anterior to the rib cage and within or adjacent to the thoracic cavity and a fluid supply attached to the supply line such that the Y-shaped tubing contains fluid.

3. A medical training model according to claim 1 or claim 2 further comprising an artificial aorta, wherein the artificial aorta comprises a fluid filled tube located adjacent to the model heart.

4. A medical training model according to any preceding claim, wherein the backboard is foldable.

5. A medical training model according to any preceding claim, wherein the backboard comprises drainage for draining fluids away from the model.

6. A medical training model according to any preceding claim, wherein one or more of the resilient members are attached to the backboard by means of a hinge.

7. A medical training model according to any preceding claim, wherein: the model further comprises a rigid breakable sternum located adjacent to the rib cage.

8. A medical training model according to any preceding claim, wherein: the model heart is located within a sealed fluid-filled bag.

9. A medical training model according to claim 7, wherein: the fluid-filled bag comprises one or more filaments mounted thereon and extending at least partially around the bag.

10. A medical training model according to any preceding claim wherein: the model further comprises an adhesive wrapping provided over the rib cage.

11. A medical training model according to any preceding claim wherein: the model further comprises an outer fat layer is provided over the rib cage.

12. A medical training model according to any preceding claim wherein: the model further comprises an outermost skin layer formed outwardly from all over components of the model.

13. A medical training model according to claim 12, wherein the outermost skin layer is formed of silicone.

14. A medical training model according to any preceding claim wherein the model comprises an artificial aorta that is provided with an external fluid supply.

15. A medical training model according to claim 14, wherein the aorta further comprises an outer fabric casing provided around the fluid filled tube.

16. A medical training model according to any preceding claim, wherein a wound is provided on the model heart.

17. A medical training model according to any preceding claim, further comprising one or more pumps for inflating and deflating the lungs.

18. A medical training model according to claim 17, wherein the lungs are independently inflatable. A medical training model according to claim 18, wherein a separate pump is provided for each of the lungs. A medical training model according to claim 19 wherein valve members are provided to control the inflation of each lung separately.