There are some limitations. Stan doesn't bleed, but he can urinate. He can't really talk, but an instructor behind mirrored glass in an adjoining room can make a voice come from his mouth. His skin, which is a racially unidentifiable shade of reddish brown, still feels like plastic.
To turn Stan into Stanette, you simply remove his penis - the hospital uses it for teaching how to insert catheters - but the simulator is always flat-chested and comes with a short, traditionally male haircut.
The simulator - Lehigh Valley officials are still debating whether to give Stan a new name - can be programmed to be young or old, healthy or loaded with underlying medical problems. It can have heart attacks, collapsed lungs, gunshot wounds, and a myriad of other medical emergencies.
Stortz laughed appreciatively when Kostenbader finished explaining. "This thing does everything," he said.
"Are we set and ready to rock and roll?" the instructor said.
The maitre d' whisked Stortz to a table in the back of the restaurant, where a man was complaining that his chest hurt.
"Hi, my name is Stephen. I'm a paramedic," he said. Stortz, a stocky, crew-cut 30-year-old, leaned toward the man. "What's the problem today?"
"Ooohh," Stan groaned in a curiously high-pitched voice. "My chest. I just have such pressure in my chest."
Working with his assistant (and fiancee), Jennifer Skvoretz, Stortz checked Stan's breathing and heart rate. They fitted an oxygen mask over his face. Stortz started IV fluids.
"Oh, the pain is getting worse, and I can't stop sweating," the man said. "I feel like I'm going to pass out."
Stortz felt for his pulse. It was gone. He looked at the heart monitor. Stan had gone into ventricular tachycardia, a potentially lethal heart rhythm.
* Stortz, who works for an Allentown ambulance corps, is no stranger to such training scenarios. But this, he said, was "worlds above" working with other mannequins. "You get the actual feel for what's going on," he said.
This heightened sense of medical verite is what Lehigh Valley was hoping for when it acquired Stan in June with a grant from the Dorothy Rider Pool Health Care Trust.
The hospital, which trains about 4,000 emergency medical responders each year, plans to use Stan to teach EMTs and paramedics as well as doctors and nurses.
"It's a phenomenal teaching tool," said Michael Weinstock, chair of emergency medicine at Lehigh.
"What this really does is move you from the classroom to a real situation. Yet there's no risk to a patient." He put his hand on Stan's foot. "This is the greatest place to make errors."
There's been no shortage of those. In his short stay at Lehigh, Stan has died three times: One student failed to notice that he had no pulse, another gave the wrong medicine, and the third inserted a breathing tube incorrectly.
* "Start CPR while I get a defibrillator," Stortz calmly told Skvoretz.
He grabbed the paddles and placed them over two metal circles on Stan's chest. "OK, we're going to shock him at 200," he said. No reaction. He tried 300 joules, then 360. Still no good.
"Try and get some chest compressions going," he told Skvoretz, who is an EMT and a registered nurse.
He looked for a syringe of lidocaine.
Kostenbader, a nurse and paramedic, broke in to ask a question: "What have you given at this point?"
Oops. Protocol calls for giving epinephrine before lidocaine. Epinephrine helps restore normal heart rhythm, and lidocaine prevents the heart from going back into the abnormal rhythm. Stan wouldn't respond to lidocaine alone.
Stortz grabbed the epinephrine syringe and injected it into a port near Stan's head. The syringe actually contained water, but a bar code on the side told Stan which drug he was getting. He beeped when he finished reading the code.
Another shock at 360. Now Stan was in ventricular fibrillation. He was getting worse.
Still calm, Stortz gave him the lidocaine. Another shock. The heart rhythm improved. Another dose of lidocaine. Another shock.
"OK," Stortz told Skvoretz, "check a pulse."
* On this day, Stortz and Skvoretz would treat an old woman who passed out at home because of a slow heart rate, a stabbed husband, and a shooting victim on a city street. All Stan - or Stanette.
These are typical cases for a paramedic. But Kostenbader, who is program coordinator for Lehigh's Human Patient Simulator Laboratory, was able to add some twists. The stabbing victim was a diabetic, something Stortz did not think to ask about. The mistake wasn't life-threatening, but proper treatment could have roused the patient more quickly. The next patient had been shot in the leg, but stopped breathing for no apparent reason. Stortz figured out that he'd also overdosed on heroin.
Kostenbader used the encounters to talk about what questions to ask, how to give drugs, even how to talk to dispatchers and the receiving nurse at the hospital.
Stortz appreciated the practice. He hadn't inserted a breathing tube in a real patient in six months. "You don't hurt anybody if it's a mistake," he said.
There are about 150 patient simulators similar to Stan in training centers around the world, including one that's been in use at Penn State since 1994. Lehigh Valley's simulator was developed at the University of Florida and sold by METI (Medical Education Technologies Inc.) of Sarasota, Fla. The competing MedSim Ltd. model, which Thomas Jefferson University will begin using this fall, grew out of work at Stanford University. Originally, the simulators were designed to train anesthesiologists but have been modified over the years to help other types of medical personnel. One of the early researchers was a doctor who was also a pilot and had used flight simulators.
There's no proof yet that the machines train doctors any more effectively than more traditional methods, just as there's no proof that flight simulators make better pilots, those associated with the patient simulators said. But, they said, common sense suggests it's better to practice difficult procedures and complex medical scenarios on machines than on people.
Amitai Ziv, a pediatrician who flew fighter planes for the Israeli air force before working at Children's Hospital of Philadelphia, is helping Jefferson set up its simulation training center. He foresees a broad array of simulation devices in the future: "This whole field of medical simulators is now flourishing."
* "I have a pulse," Skvoretz said.
With no show of relief, Stortz called for an ambulance. On the way to the hospital, he inserted a breathing tube - not quite right at first - and started intravenous lidocaine.
At the hospital, he gave his report to Kostenbader. The report was too wordy, she told him, but they'd done the right things.
"You guys," she said, "went through perfectly."
