TAMPA — The patient suddenly developed difficulty breathing, and his blood pressure plummeted. A trauma team hustled to figure out why, voices rising, the cacophony of a hovering helicopter making it difficult to concentrate.
The surgeon, nurses, respiratory therapist and emergency medicine physician from Lakeland Regional Medical Center weren't in a true life-and-death scenario. They were training last month at the Center for Advanced Medical Learning and Simulation, a $38 million University of South Florida Health facility in downtown Tampa.
“It's full-blast, full-pace,” said Olu Sobowale, medical director for trauma at Lakeland Regional. “There's a part of you that says, 'I know it's a simulation,' but you say, 'I don't want to fail.' ”
Sobowale and a pair of Lakeland trauma teams were among 16,000 people who visited CAMLS for education this year.
The center is packing local hotels to the tune of 14,000 room nights a year and more than 6,400 people have toured the building.
The center expects to bring in about $20 million in revenue this year from a number of sources. That's roughly the same as expenses, but because CAMLS has to account for depreciation of the $10 million in state-of-the-art medical equipment it opened with, the center will list a loss of about $2 million for the 2013-14 fiscal year.
That's down from $4 million in its first year, also a paper loss due to depreciation.
The red ink is not a significant concern, said Rhea Law, chairwoman of the USF Health Professions Conferencing Corp., which oversees CAMLS.
“Any time you have a start-up, you have a certain amount of time you expect to be supporting the organization while it is creating a market for this new service that it provides,” said Law, head of Florida offices for the Buchanan Ingersoll & Rooney | Fowler White Boggs law firm who was a longtime member of the USF Board of Trustees. “It is within the budget that was set, and to be at break-even early on is a good thing.”
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In a first-floor trauma center at the CAMLS building on Franklin at Brorein streets, actual troop footage from Kandahar, Afghanistan, is displayed in the “windows.” The sounds and sights of war are everywhere, from the wounded soldier lying on the gurney – actually a complicated mannequin that can be programmed to bleed, breathe, and display vital signs — to the helicopter or generator noise piped in. The temperature can be increased to simulate the desert.
“This room is set up so that it can be a disruptive environment,” said Debbie Sutherland, chief executive at CAMLS. “Or this all can be taken out.”
With the touch of a button, the room is lit in soft blue. Cartoon characters appear on the walls. The suite is ready for pediatric surgery.
Next door is the first hybrid catheterization lab ever built, allowing surgical teams to shift from an interventional procedure such as an atrial valve replacement to an open-heart surgical procedure in the same room.
With the hybrid lab, a patient wouldn't have to be stabilized, put on hold, or sent back to his or her hospital room to wait for an operating room to become available; surgical teams are simply swapped out in the same room.
“This is what state-of-the-art ORs look like nowadays,” Sutherland said.
There is a larger room with 21 surgical training stations for surgeons, cardiologists, radiologists and residents to learn how to perform robotic, computer-assisted and image-guided surgery.
A microsurgery lab trains neurosurgeons, plastic surgeons and hand surgeons who work with vessels that are typically 1 millimeter or smaller in size.
On the third floor are exam rooms where doctors can be evaluated on their interactions with patients. An Anatomage table can display full-size human anatomy and its body systems in 3D. It's one of 40 in the United States and the only one in the South.
Also upstairs is the Tampa Bay Research and Innovation Center, a combination lab and machine shop where developers of medical devices can use CAMLS' resources for testing potential products and prepare them for the Food and Drug Administration approval process. CAMLS can cut what had been up to a 6-month process down to days.
“It's a great facility,” said Mark Smith, who runs the University of Arizona's Center for Simulation and Innovation and has visited CAMLS. “One of the best in the country.”
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Administrators foresee CAMLS riding a wave of new thinking when it comes to training doctors. The field has been entrenched in what many consider the apprentice method, in which a resident trains with a practicing faculty member under what is often called the see-one, do-one, teach-one approach.
Sutherland argues that physicians and clinicians should have their skills verified through simulation programs. An analogy would be the airline industry, she said.
“When we book our flight, we don't book it based on who's flying the plane or who is on the flight crew,” she said. “We have confidence that they've all been trained to standard, and they have gone through team training so that if something happens, they all act consistently in terms of what they're going to do to keep us safe.”
Smith says it's only a matter of time before that happens. Anesthesiology groups are already requiring simulation training, he said.
“In the future,” he said, “there will be more and more of that type of thing with surgical simulation, emergency, ob-gyn. It only make sense that will move up to a credentialing standpoint.”
And when that happens, the medical industry catches up to CAMLS.
“Our whole health care system is changing pretty dramatically,” Law said. “The focus is on quality of care and safety. CAMLS is actually ahead of the market. We're creating a market for it, we're creating the ability to have better training.”
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Last month, demonstrating the importance of federal funding of medical research, U.S. Rep. Kathy Castor, a Democrat from Tampa, invited Rep. Frank Pallone of New Jersey to CAMLS. He said he was “tremendously impressed,” and vowed as ranking Democrat on the committee responsible for such funding to strongly support medical research.
CAMLS would stand to benefit from that push – but by design, it is not dependent on it.
The center's finances are difficult to scrutinize, as its budget is commingled with other USF programs overseen by the Health Professions Conferencing Board.
But Sutherland and controller Greg Vannette said CAMLS gets about $1.2 million in state funding for teaching USF medical students.
Medical device companies play a major role, making up about 40 percent of the use of CAMLS resources and paying about $5 million in revenue. Visits by medical specialty societies adds another $1 million. Other big revenue producers are hospitals and health care systems that send staff for training, such as Sobowale's group from Lakeland, along with training in robotics, continuing education and professional development in the medical professions, and international learners.
CAMLS received a significant combat casualty training federal grant, but the project expires next year.
Administrators said maintaining that diverse portfolio and adding to it is critical. They are developing franchising agreements for similar centers in Panama, Brazil and Ecuador, another money-making endeavor.
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CAMLS could have a role in intensive training in high-risk specialties, helping to cut the cost of malpractice insurance. And the facility has “just scratched the surface” in contracts with medical specialty societies, Sutherland said.
“They've really put together a good model there,” said Smith from Arizona. “It's a great model. We hope to do that sort of thing, but we're just getting rolling.”
Local leaders say the impact of CAMLS will be felt far beyond the medical field. Mark House, past chair of the Tampa Hillsborough Economic Development Corp., has said it would have the single largest economic impact in the downtown central business district in the last 10 years.
It is projected to have a $5.7 million annual impact on the local economy going forward as those visiting physicians book rooms, eat at restaurants, and seek entertainment.
Tampa Mayor Bob Buckhorn said building CAMLS was a “pivotal moment” for the city.
“Once again, we get introduced all over the world in ways that weren't even possible,” Buckhorn said. “It's exactly the demographic group we're trying to attract. This is a great asset for downtown.”