FORT WORTH, Texas -- The patient's eyes blinked, his legs trembled and his toenails turned blue as he lay on a gurney inside an ambulance.
Then he flat-lined.
"It breaks my heart," said Ronnie Ikeler, an EMS specialist. "His battery went dead."
But the patient known as iStan was revived with the help of a recharged battery. The 120-pound medical manikin, which is part of a new ambulance simulator, is the latest technology that allows paramedics to practice responding to real-life trauma -- everything from a cardiac arrest to an amputation.
"He's the most technically advanced training equipment out there," said Ikeler, who works for Dallas-area health network HCA North Texas. "You can do anything with this manikin that you can do on a real patient."
The anatomically correct iStan breathes and sweats, and he can bleed from five areas.
The manikin can also talk or shout, depending on the situation. His eyes respond to light, and his heart races. Paramedics can check everything from iStan's pulse to his bowel sounds. They can also use a defibrillator to get his heart beating or stick a needle in his chest when a lung collapses.
Inside the ambulance simulator, cameras record what happens and then display the images so other students can view the action and learn about proper responses.
Ikeler said he can put the paramedic's response on a CD so students can see what they did right and learn from what they did wrong.
Medical manikins have come a long way since the 1960s, when Resusci Anne was introduced as a teaching tool for cardiopulmonary resuscitation.
In the 1980s, paramedics had manikins to practice on, but they consisted of a head and a torso, Ikeler said.
"Back then it was more about pretending," he said. "Now we're actually doing the procedures."
At the University of Texas-Arlington's Smart Hospital, 32 patient simulators allow nursing students to practice their clinical skills.
Among the "family" of simulators is an 8-pound SimBaby that turns blue when the oxygen supply is interrupted, a female manikin that gives birth and SimMan 3G, which can bleed from wounds.
Such simulators can be programmed to portray any kind of situation that might come up, said Carolyn Cason, associate dean of nursing research for UT-Arlington.
"That enhances patient safety because we're not having to use patients to learn on."