“…Mannequins and pPatient simulators used by ambulance services are usually very heavily used and age very rapidly, hence the need for them to be robust and supported by a good customer service, preferably by a manufacturer which can offer a local technical service for maintenance. Paramedics represent a significant proportion of ambulance services staff and their roles are still evolving (Kilner, 2004) which impacts on the required functionality of patient simulators so they may be used for the practice of all relevant clinical skills within the pre-hospital setting. The latest and most advanced patient simulators allow for heart, chest, and abdominal sounds auscultation, pupil reaction, monitoring of physiological parameters, palpable pulses at several locations, variable airway resistance and lung compliance, needle or surgical cricothyroidotomy, decompression of a tension pneumothorax, and chest tube insertion (Alinier, in press;Issenberg & Scalese, 2008).…”