SimSimple in practice: airway training without a mannequin

At first, it can feel surprising.

Airway management—one of the most technical, high-stakes skills in emergency care—being practised with 2D laminated visuals on a table.

No airway head.
No laryngoscope.
No mannequin.

And yet, again and again, we’ve found that Visually Enhanced Mental Simulation (VEMS) is a powerful way to practise not just airway skills—but the thinking and teamwork that underpin them.

Beyond the Procedure

Airway management isn’t just about getting the tube in.

It’s about:
– Anticipation
– Decision-making
– Adapting to evolving conditions
– Coordinating as a team under pressure

These are cognitive and relational skills—and they’re often harder to practise than the technical steps. VEMS creates a space where those skills come to the forefront.

The Role of the Facilitator

For this to work, the facilitator has to be active.

Very active.

You can’t rely on a mannequin to “show” what’s happening. Instead, you need to provide rich, continuous cues:

– What does the airway operator see?
– How is the patient responding?
– What’s changing moment to moment?

In the video above from one team's session, you can hear that almost constant narration:
👉 describing blood in the airway
👉 visualising partial views
👉 prompting the operator to interpret what they’re seeing

This is what allows participants to build a mental picture—and act on it.

Why It Works

Interestingly, removing the mannequin solves some familiar problems.

With VEMS:

• Operators can’t “fight the mannequin” to succeed when they shouldn’t
• They can’t abandon the scenario and blame equipment limitations
• The scenario progresses based on clinical reasoning and team decisions, not hardware

It keeps the focus exactly where it should be.. on thinking, communication, and adaptation rather than how realistic or not the mannequin is.

An Example Scenario: Hematemesis and a Difficult Airway

In the video from the session at the beginning of this post, the team managed a patient with severe hematemesis requiring airway management.

The airway team worked through:
– Positioning
– Suction strategies
– Attempts at visualisation
– Iterative adjustments

Ultimately achieving successful intubation.

But the real value came in the debrief where the team unpacked how they adapted, created a shared mental model of the "SALAD" technique and even discussed trust between the airway nurse and doctor. The focus was on how we think, adapt, and communicate together in challenging situations.

There was no mention of the "realism"....

Final Thought

You don’t need a mannequin or even an airway head to practise high-level thinking.

Sometimes, simplifying the environment is exactly what allows the most important elements of performance to emerge.

With the right facilitation, even a table full of laminated pieces can become:
👉 a difficult airway
👉 a stressed team
👉 a powerful learning experience

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Interested in using VEMS for airway training? Explore Simulation Simplified: https://simulationsimplified.com