Medical City · Simulation 10 of 12
Medical Technology Detective
Diagnose real faults with a budget: scope, meter, logs, then name the cause and prove the fix.
What you do
Technology Detective
Each case is one baffling technical fault. You investigate with real instruments and records, eliminate every alternative with evidence, then choose the fix and the test that proves it.
Intermittent faults that nobody can explain erode trust in equipment and put patients at risk. Clinical engineers who can trace them systematically keep wards safe.
43 challenges, each at Foundation, Practitioner and Expert level.
How it works
Step by step.
Measure before you suspect
Spending your investigation hours on lines of inquiry: logs, records, an oscilloscope, a multimeter, loggers and interventions. Find the pattern first: when, where and on which devices.
Two sources, one clock
Setting two records side by side on one clock to see whether they move together. A true link in time is evidence; a coincidence is a mistake.
Kill the alternatives
Tying clues to each suspect as supporting or refuting, and eliminating what the evidence kills. Kill alternatives with facts, not feelings.
Name the cause
Telling the ward what is causing the fault. They will act on it. Name only what the evidence leaves standing.
Remove the cause
Choosing the fix that removes the cause, not one that hides the symptom. Fix causes, not traces.
Prove it where it failed
Choosing the test that shows the fault has really gone. Prove it where and when it failed.
The physics and your path
Reading back the case: score, Marcus's assessment, the physics and your path against the expert's. Measure, correlate, eliminate, fix, prove.
What it trains
Skills and competencies.
- Systematic fault diagnosis
- Oscilloscope and multimeter measurement
- Event-log correlation
- Verification of fixes
In the BMEssentia competency framework, this simulation builds 9 competencies across Patient & Electrical Safety, Maintenance & Performance Testing, Device Technology & Fault Finding, Clinical Environment & Infrastructure, Incident Investigation & Learning.
- Patient & Electrical Safety
Electrical safety testing
Test medical electrical equipment to IEC 62353 (earth bond, insulation, leakage) and act correctly on borderline and failed results.
- Patient & Electrical Safety
Electromagnetic compatibility
Recognise, measure and control electromagnetic interference between devices, building services and radio sources (IEC 60601-1-2).
- Maintenance & Performance Testing
Test methods and measurement uncertainty
Choose test conditions that can reveal the fault, use traceable test equipment and judge results within measurement uncertainty.
- Device Technology & Fault Finding
Device operating principles
Explain how a device turns physics and physiology into a clinical number or therapy, and where its limits come from.
- Device Technology & Fault Finding
Systematic fault diagnosis
Separate device faults from user, accessory, consumable and environmental causes, then test one hypothesis at a time.
- Device Technology & Fault Finding
Sensors, signals and instrumentation
Use multimeters, oscilloscopes and analysers to follow sensors and signal chains and find drift, noise and calibration errors.
- Clinical Environment & Infrastructure
Medical electrical installations
Specify and check medical locations, IT systems, earthing, UPS and backup power to IEC 60364-7-710 and HTM 06-01.
- Incident Investigation & Learning
Root cause analysis
Build timelines and find root and contributing causes with 5 Whys, fishbone and barrier analysis in a just culture.
- Incident Investigation & Learning
Fleet data and trend analysis
Use downtime, failure and incident data within and across hospitals to find patterns before harm happens.
The takeaways
- Measure before you suspect.
- Eliminate alternatives with evidence.
- Fix causes, not symptoms.
- Prove a fix in the conditions where the fault appeared.
The challenges
43 training cases.
- 01 The Night Shift Hum
Every ECG on Ward 7 fills with mains hum after midnight.
- 02 Desaturation Without a Cause
Patients in the hybrid theatre 'desaturate' to 88% mid-case.
- 03 The Lift and the Pumps
Infusion pumps in bays 1 and 2 restart themselves mid-infusion.
- 04 Seventeen Minutes
The CCU's central station loses every telemetry patient for a few seconds.
- 05 Rings After the Storm
Since Tuesday's storm, every CT image carries faint concentric rings.
- 06 Rain in the Expiratory Limb
In bays 3 and 4, the ventilators' measured tidal volumes creep upward over hours, then alarm.
- 07 Every Tuesday
Every Tuesday morning the dialysis machines alarm for conductivity.
- 08 The Update That Told the Truth
After a firmware update, six of twenty-two defibrillators fail their weekly self-test.
- 09 Bands Beside the Magnet
Since the new MRI opened next door, Ultrasound Room 2's images carry drifting bands of noise.
- 10 Too Warm Under the Blue Light
Incubator 4 alarms 'air temperature high' and a baby's temperature climbs, but only when the phototherapy lamp is on.
- 11 Three Devices, One Earth
Three devices from three manufacturers misbehave at once in one ICU bay.
- 12 Only When They Cut
In Theatre 4 the ECG dissolves into noise and calls VF every time the surgeon presses the diathermy pedal.
- 13 A Size Too Small
On Ward 9 the automatic blood pressures run twenty points above every manual check.
- 14 Fifty-Nine from Fifty
On the cardiology ward every heparin infusion needs more and more to reach its target, and the pumps report fifty-nine millilitres delivered from a fifty-millilitre.
- 15 Breaths Nobody Took
In two ICU bays the ventilators deliver thirty breaths a minute to patients who are paralysed.
- 16 The Breath That Came Back
On Theatre 4's anaesthetic machine the inspired CO2 creeps off zero in long cases.
- 17 No Marker, No Shock
Twice this month the Resus 1 defibrillator refused to deliver a synchronised shock to a patient in fast AF.
- 18 Low Tide at Three
Every weekday afternoon, machine after machine goes into conductivity bypass within minutes of each other.
- 19 A Line Through Every Slice
MRI 1's images carry a bright dotted line straight across, always in the same place.
- 20 Burnt Out on the Wall Stand
Since the first week of March every chest X-ray from Room 3 comes out with its lung edges burnt black.
- 21 A Shadow That Travels
Three ultrasound probes carry a dark vertical stripe from skin to depth.
- 22 Flat Before the Night Shift
Telemetry transmitters that ran for two days on a pair of cells now go flat in ten hours.
- 23 The Call That Waited
A patient presses the call bell and the light over the door comes on at once.
- 24 Eight Seconds of Dark
On Ward 7B the bedside monitors go black and restart whenever a nurse sits a patient up.
- 25 The Alarm That Added Up
Theatre 5's isolated power panel alarms most mornings, mid-operation.
- 26 The Weight of Water
Heart-failure patients lose four kilograms overnight and gain five the next day, on the bed scales only.
- 27 After Lunch, the Gases Lie
The ICU's blood gas analysers pass quality control every morning and fail it every afternoon.
- 28 Dry on the Shelf
In one coronary care bay every ECG rises and falls as if it were breathing, and the ST alarms cry wolf.
- 29 Out of the Cold
One ward's infusion pumps cry 'air in line' a dozen times a shift, and the nurses can see no air.
- 30 Rolling Bars in Room Three
Dark bars creep up the endoscopy picture in Room 3 for a few seconds, clear, and come back in a rhythm.
- 31 Slow Fall Under Blue Light
Jaundiced babies under the nursery's blue lights barely respond, and one came close to an exchange transfusion.
- 32 Damp in the Sieve
Eight oxygen concentrators come up from storage to cover a pipeline refit.
- 33 A Degree Behind the Blanket
After cardiac arrest the ICU warms its patients back to 37 °C, slowly and exactly.
- 34 Spikes Without Beats
A man in complete heart block lives on a temporary pacing wire.
- 35 Radar over Level Four
Forty pumps on one floor vanish from the server at the same second, then drift back over several minutes.
- 36 A Pulse Before the Shock
The cardiac arrest review says the team took seven minutes to shock.
- 37 Air in Every Breath
In recovery the end-tidal CO2 reads half of what the blood gas says, and the waveforms come out round and flat.
- 38 The Wing That Could Not Pull
On the east wing of Ward 6 the wall suction barely clears a mouthful.
- 39 Fever Under a Thicker Skin
9.
- 40 The Fridge That Kept Quiet
Three weekends running the vaccine fridge has warmed past 8 °C.
- 41 Awake on the Screen
On the shoulder list the BIS number leaps from 43 to 79 and back within a minute.
- 42 Two Halves, One Patient
Mid-operation the diathermy goes dead and the generator flashes RETURN ELECTRODE.
- 43 Nine Months in the Dark
Ward 12 reopens after nine months of refurbishment with its own pumps and beds back from the store.
Devices
Devices in this simulation.
Standards