Dr. James Thompson, an emergency medicine physician at Bartlett Regional Hospital, smoothly made the incision in the chest, put his finger in to feel where he was, used a metal tool to open up the space more, and quickly guided a plastic tube into the opening with a clamp.
It's a procedure that would be used to drain blood from the chest, blood that was compressing the lungs and making it hard for the patient to breathe.
The "patient's" chest moved up and down as if he breathed, the skin felt like real skin, but Thompson was practicing trauma-treatment techniques on a mannequin of a torso.
The advanced trauma class held Friday and Saturday at Bartlett, which attracted doctors and other medical personnel mostly from around Southeast, was the first time in several years that such training in treating injured patients has been given in Alaska, participants said.
Traumas include injuries such as from car crashes and falls, stabbings and shootings.
Doctors, nurses, physician assistants and paramedics used to be trained to treat traumas by working on anesthetized live dogs and pigs. But public opinion was sufficiently opposed to that practice that it was abandoned in Alaska and elsewhere, doctors said.
Now dummies like Trauma Man, manufactured by Seattle-based Simulab Corp., have changed that.
"I think it's more acceptable to public opinion. Many people feel the use of animals for training or experimentation is wrong," said Dr. Hugh Foy, a Seattle surgeon.
Foy was one of the course faculty members - doctors and nurses from the University of Washington Medical School in Seattle and the chief of surgery from Alaska Native Medical Center in Anchorage - who presented the course last week. Part of it was practicing emergency surgical techniques on Trauma Man.
"It feels on this thing that the skin texture is pretty good," Dr. Allan Schlicht, a surgeon in Juneau, commented to doctors and others working on the torso Friday.
"It's tough to get through the chest wall. This gives you a sense of how hard you have to push," course faculty member Dr. Eileen Bulger of Seattle told Carol Cheney, an advanced nurse practitioner from Craig, who was inserting a tube in the mannequin's chest.
Such training in treating trauma is especially important in Alaska, where many communities are far from major hospitals or don't have a doctor, Foy said.
"It's important education because trauma is one of the leading causes of death," said Shelly Deering, assistant chief flight nurse for Airlift Northwest in Juneau. "When you have a systematic approach, it's going to save lives."
The training was paid for with a $45,000 federal grant to the state Department of Health and Social Services, said Doreen Risley of the agency.
The trainees learned to recognize, evaluate and treat injuries, including using some simple procedures that can save lives as medical personnel face "the ultimate chaos of an injured, dying person," Foy said.
"The value of it is it provides a common language for everyone taking care of the patient," who often is injured in remote places and passes through several hands before getting to a hospital, Bulger said.
Some of the procedures practiced last week are rarely used, even by emergency-room doctors, Thompson said. Bulger showed a class how to cut an opening in the cricothyroid membrane in the throat when injuries are so severe that the usual process of opening a breathing passage with a tube down the mouth can't be used.
It's what Thompson called a "last-ditch deal" to save the patient's life. It's faster than the more commonly known tracheotomy, which is to cut an opening into the windpipe, Bulger said.
"When you have to do them it's almost as high as your blood pressure gets," Bulger told the class. "It's not going to be the most beautiful, bloodless surgery. You just want to get a tube in quickly."
Schlicht, who was helping keep Cheney's incision open, told her: "You made a tiny incision, but you're getting there. ... There's another membrane you have to pop though."
"You should hear air rush at you," Bulger said. "There you go. That looks good."
Eric Fry can be reached at firstname.lastname@example.org.