risk to patient safety. As technology developed, patient manikins evolved into advanced, realistic human-like simulators used for healthcare training and medical simulation. These simulators can be used to supplement clinical practice. In a large-scale study examining the use of simulation in nursing, it was found that high quality simulation can replace up to 50% of clinical training hours. Simulation training allows for skills training and performance measurement. Simulators transmit feedback – measuring performance in metrics including CPR, emergency cardiovascular care (ECC), automated external defibrillator (AED), arrhythmia, blood pressure, airway and ventilation management, ultrasound diagnostics, advanced critical care, endovascular procedures, neonatal, venous and arterial, and nursing and patient care. Education is hands-on with directive feedback in audio, visual or both, with apps for smartphones and tablets. Technology that offers objective feedback during and after simulation is used for debriefing and improving learner performance. Flagship products The well-known Resusci Anne simulator has been updated to include variation with CPR metrics feedback technology, advanced skill training, and first aid. The newborn and pediatric simulators, Resusci Junior and Resusci Baby, also allow for CPR feedback technology. Laerdal's introduced its high-fidelity simulator, SimMan 3G, in 2009. Several iterations have followed that include Simman 3G Trauma, SimMan Essential, SimMan ALS, SimMan Vascular, SimMom, SimBaby and SimNewb. In 2019, Laerdal acquired the company B-Line Medical, a debriefing, assessment, and training management platform. After a partnership signed in 2018, Laerdal Medical now offers integrated simulators with B-Line Medical technology. Global partnerships Laerdal works with global partners such as the British Heart Foundation on their Nation of Lifesavers project to train school children to perform CPR and AED use. From September 2020, first aid and CPR will be added to the primary and secondary school curriculum in England. Similarly, Laerdal supplies the American Heart Association (AHA) with CPR training kits for use with their CPR in schools program. In the United States, 38 states now require CPR training as part of the high school graduation requirement. Together with the AHA and the Global Resuscitation Alliance, Resuscitation Quality Improvement (RQI) programs are used at hospitals to refresh the CPR skills of healthcare providers using short, frequent training sessions. Laerdal is also a partner of the National League for Nursing for patient simulation training for nursing education and collaborates with the American Academy of Pediatrics to develop neonatal resuscitation education through education and technology. Not-for-profit initiatives Laerdal Global Health (LGH) is