Q&A: Virtual reality program prepares EMTs, physicians for mass casualty disasters

A new virtual reality program is providing first responders, law enforcement and physicians with training and experience in mass casualty disasters, occurrences that have grown significantly over the last several years.

The program was developed by researchers from The Ohio State University College of Medicine and the Advanced Computing Center for Art and Design. It has been implemented in several EMS and fire departments and is “quickly expanding across the country,” according to a press release.

“Our high-fidelity program is designed to look very realistic, and once you put that headset on you are immersed into a scenario where you can move around, interact with victims, and make life-saving decisions,” Nicholas Kman, MD, a professor of emergency medicine at The Ohio State College of Medicine, said in the release.

The program allows participants to give commands and ask questions during simulated disasters while receiving realistic feedback from patients that is consistent with their current condition, according to the release. Its settings are also customizable, from background noise and smoke to the number of victims.

“This hands-on type of training also helps with information retention so first responders can recall what they’ve learned when it matters most,” Kman said.

Healio spoke with Kman to learn more about the program, the kind of virtual scenarios utilized and potential impacts that the program could have in the clinical setting.

Healio: What prompted you to create this program?

Kman: These mass casualty events have unfortunately become more common for different first responders to have to respond to and appropriately treat the patients. In the years prior to us receiving this grant, there had been some news coming out about things that could have been done better with mass casualty response.

Because these are low frequency but very high-stress and high-importance events, they’re hard to train for. But it's very important that our firefighters and paramedics know what to do if they're confronted with this type of situation.

We applied for a grant to use virtual reality to train first responders in a way that's repeatable. We could put somebody in the scenario over and over again and have them experience this because, frankly, there's just not a lot of other great ways to train for a mass casualty incident.

Healio: What kind of scenarios are given to trainees?

Kman: In the years just prior to us submitting this grant, there was a subway bombing in France and in Brussels that we kind of used as a template for first responders who would come into the subway platform, and they would have to take care of the patients and then triage the scene.

We’re able to alter the scene so we can have as many patients in there as we want. We can have as much acuity as we want from the standpoint of, they could be either sick or less sick. They can have different injuries. But the backdrop of the scenario is always the subway bombing.

Healio: What kind of skills are you hoping trainees take away from the program?

Kman: The two biggest goals for us to teach are the importance of hemorrhage control and the importance of identifying the sickest patients that they can help. We call that triage or field triage.

We want the first responders to be able to recognize someone with uncontrolled hemorrhage who would benefit from a tourniquet, compression or packing. Then we want them to triage the scene by placing a colored tag or wristband on a patient to signify which patients need the most immediate help.

Healio: What kind of feedback have you received from participants?

Kman: We've been very active in taking the virtual reality out to the community. We've trained over 200 first responders, and the feedback that we get is, in general, very positive.

They like the ability that they can go in and do a tutorial. You don't have to be a virtual reality expert to go in. The system puts out a score report, and myself or another physician will go over the score report with them, so we get an opportunity to do some teaching with them afterwards, and I think they really appreciate that again.

This is a concept that, thankfully, many people haven’t had to do for real. These situations are becoming more common, but I think they appreciate the opportunity to experience this and train for it in case it ever happens when they’re working.

Healio: Does the program have implications for physicians?

Kman: Absolutely. First of all, I think it's the responsibility of physicians, regardless of their specialty, to know what paramedics and first responders experience in the field. I also think it’s the responsibility of physicians to know what their patients might experience.

I would also say that in an event where there would be a large volume of mass casualties, a primary care physician may be asked to help out with the response. Most emergency departments aren’t equipped to handle a surge like what was seen in the 2017 Las Vegas mass shooting.

Because the emergency departments might be overloaded, primary care doctors like internal medicine, family medicine or pediatrics might be asked to help out. An OB/GYN doctor might be asked to help with trauma-related surgery.

In times of disasters, sometimes we have to practice medicine outside of the scope of our practice. So, I do think it's important for all physicians to understand this concept. I don't know that they need to be an expert in field response, but I would say that physicians should be able to do “Stop the Bleed” hemorrhage control. That would be something that our system could also help with.

Healio: Anything else you’d like to add?

Kman: We also do virtual reality simulation for our medical students. Virtual reality simulation in general is a great way for a physician to practice taking care of a patient who they may not see that often. With our medical students, we have two cases of a patient who is sick and comes to the emergency department.

I would say that virtual reality in general as a training platform, I think, has a lot of implications for physicians, and there are several companies out there that provide cases where doctors can don the headset and take care of a patient. Virtual reality has been shown as a good adjunct for pain control as well.

Virtual reality has a lot of implications for physicians, not just from a training standpoint, but for patient care and comfort.

References:

• New virtual reality technology prepares first responders to respond to mass casualty disasters. http://osuwmc.multimedia-newsroom.com/index.php/2023/02/07/new-virtual-reality-technology-prepares-first-responders-to-respond-to-mass-casualty-disasters/. Accessed Feb. 8, 2023.
• Stop the Bleed. https://www.stopthebleed.org/. Accessed Feb. 10, 2023.