Virtual reality mass casualty triage training for paramedics hailed as a ‘game-changer’

A group of 36 Hazardous Area Response Team (HART) paramedics have tested  virtual reality (VR) mass casualty triage training that was developed for a paramedic’s Master of Science Degree program final year project.

HART colleagues from the North West Ambulance Service (NWAS) responded to a marauding terrorist attack (MTA) at a football stadium in the VR simulation.

They rapidly and accurately triaged 16 casualties with participants seeing blood and hearing casualty sounds and environmental noises as part of the virtual MTA incident. 

The VR simulation was developed by NWAS HART paramedic Steven Thompson for his Queen Mary University in London MSc to test the effectiveness of modern technologies to improve the training of specialist paramedics who go into highly hazardous environments.

Current HART training consists of PowerPoint presentations, paper-based exercises, practical skills stations and an exercise using heavy plastic manikins with observations written on casualty cards. This is generally followed by large scale exercises involving live actors as simulated patients.

The traditional manikins are cumbersome and offer limited feedback to the clinician when assessing for catastrophic haemorrhage, respiration rate and pulse/capillary refill as a real-life patient would. These physiological assessments are key components of the NaSMED triage sieve currently used by ambulance services in the UK.

When clinicians are utilising manikins for triage training, they refer to a casualty card which does not provide real-time feedback of patient emotion or physiological status.

Developed in partnership with Manchester-based v360group, the VR headset and simulation allows clinicians to deploy the triage process in real-time. This includes feedback from patients (unless deceased or unconscious), who could inform them of what injuries they had alongside distractions such as background noises from sirens and radio chatter.

Clinicians can interact with the casualties and select treatments like tourniquet application, wound packing, applying pressure bandages, opening  airways and placing casualties in the recovery position.

Osian Parry, a HART operative who has been on SORT and HART training for several years and trialled the VR triage, said the software and hardware was ‘an absolute game-changer’. He said;

It’s incredible how immersive the virtual reality software is. Being able to assess a patient, visualising their condition and injuries, hear audible prompts and navigate through the realistic virtual environment gets you lost in the VR world. This pushes you as a clinician whilst stimulating all your senses.

All 36 HART participants involved in the trial said that VR improved the effectiveness of the HART paramedic training process for a mass casualty incident and 86% agreed that the VR experience increased their confidence in applying the triage process and attending a mass casualty incident.

HART paramedic Steven Thompson said:

Virtual reality helps fully immerse paramedics into an incident and provides real time tests with visual and audio clues working under time pressure.

I’m really pleased with the feedback because all participants said it helped improve training and confidence, which could be really useful in how we train all paramedics in the future especially to help assist with the rollout of a new triage sieve.

VR technology is an excellent supplementary training tool. Exercises in VR can be easily be created and replicated as many times as required at relatively low cost compared to staging multi-agency, mass casualty exercises.

In addition, participant performance data can be captured so training needs can be identified and this data is key to proving that staff are adequately trained and assessed and have enough resilience within regions to respond to mass casualty incidents.

Steven concluded:

I hope that every paramedic, nurse or doctor that may respond to mass casualty incidents gets the opportunity to use virtual reality, including the system I have helped developed with 360 Group, to improve their own training.

David Bull, NARU Head of Education, said:

 This is an exciting development that promises to add to the wealth of training resources that NARU provides to ensure our Hazardous Area Response Teams are best equipped and prepared to save lives in the some of the most challenging environments. 

I want to congratulate Steve on his project and thank him for using his extensive experience as a HART operative to investigate how new technology can be used as yet another resource to help equip HART paramedics.

It’s clear that alongside table-top training and in situ exercises as well as large scale multi agency exercises, virtual reality could play a new role in delivering realistic training.

Sam Slater, CEO of v360group, said:

At v360group, we specialise in creating immersive solutions for safety-critical industries such as nuclear, offshore, and renewables, where emergency response training is a top priority.

The results and feedback from the HART trial are very encouraging and confirm that VR is extremely effective in emergency response settings.

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