Virtual reality simulation for multicasualty triage training

Abstract

Multicasualty triage, establishing the priority of care among casualties in disaster management, is generally practiced using constructive tabletop or live exercises. Live exercises require scheduling of medical providers, trained actors, and frequently focus on organizational and logistical issues, with little practice of medical response. Actual disasters, such as explosions, hurricanes, or toxic exposures, occur so rarely that there is little opportunity for gaining experience during real events.

The triage simulation described in this paper is the result of over a decade of development of virtual reality systems for medical care training, including trauma, bioterrorism, and chemical agent casualties. These simulators present scenarios comprising a scene and one or more virtual patients. Each casualty has its own injuries, physiological simulation, and signs and symptoms that change with the evolving condition. Animations such as vomiting, tearing, coughing, seizure, and convulsions relate to physiological status and interventions. The caregiver can navigate the scene, assess and converse with the patient, monitor diagnostic data, and apply medical devices, medications, and other interventions. Scenarios were developed for training military physicians how to perform effective multicasualty triage and practice initial care of casualties consistent with improvised explosive device (IED) injuries. These scenarios provide an evolving medical situation with graphically intense casualties including amputations, penetrations, massive burns, chest wounds, and blunt trauma. Child and adult civilian casualties are embedded with the military casualties to provide an engaging urban disaster scenario. Caregivers assign the virtual casualties a triage priority and administer immediate care as indicated. A learning module guides the user through standardized protocols, and interactions are recorded for review, along with pertinent physiological and behavioral data. This triage simulator has been used at Fort Campbell and Fort Drum for pre-deployment training of Army medical staff, and at Fort Bucca, Iraq for sustainment training. User surveys have been requested from medical personnel for usability and face value comments. Available summary results will be presented.