Primary Mass Casualty Virtual Reality (VR) Triage

This MSc project is investigating whether modern technologies like VR can improve training and in-turn improve HART preparedness for a mass casualty incident (MCI) and specifically, primary mass casualty triage. Previous studies have shown VR to be a pedagogic resource which compliments the holistic training healthcare professionals undergo for MCI triage (2).  Furthermore, objective data is provided to the user facilitating individual and organisational learning (2). Over the last 20 years the prevalence of MCI’s has increased with a current rate of 3-4 MCI’s a year in the UK from infectious diseases, terrorist attacks, transportation incidents and natural disasters (3). Ambulance services have a legal obligation under the Civil Contingencies Act 2004 to adequately prepare for MCI’s which involves the training of first responders in triage (3).

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The National Ambulance Resilience Unit (NARU) train and manage HART, each located within ambulance trusts in England (4). 

At an MCI, HART would work closely with partner agencies within the hot zone/inner cordon to locate, triage and treat casualties (4). HART operatives are expected to make decisions in high stress MCI environments to rapidly and accurately triage casualties (4).

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Currently, triage training for HART teams have a day of training consisting of Power Point presentations, paper-based exercises, practical skills stations and an exercise using heavy plastic low-fidelity manikins with observations written on casualty cards. Following this training, each team takes part in one large scale exercise annually involving live actors as simulated patients. 

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The manikins are extremely cumbersome and offer no feedback to the clinician when assessing for catastrophic haemorrhage, respiration rate and pulse/capillary refill as a real-life patient would. All of the aforementioned physiological assessments are key components of the NaSMED triage sieve currently utilised by the ambulance services in the United Kingdom (UK) (APPENDIX 1) (5).  When clinicians are utilising manikins for triage training, they refer to a casualty card which offers no real-time feedback of patient emotion or physiological status (6).  This lack of feedback and real-life experience is likely to inhibit the HART paramedic’s preparedness for an actual MCI or large-scale exercise as environmental conditions between theory-based training and real-life experience differ widely. (6). 

The author intends to incorporate VR into HART operative triage training at one HART base in an effort to understand whether VR can supplement operative training to increase confidence, preparedness and subsequently the effectiveness of unit/national resilience for an MCI.