Virtual Reality Simulation Meets a Need to Train Knowledge, Skills and Abilities for Aeromedical Transport with a Novel Training Platform

Introduction: Aeromedical transport providers must be prepared to deliver complex medical care to critically injured patients during handoff and while in transit. These providers work in teams that do not routinely practice in a transport environment, which necessitates frequent re-training for specific tactics, techniques, and procedures (TTPs) required to provide critical care management in flight. Medical simulation training is an evidence-based approach to improving medical readiness. However, traditional simulation modalities are cost-prohibitive and inflexible to changing needs, limiting the utility of these methods for frequent, team-based training. Because it can simulate rare situations with high fidelity at low cost, virtual reality (VR) provides an innovative approach to training these providers. Accordingly, a VR simulation curriculum was developed in collaboration with the United States Air Force to enable learners to practice TTPs for en-route care. This qualitative study aimed to evaluate a VR simulation curriculum for its coverage of aeromedical transport TTPs. We hypothesized that a VR platform can provide substantial coverage of medical decision-making TTPs, thereby demonstrating utility as a teaching modality for both military and civilian transport providers.

Methods: An interdisciplinary working group was formed, consisting of physicians, registered nurses, VR simulation experts, and military aerospace medicine educators. Utilizing aeromedical transport and en-route care clinical practice guidelines, two members independently reviewed the simulation scenario documentation for TTPs utilized throughout the curriculum. The full curriculum TTP descriptions were shared with the working group, who then provided input and revisions. A final list of covered TTPs was then included in a survey distributed to aeromedical transport educators to determine if the selected TTPs were educationally valuable as part of an aeromedical transport training curriculum. The working group reviewed the returned surveys and performed a thematic analysis to summarize the results.

Results and Discussion: The VR aeromedical curriculum working group identified TTPs across 10 medical decision-making simulation scenarios. Key TTPs included evaluating and packaging a critically injured patient, identifying abnormal vital signs, managing increased intracranial pressure, adjusting ventilator settings, providing advanced cardiac life support, performing procedures such as arterial line placement, and communicating effectively with team members. Preliminary responses from aeromedical transport educators indicated that these TTPs cover substantial depth and breadth that would be of high value for training medical transport providers. While this curriculum was developed specifically for military transport teams, this curriculum also shows potential to be adapted for civilian aeromedical en-route care.