Integrating Battlefield Documentation into Virtual Reality Medical Simulation Training: Virtual BATDOK

Background: Clinical documentation is an essential component of the provision of medical care, enabling continuity of information across provider and site hand-offs. This is particularly important in the combat casualty care setting, when a single casualty may be treated by four or five completely disparate provider teams (bridging the spectrum of roles of care from medics at the point of injury to surgeons in a Role 4 operating room). The Battlefield Assisted Trauma Distributed Observation Kit (BATDOK) is a digital battlefield clinical documentation system developed by the 711th Human Performance Wing at the Air Force Research Laboratory to address this need. In order to ensure that warfighters are able to make use of BATDOK effectively on the battlefield, it is essential to integrate it into routine training to enable medical personnel to "train how they fight." To support this need, we integrated BATDOK into a commercially available virtual reality medical simulation system (VRMSS, SimX, Inc.) used by USAF Pararescuemen (PJs) in order to provide an immersive simulation training experience which included battlefield documentation.

Methods: A multidisciplinary team consisting of the Principal Investigator, a USAF Pararescue Medical Director, a USAF PJ, an Emergency Physician, an Emergency Medical Services Technician, a virtual reality engineer, and a virtual simulation implementation specialist in collaboration with the 711th HPW BATDOK team first developed a specification for a virtual BATDOK capability, including a detailed listing of learning objectives (including specific tasks that must be performed using a BATDOK device), critical interfaces and task plans, and sensor integrations. These specifications were then implemented into the commercially available VR medical simulation system, and the resulting capability then underwent developmental testing and evaluation during PJ training exercises at Hurlburt Field AFB and the Special Operations Center for Medical Integration and Development at the University of Alabama - Birmingham.

Results and Discussion: The BATDOK capability was successfully implemented within the VR medical simulation system. The capability consisted of a virtual tablet, modeled after the Android BATDOK tablets used in the field, with replicated interfaces and capabilities based on the developed specifications. These interfaces and capabilities included integrated point-of-care ultrasound capability, multi-patient management, vitals sign monitoring with sensor pairing and continuous monitoring, mechanism of injury documentation (including injury pattern documentation), intervention logging (including tourniquets, dressing, airways, lines, tubes and drains, splints, fluids, and medications), and event logging. These capabilities were fully integrated with the underlying VR platform in order to enable dynamic response based on the underlying evolving simulated patient state(s). The resulting virtual BATDOK training capability was then deployed for development testing and evaluation, with initial acceptance testing demonstrating positive feedback. The full capability was found to be operational and in alignment with learning objectives. Additional capability enhancements are in development to enable use with canine patients, replication of the integrated tablet-to-tablet transfer capability and handoff summary, and medical history documentation. A comprehensive evaluation for educational efficacy is now being planned.