Enabling Flexible Medical Simulation Training for Emergency Medical Services using Virtual Reality

Introduction: Emergency medical services personnel have a unique operational need to meet a wide scope of practice in highly unpredictable and diverse situations which present interpersonal, interprofessional, and environmental challenges that significantly complicate the provision of care and which are difficult to reproduce in traditional controlled simulation training. This presents a critical gap because medical simulation training is among the only evidence-based approaches to improve outcomes in patient care. To most effectively train, however, it is necessary to replicate the full scope of challenges presented in real practice, including both social factors (such as agitated patients and bystanders, law enforcement activity, etc.) and environmental factors (including unsafe and evolving scenes, visual and aural distractors and irritants, etc.) integrated with the high fidelity patient and intervention simulations which are the mainstay of modern simulation training. In this research, we report our investigation into the adaptation of a commercially available virtual reality (VR) medical simulation training platform previously used for hospital-based training for use in prehospital emergency care simulation.

Description: An interprofessional clinical educator working group was formed with participation from emergency physicians, emergency medical technicians, emergency physician assistants and registered nurses. The working group collaboratively developed an initial five-scenario curriculum based on realistic medical emergencies requiring treatment at the point of injury by emergency medical personnel. Once the primary curricular goals were completed, the team designed social and environmental complications for each scenario. Upon completion of the design process, scenarios were implemented using a previously existing VR medical simulation system.

Discussion: The resulting curriculum included the following presenting situations: cerebrovascular stroke, accidental multitrauma, unknown drug overdose, myocardial infarction, and anaphylaxis. Once the primary curricular goals were completed, the team designed social and environmental complications for each scenario, including patient refusal of transport without capacity, challenging radio handoff, bystander distress and interference, and unstable moving transport. Scenarios were evaluated for acceptance first by members of the clinical educator working group, and then by educators and trainees at a major emergency medical services conference (EMS World), with positive initial acceptance suggesting that successful replication and integration of high fidelity medical and interventional simulation training and complex social and environmental situations is possible. Future evaluation of the resulting curriculum may continue to elucidate the differential value and limitations of this integrated virtual simulation approach and provide avenues for additional engineering research.