Virtual encounters with mass casualty incidents


A team of students using the VISE system


Disaster scenarios are closer to real life now, thanks to Virtual Interactive Simulation Environment (VISE), the latest virtual reality (VR) project at the Centre for Healthcare Simulation. Fully developed in the University by the NUS Yong Loo Lin School of Medicine and researchers from the Keio-NUS CUTE Center, the system can create a three-dimensional scenario of the aftermath of a bomb explosion on a highway — for a start. These realistic simulations allow students from NUS Medicine to take on roles of members in an emergency response team and put their skills in triage and situational patient management to the test during a mass casualty situation.

“One major push for developing this was to educate our learners on complex real world environments that are uncommon but can cause a lot of chaos when they happen. One of those common scenarios is a mass casualty incident. Although we can create such a mass casualty incident in a real environment, it is difficult, and the manpower and logistics involved in creating this complex environment are not cost effective, and can be time consuming and laborious,” said Associate Professor Suresh Pillai, the Centre Director and Principal Investigator of the VISE project, adding that a VR programme would allow for repetition if necessary, which would not be possible when created in a real environment.

VISE allows teams of up to six students to be immersed in a mass casualty situation. Using a VR headset and a pair of hand-held controllers, the students are able to interact with each other in real time while simultaneously managing multiple casualties. Their physical movements and actions will be tracked and displayed in real time. The range of casualties featured in the scenario will have a range of injuries and the students will need to conduct a host of life-saving interventions such as controlling major haemorrhage, opening obstructed airways, evaluating breathing, assessing circulation by measuring capillary refill time and pulse rate, and determining physical disability status.

Having a VR helps to bring to life the things that you learn in theory. It helps you to tackle the situation in real life better and I think it will give us more confidence so that when these things do happen we're not frozen and we're not caught off guard.

In mass casualty situations, there are often more casualties than resources — physical, manpower, equipment or infrastructure. Hence, healthcare providers in emergency response teams use a process called triage, where they prioritise casualties according to the severity of their injuries to ensure survival of as many casualties as possible. This would require care providers to make quick, effective and often painful decisions on who to save and who to let go.  VISE thus challenges students to appreciate this dilemma and learn how to react in such situations.

“When we were in our emergency posting we did go through theoretically on what to do in a disaster management situation. But when you are actually in the situation, there's a lot of adrenaline. When you see everything going on visually, it's just not the same. Having a VR helps to bring to life the things that you learn in theory. It helps you to tackle the situation in real life better and I think it will give us more confidence so that when these things do happen we're not frozen and we're not caught off guard,” said final-year NUS Medicine student Louiza Pittas, who has tested out the VISE system.

Aiming to develop independent and self-motivated learners in accordance with the principles of Andragogy or Adult Learning, an in-built self-evaluation component in the VISE system allows learners to evaluate their actions, and provides immediate feedback on the accuracy of their actions, ensuring maximum interaction and feedback loops and high student engagement.

VISE has been undergoing pilot studies with NUS Medicine students, alumni as well as physicians since last August and Assoc Prof Pillai hopes to incorporate it into the curriculum for Year 4 and Year 5 students in the next academic year.

“The initial feedback from pilot studies amongst medical students have been very encouraging and we believe that this sort of experiential learning is integral in helping to enhance and reinforce the didactic curriculum. VISE will not be limited to healthcare students but can be developed to include scenarios for more advanced healthcare practitioners. We also hope to extend the use of VISE to other healthcare providers, including the all-important pre-hospital personnel from the Singapore Civil Defence Force as well as military personnel from the Singapore Armed Forces,” said Assoc Prof Pillai.


Assoc Prof Pillai (3rd from left) with Keio-NUS CUTE Center researchers Assoc Prof Yen Ching-Chiuan (far left) and Ms Teo Chor Guan (far right), and NUS Medicine final year students Amanda Chia, Pearl Wee and Louiza

While the current system only offers one mass casualty incident, the team aims to progressively add more scenarios to the system in the future, including multiple casualty management in an emergency room or operating theatre, infectious disease pandemics and terrorist attacks. They also hope to look into using the system for inter-professional and interdisciplinary training, for example involving nursing students.

See press release and media coverage.


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