Kellen Maicher, a learning and development consultant at Ohio State’s Arthur G. James Cancer Hospital, demonstrates the Virtual Reality system in Graves Hall on Sept. 18. Credit: Shelby Metzger | Social Media Editor 

Virtual reality isn’t just fun and games anymore.

The Ohio State College of Medicine is developing VR technology to further educate medical students and professionals on how to assess mass-casualty situations, such as shootings or bombings.

The program, which is the result of a five-year, roughly $1.8-million grant from the Agency for Healthcare Research and Quality, is expected to roll out within the next one to two years, Douglas Danforth, academic program director at the Ohio State College of Medicine, said.

The new VR simulation — led by Danforth and his co-principal investigator Nicholas Kman, an emergency medicine physician at the medical center — will show trainees ranging from medical students to EMTs a subway bombing scene with multiple victims.

The user is responsible for acting as a first responder who determines the extent of the patients’ injuries, as well as takes the appropriate steps to treat them if necessary. The simulation also gives the “first responder” access to a medical bag with several tools such as tourniquets and triage tags, Danforth said.

Danforth said simulation users will practice triage, the process of assessing a large number of injured people and determining in what order to treat them.

“Each trainee is expected to triage and treat every patient in the scene using the Sort-Assess-Lifesaving Interventions-Treatment or Transport (SALT) triage system,” Kman said in an email. “While implementing SALT Triage, trainees must also identify which lifesaving procedures are appropriate for each patient.”

In a mass-casualty situation, first responders must prioritize those whose injuries are severe yet treatable, Danforth said. Victims who are so extensively injured they cannot be saved, as well as those who sustained only minor injuries, are not a priority.

In addition to providing a lifelike mass-casualty experience, the system grades the user’s performance based on a series of criteria, such as the correct procedure and victim categorization, Danforth said.

Up until about four years ago, the College of Medicine would utilize a simulation center and hire “standardized patients” — or actors trained to behave like a patient — in order to conduct training sessions, which wasn’t as realistic as doctors would like it to be, Danforth said.

“What we used to do is we used to have our simulation center, which is right across the street from [Graves Hall], build us a plywood subway car, and we would hire standardized patients, or we would use mannequins, and we would create what we would call an analog simulation,” Danforth said. “We put some smoke in there, and we’d have standardized patients walking around screaming and we would put makeup on them.”

The College of Medicine has been using virtual patients — artificial intelligence-based patients with whom trainees practice communicating — for about five years, Danforth said. The virtual patients are available through a text-based online version or an iPad app capable of holding a conversation with the student.

Similar to interacting with virtual patients, users will be able to speak to the victims in the VR.

“When you go to a victim, we want you to be able to talk to the victim. We want the victim to be able to understand, communicate, respond if they can,” Danforth said.

In addition to communicating with the victim, trainees are able to use the handheld controls to feel the victims’ pulses, which correlates with the extent of their injuries.

Danforth said the simulation will also have multiple levels tailored to each user’s experience, similar to a game.

For example, a simpler scene with three to four victims might be created for a medical student who hasn’t experienced a lot of triaging yet, he said.

“A paramedic, an EMT, first responder who needs to be really — and probably already is — pretty skilled at this, we would create a much more difficult scene,” he said. “And we’re going to create it so that you can level up if you treat everybody correctly.”

Danforth said in one or two years, the College of Medicine will begin testing the finished product on trainees to determine if it is an effective training tool.

“It’s one thing to create a fancy simulation that everybody likes and goes, ‘Wow,’ and it’s shiny and all that. But really what you want is that someone who’s done and gone through the simulation is now more skilled and better at it,” Danforth said.

Danforth said although the simulation is still in the early prototype phase, there are plans to create another training simulation that depicts an active-shooter scene.