by Thomas Luiz, Dieter Lerner, Dominik Schnier (Fraunhofer IESE)
Virtual Realities (VR) are increasingly used as a simulation technology in emergency medicine education and training. In the project EPICSAVE, a highly immersive room-scaled multi-user 3D virtual simulation environment was developed for medical training scenarios. This enables a realistic and sustainable training experience.
Working in emergency medicine is characterised by constraints that constitute a high-risk constellation: need for situational assessment and decision-making as well as initiation of appropriate emergency measures under time pressure, often under adverse external conditions, and, at the same time, with little or no fault tolerance. Virtual realities (VR) are increasingly used as a simulation technology in emergency medicine education and training, in particular for the training of “non-technical” skills (clinical and procedural reasoning) and teamwork skills. Experimental studies have demonstrated that VR is equivalent, or even superior, to traditional training media (i.e., patient actors or manikins) for training purposes.
In the project EPICSAVE, a highly immersive room-scaled multi-user 3D virtual simulation environment was developed for medical training scenarios. This project involved an interdisciplinary consortium incorporating expertise from all relevant disciplines, i.e., paramedic training academies, medical and media education, media design research, and production of virtual 3D learning environments. Following a two-year interdisciplinary and iterative development and evaluation process, the second prototype of the virtual simulation environment now consists of different virtual emergency locations with integrated virtual patients of different age groups [L1]. The virtual environment contains more than 60 virtual objects, e.g., interactively usable virtual instruments for the diagnosis and therapy of the virtual patient:
- Change of posture and undressing of the virtual patient
- Monitor-based measurement, e.g., electrocardiogram, blood pressure
- Clinical examination, e.g., breathing sounds
- Medical treatment, e.g., administration of oxygen, application of infusions.
The hardware equipment for a team training with two trainees consists of two VR head-mounted displays (HTC Vive®), four input devices (HTC Controller®), and two computers with display, which are used by the trainers to control the simulation and follow the training. The trainees and their interactions are transmitted to the VR in real time by means of a motion-tracking system. In the VR, the trainees are represented by avatars. This enables collaborative activities connecting the real world with the VR (e. g., handing over medical equipment). The VR system automatically records the training sessions and documents important diagnostic steps or therapeutic interventions . The virtual patient represents a multitude of pathological parameters and symptom characteristics:
- Psychomotor condition
- Different states of consciousness
- Breathing sounds
- Pulse frequency and strength
- Cyanosis, blue coloration of the skin.
This goes beyond the current capabilities of commercially available, costly high-fidelity simulators or patient actors. The EPICSAVE virtual simulation environment enables the realistic treatment of complex, dynamic, and rare emergencies without compromising real patients (see Figure 1).
Figure 1: The virtual patient in the virtual simulation environment, (source: TriCAT GmbH, Ulm).
The highly immersive VR has made possible a dynamically changeable, realistic, and three-dimensional visualisation of different clinical environments and patients from different perspectives . This enables spatial positioning of the trainees in the virtual 3D emergency environment and fosters the feeling of being present in this scenario. A high level of presence experience correlates positively with variables for learning or training effectiveness. Furthermore, a high degree of realism increases the likelihood that the learning experiences will be transferred to real environments. As part of the project, the virtual simulation environment was evaluated with five study groups. The following parameters were measured during each training session: presence experience, usability, cyber sickness, assessment of training effectiveness, cognitive load, current learning motivation, and up-to-date knowledge of the respective emergency scenario. The participants of the five studies rated the VR simulation training above average in terms of training effectiveness, quality of training execution, and potential for improving motivation and immersion .
The EPICSAVE VR will continue to be developed even after the project has ended. In the follow-up BMBF project ViTAWiN (Virtuell-augmentiertes Training für die Aus- und Weiterbildung in der interprofessionellen Notfallver-sorgung [Virtual-augmented training for education in interprofessional emergency care], FKZ 01PV18006), mixed-reality technologies are now being combined with VR. The ViTAWiN approach pursues the goal of expanding VR through the integration of haptic input and output devices, such as augmented virtuality (AV). Thus, the previous potential of training and learning in VR (non-technical skills) can be extended to the training of technical skills. In addition to this realistic and three-dimensional visualisation, a perceptualisation of virtual objects (virtual patient, virtual equipment) can also be achieved. The learning- and training-relevant contents in the VR will be presented to the trainees using means of visual, auditory, and haptic-tactile interaction [L2].
The project EPICSAVE (Enhanced ParamedIC vocational training with Serious games And Virtual Environments) was funded by the German Federal Ministry of Education and Research (BMBF) and the European Social Fund of the European Union (EFS) (duration: 03/2016-02/2019, FKZ 01PD15004).
 J. Schild, et al.: “EPICSAVE – Enhancing Vocational Training for Paramedics with Multi-user Virtual Reality”, in IEEE SeGAH, pp. 1-18, 2018. DOI: 10.1109/SeGAH.2018.8401353.
 D. Lerner, T. Luiz: “Close to reality. Learning with virtual patients” [Nah an der Realität. Lernen mit virtuellen Patienten], Intensiv 27 (2), 64–69, 2019. DOI: 10.1055/a-0821-3183
 D. Lerner, D. Wichmann, K. Wegener: “Virtual reality simulation training in emergency paramedic training” [Virtual-Reality-Simulationstraining in der Notfallsanitäterausbildung], retten! 2019; 8(04), 234–237. DOI: 10.1055/a-0820-8614
Fraunhofer IESE, Germany
Research Program Healthcare