You look down, and a woman is holding her arm. Her hand’s been blown off. A man next to her has a gaping, bleeding hole in his gut. People are scattered around the subway platform you stand on as smoke swirls, lights flash and noise fills your ears. Some people have shrapnel in their legs; others are confused and limping.
As a first responder inside this training scenario, your job is to perform a SALT (sort, assess, life-saving interventions, treatment and/or transport) mass casualty triage. It’s a virtual reality mass casualty simulation of a subway bombing, a VR training scenario designed by Ohio State’s Dr. Doug Danforth and Dr. Nick Kman to help teach Ohio State’s medical students, emergency medicine residents, and first responders SALT triage.
Danforth, who has a background in designing VR simulations for medical students, and Kman, a FEMA first responder and professor of emergency medicine, collaborated with other medical center faculty and designers from the Advanced Computing Center for the Arts and Design (ACCAD) and have nearly completed the project.
Both recently spoke about the VR training tool.
The fact we can take this out to Worthington Fire or Delaware EMS or the University of Michigan, who’s going to partner with us, that makes it incredible. Obviously, we could never transport the sixth floor of Prior Hall (where live simulations once took place).
This is a really hard concept to study and simulate. Many EMS providers won’t be confronted with a situation like this, so it’s not that well taught or learned. But we know that prioritizing victims in a mass casualty scenario is important. So there’s going to be a huge benefit to those learning here.
And because Dr. Danforth and the development team have made it to where there’s varying degrees of severity of patients, this could be a training course for lay responders all the way up to trauma surgeons and ER doctors. The sky’s the limit for this.
Columbine was the big first one but then there was Sandy Hook and Aurora, Colorado, and Orlando, incidents where patients die at the scene. There was a lot of discussion about how to serve the greatest number of patients at these events. We learned at Sandy Hook especially that if responders could stop the bleeding and triage in the right way, they could save more lives.
All of this spun up into the idea of let’s use virtual reality to make something that’s very realistic to teach people a concept that is super important but foreign to their day-to-day work.
We focused a lot of our development energy on creating what we call the universal patient. We’ve built our mass casualty incident in a subway. But it would be easy to change out our environment to do an active shooter simulation in an office building. We’ve made it so it’s easy to build a new environment, change the injuries.
We wanted this to look realistic. We used pictures from the Boston Marathon bombing and other realistic, actual pictures. We also want to continue to look at how much stress to add to the scenario. We want this to be a realistic exercise but not be triggering or contribute to post-traumatic stress. It will be an interesting balance.
The team was great about asking questions, and those were some of the most interesting conversations and aspects of this. I would venture to say a handful of people from ACCAD could probably do field triage now.
This will be a fantastic simulation, very high fidelity, and we have high hopes that this will really help not only our students and local EMS, but we’ll make it available to collaborators around the country and around the world.