Nicholas Kman, a professor at Ohio State College of Medicine, talks with Chief Healthcare Executive about using VR to prepare first responders.
It’s difficult to train for disaster response, NIcholas Kman says.
Kman, a professor of emergency medicine at Ohio State College of Medicine, possesses deep experience in the field. His clinical background is in disaster response and he’s a member of Ohio Task Force 1, an urban search-and-rescue team.
Kman says disaster training either involves a large-scale exercise on one day, which is difficult to coordinate, or training with a textbook or PowerPoint, which doesn’t equate to hands-on learning.
So Kman has developed a different approach for disaster response: virtual reality.
He’s developed a program to use virtual reality headsets to help train first responders. His team visits fire stations and EMS departments and will spend a few days, giving more opportunities for training in case some can’t be there on a given day.
“We make sure that each first responder gets a chance to go in virtual reality, to learn the principles of hemorrhage control, and field triage,” Kman says. “And then we go over their assessment with them.”
In an interview with Chief Healthcare Executive®, Kman discusses the program, the need for more disaster training in healthcare, and the use of virtual reality in medical education.
(See part of our conversation with Nicholas Kman in this video. The story continues below.)
‘Triage the scene’
So far, Kman’s program has used virtual reality to help train 250 first responders. The Agency for Healthcare Research and Quality provided a $1.8 million grant over five years, and the program is now in its fifth year. Kman says the program has also received a grant from the Defense Advanced Research Projects Agency, a division within the Defense Department.
Generally, fire and EMS personnel have embraced the training, and he said there has been little resistance to using virtual reality as a teaching tool for disaster response.
A few of those involved said they were worried about motion sickness, but he said that’s only been an issue for a few participants. Each participant is in virtual reality for 15 to 25 minutes, he says.
The training program places participants at the virtual scene of a subway bombing. Ohio State’s Advanced Computing Center for Art and Design designed the artwork and animation for the program. In the scenario, the trainees encounter a host of victims.
“There are multiple victims of this subway bombing,” Kman says. “So the types of injuries are penetrating injuries and blast injuries. So the learners have to respond to this mass casualty incident, they have to do sound principles of hemorrhage control, like tourniquets, wound packing, and then they have to triage the scene.”
While the training program has one backdrop, Kman says it can be altered.
“We can do a lot of things to make the scenario more challenging, or, you know, even easier, so we can make it darker, we can make more smoke, we can make more noise, we can make more victims,” Kman says.
While the scenario can be intense, Kman says they were careful not to make the exercise too horrific.
“We've kind of asked ourselves, you know, ‘How realistic do we want this to be?’ I mean, we don't want people to have PTSD or be triggered by the scenario,” he says. “We want it to be a good learning tool.”
While it’s a training exercise in virtual reality, the scene can be a bit overwhelming for participants in the beginning. Even though the trainees are members of fire departments or EMS units, they typically go to scenes with one or two victims, and a mass casualty event is very different.
“We've seen people when the stress of the scenario starts, and the noise and the siren, the smoke, they kind of forget what to do to start with,” Kman says. In a few cases, Kman says, they need some prompting to begin.
There have also been a handful of trainees who tended to patients with less serious injuries first. “But I really view those as teaching points,” Kman says.
After the exercise, the participants receive a report that gives them a score on their performance, including how they fared in treating the injured and assessing which patients need immediate attention.
“The vast majority of the folks we've trained, have done pretty well, and some quite well,” Kman says. “But for the ones that don't kind of get the core concepts, we can go through and teach those things. And then in some scenarios, we've had them go back in and try it again. And so that's one of the advantages to a system like this. If there was a city-wide disaster drill, it happens, and then it's over.”
Even some who did well sometimes ask to go back into the virtual reality exercise again, with an enthusiasm any video game enthusiast can appreciate.
“They want to beat their score,” Kman says. “Like, you know, ‘I got eight of the 11 patients triaged correctly, I want to go back in and see if I can get them all.’”
"There's kind of that video game component to it that I think the first responders really enjoy," he adds.
Kman says he hopes to license the software in the near future so other organizations can run their own programs.
Need for training
As he’s led training sessions, Kman says he’s seen a high level of interest from first responders in getting better training for disasters.
“The training for a mass casualty incident was not adequate, and probably still isn't,” Kman says. “I mean, I think this type of training needs to happen multiple times a year. But we know these events are coming more frequently, unfortunately. And so I think one of the biggest lessons for me has just been how great the need for this was and how many people are interested in doing the training.”
Hospitals need to be planning for disaster response, Kman says.
“I would say that my advice to hospitals would be to never pass up on the opportunity to do a disaster drill or a mass casualty drill, and make it more than a tabletop,” Kman says. “Do a drill where you'll be receiving a surge of patients. Can our ER handle this surge of patients? Can the ORs handle multiple patients, let's say with gunshot wounds, or penetrating trauma?”
Smaller hospitals, even those with limited resources, should be developing plans on for a disaster. He points to the recent train derailment in his own state, in the small community of East Palestine.
“If you're at a smaller hospital, you still need to think about that, because you may be the closest place that gets victims,” Kman says. “And at the very least, you need to be able to stabilize those victims, and have a plan for who you transfer.”
Other healthcare facilities, including nursing homes, psychiatric hospitals, and dialysis centers should have response plans.
He recalls deploying with federal emergency management personnel and assisting with the evacuation of a nursing home amid rising water in the wake of Hurricane Harvey in 2017.
“You should have a plan for what you're going to do if there's a disaster, if you have to evacuate, if there's an active shooter, heaven forbid, you know, at your institution,” Kman says. “So absolutely a duty to plan.”
‘The possibilities are great’
Even as he uses virtual reality in training for emergencies, Kman says the technology is likely to play a greater role in medical training.
At Ohio State, medical students in their fourth year use virtual reality in training.
“So every medical student at Ohio State gets a session where they take care of a sick patient in virtual reality. And they've given us the feedback that they really enjoy that experience,” he says.
In the simulation, students go into virtual reality and they have to evaluate and treat the patient.
“The possibilities are really great,” Kman says. “You know, normally, we would do that kind of training with a high fidelity simulator, like a mannequin. And, you know, the mannequin can be $80,000 in cost, and it requires a simulation to run the program."
“Whereas with virtual reality, all we need is a space and a computer and headsets and, you know, we could do the training, whatever we want to do it,” he says. “So there are a lot of possibilities for virtual simulation and in healthcare, for sure."