Bringing it to life – VR in trauma training
Training for mass casualty events is vital, but also difficult and expensive. A British former military doctor is using virtual reality to help colleagues imagine the barely imaginable. By Jennifer Trueland
‘Around 8 per cent of global deaths are down to trauma, yet very few people on the street know how to save a life if someone gets blown up or hit by a car. There is very little training. People seem to know about CPR but they don’t know about trauma first aid.’
Having served in the military as a doctor – and been seriously injured while serving – James Gough (pictured, top right) knows more than most about the effects of trauma and his experience showed him that we are not very well prepared for it.
Whether it is a mass-casualty event, such as a train crash, or an influx of injuries following a bomb blast, it is very difficult – and hugely expensive – to provide realistic and useful training to healthcare professionals to help them in the moment.
This is why he turned to VR (virtual reality). Back in 2018, he started to develop a prototype which was to develop into a tool now deployed in the world’s trouble spots, teaching healthcare workers how to respond when the unthinkable happens.
‘My vision was for the Netflix of trauma training – a kind of 360-degree training where you could put the headset on and train for a chemical-weapons attack, for example.’
Tested in Syria
Although the prototype had an enthusiastic reception from those who tried it, it was a meeting with renowned war surgeon David Nott which really took the project forward.
‘I put the headset on David’s head. It was the experience of a catastrophic injury of an individual in 360 [degrees], during an attack on the London Underground. We were in London, it was a Thursday, and David’s immediate response was: “Can you come to Syria with me on Monday to test this equipment?” And so, I jumped on a plane with him a few days later.’
At that point, the David Nott Foundation was running a hostile-environment training session on the Turkish/Syrian border. ‘I put the VR headsets on the heads of Syrian surgeons and we gained some amazing feedback. Fast forward to 2020, and we delivered the first use of VR mass-casualty training in Yemen.’
The current version of the tool was developed with insights from Professor Nott himself, based on the scenarios he himself had experienced throughout his long career in operating and training doctors in war and disaster zones.
‘It shows a mass-casualty event because David identified that as one of the hardest things to teach and train for,’ explains Dr Gough, who, since last year, has been chief executive of the David Nott Foundation.
‘We designed an experience where you are the triage officer and you put the headset on and are told 60 people have been injured. They’re going to be arriving at your hospital and you’ve got to start triaging them and decide who is going to live, and who is going to die; who is going to get the resources – it is really that bleak.’
My vision was for the Netflix of trauma training
James Gough
The tool takes 10 of these 60 patients, all of whom were based on people Professor Nott had personally met, and builds up stories around them, with the user having to make split-second decisions. The scenarios chosen give a sense of the urgency of each person’s need but also bring in other potentially conflicting factors.
‘One is a pregnant lady, and it’s a really good example of why triage is difficult,’ says Dr Gough. ‘She’s also a colleague of the hospital staff. So, they’re faced not only with a pregnant woman who has maybe suffered an injury but also with a colleague, so it would be very hard to say no to treating her right now. But actually, she is “walking wounded”, and a low categorisation, so you have to put the emotion to one side and focus on other people.’
The tool has now been used for training in other hostile environments including Somalia and Somaliland and Ukraine. Feedback has been overwhelmingly positive. ‘One of the surgeons we were training in Somaliland said to me: “This is a game-changer; nobody comes here to train us; nobody seems to care about us.” Having access to this technology goes some way to solving that problem.’
Huge potential
Although the tool is still in use, Dr Gough would like to see the use of VR expanded in training, believing it has enormous untapped potential – not just for medics but for everyone.
‘There are five billion people in the world who don’t have access to safe, skilled surgical care. There are probably seven billion people in the world who do not know how to give trauma first aid. Technology is the way you scale training like that. It’s easy, relatively, to train a bunch of military doctors in these skills, but it’s not easy to train the general public, and that’s where the tech comes in.
'With the David Nott Foundation we can go to a war zone, we can give hands-on training to surgeons face to face. But to solve the whole problem around trauma deaths, you need to educate many more people than surgeons, and VR is one way to do that.’
You know that if the people around you have decent training, they have strength, and they are empowered from that
James Gough
Dr Gough’s own experience of serving in war zones as a military doctor also came into play when developing the tool. He himself received a serious blast injury in 2012 – which left him incapacitated for a long time and eventually led to his decision to leave the military.
‘The bit that sticks with you as a casualty is the vulnerability. You are completely reliant on the person in front of you to get you out of that situation.’
In his case, he was directing a combat medical technician (not a doctor) in how to manage him.
‘I asked him to put my stethoscope on and listen to my chest because I had a blast wound just above my lung. I felt breathless and worried that something had happened to my lung. Being a patient, you’re so vulnerable, but you know that if the people around you have decent training, they have strength, and they are empowered from that.’
'Dark places'
He is clear VR is not a substitute for hands-on, in-person training but he does believe it is an important training adjunct. ‘Somebody said to me – and I think it rings true – that VR is for the expensive, difficult and unethical. Putting on high-fidelity training events is expensive and difficult.
‘And how do you blow up children or do a chemical attack on children in some part of the world – how do you recreate that? But if you do it in VR you can do what you like and you can create these horrific events.
‘VR lets you go to these difficult, dark places, train for them, then come out immediately.’
