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Mass casualty triage: using virtual reality in hazardous area response teams training

02 October 2023
Volume 15 · Issue 10



In recent years, virtual reality (VR) has become a pedagogic resource that complements the general training health professionals receive. VR could revolutionise hazardous area response team (HART) mass casualty incident (MCI) triage training.


The study aimed to establish whether VR could improve the overall effectiveness of HART triage training and increase practitioner confidence and preparedness for an MCI.


The author co-developed a VR marauding terrorist attack (MTA) triage scenario at a football stadium. The software was loaded onto Oculus Quest 2 VR headsets. HART paramedic participants completed an online survey before the exercise, which focused on demographics and experience. They were then familiarised with the VR equipment, which incorporated a tutorial on patient interaction. This was followed by a VR MTA exercise with 15 casualties, after which they completed an online survey to gauge their opinions.


All 36 HART paramedics recruited agreed VR would improve the effectiveness of HART paramedic training for mass casualty triage. Furthermore, 30 (83%) agreed that VR was more effective than the sand manikins currently used in training. Following the VR scenario, 31 (86%) of participants reported increased confidence in responding to an MCI and carrying out mass casualty triage.


VR can improve the effectiveness of the HART triage training and may increase HART paramedic confidence in responding to an MCI and carrying out primary triage. Further studies with larger samples could determine if the results from this study can be generalisable across all frontline paramedic clinicians. Additionally, participant accuracy and time on task data should be evaluated.

In recent years, the prevalence of mass casualty incidents (MCIs) has increased, with 3-4 MCIs a year occurring in the UK from infectious diseases, terrorist attacks, transportation incidents and natural disasters (Lowes and Cosgrove, 2016). On 22 May 2017, the Manchester Arena bombing became the deadliest terror attack in Britain since the 2005 London terror attacks (Bennett, 2018; Craigie et al, 2020). An Islamist suicide bomber detonated an improvised explosive device in the main foyer area, killing 22 and injuring hundreds of people (Bennett, 2018; Craigie et al, 2020). Hazardous area response team (HART) paramedics responded to the incident and triaged the casualties in very difficult circumstances (Bennett, 2018).

NHS England funds the National Ambulance Resilience Unit (NARU) to manage the NHS major incident response by ensuring the ambulance service meets the core standards of the Emergency Preparedness, Resilience and Response (EPRR) framework (Makin and Groves, 2020; NHS England, 2023)' NARU trains and manages the HART teams, which are located within the 10 ambulance trusts in England (NARU, 2022).

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