Simulation In A Virtual Combat Environment Puts Surgical Skills To The Test
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Date posted: 17/05/2008
Posted by: Site Administration
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A unique study by human factors/ergonomics researchers in Norfolk, Virginia, USA, has concluded that VR simulators may well be the best way to prepare surgeons for battlefield medicine, as it is ideal for creating a safe replica of the in high-stress, high-workload conditions combat zones present. Conditions which traditional training cannot replicate, and which often cause issues in medical staff encountering it live for the first time.

Simulations provide safe and controlled environments, immediate performance feedback, and practice for skills under unique or dangerous conditions. Virtual environments have proven to be effective in training dismounted soldiers and military checkpoint guards, so why not battlefield medics?

In this study, 15 medical students had to perform an emergency chest tube thoracostomy -- incision and insertion of a tube in the chest to permit fluid to drain -- on a mannequin in a CAVE immersive VR interface.

Dictionary Term: CAVE

The CAVE VR interface is a physical construction whereby the user is inside the projector. They typically wear goggles, or headgear that does not block out the world arond them, but does send data back to the computer system about their head movements and the position of the eyes.

This information is then used to alter projections, produced outside the system, and imposed on the floor, the ceiling, and all walls, to give the user the impression (s)he is actually completely inside an immersive, 3D environment, that moves with their body, and desplays correctly, no matter how they twist and turn their head.

CAVE technology is typically used for high-end research VR due to its high cost, and demands on space.

See also: BAT CAVE

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Whilst they did this, they were surrounded by the simulation ? literally on all sides ? of gunfire going off, explosions both distant and right on top of the open air ?hospital?, a sniper firing from a concealed position at them, and soldiers and military vehicles rushing every which way. The auditory feedback matching the visuals, they were operating in as close to a real battlefield as the simulator could get.

They performed the same surgery under both day and night combat conditions. Four months later, they were tested on their battlefield thoracostomy skills, and the students all demonstrated they had retained the basic battlefield surgical skills necessary.

The students' completion times demonstrated that they could perform the surgery efficiently, but the quality of their work suffered. This was undoubtedly due to the stress caused by the simulated surgical environment. In many way,s the simulator stacked the odds against them, but an actual battle would do much the same.

Those students who were able to complete the thoracostomies in the fastest times, were sniped at much more often. After all, on an actual battlefield, snipers would likely aim at the most productive medical staff, taking them out of the picture.

Worse, had it been a real battle, and not a simulation, several of the students demonstrated stress-related behaviour problems, that would almost certainly have led to their deaths had they been dropped into firefight medicare without the prior simulatory training.

The researchers will present their results on Friday, October 20, 2006, at the Human Factors and Ergonomics Society 50th Annual Meeting at the Hilton San Francisco Hotel, which takes place October 16--20.

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