Disaster medicine and virtual reality simulation: tracking down the factors impacting triage performance

IntroductionMass Casualty Incidents (MCIs) are characterized by an imbalance between limited medical resources in view ofoverwhelming patients’ needs [1]. As a result, Emergency medicine professionals (EMPs) have developed triagesystems to cope with such situations [2]. Environmental, emotional and social factors might impede these triage process,especially when EMPs are facing injured children [3]. Besides, the challenge of replicating complex medical conditions inMCI and providing feedback implies high logistics burden and considerable costs in human resources and timeallocation [4]. Virtual reality (VR) could offer a realistic cost-effective solution to overcome difficulties [5]. We analyzedthe socio-professional and psychological factors potentially mitigating children’s triage during a MCI using an original VRenvironment.MethodsA mixed approach study, involving both qualitative and quantitative methods, was adopted. Ten emergency residentswere immerged in two VR environments simulation: a coach accident in a tunnel and a detonation in a Grand-place. Atpre-immersion, each resident completed a sociodemographic questionnaire. Post-immersion included the Frenchadaptation of the Coping Checklist and a self-efficacy questionnaire. At each stage, participants evaluated their stress.Triage effectiveness was rated by an expert. A qualitative analysis of the debriefings was performed.Results & DiscussionFemales (11.33±0.57) obtained significantly better triage scores (p=0.03) than male (9.71±1.38). We found that the levelof stress at pre-immersion was significantly correlated with the triage scores (r=0.89; p=0.02). Participants’ self-efficacyof and previous training in MCI (p=0.11) were not correlated with triage scores. Qualitative findings revealed difficultiesin identifying deceased children, which conducted to incorrect triage, or inappropriate life-saving interventions (e.g.resuscitation). During debriefings, participants highlighted the pictorial realism leading to higher immersion and a highlevel of stress as previously reported [6]. This exploratory study about the factors influencing triage scoring reveals thatgender and stress before immersion might impact triage performance. Furthermore, our results enable further researchon educative perspectives to develop standardized practices in VR simulations.