VR training for paramedics and police: “Increased heart rate and tunnel vision are crucial”

A wounded man’s screams are heard again and again as his rescuer tries to stop the massive bleeding from his gunshot wound.

At the same time, the building’s loud alarm system makes it difficult to hear and even more difficult to focus on what his colleague is saying about the next casualty.

A bang comes from somewhere else in the building. The police are still trying to catch the perpetrator.

This situation is an imaginary one, and it takes place in the virtual space. But it is not far from a real situation that first responders or paramedics may encounter in their work if they are unlucky.

Ricki Toft Kristiansen knows that.

He himself has worked as a paramedic for years and trained many new people in the field. He is also the mastermind behind EVRT, a VR platform developed to train paramedics and other emergency personnel.

“One of the things that is really difficult for paramedics to train is mental preparedness and decision-making ability when it comes to major incidents, and this is what I am addressing with EVRT. Because the decisions you make as the first responder in this kind of situation, the triage of the injured you carry out, have a great impact on who lives and dies, so it is really important to train those skills,” Ricki Toft Kristiansen says.

Major incidents are a paramedics’ term for, i.e., terrorist attacks, explosions, or major traffic accidents.

In short, situations where the number of available paramedics, policemen, and other personnel is insufficient to treat all the casualties.

In order to simulate such a situation, the screaming, the alarms, and the countdown to the death of the injured are a key factor. Even if it takes place in a virtual world where the people are clearly not real.

“Our brains are not developed to know the difference between the response to a virtual world and the real one, so it’s an absolutely crucial part of these exercises that the participants experience being under real pressure. Their heart rate has to rise, and they have to deal with many people and sounds at once. These are not things we have control over in reality, and they shouldn’t have that in the simulation either, because they have to learn to focus and act under such circumstances,” Ricki Toft Kristiansen explains.

No ragdoll physics

Until recently, Ricki Toft Kristensen travelled around with a larger VR setup installed in a trailer, where one or two people could train at the same time.

With the latest rapid development in VR technology, he has recently switched to the Oculus Quest headset, which makes it significantly easier to scale up the training.

For this, he has sought help from SynergyXR, a company that develops VR simulations and XR universes for various types of clients, including companies and increasingly clients within the fields of education and training.

“The technical setup that Ricki runs is fairly complicated. He acts as a kind of gamemaster, so he has a great deal of control over the simulation and can manage different characters and escalations in the scenario together with a partner. It’s difficult to scale up such a solution, so we had to figure out how to best automate the execution of a scenario,” Thomas Fenger from SynergyXR explains.

The solution that SynergyXR ended up creating for Ricki Toft Kristensen is more accessible than the EVRT platform he used before.

But, at the same time, it is significantly more complicated than the platforms that SynergyXR normally makes.

The task has also not been made simpler by the fact that the individual training sessions must be recorded so that the participants can subsequently evaluate the process.

“The key to making the simulation more manageable has been to divide it into different layers and have as much of it as possible run automatically, so that the instructor can use the bandwidth where it matters. We have built a system that allows the instructor to prepare by defining how the characters should behave. How many wounds and injuries do they have? Are they still or are they moving? How does the police behave? And then it actually runs in a loop until the instructor changes something,” Thomas Fenger says.

When it comes to the animations, there was a question of how bloody they should be.

Here, the guideline was that the lethality should only be turned up if it supports the emotional reaction and not to increase the entertainment value. And finally, it had to not come across as comical, so that it breaks the concentration of the participant.

“When we started development, we originally created ragdoll physics for the characters, so that you could move them around in several different ways, but it quickly came to look unintentionally comical when, for example, you had to pull a victim out of a room. Now, instead, you can only move them around between different predefined positions, which, in turn, are more correct in relation to the training procedures,” Thomas Fenger says.

An exciting case

XR technologies are currently in high demand at both educational institutions and companies, but not all of them lead to better learning, Professor Guido Makransky says.

As the leader of the University of Copenhagen's Virtual Learning Lab, he has tested many different VR solutions, and he actually thinks that the EVRT platform sounds like one of the best of its kind.

“It sounds like a really exciting case, because the situations it simulates are not something you can easily train for in other ways, which is an important aspect of good VR learning,” Guido Makransky says, but also points out that he has not had the opportunity to study the solution himself, even though it is now something he has become very interested in trying.

“If one makes a proper simulation, the user will feel like they are a part of the situation, and that is absolutely the most important thing. Our research indicates that psychological realism is far more important for learning in a VR environment than whether it looks photorealistic,” Guido Makransky explains.

Another thing that can be effective for learning is that the modules are designed to be used more than once, and some of the latest advancements in VR development are simulations in which there can be more than one participant at a time, so it becomes a social experience and there is a possibility of getting feedback.

“Many VR solutions are designed so that the user only tries them once, but as with all other learning, it’s important that you have the opportunity to make mistakes and get feedback, reflect on that feedback, and then try again,” Guido Makransky says.

Physical training is still necessary

Physical training intended as preparation for handling major incidents is also available.

Four times a year, large-scale training exercises are held, at a cost of DKK 2 million, but the focus is primarily on the training of team leaders from various disciplines—paramedics, fire department, the police, and doctors.

“I am in no way trying to say that it is bad to hold the large-scale physical training exercises, because we absolutely cannot live without them, but by having more people who had first tried to train in a virtual universe, I believe that we would get much more out of the large-scale physical exercises because people would have a better sense of their tasks and the situation. At the same time, you would have the opportunity to run the scenarios again and again,” Ricki Toft Kristiansen says and adds that he also sees EVRT as an opportunity to train for new procedures before they are implemented in practice.

And then we come back to the EVRT setup.

Because the idea is to make it easier for more people to get training in major incidents without it being too expensive in relation to replacements, transport, and so on.

“With the new setup, it will be easier. In principle, you can have a headset at three different ambulance, police, and fire stations across the country, and they can meet up and participate in a scenario once a month. One that you can repeat several times to test different outcomes,” Ricki Toft Kristiansen says.

“I’ll warrant that if you held two large-scale exercises a year instead of four, but in return gave more people the opportunity to train in VR simulations in advance, you would both get more out of these very costly exercises as well as a whole new opportunity for knowledge sharing,” he adds.