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EPICSAVE – A Multi-user Virtual Reality-Simulation 2. Schild J, Lerner D, Misztal S, Luiz T (2018): EPICSAVE—En-
for Paramedic Education hancing Vocational Training for Paramedics with Multi-user
Th. Luiz, D. Lerner, J. Pranghofer, A. Franke, M. Herkersdorf, Virtual Reality. In: IEEE SeGAH. [In press]
K. Wegner, J. Schild, S. Misztal, B. Roth, L. Flock
3D-SC1, a Serious Game for Forward Combat
Introduction: Rare exposure to critical, complex, highly dy-
namic emergencies, such as severe anaphylaxis, is a major chal- Casualty Care Training of French Soldiers:
lenge during vocational training. Widespread training methods Development, Deployment and Assessment
using low- or high-fidelity simulators or even standardized sim- Soldiers: Development, Deployment and Assessment
1,2
3
ulation patients show considerable limitations in representing Pierre Pasquier, MD, MSc ; Jérôme Planchon, MD ; 5
Anthony Vacher, MD, PhD ; Alexandre Mignon, MD, PhD ;
4
the dynamically fluctuating symptoms (e.g. cyanosis, rash, level Stéphane Mérat, MD 6
of consciousness, postural change) and vital signs. Immersive
VR environments are learn-effective and cost-efficient solu- 1 Percy Military Teaching Hospital, Department of anesthesiology
tions for creating simulations in a vast set of areas, especially and intensive care, French Military Medical Service, Clamart, France
École du Val-de-Grâce, French Military Medical Service Academy,
2
in emergency medicine. Furthermore, multi-user VR-environ- French Military Medical Service, Paris, France
ments enable social interaction through several multisensory 3 Bégin Military Teaching Hospital, Department of anesthesiology
channels; they also support coordinated and cooperated ac- and intensive care, French Military Medical Service, Saint-Mandé,
tions and improve collaborative learning and team training. France
4 Action and Cognition in Operational Situations Department,
Methods: EPICSAVE (www.epicsave.de) is a project funded
by the German Ministry of Education and Research and the Institut de Recherche Biomedicale des Armées, French Military
Medical Service, Brétigny sur Orge, France
European Union Social Funds (support file: 01PD15004). It 5 AP-HP, Pôle Anesthésie-Réanimation, Hôpital Cochin, Paris,
involves an interdisciplinary consortium that incorporates France
expertise from all relevant disciplines, i.e., emergency medi- 6 Marie Lannelongue surgical centre, Department of
cine, paramedic-training academies, media education, media anaesthesiology, Le Plessis-Robinson, France
design, and VR-technology.
Background: The French Military Medical Service has stan-
Project aims were: dardized its military prehospital care policy in a ‘‘Sauvetage au
1. Development of a virtual reality-(VR)-simulation environ- Combat’’ (SC) program (Forward Combat Casualty Care). A
ment and major part of the SC training program relies on simulations,
2. Implementation and evaluation of the training system which are challenging and costly when dealing with more than
within two paramedic vocational training institutions. 80,000 soldiers. In 2014, the French Military Medical Service
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decided to develop and deploy 3D-SC1 , a serious game in-
In an iterative process, we developed an immersive, navigable,
multi-user 3D VR emergency scenario with an integrated vir- tended to train and assess soldiers managing the early steps
tual patient (VP). The VP represents all common clinical symp- of SC.
toms of anaphylaxis—and many other cardiovascular and Objective: The purpose of this paper is to describe the cre-
pulmonary emergencies. The VR environment allows the train- ation and production of 3D-SC1 as well its deployment and
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ing of task-work skills, such as clinical and procedural reason- assessment, based on a study aiming to evaluate the impact on
ing, and of teamwork skills, which are necessary for effective performance of additional training with 3D-SC1 .
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crisis resource management. The VR environment, in which the
trainees interact via a head-mounted display and hand-control- Methods: A 10 experts group, and the Paris Descartes Univer-
lers, offers many interaction tools, such as the use of diagnostic sity Medical Simulation Department spin-off, Medusims, co-
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(penlight, stethoscope, ECG, pulse oximetry, measurement of produced 3D-SC1 . Medusims are virtual medical experiences
blood pressure, temperature, and blood glucose) and therapeu- using 3D real-time videogame technology designed for educa-
tic equipment (e.g. oxygen insufflation, airway management, tional purposes (training and assessment) to simulate medical
defibrillation, i.v. and i.m. injection, pharmacotherapy). The situations. These virtual situations have been created based on
system allows spatial navigation through the emergency sce- real cases and tested on mannequins by experts. Trainees are
nario and verbal communication with trainees and trainer. A asked to manage specific situations according to best practices
tutoring system records all actions within the VR and supports recommended by SC, and receive a score and a personalized
trainers in the debriefing phase. feedback regarding their performance. Furthermore, a recent
study assessed the performance of soldiers randomly assigned
Results: In a formative evaluation of the prototype by 24 para- to one of two groups, before (measure 1) and after (measure
medic trainees, we could demonstrate a positive and sustained 2) receiving additional training. This training involved either
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learning experience that depends on a high presence experi- 3D-SC1 (Intervention group), or a DVD (Control group).
ence, which in turn depends on an acceptable usability. The principal measure was the individual performance (on
a 16-point scale), assessed by two investigators during a
Discussion: Usability in VR is an important issue as there are
no standards, yet. We identified and solved several aspects in hands-on simulation. First, the mean performance score
our VR-prototype that caused “breaks in presence” and cog- was compared between the two measures for Intervention
nitive load (e.g., communication and navigation problems). and Control groups using a two-tailed paired t-test. Second,
Further studies should focus on long-term learning effects. a multivariable linear regression was used to determine the
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difference in the impacts of 3D-SC1 and DVD training, and
the order of presentation of the two scenarios, on the mean
References
1. Schild J, Misztal S, Roth B, et al. (2018): Applying Multi-user change from baseline in performance scores.
Virtual Reality to Collaborative Medical Training. In: IEEE
VR 2018. [In press]

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